Nutritional status of children and adolescents hospitalized at the pediatric surgery unit

OBJECTIVE: To evaluate the nutritional status, duration of hospital stay and clinical specialties of patients hospitalized in the Pediatric Surgery Unit of São 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 children were classified according to the surgical procedures performed. Results were compared by ANOVA followed by Bonferroni multiple comparisons test, being significant p<0.05. Statistical analysis was carried out through STATA 8.0 software. RESULTS: Patients' mean age was seven years old (0 to 18), 59% were males and 18% had ear, neck or throat surgery. Among the hospitalized patients, 66% had appropriated height for age, 43% were eutrophic and 31% obese/overweight. The malnourished patients presented longer hospital stay than the obese/overweight patients (7.2 versus 4.1 days; p=0,035). Infants had prolonged hospital stay (p=0,006) and less Z BMI values in comparison to the other age groups. (p=0,001). Infants that needed cardiac surgery presented lower Z BMI in relation to the others (p=0,002). CONCLUSIONS: The patients profile in the Pediatric Surgery Unit followed the nutritional pattern observed in Brazil, with increasing prevalence of obesity together with malnutrition. However, malnutrition is still an aggravating factor for prolonged hospital stayOBJETIVO: Avaliar o estado nutricional, o tempo de internação e as especialidades clínicas de pacientes internados na enfermaria de Cirurgia Pediátrica do Hospital São Paulo da UNIFESP-EPM. MÉTODOS: Estudo transversal retrospectivo, com 749 crianças e adolescentes de ambos os gêneros acompanhados por equipe interdisciplinar durante o período de agosto de 2007 a julho de 2008. Foram coletados dados antropométricos, dias de internação e procedimento cirúrgico segundo a especialidade. Para a classificação do estado nutricional, utilizou-se o escore Z do índice de massa corporal (Z IMC) e da estatura/idade (Z E/I) segundo a curva da Organização Mundial de Saúde (OMS, 2007). As crianças foram classificadas segundo diagnóstico estabelecido previamente à cirurgia. Utilizou-se o programa STATA 8.0 para análise dos dados e aplicou-se o teste ANOVA e comparações múltiplas de Bonferroni, considerando-se significante p<0,05. RESULTADOS: A mediana de idade foi sete anos (0 a 18), predominando o gênero masculino (59%) e as internações para cirurgia otorrinolaringológica (18%). Dos pacientes internados, 66% tinham estatura adequada para idade, 43% eutróficos e 31% obesos/sobrepeso. Os pacientes desnutridos permaneceram mais dias internados quando comparados aos obesos/sobrepeso (7,2 versus 4,1 dias; p=0,035). Os lactentes apresentaram maior tempo de internação (p=0,006) e menor valor de Z IMC, comparados aos outros grupos etários (p=0,001). Os lactentes com programação de cirurgia cardíaca apresentaram Z IMC menor em relação às demais especialidades (p=0,002). CONCLUSÕES: O perfil dos pacientes internados condiz com a atual transição nutricional, aumento da prevalência de obesidade concomitante à desnutrição. Entretanto, a desnutrição ainda constitui fator agravante para a permanência hospitalarUNIFESP-EPM Departamento de Pediatria Disciplina de NutrologiaUNIFESP-EPM Programa de Pós-Graduação em Ciências da NutriçãoUNIFESP, EPM, Depto. de Pediatria Disciplina de NutrologiaUNIFESP, EPM Programa de Pós-Graduação em Ciências da NutriçãoSciEL

Metabolic changes in HIV-infected children and adolescents from São Paulo city, Brazil

Universidade Federal de São Paulo UNIFESP EPM, São Paulo, BrazilUniversidade Federal de São Paulo UNIFESP EPM, São Paulo, BrazilWeb of Scienc

Influência da ingestão de peixe nos níveis de ácidos graxos polinsaturados da serie W3 no leite materno

Os acidos graxos (AG) da serie w3 sao encontrados em estruturas do cerebro, retina, e participam nos processos de crescimento e desenvolvimento da crianca. A proposta deste estudo foi avaliar a influencia da inGestão de peixe (sardinha), rico em AG da serie w3, na composicao dos AG do leite materno. Foram estudadas 31 nutrizes, acompanhadas no Hospital Guilherme Alvaro, as quais receberam 2 Kg de sardinha, em intervalos de 15 dias, por um mes. Nos tempos 0, 15 e 30 dias (T0, T15 e T30) realizou-se inquerito alimentar de 24 horas e coleta de leite. Determinou-se os AG do leite materno por cromatografia a gas. Para analise estatistica dos acidos graxos utilizou-se testes nao parametricos, nivel de significancia p< 0.05. Os resultados mostraram que o consumo alimentar das nutrizes estava adequado quanto a inGestão calorica, proteica, lipidios, calcio, ferro e vitamina C, porem deficiente em vitamina A. Quanto aos AG da serie w3 no leite, pode-se observar que o EPA demonstrou menores proporcoes em T15 e T30. Quando se verificou o intervalo entre o consumo da sardinha e a coleta de leite, constatou-se que o consumo regular e os menores intervalos entre coleta de leite e inGestão de sardinha, determinaram maiores proporcoes de acido docosapentaenoico (DPA) e acido docosahexaenoico (DHA) em T15 e principalmente T30. Os AG w6 e w3 apresentaram correlacao significante, r2: 0,58 e 0,59 respectivamente para T15 e T30. Estes resultados sugerem que a inGestão de peixe pode ser incorporado ao habito da nutriz durante a lactacao, contribuindo para o aumento dos AG da serie w3 sem a necessidade de medidas drasticas, utilizando suplementos com oleo de peixeBV UNIFESP: Teses e dissertaçõe

Nutritional Status in antioxidants micronutrients and superoxide dismutase enzyme in school children HIV

BV UNIFESP: Teses e dissertaçõe

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

ABSTRACT 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 HAZ-scores for BMC; BMI Z-score, adequate serum magnesium concentration and dietary calcium intake for TBMD; adequate serum concentration of magnesium, BMI and HAZ-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 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 (UNIFESP), 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.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP, EPMSciEL

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

Body composition measurements and fat redistribution in HIV-infected children and adolescents from São Paulo city, Brazil

Universidade Federal de São Paulo UNIFESP EPM, São Paulo, BrazilUniversidade Federal de São Paulo UNIFESP EPM, São Paulo, BrazilWeb of Scienc

Lipodystrophy and antioxidants in school-aged children infected with human immunodeficiency virus

Universidade Federal de São Paulo UNIFESP EPM, São Paulo, BrazilUniversidade Federal de São Paulo UNIFESP EPM, São Paulo, BrazilWeb of Scienc