Thaís Tobaruela Ortiz

Alimentação complementar: práticas inadequadas em lactentes

OBJETIVO: Avaliar as praticas e o consumo alimentar de lactentes saudaveis de tres metropoles do Brasil. METODOS: Por meio de estudo prospectivo, analisaram-se registros alimentares de 7 dias consecutivos de amostra intencional, por cotas e ponderada, das cidades de Curitiba, Sao Paulo e Recife, de 179 lactentes saudaveis, entre 4 e 12 meses, que nao se encontravam em aleitamento materno (AM) exclusivo. As maes receberam orientacao verbal e escrita, por nutricionista, visando a uniformizacao da anotacao do registro alimentar. Para o calculo de ingestao, utilizou-se o Programa de Apoio a Nutricao (NutWin). RESULTADOS: A mediana de idade dos lactentes foi de 6,8 meses (4,0-12,6 meses). Observou-se que 50,3% ja nao recebiam AM. Destes, 12,0 e 6,7% dos menores e maiores de 6 meses, respectivamente, utilizavam formulas infantis em substituicao ao leite materno. A maioria dos lactentes, portanto, recebia leite de vaca integral. A diluicao da formula infantil foi correta em apenas 23,8 e 34,7% das criancas menores e maiores de 6 meses, respectivamente. Em relacao a alimentacao complementar, observou-se que a mediana de idade foi de 4 meses para sua introducao e de 5,5 meses para a alimentacao da familia. Verificou-se elevada inadequacao quantitativa na ingestao de micronutrientes para lactentes de 6 a 12 meses que nao recebiam AM, destacando-se as de zinco (75%) e ferro (45%). CONCLUSAO: O presente estudo mostrou elevada frequencia de praticas e consumo alimentar inadequados em lactentes muito jovens. E possivel que essas praticas levem a aumento no risco de desenvolvimento futuro de doencas cronicas.

Inadequação do consumo alimentar de crianças e adolescentes com artrite idiopática juvenil e lúpus eritematoso sistêmico

OBJECTIVES: To evaluate the dietary intake of children and adolescents with juvenile idiopathic arthritis (JIA) and juvenile systemic lupus erythematosus (JSLE) using a 24-hour diet recall and relating it to the patients clinical and anthropometric characteristics and to the drugs used in their treatment. METHODS: By means of a cross-sectional study, we assessed the 24-hour diet recalls of outpatients. Their nutritional status was classified according to the CDC (2000). The computer program NutWin UNIFESP-EPM was used for food intake calculation. The Recommended Dietary Allowances and the Brazilian food pyramid were used for quantitative and qualitative analysis. RESULTS: Median age was 12 years for JIA patients and 16.5 years for JSLE patients. Among the JIA patients, 37.5% had active disease, and among the JSLE patients, 68.2% showed Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) > 4. Malnutrition was found in 8.3 and 4.5% of the JIA and JSLE patients, respectively, and obesity was present in 16.7 and 18.2%. For JIA patients, the excessive intake of energy, protein, and lipids was 12.5, 75, and 31.3%, respectively. For JSLE patients, the excessive intake of energy, protein, and lipids was 13.6, 86.4, and 36.4%, respectively. Low intake of iron, zinc, and vitamin A was found in 29.2 and 50, 87.5 and 86.4, and 87.5 and 95.2% of the JIA and JSLE patients, respectively. There was not a significant association between intake, disease activity, and nutritional status. CONCLUSION: Patients with rheumatic diseases have inadequate dietary intake. There is excessive intake of lipids and proteins and low intake of micronutrients.

Dyslipidemia in Pediatric Systemic Lupus Erythematosus: The Relationship with Disease Activity and Plasma Homocysteine and Cysteine Concentrations

Objective: To evaluate the presence of dyslipidemia and plasma concentrations of homocysteine (Hcy) and cysteine (Cys) in adolescents with juvenile systemic lupus erythematosus (SLE) and relate these findings to disease activity (Systemic Lupus Erythematosus Disease Activity Index, SLEDAI) and cardiovascular risk factors. Methods: A cross-sectional controlled study including 26 female adolescents with SLE and 26 healthy controls was conducted. We evaluated SLEDAI, medications, anthropometric data, dietary intake, lipid profile, proteinuria, Hcy, Cys, folic acid, vitamin B12, and high-sensitivity C-reactive protein levels. Results: Dyslipidemia was observed in 46.2% of the patients and in 19.2% of the controls. The SLE group had a higher Cys concentration and a lower high-density lipoprotein cholesterol concentration compared with the controls. In the multivariate analysis only Hcy was significantly and independently associated with the presence of dyslipidemia in the juvenile SLE group; an increase of 1 μmol/l in the Hcy concentration doubled the chance of dyslipidemia (OR: 2.1; 95% CI: 1.1-4.9; p = 0.030). The Cys concentration was correlated with Hcy, total cholesterol, low-density lipoprotein cholesterol, and triglyceride concentrations. Conclusion: We observed the presence of cardiovascular risk factors in adolescents with juvenile SLE. The early identification of biochemical alterations allows the development of intervention strategies that may lower the risk of cardiovascular disease.

Complementary feeding of infants in their first year of life: focus on the main pureed baby foods

OBJECTIVE to analyze womens perception in relation to their partners reaction and behavior during the abortion process in two Brazilian capitals, associating the variables from women who suffered a spontaneous abortion with those from women who induced it. METHODS semi-structured, questionnaire-based interviews were conducted with 285 women who underwent spontaneous abortion and 31 who reported having induced it. The data were analyzed using the thematic analysis technique, and, subsequently, by the IBM SPSS Statistics Standard Edition software program. The significance level was set at p < 0.05. RESULTS in both capitals, the women who induced an abortion referred to the partner as the person who could not find out about the abortion (p<0.01 in Natal; p = 0.02 in São Paulo-SP) and, simultaneously, as the one who could have avoided it (p < 0.01 in Natal; p = 0.03 in São Paulo). In Natal-RN, induced abortion was associated with the partners absence at the time pregnancy was confirmed (p = 0.02) and, in Sao Paulo-SP, with their negative reaction to news of the pregnancy (p = 0.04) and lack of participation in the abortion process (p < 0.01). CONCLUSION despite having achieved independence, women still regard male participation in the abortion process as an important factor. The specifics of each capital denote the influence of the geographic and cultural dimension, indicating the need to take into account the particulars of each region in Brazil while considering a holistic approach to womens health.OBJECTIVE To evaluate the complementary feeding practices for infants, focusing on the main pureed baby foods, and verify adherence to the guidelines adopted in Brazil. METHODS Through cross-sectional study, aspects of complementary feeding of 404 healthy infants between 4 and 9 months of age (São Paulo, Curitiba and Recife) were evaluated. Socio-demographic data, history and food habits were collected. Mothers described three recipes (preparations) usually used in key baby foods. The findings were compared with those recommended by the Brazilian Society of Pediatrics. RESULTS The average age was 6.9 ± 1.6 months. Among infants, 241/404 (59.6%) were still breastfeeding. Among those who received another type of milk, 193/368 (52.4%) received whole cows milk, while 151/368 (41.0%) drank infant or follow-on formulas. Regarding baby food recipes salted reported by mothers, it was seen that 30% and 60% contained meat and vegetables, respectively. The percentages less suitable for feeding in general were observed for use of cows milk and added sugar, chocolate and cereal in feeding bottles; 79% and 80.5% of the families interviewed would adopted such practices. CONCLUSION The early termination of exclusive/predominant breastfeeding and the practice of an inadequate transition diet have shown a picture of quantitatively and qualitatively inadequate feeding, with the risk of causing serious nutritional problems in later ages, such as anemia and vitamin A deficiency, or excess of nutrients, leading to obesity, diabetes and dyslipidemias.

Cardiovascular risk assessment in adolescents with systemic lupus erythematosus: biomarkers related to lipid metabolism

Juvenile systemic lupus erythematosus (JSLE) is a chronic, autoimmune and multisystem disease. Adult patients with SLE have an elevated risk of premature atherosclerosis and myocardial infarction. Dyslipidemia is a risk factor for the development of future chronic diseases and is associated with disease activity, corticosteroids use (CTC), renal impairment, among other factors. Other biochemical markers have been proposed for identification of cardiovascular risk, among them the protein components of lipoproteins (apolipoproteins - Apo) and enzyme related to cardiovascular risk (paraoxonase - PON).