Rose Vega Patin

Risk factors for atherosclerosis in students of a private university in São Paulo - Brazil

OBJECTIVE To characterize the risk profile for atherosclerosis (AS) in adolescents and young adults of a private university in São Paulo. METHODS Clinical, nutritional, and laboratory parameters were evaluated in 209 students of both genders aged 17 to 25 years. In addition to determination of the lipid profile, the association of its abnormal values with other risk factors for AS was also investigated. RESULTS Increased levels of total cholesterol, LDL-C and triglycerides (TG) were observed in 9.1%, 7.6% and 16.3% of the students, respectively, and decreased levels of HDL-C in 8.6% of them. Prevalence of the remaining risk factors analyzed was elevated: sedentary life style (78.9%); high intake of total fat (77.5%); high cholesterol intake (35.9%); smoking, hypertension (15.8%) and obesity (7.2%). There was an association between elevated LDL-C and TG levels and sedentary life style and body mass index. CONCLUSION The high prevalence of risk factors for AS in young individuals draws attention to the need for adopting preventive plans.

The influence of sardine consumption on the omega-3 fatty acid content of mature human milk

OBJECTIVES The purpose of this study was to investigate what effect the ingestion of sardines, rich in omega-3 series polyunsaturated fatty acids, has on the composition of breastmilk. METHODS This was a prospective study of 31 nursing mothers under observation at the Hospital Guilherme Alvaro. Each was given 2 kg of fresh sardines twice with a 15-day interval. Milk was sampled and a 24-hour dietary recall questionnaire was applied on days 0, 15 and 30. Milk was assayed for fatty acid content by gas chromatography. Statistical analysis of the results was performed using nonparametric tests with significance set at p < 0.05. RESULTS The results demonstrate that the nutritional intake of the nursing mothers was adequate at all three sample points. With regard to the omega-3 series fatty acid content of the breastmilk, it was observed that regular consumption and shorter intervals between ingestion and milk collection resulted in higher concentrations of docosapentaenoic acid and docosahexaenoic acid at 15 and 30 days into the study. Fatty acids from the omega-3 and omega-6 series exhibited a significant correlation, r2 was 0.58 and 0.59 at 15 and 30 days, respectively. CONCLUSION These results suggest that incorporating fish into the diets of nursing mother during lactation, in the form of 100 g of sardines two or three times a week, contributes to an increase in omega-3 series fatty acids.

Atherosclerosis prevention and treatment in children and adolescents.

The atherosclerotic process starts in childhood and studies show its development in fetuses. Clinical manifestation often occurs only in the sixth decade of life. Adolescence is a critical period in the development of atherosclerosis, because fatty streaks may change to transition plaque owing to genetic and environment factors. Healthcare by professionals plays a crucial role in the prevention and treatment of atherosclerosis, identifying poor lifestyle, positive family history of early cardiovascular disease, or other diseases such as dyslipidemia, obesity, arterial hypertension and diabetes. Dyslipidemia in childhood and adolescence should be treating by dietary therapy and change in lifestyle. Children with high-risk lipid abnormalities should be considered for drug treatment.

Estado nutricional de crianças e adolescentes hospitalizados em enfermaria de cirurgia pediátrica

Objective: To evaluate the nutritional status, duration of hospital stay and clinical specialties of patients hospitalized in the Pediatric Surgery Unit of Sao Paulo Hospital, Unifesp-EPM. Methods: This cross-sectional retrospective study enrolled 749 children and adolescents of both genders admitted to the Pediatric Surgery Unit during the period of August 2007 to July 2008. The following data were collected: anthropometric variables, duration of hospital stay and surgical procedures. For nutritional status classification, the Z score for body mass index (Z BMI) and height-for-age (Z H/A) were used according to the World Health Organization growth chart (WHO, 2007). The 5Pediatra Nutrologa; Doutora em Pediatria e chefe do Setor de Suporte Nutricional da Disciplina de Nutrologia do Departamento de Pediatria da Unifesp-EPM, Sao Paulo, SP, Brasil Endereco para correspondencia: Fernanda Luisa C. Oliveira Rua Loefgreen, 1.647 – Vila Clementino CEP 04040-032 – Sao Paulo/SP E-mail: fernandalco.dped@epm.br Conflito de interesse: nada a declarar Recebido em: 17/3/2009 Aceito em: 30/6/2009 Rev Paul Pediatr 2010;28(1):41-7. Artigo OriginalObjective: To evaluate the nutritional status, duration of hospital stay and clinical specialties of patients hospitalized in the Pediatric Surgery Unit of Sao Paulo Hospital, Unifesp-EPM. Methods: This cross-sectional retrospective study enrolled 749 children and adolescents of both genders admitted to the Pediatric Surgery Unit during the period of August 2007 to July 2008. The following data were collected: anthropometric variables, duration of hospital stay and surgical procedures. For nutritional status classification, the Z score for body mass index (Z BMI) and height-for-age (Z H/A) were used according to the World Health Organization growth chart (WHO, 2007). The

Influência da ingestão de sardinha nos níveis de ácidos graxos poliinsaturados da série ômega3 no leite materno

OBJETIVOS: A proposta deste trabalho foi verificar a influencia da ingestao de sardinha, alimento rico em acidos graxos poliinsaturados da serie w3, na composicao do leite materno. METODOS: Estudo prospectivo avaliou 31 nutrizes acompanhadas no Hospital Guilherme Alvaro, as quais receberam 2 kg de sardinha fresca por duas vezes, em intervalos de 15 dias. Nos tempos 0, 15 e 30 dias, realizou-se inquerito alimentar de 24 horas e coleta de leite. Determinaram-se os acidos graxos do leite materno por cromatografia a gas. Para analise estatistica dos resultados, utilizaram-se testes nao parametricos, com nivel de significância p < 0,05. RESULTADOS: Os resultados mostraram que o consumo alimentar das nutrizes estava adequado e apresentou-se constante durante os tres momentos do estudo. Quanto aos acidos graxos da serie w3 no leite, verificou-se que o consumo regular e os menores intervalos entre coleta de leite e ingestao de sardinha determinaram maiores proporcoes de acido docosapentaenoico e acido docosahexaenoico apos 15 e 30 dias do inicio do estudo. Os acidos graxos da serie w6 e w3 apresentaram correlacao significante, r2 = 0,58 e 0,59, respectivamente, nos tempos 15 e 30 dias. CONCLUSAO: Esses resultados sugerem que a ingestao de peixe incorporada ao habito alimentar da nutriz durante a lactacao, com o consumo de 100 g de sardinha, duas a tres vezes por semana, contribui para o aumento dos acidos graxos da serie w3.

Body composition and lipodystrophy in prepubertal HIV-infected children

OBJECTIVE To identify lipodystrophy in prepubertal HIV-infected children using anthropometric parameters and body composition assessment. METHODS Cross-sectional study including 40 prepubertal HIV-infected children of both genders seen at the Care Center of the Division of Pediatric Infectious Diseases - Universidade Federal de São Paulo, São Paulo city, Brazil, was carried out from August to December 2008. Age, clinical and immunological status, prophylaxis, transmission and highly active antiretroviral therapy were recorded. Body mass index z-score and height-for-age z-score were calculated to characterize the nutritional status. Circumferences were measured with flexible tape and skinfolds were assessed by an adipometry. Fat mass and lean mass were determined by dual-energy X-ray absorptiometry. Presence of clinical signs of lipodystrophy was assessed by a trained clinician. Data were analyzed using SPSS 12.0 software. RESULTS The mean age and standard deviation were 9.8 (1.2) years, 50% were girls and 82.5% children from B and C categories. Clinical lipodystrophy and dislypidemia were present in 27.5% and 70%, respectively. The trunk to arm ratio and the limb to trunk ratio had positive association with lipodystrophy. Patients with lipodystrophy had short stature, higher triglycerides values and lower HDL-cholesterol. CONCLUSION The ratios obtained by skinfolds and dual-energy X-ray absorptiometry measurements can be considered as indicators of preclinical lipodystrophy. The cutoff points have not been determined yet; however, continuous assessment may be useful to identify early body composition changes.

Assessment of antioxidants status and superoxide dismutase activity in HIV-infected children

OBJECTIVE This study aims to assess the nutritional status of selenium, copper and zinc; and also the erythrocyte superoxide dismutase activity of HIV-infected children compared to a control group. METHODS A cross-sectional study was carried out with prepubertal HIV-infected children (n=51) and their healthy siblings (n=32). All biochemical measurements including plasma selenium, serum copper levels, serum and erythrocyte zinc levels and erythrocyte superoxide dismutase activity were evaluated according to dietary, clinical and biochemical parameters. RESULTS Compared to the control group, the HIV-infected children had lower z-score values for height-for-age (p=0.0006), higher prevalence of stunting (11.8%) (p=0.047), lower selenium levels (p=0.0006) and higher copper levels (p=0.019). No difference was found concerning superoxide dismutase activity (p>0.05). The HIV-infected group presented a higher proportion (45.1%) of children with zinc intakes below the estimated average requirement (p=0.014); however, no association with zinc biochemical parameters was found. CONCLUSION HIV-infected children have an inadequate selenium and copper nutritional status, which could influence the progression to AIDS. An adequate micronutrient status could improve the clinical conditions in these patients and minimize free radical production and cellular oxidative stress.

Impaired bone mineral accrual in prepubertal HIV-infected children: a cohort study

OBJECTIVE To evaluate bone mass accrual and determine the influence of clinical, anthropometric, dietary and biochemical parameters on bone mass. METHODS A cohort study including 35 prepubertal HIV-infected children, between 7 and 12 years, attended at a referral center. At time 1 (T1) and time 2 (T2), patients were assessed according to clinical, anthropometric, dietary, biochemical parameters and bone mineral density (BMD). At T2, patients were divided into prepubertal and pubertal. RESULTS Despite the increase in bone mass absolute values, there was no improvement in lumbar spine BMD (LSBMD) Z-score (p=0.512) and worsening in total body BMD (TBMD) Z-score (p=0.040). Pubertal patients (n=19) showed higher bone mineral content (BMC) (p=0.001), TBMD (p=0.006) and LSBMD (p=0.002) compared to prepubertal patients. After multivariate linear regression analysis, the predictors of bone mass in T1 were age, BMI and HA Z-scores for BMC; BMI Z-score, adequate serum magnesium concentration and dietary calcium intake for TBMD; adequate serum concentration of magnesium, BMI and HA Z-scores for LSBMD. In T2, age, total body fat and lean body mass (kg) for BMC; BMI Z-score and puberty for TBMD; dietary fat intake, BMI Z-score for BMD and puberty for LSBMD. CONCLUSION HIV-infected children have compromised bone mass and the presence of puberty seems to provide suitability of these parameters. Adequate intake of calcium and fat appears to be protective for proper bone mass accumulation factor, as well as monitoring nutritional status and serum magnesium concentration.

Body composition changes and predictors of lipodystrophy in a cohort of pre-pubertal HIV-infected children.

1 Division of Nutrology, Departament of Pediatrics, Escola Paulista de Medicina, Universidade Federal de Sao Paulo (UNIFESP/EPM), 04040-032, Sao Paulo, SP, Brazil. Division of Pediatric Infectious Diseases, Departament of Pediatrics, Escola Paulista de Medicina, Universidade Federal de Sao Paulo (UNIFESP/EPM), 04040-003 Sao Paulo, SP, Brazil. Division of Rheumatology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de Sao Paulo (UNIFESP/EPM), 04023-900, Sao Paulo, Brazil.