Energy-protein Malnutrition Research Articles

Integrated Approach of The Health Team in The Management of Malnutrition Marasmus in Children

Objective: To analyze, through the scientific literature, the importance of the integrated approach of the health team in the management of childhood marasmus malnutrition. Theoretical framework: Childhood marasmus malnutrition is a severe medical condition that mainly affects children under five years of age, and is characterized by an extreme lack of calories and essential nutrients, resulting in a state of severe emaciation where the child's body consumes its own tissues in an attempt to survive. Method: A descriptive integrative review with a qualitative approach, in which a search was carried out in Sicelo, PubMed, LILACS and the Cochrane Library. The descriptors "Malnutrition", "Protein-Calorie Malnutrition", "Patient Care Team" and "Child Health" were used in combination with the Boolean operator AND. Initially, 9,887 studies were found, but this was reduced to 119 studies, of which 12 were selected. Results and Discussion: The management of childhood marasmus malnutrition was shown to be crucial to ensuring the recovery and healthy development of affected children. Marasmus is a severe form of energy-protein malnutrition, characterized by extreme weight loss and loss of fat and muscle tissue, caused mainly by inadequate calorie and protein intake. Research Implications: The implementation of solid policies, education, continuous support for families and the commitment of health professionals are fundamental pillars for reversing malnutrition and corroborating healthy child development. Originality/value: The study incorporates pertinent theories, corroborating the literature through contributions to clinical practice in the face of childhood stunting.

A Cross-Sectional Study: Animal and Vegetable Protein Intake Among Preschool Children

Protein is one of the macronutrients needed in child growth, which can be obtained from animal and plant foodstuffs. Protein intake gets more attention because energy-protein malnutrition is more common in children under five. Protein nutrition for children must be fulfilled to prevent growth retardation in the next phase. This research aims to establish a profile of preschool children's animal and vegetable protein intake. This type of research is descriptive observational with a cross-sectional design. This research was conducted at Bina Anasprasa Nuris Jember Kindergarden in March 2023. The sample in this study was preschool children aged 3-5 years, totaling 53 people who were taken by purposive sampling. Food consumption data for children was obtained using the 1x24-hour food recall method. Processing and analysis of data using univariate analysis. Preschool girls have more than boys (67.9% and 32.1%). The majority of mothers are not working/housewives (62.3%), while the majority of fathers are self-employed (45.3%). Most families have income above the 2023 Jember UMK (62.3%). Nutritional status with indicators of weight/age, height/age, weight/height of all preschool children has normal, normal, and good nutritional status (100%). Total protein intake increased slightly for boys and families whose income was above the minimum wage. Meanwhile, the intake of vegetable and animal protein sources in preschool children is similar but slightly higher in vegetable protein. Animal protein food ingredients still have high biological value because they contain all essential amino acids compared to vegetable protein. Therefore, preschoolers need to increase their consumption of animal protein food ingredients in their daily diet.

Foliar application of pyraclostrobin alleviates oxidative stress and improves carbon assimilation in soybean

Abstract Due to its protein and oil content, soybean is an important crop in developing countries like India to combat energy-protein malnutrition. In a field study, soybean plants- foliar treated with pyraclostrobin- were evaluated for carbon fixation efficiency and antioxidant levels response. Pyraclostrobin (F500) was sprayed over soybean leaves on the tenth and twentieth day after the emergence (DAE) of seedlings at concentrations ranging from 0.05% to 1%. Parameters associated with carbon fixation, like photosystem II efficiency, gas exchange parameters, carbonic anhydrase activity, and biomass accumulation, were quantified on the 45th DAE. Antioxidant level and activity of antioxidant enzymes were also analyzed at the same stage. The amount of antioxidants like ascorbate (ASA) and the activity of antioxidant enzymes (i.e., guaiacol peroxidase, ascorbic acid peroxidase, superoxide dismutase, and catalase) decreased after pyraclostrobin application indicating alleviation of oxidative stress in treated plants as compared to control. A significant increase in the rate of photosynthesis was also recorded in the treated plants. Limiting factors of net photosynthesis like chlorophyll content, carbonic anhydrase activity, stomatal conductance, inter-cellular CO2 concentration, and transpiration rate improved after 0.1% F500 treatment. Mitigation of oxidative stress by pyraclostrobin improves the primary metabolism (fixation) in soybean, resulting in enhanced biomass accumulation.

The Role of Dietary Fibers in the Management of IBD Symptoms.

Inflammatory bowel diseases (IBDs) are chronic, progressive, immune-mediated diseases of the intestinal tract. The main subtypes of IBDs are Chron's disease (CD) and ulcerative colitis (UC). The etiology is still unclear, but there are genetic, environmental and host-related factors that contribute to the development of these diseases. Recent literature has shown that dietary therapy is the cornerstone of IBD treatment in terms of management of symptoms, relapse and care of the pathology. IBD patients show that microbiota dysbiosis and diet, especially dietary fiber, can modulate its composition. These patients are more at risk of energy protein malnutrition than the general population and are deficient in micronutrients. So far, no dietary component is considered responsible for IBD and there is not a specific therapeutic diet for it. The aim of this review is to evaluate the role of dietary fibers in CD and UC and help health professionals in the nutritional management of these pathologies. Further studies are necessary to determine the appropriate amount and type of fiber to suggest in the case of IBD to ameliorate psychosocial conditions and patients' quality of life.

The effects of synbiotic supplementation on enteral feeding tolerance, protein homeostasis, and muscle wasting of critically ill adult patients: a randomized controlled trial

BackgroundEnteral feeding intolerance, energy-protein malnutrition, and muscle wasting are common conditions in the critical care setting. The primary aim of this study was to investigate the effect of synbiotic supplementation on enteral feed volume, energy and protein homeostasis, and muscle mass maintenance in critically ill adult patients.MethodsA consecutive of 42 patients admitted to the Edalatian Medical ICU, requiring enteral nutrition (EN), were prospectively randomized to receive the synbiotic capsule (containing a combination of Lactobacillus, Bifidobacterium, Streptococcus, and fructooligosaccharides) or placebo (21 patients in each group) for a maximum of 14 days. Enteral intolerance and energy homeostasis were evaluated on a daily basis. Nitrogen balance and 24-h urine creatinine excretion were recorded on days 1 and 14. Mid-arm circumference was recorded every 3 days.ResultsMean EN volume, energy, and protein intake per day were 962.5 ± 533.82 ml, 770 ± 427.05 kcal, and 38.5 ± 21.35 g (fourth day) vs. 590 ± 321.1 ml, 472 ± 256.81 kcal, and 23.6 ± 12.84 g (first day) in the synbiotic group (p < 0.05). Changes in the placebo group were not statistically significant. On day 1, nitrogen balance (NB) was − 19.84 ± 8.03 in the synbiotic vs. − 10.99 ± 9.12 in the placebo group (p = 0.003). On day 14, NB was − 14.18 ± 13.05 in the synbiotic and − 9.59 ± 7.71 in the placebo group (p = 0.41). Mid-arm circumference (MAC), 24-h urine creatinine, and creatinine-height index were almost steady in the synbiotic group, while they decreased in the placebo group.ConclusionOverall, it can be concluded that enteral nutrition supplemented with synbiotics has no statistically significant effect on energy and protein homeostasis and muscle mass maintenance of critically ill patients on day 14, but it can increase enteral feed volume and energy and protein intake during the first 4 days of ICU admission.Trial registrationThe trial protocol has been approved in Iranian Registry of Clinical Trials on March 17, 2019. The registration reference is IRCT20190227042857N1.

Evaluation of anorexia and analysis of related factors in patients with COVID-19

ObjectiveCOVID-19 may cause an anorexic situation. This in turn leads to underfeeding, puts the patient in an energy protein malnutrition state, develops the hyperinflammation, weakens the immunity, and makes COVID-19 conditions more dangerous. Meanwhile, the more severe inflammation conditions in the body, the more severe the anorexia, which in turn affect the disease severity. Studies evaluating appetite in COVID-19 patients are very rare; therefore, we evaluated anorexia and analyzed the related factors in patients with COVID-19. Material and methodsIn this cross sectional study, adult patients’ ≥18 years old with the positive real-time fluorescence polymerase chain reaction for COVID-19 were included. The patients were classified as mild, moderate, and severe based on the WHO classification. We measured the appetite score, weight, height, body mass index (BMI), depression and anxiety score, at admission for every patient. ResultsA total of 301 patients participated in the study. The prevalence of admission anorexia was 58%, and this rate was significantly more in the severe group compared to the mild and moderate groups (P<0.001). Comorbidities, depression and anxiety were independently correlated with anorexia risk [(OR=3.6, 95% CI 1.68–7.70, P=0.001), (OR=1.23, 95% CI 1.16–1.30, P<0001), and (OR=1.24, 95% CI 1.17–1.31, P<0001)], respectively. This correlation was adherence to a U-shape association for BMI, which means BMI<18.5 (OR=3.35, 95% CI 1.8–10.42, P<0001) and BMI ≥30 (OR=2.45, 95% CI 1.02–6.53, P=0.048) were related to higher risk of anorexia. ConclusionWe reported a high prevalence of anorexia (58%) in COVID-19 patients, which was positively correlated with disease severity. Furthermore, any factor worsening inflammatory state, including underweight, obesity, comorbidities, depression and anxiety can exacerbate anorexia in these patients.

POTENTIALS OF NUTRITIONAL FOLLOW-UP IN A DIABETIC PATIENT HOSPITALIZED WITH ULCERATION TABLE IN PLANT REGION

Introduction: Approximately 15% of diabetic individuals are affected with foot ulceration, one of the main causes of lower limb amputation. The percentage of diabetic survival after amputation of a lower limb (MI) is 50% three years after the surgical procedure and the mortality rate varies between 39% to 68% after five years. The impact on the quality of life of diabetic people is high, not only economically, the feelings involved contribute to a negative prognosis. Therefore, adequate metabolic and nutritional control, as well as periodic assessment of immunity and comorbidities, should be part of the therapeutic routine of diabetic patients. Experience report: The work in question refers to the nutritional approach performed on a 71-year-old female patient admitted to the hospital with an ulcer in the right plantar region. In anthropometry, the nutritional status indicators indicated eutrophy with nutritional risk. The biochemical evaluation identified anemic condition and sepsis. Physical evaluation showed the presence of edema in the right and left MI. Glycemic and blood pressure levels were monitored daily. A hypercaloric and hyperprotein diet was prescribed, plus protein supplementation with specific immunomodulators for special metabolic situations that prevent energy-protein malnutrition, in addition to the adequacy of vitamins and minerals, in order to avoid nutritional deficiencies arising from the drug-nutrient interaction. Nutritional monitoring lasted 13 days. Ulceration regressed from the entire plantar region, only to the right hallux, which was amputated. Final considerations: There was an improvement in nutritional and biochemical parameters until hospital discharge.

Influência do estado nutricional e inflamatório na mortalidade de pacientes submetidos à hemodiálise

Introduction: Chronic kidney disease is a global public health problem and patients undergoing hemodialysis (HD) present energy-protein malnutrition (DEP) frequently and presenting a multifactorial etiology, resulting in tissue losses with functional consequences, associated with high morbidity and unfavorable prognosis. The low albumin value is associated with the state of persistent inflammation, being the main responsible for the documented association between mortality and hypoalbuminemia. The present study aimed to analyze the influence of nutritional and inflammatory status on the mortality of patients submitted to HD. Methods: Observational longitudinal study, carried out in the HD program of the Institute of Integral Medicine Professor Fernando Figueira - IMIP (Recife-PE), from August 2015 to November 2016. Clinical data (dialysis time, underlying disease and clinical outcome), biochemical tests (C-reactive protein and serum albumin) and anthropometric indicators, such as body mass index, waist circumference, waist-to-height ratio (WHT), arm muscle circumference and triceps skinfold (TCd), were analyzed. Results: Fifty-five patients with a mean age of 47.84 ±16.5 years were evaluated. It was evidenced that 16.4% of the patients died and that the male sex presented a higher risk of mortality when compared to the female (HR 12.7, p=0.030). Regarding biochemical evaluation, a significant decrease in mortality was observed with increased serum albumin levels (HR 0.05, p=0.031). Regarding anthropometric evaluation, it can be observed that adequate WHT was associated with decreased mortality (HR 0.11, p=0.027). Conclusion: It can be concluded that it is extremely important to identify early changes in albumin and WHT levels, as it will enable targeted dietotherapeutic treatment with the aim of reducing the risk of mortality in this population.

Amazonian Foods: Açaí, Camu-Camu, Cubiu and Pupunha

What is the nutritional value of typical Amazonian products such as açaí wine (Euterpe precatoria Mart.), Camu-camu (Myrciaria dubia (Kunth) McVaugh), cubiu (Solanum sessiliflorum Dunal) and peach palm flour (Bactris gasipaes Kunth).? Can these foods be used to prevent common diseases in the Amazon, such as energy-protein malnutrition, iron deficiency anemia and hypovitaminosis A? If not as a preventive way, can these foods be used to minimize these public health problems still registered in different population groups in the Amazon region?

Inspiratory muscle training improves strength and health-related quality of life in hemodialysis patients

Background: Patients undergone hemodialysis (HD) suffer with energy-protein malnutrition, uremic myopathy and protein catabolism reducing their functional capacity, tolerance to exercise and aspects related to quality of life. Objective: The aim of this study was to evaluate the effects of the two protocols of inspiratory muscle training (IMT) on muscle strength, pulmonary function and related-health quality of life on male HD patients. Methods: Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP), peak expiratory flow (PEF), forced expiratory volume in first second (FEV1 ), forced vital capacity (FVC) and the FEV1 /FVC ratio and quality of life were evaluated pre and post six months of IMT in HD patients. IMT was performed by one group using a specific training (Power breathe) device (T-IMT, n=19) and by the other with incentive spirometry (I-IMT, n= 15). Results: Following the inspiratory training, muscle strength improved in both groups. The group that used incentive spirometry had increments in MIP larger (39.8%, p&lt;0.001) than the group that trained with the specific training device (28.3%, p=0.001). The KDQOL-SF dimensions showed significant difference in the T-IMT group in cognitive function (p=0.03), sexual function (p=0.009) and social function dimensions (p=0.04) and in the I-IMT group in the physical function dimension (p=0.03). Conclusion: It was proved that IMT improved muscle strength and I-IMT promoted increments significantly larger in MIP. Aspects of health-related quality of life of HD male patients improved significantly with T-IMT (sexual, social and cognitive functions), while I-IMT ameliorated only physical function.

Moderate Protein Restriction Protects Against Focal Cerebral Ischemia in Mice by Mechanisms Involving Anti-inflammatory and Anti-oxidant Responses

Food composition influences stroke risk, but its effects on ischemic injury and neurological deficits are poorly examined. While severe reduction of protein content was found to aggravate neurological impairment and brain injury as a consequence of combined energy-protein malnutrition, moderate protein restriction not resulting in energy deprivation was recently suggested to protect against perinatal hypoxia-ischemia. Male C57BL6/j mice were exposed to moderate protein restriction by providing a normocaloric diet containing 8% protein (control: 20% protein) for 7, 14, or 30 days. Intraluminal middle cerebral artery occlusion was then induced. Mice were sacrificed 24 h later. Irrespective of the duration of food modification (that is, 7–30 days), protein restriction reduced neurological impairment of ischemic mice revealed by a global and focal deficit score. Prolonged protein restriction over 30 days also reduced infarct volume, brain edema, and blood-brain barrier permeability and increased the survival of NeuN+ neurons in the core of the stroke (i.e., striatum). Neuroprotection by prolonged protein restriction went along with reduced brain infiltration of CD45+ leukocytes and reduced expression of inducible NO synthase and interleukin-1β. As potential mechanisms, increased levels of the NAD-dependent deacetylase sirtuin-1 and anti-oxidant glutathione peroxidase-3 were noted in ischemic brain tissue. Irrespective of the protein restriction duration, a shift from pro-oxidant oxidative stress markers (NADPH oxidase-4) to anti-oxidant markers (superoxide dismutase-1/2, glutathione peroxidase-3 and catalase) was found in the liver. Moderate protein restriction protects against ischemia in the adult brain. Accordingly, dietary modifications may be efficacious strategies promoting stroke outcome.

Use of low-level laser therapy on children aged 1 to 5 years with energy-protein malnutrition: A clinical trial.

Background:Episodes of malnutrition in early childhood can produces alterations in the salivary glands. The investigation of mechanisms that can reduce the impact of malnutrition on the defenses of the organism is of the utmost important and interest to public health. The aim of this study is to evaluate the effect of low-level laser on the saliva of children aged 1 to 5 years with energy-protein malnutrition.Methods:Mandatory inclusion criteria are diagnosis of malnutrition. The sample will consist of 50 men and women malnourished children aged 12 to 71 months. Saliva will be collected and the volume of saliva will be measured and the salivary flow rate will be determined (mL/min). Concentrations of salivary IgA in all samples will be measured using a commercial Enzyme-Linked Immunosorbent Assay (ELISA) kit. Low-level laser (laser diode) will be administered in the region of the parotid glands bilaterally as well as in the regions of the submandibular and sublingual glands.Discussion:This study will be the first that investigate the effects of local laser therapy on the salivary glands of malnourished children.Trial registration:Clinical.trials.gov as NCT03355313, first received in 21 November 2017.

Pengaruh Pemberian Makanan Pendamping Asi ( MP – ASI) Dini Terhadap Kejadian Kekurangan Energi Protein (KEP) Pada Anak Umur 0 – 24 Bulan Di Wilayah Kota Kediri

Should we know that Mother’s Milk Complementary Foods is begin giving when someday after the baby was born. This is deficient think, because Mother’s Milk Complementary Foods present can make malnutrition consist or disturb child development (Energy-Protein Malnutrition). The destination of this research is to find out effect of giving too early Mother’s Milk complementary Foods with Energy-Protein Malnutrition incident to children on zero until twenty four months old. The methode of this research is the corelation with analitic case control characteristic that is eight child as case and eight others as control of fill up inclusion criteria . The samples will take by purposive sampling tehnis . The finishing data collection are using questionaire by weight and height measurement. The data analitic are using fisher exact probability test with 5% significancy. The result of this research is giving Mother’s Milk Complementary Foods to 87,5% Energy-Protein Malnutrition group and 25% non Energy-Protein Malnutrition is not timely. 100% Energy-Protein Malnutrition is nasty. There is an effect of giving too early Mother’s Food Complementary Foods in Energy-Protein Malnutrition accident on children at zero untill six months old. Be expected for the health personnel to give information and counseling about to give too early Mother’s Milk Complementary Foods about effect and the interval, at the same time for a children whio has Energy-Protein Malnutrition must give supplementary food that appropriate with the local program and integrated by Department of health.; Keywords = Giving too early Mother’s Milk Complementary Foods, Energy-Protein Malnutrition

Honey can repairing damage of liver tissue due to protein energy malnutrition through induction of endogenous stem cells.

Aim:This study was to evaluate effect of honey in repairing damage of liver tissue due to energy protein malnutrition and in mobilization of endogenous stem cells.Materials and Methods:Male mice model of degenerative liver was obtained through food fasting but still have drinking water for 5 days. It caused energy protein malnutrition and damage of liver tissue. The administration of 50% (v/v) honey was performed for 10 consecutive days, while the positive control group was fasted and not given honey and the negative control not fasted and without honey. Observations of regeneration the liver tissue based on histologically examination, observation of Hsp70 expression, and homing signal based on vascular endothelial growth factor-1 (VEGF-1) expression using immunohistochemistry technique. Observation on expression of CD34 and CD45 as the marker of auto mobilization of hematopoietic stem cells using flow cytometry technique.Results:There is regeneration of the liver tissue due to protein energy malnutrition, decrease of Hsp70 expression, increase of VEGF-1 expression, and high expression of CD34 and CD45.Conclusion:Honey can improve the liver tissue based on: (1) Mobilization of endogenous stem cells (CD34 and CD45); (2) Hsp70 and VEGF-1 expressions as regeneration marker of improvement, and (3) regeneration histologically of liver tissue

Pengaruh status gizi &amp; asupan gizi ibu terhadap berat bayi lahir rendah pada kehamilan usia remaja

Introduction. Teenage pregnancy at risk of having a baby with low birth weight (LBW). This happens because of the condition of the mother is still in the growth, physical development is not perfect so it can be detrimental to the health of mother and fetus. The research objective is to analyze the effect of nutritional status and nutrient intake of mothers of low birth weight in pregnancy adolescence.Methods: The study design was observational with prospective cohort approach.The subject is the population of third trimester pregnant women aged 16-19 years amounted to 27 people. The nutritional status measured by antropometry. Nutrient intake was measured by 24-hour food recall method. Data were analyzed by calculating the relative riskResults: 66,7% had a protein energy malnutrition, 51,9% had less weight gain during pregnancy, and 59,3% are anemic. The mean intake of energy, protein, folic acid, iron, zinc, vitamin A and C are in not enough categories. The relative risk test showed that less weight gain during pregnancy (RR= 3,71;95% CI 1,34-10,25, low energy intake (RR =6.03; 95% CI 5,68-898,64), low protein (RR= 13,00;95% CI 1,97-85,45), low folic acid (RR = 13,00;95% CI 1,97-85,45), low iron (RR= 4,00;95% CI 1,71-9,34) at risk of having low birth weight. Conclusions: Pregnant women-adolescence with less weight gain during pregnancy, energy protein malnutrition and low energy, protein, folic acid and iron intake at risk of having low birth weight.

Oil content and fatty acid composition of soybean (Glysine max L.) genotypes evaluated under rainfed conditions of Kashmir Himalayas in India

Soybean (Glycine max), a multipurpose crop with much appreciated nutritional and functional properties, has generated a lot of interest during last few decades for improving its cultivation and characteristics. Besides having a great potential of energy-protein malnutrition eradication, it can contribute greatly to edible oil pool in the region. This study investigates some agro-morphological characters, besides seed oil content and fatty acid composition of two local soybean genotypes labeled as S/D-18 and S/D-22 grown under rainfed conditions of Kashmir Himalayas in India. The genotype S/D-22 matured earlier than that of S/D-18. Seed yield/plant of 18.5 g (S/D-18) and 20.1g (S/D-22) was recorded in these genotypes with 100-seed weight of 14.3 g and 14.7 g respectively. Seeds of genotype S/D-18 yielded an oil content of 19.54% while in genotype S/D-22 oil content of 19.74% was recorded. Fatty acids of myristic, palmitic, stearic, oleic, linoleic and linoleinic were detected and quantified in the oil extracted from the seeds of these genotypes. Saturated fatty acids constituted 11.88%(S/D-18) and 11.42%(S/D-22) while unsaturated fatty acids constituted 88.12% (S/D-18) and 88.58% (S/D-22) of the oil. The study has thus, revealed that under dry land conditions, although soybean seed yield/plant is lesser, percentage oil content and fatty acid composition essentially remained unaltered and that significant differences can occur in individual fatty acid contents between genotypes.

Dietary Modulation of Thymic Enzymes

Malnutrition is a complex syndrome caused by an inadequate intake of energy, protein, minerals and vitamins which affects the immune system. Nutritional imbalances, present in children with energy-protein malnutrition and infections, make defining the specific effects of each of them on the thymus difficult. For this reason, it is necessary to design an experimental model in animals that could define a single variable. As the thymus atrophy described in humans is similar to that observed in murines, a rat experimental model makes the extrapolation to man possible. Some authors suggest that the activity of Adenosine Deaminase (ADA) and Purine Nucleoside Phosphorylase (PNP)--involved in purine metabolism--have an influence on T lymphocyte development and the immune system, due to intracellular accumulation of toxic levels of deoxynucleotides. Studies in our group, performed in an experimental model on Wistar growing rats, have demonstrated that protein deficiency or imbalance in the profile of essential amino acids in the diet, produce loss of thymus weight, reduction in the number of thymocytes, a diminished proportion of T cells presenting the W3/13 antigenic determinant and DNA content with concomitant increase in cell size, and the proportion of immature T cells and activity of ADA and PNP, without modifying the activity of 5´Nucleotidase in the thymus. It is important to point out that there were neither differences in energy intake between experimental groups and their controls, nor clinical symptoms of deficiency of other nutrients. The increase in these thymic enzyme activities was an alternative mechanism to avoid the accumulation of high levels of deoxynucleotides, which would be toxic for T lymphocytes. On the other hand, the administration of a recovery diet, with a high amount of high quality protein, was able to reverse the mentioned effects. The quick reply of Adenosine Deaminase to nutritional disorders and the following nutritional recovery, points out to this determination as a potential functional marker of nutritional status. Some authors have demonstrated an increase in ADA activity, in serum and other biological fluids in patients with various diseases involving defense mechanisms. According to these findings, it could be inferred that ADA activity in serum would follow the same behavior as observed in a rat thymus. So, we have analyzed if its determination could be considered a functional biochemical parameter in populations at nutritional risk. We analyzed the serum ADA activity in groups of individuals with altered nutritional status evaluated through different markers--young adult patients with Nervous Anorexia, overweight or obese school children, children suffering cystic fibrosis. The results show a statistically significant increase in the ADA activity in all groups, with respect to their healthy controls--same age range and socio economic status. The results obtained to date suggest the importance of including the determination of serum Adenosine Deaminase activity in the biochemical evaluation of the nutritional status, as a functional marker related to defense mechanisms.

High prevalence of vitamin D deficiency and osteoporosis in out-patients with intestinal failure

In intestinal failure, specific nutrient deficiencies especially for fat-soluble vitamins can be expected in addition to energy-protein malnutrition. We report serum levels of fat soluble vitamins, and bone density in out-patients with intestinal failure (IF). 106 outpatients with IF were assessed during routine visits. 78 patients underwent DXA-scan for bone density. Vitamin D levels < 50 nmol/l were defined as deficiency, and 75-150 as optimal. Vitamin A and E deficiencies were defined as <1.0 and <14 μmol/l respectively. INR ≥ 1.2 without liver disease or anti-vitamin K therapy was classified as vitamin K deficiency. Mean serum vitamin D level was 45 nmol/l at first visit, and 64 nmol/l at follow up (n = 76, p = 0.0001 by paired t-test). Overall prevalence of vitamin D deficiency was 67%. Only 12% of all patients had optimal D-vitamin status. 88% of assessed patients had low bone density. 12% had subnormal vitamin A levels and 25% had subnormal vitamin E levels. 32% had abnormal INR values. At follow up 34% remained vitamin D deficient whereas 29% had optimal levels. By oral substitution, vitamin A and E status were normalised, and K status improved. Vitamin D deficiency and osteoporosis are common in outpatients with intestinal failure, and should be adequately substituted.

Is malnutrition associated with crowding in permanent dentition?

Evidence suggests that energy-protein malnutrition is associated with impaired growth and development of facial bones. The objective of this study was to investigate the association between nutritional status and reduced space for dental eruption (crowding) in permanent dentition. A cross-sectional study with probabilistic sampling design was used. We evaluated 2,060 students aged 12 to 15 years enrolled in schools in the northeast of Brazil. Crowding was defined according to World Health Organization (WHO) as misalignment of teeth due to lack of space for them to erupt in the correct position. Nutritional status was evaluated by means of body mass index and height-for-age, using the WHO’s reference curves. Parents and adolescents responded to a questionnaire about demographic, socioeconomic, biological and behavioral characteristics. The associations were estimated by odds ratio (OR) in multivariate logistic regression analysis (alpha = 0.05). Confounding and effect-modification were taken into account. An association between low height-for-age (z-score < −1SD) and crowding was only observed in adolescents with a prolonged history of mouth breathing (OR = 3.1). No association was observed between underweight and crowding. Malnutrition is related to crowding in permanent dentition among mouth-breathing adolescents. Policy actions aimed at reducing low height-for-age and unhealthy oral habits are strongly recommended. However, further studies are needed to increase the consistency of these findings and improve understanding of the subject.

Citologia de impressão conjuntival em crianças desnutridas graves hospitalizadas

OBJETIVOS: avaliar os achados da citologia de impressão conjuntival (CIC) em crianças com desnutrição energético protéica (DEP) grave, hospitalizadas no Instituto de Medicina Integral Prof. Fernando Figueira (IMIP). MÉTODOS: estudo descritivo, tipo série de casos, realizado no período de agosto de 2005 a maio de 2006, envolvendo 41 crianças de um a 60 meses, com desnutrição grave (peso/altura &lt; -3DP e/ou edema - padrão NCHS). A técnica para a realização da CIC seguiu normas padronizadas segundo estudo de validação. A leitura das lâminas foi realizada por dois observadores independentes. RESULTADOS: a idade dos casos variou de um a 47 meses, com a mediana de nove meses. Observou-se padrão de anormalidade da CIC em 46,3% das crianças. Entre os casos com CIC anormal (marginal (-) e deficiente), 40% apresentaram edema. CONCLUSÕES: a prevalência elevada de resultados anormais de CIC, resumindo as classificações marginal (-) e padrão deficiente, justifica, na experiência aqui relatada, o cuidado normativo de se utilizar doses elevadas de vitamina A no tratamento hospitalar de desnutridos graves.