Ulysses Fagundes Neto

Cow's milk protein intolerance and chronic constipation in children

Cows milk protein (CMP) allergy was investigated in 25 children (age‐range 3 months to 11 years) with chronic constipation. A diagnosis of constipation was made on the basis of a history of painful elimination of hard stools for at least 1 month, whether or not associated with a reduced frequency of stools or soiling. The children were evaluated using clinical parameters and the following laboratory tests: total serum immunoglobulin E (IgE); specific IgE (radioallergosorbent test [RAST]) for whole cows milk, α‐lactoalbumin, β‐lactoglobulin, and a food group; and skin‐prick tests with whole milk, α‐lactoalbumin, β‐lactoglobulin, and casein. Following the evaluation, the children were submitted to a CMP‐free diet for a period of 4 weeks. In seven patients (28%), constipation disappeared during the CMP‐free diet and reappeared within 48–72 h following challenge with cows milk. In two infants a rectal biopsy revealed allergic colitis and they therefore did not undergo the challenge. High serum levels of total IgE were observed in five of the children who showed a clinical improvement (71%), a positive skin‐test in two (29%), and detectable specific IgE in two (29%). These results suggest that CMP allergy or intolerance should be considered as a cause of chronic refractory constipation in children, although the underlying mechanism still require further investigation.

Asymptomatic giardiasis does not affect iron absorption in children with iron deficiency anemia.

OBJECTIVE Malabsorption of iron has been reported in children with symptomatic giardiasis. The aim of this study was to evaluate intestinal absorption of iron in children with asymptomatic giardiasis and iron deficiency anemia. SUBJECTS Based upon results of blood hemoglobin and stool examination, two groups were established: asymptomatic giardiasis and anemia, and anemia without intestinal parasitosis (control group). Patients were aged 1-6 years. There was no difference in age, weight, height, or iron nutritional status between the asymptomatic giardiasis and control groups on admission to the study. MEASURES Intestinal absorption of iron was evaluated using the iron tolerance test and the hemoglobin response to iron therapy. The serum iron tolerance test was based on the increment of iron level 2 hours after administering an iron load of 1 mg/kg of elemental iron in the form of ferrous sulfate, in comparison to the fasting iron level. Hemoglobin response to oral iron therapy was determined by the increment of hemoglobin on day 30 of therapy with ferrous sulfate (5 mg/kg/day of elemental iron). RESULTS There was no statistical difference between the asymptomatic giardiasis and control groups with reference to the iron tolerance test (159.1 +/- 73.1 micrograms/dl and 154.5 +/- 76.5 micrograms/dl, respectively) and to the hemoglobin response to iron therapy (1.5 +/- 0.7 g/dl and 1.8 +/- 1.1 g/dl, respectively). The presence or absence of trophozoites of Giardia lamblia on duodenal aspirate did not affect intestinal absorption of iron. CONCLUSION Asymptomatic giardiasis did not affect the intestinal absorption of iron and the hemoglobin response to oral iron therapy in iron-deficient anemic children.

Prevalência de parasitoses intestinais em crianças do Parque Indígena do Xingu

OBJECTIVE: To evaluate the prevalence of intestinal parasitoses in Native Brazilian children from 2 to 9 years old. METHODS: A search for ova and parasites was conducted in the stools of children between 2 to 9 years old living in six indigenous villages located in the Middle and Lower Xingu River, to wit: Pavuru, Moygu, Tuiarare, Diauarum, Capivara, and Ngojwere. The study utilized the Paratest kit® (Diagnostek, Brazil) to preserve collected stools. Fecal samples were shipped to the Laboratory of the Pediatric Gastroenterology Division of the UNIFESP/EPM, in Sao Paulo, for analysis. The search for ova and parasites was performed utilizing the Hoffman method, and later through optical microscopic evaluation. Fecal samples were collected one year apart from each other. RESULTS: There were no significant statistical differences between the mean ages of the children from the six indigenous villages studied. The search for ova and parasites found positive results for the stools of 97.5% (198/202) and 96.1% (98/102) of children in the first and second collections, respectively. There was no statistical association with the childrens age. The search performed one year later found no differences in the proportion of parasites identified in the first collection for protozoa (93.3% in 2007 versus 93.3% in 2008, McNemar = 0.01, p = 0.1) or for helminths (37.1% in 2007 versus 38.2% in 2008, McNemar = 0.03, p = 0.85). There were significant differences in prevalence of Entamoeba coli between 2007 (43.8%) and 2008 (61.8%) (McNemar Chi 6.1; p = 0.0135). There were no significant differences for other parasites when comparing the results of the two studies. CONCLUSION: The high prevalence of intestinal parasitosis matched the elevated rates of environmental contamination in this indigenous community.

Estado nutricional de crianças índias do Alto Xingu em 1980 e 1992 e evolução pondero-estatural entre o primeiro e o quarto anos de vida

This study focused on the under-five population of the Alto Xingu region in Brazil, with the following objectives: (1) to evaluate height and weight increment from the first through the fourth years of life and (2) to compare nutritional status in 1980 and 1992. Height and weight increases were evaluated in 81 children. Weight and height were measured in 264 children evaluated in 1980 and in 172 in 1992 (< 10 years of age). Median Z-scores in the first and fourth years of life, respectively, showed: (1) a decrease in weight-for-age, (-0.12 in the first year and -0.51 in the fourth year of life; p = 0.002); (2) a decrease in weight-for-height (+1.31 and +0.08; p < 0.001); (3) an increase in height-for-age (-1.50 and -0.94; p < 0.001). Median Z-scores in 1980 and 1992 showed: (1) no change in weight-for-age (-0.61 in 1980 and -0.62 in 1992; p = 0.90); (2) no change in weight-for-height (+0.27 and +0.34; p = 0.10); and (3) a decrease in height-for-age (-1.04 and -1.22; p = 0.02). Height-for-age increased and weight-for-height decreased between the first and fourth years of life. A decrease in height-for-age was observed from 1980 to 1992, demonstrating the importance of nutritional surveillance among the population of the Alto Xingu.

Aggressiveness and Hostility in the Family Environment and Chronic Constipation in Children

Objective To compare the emotional aspects of children with and without constipation. Methodology Some emotional aspects were studied in children with and without constipation. A nonstructured interview was performed with the mothers regarding the emotional aspects of their children. The children were asked to tell a story based on the observation of a board from the thematic children apperception test. This is a qualitative study using the technique of constant comparison. Results In the interview with the mothers of constipated children. Conclusion In the children with constipation a higher prevalence of some emotional aspects was observed.

Prevalence of Helicobacter pylori infection and intestinal parasitosis in children of the Xingu Indian Reservation

OBJECTIVE To evaluate the prevalence of Helicobacter pylori infection and its association with intestinal parasitoses in children from indigenous communities of the Xingu Indian Reservation, in Brazil. METHODS A total of 245 Native Brazilian children between 2 and 9 years of age, from six villages of the Xingu River region, a tributary of the Amazon River, were assessed. H. pylori was detected using the (13)C-urea breath test. Breath samples were collected at baseline and 30 minutes after ingestion of 50 mg of (13)C-urea diluted with 100 mL of water flavored with passion fruit juice and sweetener. Stool samples were collected for the stool ova and parasites exam for 202/245 (82.4%) children. RESULTS The overall prevalence of H. pylori was 73.5%. A significant association of H. pylori with increased age was observed among the different villages and ethnic groups. Positive results for the presence of parasites - 97.5% (198/202) - from the stool samples collected showed no association with H. pylori. Giardia showed an association with H. pylori in the multivariate analysis. Risk factors for H. pylori infection were observed in Kisêjê and Kaibi ethnic groups (OR [odds ratio] = 3.36 and 4.00, respectively), as well as in Tuiararé, Ngojwere, Capivara, Diauarum, and Pavuru villages (OR = 8.10, 4.10, 4.88, 1.85, and 1.40, respectively). CONCLUSIONS H. pylori infection is highly prevalent in these communities, as well as intestinal parasitoses. However, there were significant differences in the prevalence of H. pylori among the diverse villages studied. Giardia was closely associated with H. pylori infection.

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.

Prevalência da infecção por Helicobacter pylori e de parasitoses intestinais em crianças do Parque Indígena do Xingu

OBJECTIVE: To evaluate the prevalence of Helicobacter pylori infection and its association with intestinal parasitoses in children from indigenous communities of the Xingu Indian Reservation, in Brazil. METHODS: A total of 245 Native Brazilian children between 2 and 9 years of age, from six villages of the Xingu River region, a tributary of the Amazon River, were assessed. H. pylori was detected using the 13C-urea breath test. Breath samples were collected at baseline and 30 minutes after ingestion of 50 mg of 13C-urea diluted with 100 mL of water flavored with passion fruit juice and sweetener. Stool samples were collected for the stool ova and parasites exam for 202/245 (82.4%) children. RESULTS: The overall prevalence of H. pylori was 73.5%. A significant association of H. pylori with increased age was observed among the different villages and ethnic groups. Positive results for the presence of parasites - 97.5% (198/202) - from the stool samples collected showed no association with H. pylori. Giardia showed an association with H. pylori in the multivariate analysis. Risk factors for H. pylori infection were observed in Kiseje and Kaibi ethnic groups (OR [odds ratio] = 3.36 and 4.00, respectively), as well as in Tuiarare, Ngojwere, Capivara, Diauarum, and Pavuru villages (OR = 8.10, 4.10, 4.88, 1.85, and 1.40, respectively). CONCLUSIONS: H. pylori infection is highly prevalent in these communities, as well as intestinal parasitoses. However, there were significant differences in the prevalence of H. pylori among the diverse villages studied. Giardia was closely associated with H. pylori infection.

Doença celíaca em tratamento: avaliação da densidade mineral óssea

OBJETIVO: comparar a densidade mineral ossea de criancas e adolescentes com doenca celiaca em tratamento com controles sadios, e avaliar exames laboratoriais relacionados com o metabolismo do calcio. METODOS: foram estudados 30 pacientes com doenca celiaca em dieta isenta de gluten, 17 criancas e 13 adolescentes, e 23 individuos saudaveis. Todos os pacientes e controles realizaram a densidade mineral ossea (DEXA, Lunar). Os pacientes realizaram dosagem serica de calcio total, calcio ionizado, fosforo, magnesio, fosfatase alcalina e paratormonio. RESULTADOS: a media de peso, estatura e densidade mineral ossea dos adolescentes com doenca celiaca foi menor do que dos controles (p<0,05), enquanto que nao se observaram diferencas estatisticamente significantes destes parâmetros, comparando as criancas com doenca celiaca com os controles. A proporcao de adolescentes que iniciou dieta isenta de gluten apos os dois anos de idade foi maior do que a de criancas (p<0,05). Os pacientes apresentaram niveis sericos normais de calcio ionizado, calcio total e paratormonio. CONCLUSOES: a densidade mineral ossea dos adolescentes com doenca celiaca em dieta isenta de gluten foi menor do que dos controles. Por outro lado, nao houve diferenca entre a densidade mineral ossea de criancas com doenca celiaca e controles.

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.