RESUMO
Introducción. La deficiencia de hierro (DH) es la carencia nutricional más prevalente y la principal causa de anemia en lactantes. Existe consenso en la suplementación diaria con hierro como estrategia de prevención; también se demostró que la suplementación semanal es eficaz, pero la evidencia en lactantes es escasa. El objetivo fue comparar la efectividad de la administración diaria de hierro frente a la semanal para la prevención de la anemia por DH del lactante. Población y métodos. Ensayo clínico controlado y aleatorizado. Lactantes atendidos en un centro de salud público, sin anemia a los 3 meses de edad, aleatorizados en tres grupos: suplementación diaria (1 mg/kg/día), semanal (4 mg/kg/semana) o sin suplementación (grupo control con lactancia materna exclusiva [LME]). Se evaluó anemia y DH a los 3 y 6 meses. Se registró grado de adherencia y efectos adversos. Los datos se analizaron con el software R versión 4.0.3. Resultados. Participaron 227 lactantes. A los 6 meses el grupo de lactantes con LME sin suplementación (control) presentó prevalencias de DH y anemia por DH (ADH) mayores que los grupos intervenidos (diario y semanal). DH: 40,5 % vs. 13,5 % y 16,7 % (p = 0,002); ADH: 33,3 % vs. 7,8 % y 10 % (p < 0,001). No hubo diferencias entre los grupos diario y semanal. Tampoco hubo diferencias en el porcentaje de alta adherencia a la suplementación (50,6 % diaria vs. 57,1 % semanal), ni en los efectos adversos. Conclusiones. No se hallaron diferencias significativas en la efectividad entre la administración diaria y semanal para la prevención de ADH del lactante.
Introduction. Iron deficiency (ID) is the most prevalent nutritional deficiency and the main cause of anemia in infants. There is consensus on daily iron supplementation as a preventive strategy; and weekly iron supplementation has also been shown to be effective, but evidence in infants is scarce. The objective of this study was to compare the effectiveness of daily versus weekly iron administration for the prevention of ID anemia (IDA) in infants. Population and methods. Randomized, controlled clinical trial. Infants seen at a public health center, without anemia at 3 months of age, were randomized into 3 groups: daily supplementation (1 mg/kg/ day), weekly supplementation (4 mg/kg/week), or no supplementation (control group with exclusive breastfeeding [EB]). Anemia and ID were assessed at 3 and 6 months old. Adherence and adverse events were recorded. Data were analyzed using the R software, version 4.0.3. Results. A total of 227 infants participated. At 6 months, the group of infants with EB without supplementation(control) had a higher prevalence of ID and IDA than the intervention groups (daily and weekly). ID: 40.5% versus 13.5% and 16.7% (p = 0.002); IDA: 33.3% versus 7.8% and 10% (p < 0.001). There were no differences between the daily and weekly supplementation groups. There were also no differences in the percentage of high adherence to supplementation (50.6% daily versus 57.1% weekly) or adverse events. Conclusions. No significant differences in effectiveness were observed between daily and weekly administration for the prevention of infant IDA.
Assuntos
Humanos , Lactente , Anemia Ferropriva/prevenção & controle , Anemia Ferropriva/epidemiologia , Ferro/uso terapêutico , Aleitamento Materno , Anemia Ferropriva/tratamento farmacológico , Suplementos Nutricionais , Desnutrição/complicações , Deficiências de FerroRESUMO
The aim of this study was to assess the fatty acid (FA) percentage distribution in complex lipids of breast milk from mothers on a low docosahexaenoic acid (DHA) diet. We performed a descriptive, cross-sectional study of milk samples (n = 14) collected 90 days after delivery and analyzed them using gas chromatography, thin-layer chromatography, and the Fiske-Subbarow method. Complex lipid distribution was 40.70 ± 5.11% sphingomyelin (SM), 26.03 ± 5.98% phosphatidylethanolamine (PE), 21.12 ± 2.32% phosphatidylcholine, 7.94 ± 1.96% phosphatidylserine, and 4.22 ± 1.25% phosphatidylinositol. Median DHA and arachidonic acid values were 0.13% (0.12; 0.18) and 0.42% (0.33; 0.53), respectively. Mean FA percentage in SM and PE was as follows: palmitic acid, 34.45 ± 1.94% and 5.38 ± 0.94%; oleic acid, 16.50 ± 4.07% and 9.43 ± 4.05%; linoleic acid, 5.91 ± 4.69% and 9.05 ± 4.5%. DHA was not detectable in SM, but it was found in PE (55.33 ± 14.46). In conclusion, breast milk of mothers on a low DHA diet contained 55% DHA in PE, but no DHA in SM.
Assuntos
Ácidos Graxos , Leite Humano , Humanos , Feminino , Ácidos Graxos/análise , Leite Humano/química , Ácidos Docosa-Hexaenoicos/análise , Mães , Estudos Transversais , DietaRESUMO
BACKGROUND AND AIM: The selection of appropriate criteria is essential to accurately identify cancer patients eligible for home parenteral nutrition (HPN). In this study, the association between Karnofsky Performance Status (KPS) Scale scores and outcomes in cancer patients on HPN was evaluated. METHODS: Retrospective-observational-longitudinal-analytical study of a database of adult cancer patients on HPN. The variables analyzed were sex, age, cancer diagnosis, cancer location (digestive tract and genitourinary), nutritional status, including initial weight (IW), at the start of HPN), usual weight (UW) and IW/UW ratio, and body mass index (BMI) at the start of HPN. Performance status was assessed with the KPS scale. Type of catheter used, number of days on HPN and clinical progression of cancer patients were also studied. RESULTS: Data of 41 cancer patients (60.8% female) were evaluated. Mean age at the start of HPN was 60.45 years. Cancer location was digestive tract (n = 36; 87.8%); gynecologic (n = 4; 9.7%), urinary tract (n = 1; 2.4%). Median IW was 55 kg (45; 64) and BMI was 20 (17.58; 22.84). The IW/UW ratio was -15 kg (-20;-10). The catheters used were peripherally inserted central catheter (n = 30; 73.2%), tunneled (n = 9; 22%) and port (n = 2; 4.8%). The median duration of HPN was 72 days (30; 159). The KPS results showed that 16 cancer patients (39%) had KPS scores ≤50, 17 (41.5%) requiring HPN were discharged and 24 (58.5%) died. The association between disease progression and KPS scores ≤50 was significant (p = 0.025; OR (95% CI): 5.28 (1.07; 36.18). CONCLUSION: The KPS scale is a reliable tool to identify cancer patients eligible for HPN. Cancer patients with ≤50 scores had a five-fold increased risk of death than patients with >50 scores.
Assuntos
Neoplasias , Nutrição Parenteral no Domicílio , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Estado de Karnofsky , Estudos Longitudinais , Neoplasias/terapia , Neoplasias/complicações , Nutrição Parenteral no Domicílio/efeitos adversos , Estudos RetrospectivosRESUMO
Introduction. Iron deficiency (ID) is the most prevalent nutritional deficiency and the main cause of anemia in infants. There is consensus on daily iron supplementation as a preventive strategy; and weekly iron supplementation has also been shown to be effective, but evidence in infants is scarce. The objective of this study was to compare the effectiveness of daily versus weekly iron administration for the prevention of ID anemia (IDA) in infants. Population and methods. Randomized, controlled clinical trial. Infants seen at a public health center, without anemia at 3 months of age, were randomized into 3 groups: daily supplementation (1 mg/kg/day), weekly supplementation (4 mg/kg/week), or no supplementation (control group with exclusive breastfeeding [EB]). Anemia and ID were assessed at 3 and 6 months old. Adherence and adverse events were recorded. Data were analyzed using the R software, version 4.0.3. Results. A total of 227 infants participated. At 6 months, the group of infants with EB without supplementation (control) had a higher prevalence of ID and IDA than the intervention groups (daily and weekly). ID: 40.5% versus 13.5% and 16.7% (p = 0.002); IDA: 33.3% versus 7.8% and 10% (p < 0.001). There were no differences between the daily and weekly supplementation groups. There were also no differences in the percentage of high adherence to supplementation (50.6% daily versus 57.1% weekly) or adverse events. Conclusions. No significant differences in effectiveness were observed between daily and weekly administration for the prevention of infant IDA.
Introducción. La deficiencia de hierro (DH) es la carencia nutricional más prevalente y la principal causa de anemia en lactantes. Existe consenso en la suplementación diaria con hierro como estrategia de prevención; también se demostró que la suplementación semanal es eficaz, pero la evidencia en lactantes es escasa. El objetivo fue comparar la efectividad de la administración diaria de hierro frente a la semanal para la prevención de la anemia por DH del lactante. Población y métodos. Ensayo clínico controlado y aleatorizado. Lactantes atendidos en un centro de salud público, sin anemia a los 3 meses de edad, aleatorizados en tres grupos: suplementación diaria (1 mg/kg/día), semanal (4 mg/kg/semana) o sin suplementación (grupo control con lactancia materna exclusiva [LME]). Se evaluó anemia y DH a los 3 y 6 meses. Se registró grado de adherencia y efectos adversos. Los datos se analizaron con el software R versión 4.0.3. Resultados. Participaron 227 lactantes. A los 6 meses el grupo de lactantes con LME sin suplementación (control) presentó prevalencias de DH y anemia por DH (ADH) mayores que los grupos intervenidos (diario y semanal). DH: 40,5 % vs. 13,5 % y 16,7 % (p = 0,002); ADH: 33,3 % vs. 7,8 % y 10 % (p < 0,001). No hubo diferencias entre los grupos diario y semanal. Tampoco hubo diferencias en el porcentaje de alta adherencia a la suplementación (50,6 % diaria vs. 57,1 % semanal), ni en los efectos adversos. Conclusiones. No se hallaron diferencias significativas en la efectividad entre la administración diaria y semanal para la prevención de ADH del lactante.
Assuntos
Anemia Ferropriva , Ferro , Feminino , Humanos , Lactente , Anemia Ferropriva/epidemiologia , Anemia Ferropriva/prevenção & controle , Anemia Ferropriva/tratamento farmacológico , Aleitamento Materno , Suplementos Nutricionais , Ferro/uso terapêutico , Deficiências de Ferro , Desnutrição/complicaçõesRESUMO
Introducción: La malnutrición y la deficiencia de micronutrientes son complicaciones frecuentes en los pacientes con parálisis cerebral (PC). Objetivo: Analizar los niveles de vitamina D (VitD) en pacientes PC en Nutrición Enteral Domiciliaria (NED). Material y Métodos: Estudio retrospectivo analítico de corte transversal. Se incluyeron pacientes PC, e/ 2-18 años, con dosaje de VitD al final del invierno 2021. Se analizó: sexo, edad, discapacidad por Gross Motor Scale (GMS), estado nutricional, drogas antiepilépticas, fórmula, aporte de VitD, volumen, vía de acceso, gasto energético basal (GEB). Se agruparon: Grupo I (GI VitD ≥ 30 ng/ml) GII (VitD ≤ 29 ng/ml). Resultados: se incluyeron 34 pacientes PC, 15 femeninos (44,11 %), edad media 10,87 años (DS 4,78), todos fueron grado V (GMS). La media de Z score de IMC (OMS) fue -1,33 (DS 3,14). Todos recibieron NE diaria. El aporte medio fue de 1270 Kcal (DE:243), 1,16 (Kcal sobre lo estimado según Schofield). Las fórmulas aportaron el 80% del requerimiento de VitD. Los niveles sanguíneos de VitD mostraron: 16 pacientes ≥ de 30 ng/ml y 18 ≤ 29 ng/ml. 14 fueron deficientes y 4 insuficientes. El 59% (20) de los pacientes recibían medicación anticonvulsivante. No se encontraron diferencias significativas entre G1 y G2 para sexo, edad, Z score de IMC, aporte de VitD, calorías recibidas/ GMB y medicación anticonvulsivante. Conclusión: El alto porcentaje de pacientes PC pediátricos con niveles subóptimos de VitD muestra que se trata de una población de riesgo y sugiere la necesidad del chequeo sistemático para una adecuada prevención y tratamiento
Introduction: Malnutrition and micronutrient deficiencies are frequent complications in patients with cerebral palsy (CP). Objective: to analyze the levels of vitamin D (VitD) in CP patients receiving Home Enteral Nutrition (HEN). Material and Methods: Retrospective analytical cross-sectional study. CP patients, from 2 to 18 years old, with measured VitD at the end of winter 2021, were included. The following study variables were analyzed: sex, age, disability by Gross Motor Scale (GMS), nutritional status, antiepileptic drugs, formula, VitD intake, volume, access route, basal energy expenditure (BEE), according to Schofield P/T. They were grouped: Group I (GI VitD ≥ 30 ng/ml) GII (VitD ≤ 29 ng/ml). Results: 34 CP patients were included, 15 female (44.11 %), mean age 10.87 years (SD 4.78), all grade V (GMS). The mean BMI Z score (WHO) was -1.33 (SD 3.14). EN was daily in all, 33 due to gastrostomy and 1 due to SNG. The average contribution 1270 Kcal (DS243), 1.16 (Kcal received according to Schofield). The formulas provided 80 % of the VitD requirement. VitD blood levels showed: 16 patients (47 %) ≥ 30 ng/ml and 18 (52 %) ≤ 29 ng/ml. 14 (41.17 %) were deficient and 4 insufficient (11.76 %). 59 % (20) of the patients received anticonvulsant medication. No significant differences were found between G1 and G2 for sex, age, BMI Z score, VitD intake, calories received/GMB and anticonvulsant medication. Conclusion: The high percentage of pediatric CP patients with suboptimal levels of Vit D shows that it is a population at risk and suggests the need for systematic check-up for adequate prevention and treatment
Assuntos
Humanos , Criança , Adolescente , Adulto , Paralisia Cerebral , Nutrição EnteralRESUMO
La leche humana es el alimento ideal para los lactantes y sus beneficios se manifiestan en el corto y el largo plazo. En situaciones de crisis es cuando más se debe enfatizar en la lactancia materna, considerada una de las intervenciones más costo-efectivas para reducir la morbimortalidad infantil. Más allá de las múltiples ventajas que la leche humana tiene en relación con el vínculo madre-hijo y las capacidades biológicas e inmunológicas, lo más importante es que la leche materna cubre todas las necesidades nutricionales. Cuando la lactancia materna no es posible, la Organización Mundial de la Salud recomienda, como primera opción, las fórmulas infantiles. La segunda opción es leche de vaca (LV) diluida, que conlleva riesgos de deficiencias nutricionales en el lactante que deben ser monitoreadas en forma estrecha y oportunamente subsanadas. Los principales riesgos de deficiencias en el lactante que recibe LV diluida son las de hierro, cinc, vitaminas A, D, C y E, aminoácidos y ácidos grasos esenciales
Breast milk is the ideal food for infants and its benefits can be observed in the short and long term. In crisis situations, breastfeeding should be promoted the most because it is one of the most cost-effective interventions aimed at reducing infant morbidity and mortality. In addition to the multiple advantages of breast milk in the mother-child bond and biological and immune properties, the most relevant characteristic of breast milk is that it covers all nutritional needs. When breastfeeding is not possible, the World Health Organization recommends infant formula as the first option. The second option is diluted cow's milk, which entails the risk for nutritional deficiency that should be strictly monitored and timely resolved. When infants are fed with diluted cow's milk, they are mainly at risk for iron, zinc, vitamin A, D, C, and E, amino acid, and essential fatty acid deficiency.
Assuntos
Humanos , Lactente , Aleitamento Materno , Hipersensibilidade a Leite , Fórmulas Infantis , Leite , Fenômenos Fisiológicos da Nutrição do Lactente , Leite HumanoRESUMO
Introducción: los niños con parálisis cerebral (PC) presentan habitualmente compromiso nutricional. Objetivos: evaluar el estado nutricional antropométrico de niños con PC con nutrición enteral (NE) asistidos por un equipo especializado en domicilio. Materiales y métodos: cohorte retrospectiva sobre datos de historia clínica, evaluados durante un año (2018-2019). Se evaluó: z score de .peso (Pz), z score de talla (Tz), z score de índice de masa corporal (IMC) (IMCz). En los que no pudo usarse pediómetro, se utilizó medición de la longitud de la tibia (LT). Se los dividió en:
Introduction: children with cerebral palsy (CP) usually present nutritional compromise. Objectives: to evaluate the anthropometric nutritional status of children with CP with enteral nutrition (EN) assisted by a specialized team at home. Materials and methods: a retrospective cohort study on clinical report data, evaluated during one year (2018-2019). The following were evaluated: weight z score (Pz), height z score (Tz), BMI z score (BMIz). In those that could not be used a pediometer, measurement of the tibia length (TL) was used. They were divided into: <10 years (Group1) and >10 years (Group2). The following were excluded: genetic syndromes and/or refractory epilepsy, and those who did not adhere to nutritional treatment. Complications associated with nutritional treatment were recorded. Results: 72 patients were analyzed, Group 1: 38 patients: baseline: Tz x -2.85 (-4.50, -1.41), Pz x -2.83 (-3.72, -1.59), BMIz 0,93 (SD 2,21). Final, Tz was x -2.55 (-3.92, -1.42), Pz x -2.15 (-3.05, -1.03), BMI x: 15.95. Significant differences were observed between the start-end in P p<0.001, T p0.001, and Pz p0.030. Group 2: 34 patients, 2018: Tz x -3.00 (-3.81, -1.53), Pz x -2.63 (-3.68, -2.23), BMIz x -1,75 (DE:1,73). Final Tz x -2.84 (-4.13, -1.25), Pz x -2.84 (-3.42,-1.83) BMI -1,53 (DE: 2,19).Significant differences were observed between the beginning and end of the period observed in the Pz (p=0.049). No severe complications were recorded (hospitalizations, bronchial aspiration, death). Conclusions: an improvement in nutritional status and no severe complications were observed in the period studied
Assuntos
Humanos , Lactente , Pré-Escolar , Criança , Paralisia Cerebral , Nutrição Parenteral no Domicílio , AntropometriaRESUMO
Breast milk is the ideal food for infants and its benefits can be observed in the short and long term. In crisis situations, breastfeeding should be promoted the most because it is one of the most cost-effective interventions aimed at reducing infant morbidity and mortality. In addition to the multiple advantages of breast milk in the mother-child bond and biological and immune properties, the most relevant characteristic of breast milk is that it covers all nutritional needs. When breastfeeding is not possible, the World Health Organization recommends infant formula as the first option. The second option is diluted cow's milk, which entails the risk for nutritional deficiency that should be strictly monitored and timely resolved. When infants are fed with diluted cow's milk, they are mainly at risk for iron, zinc, vitamin A, D, C, and E, amino acid and essential fatty acid deficiency.
La leche humana es el alimento ideal para los lactantes y sus beneficios se manifiestan en el corto y el largo plazo. En situaciones de crisis es cuando más se debe enfatizar en la lactancia materna, considerada una de las intervenciones más costo-efectivas para reducir la morbimortalidad infantil. Más allá de las múltiples ventajas que la leche humana tiene en relación con el vínculo madre-hijo y las capacidades biológicas e inmunológicas, lo más importante es que la leche materna cubre todas las necesidades nutricionales. Cuando la lactancia materna no es posible, la Organización Mundial de la Salud recomienda, como primera opción, las fórmulas infantiles. La segunda opción es leche de vaca (LV) diluida, que conlleva riesgos de deficiencias nutricionales en el lactante que deben ser monitoreadas en forme estrecha y oportunamente subsanadas. Los principales riesgos de deficiencias en el lactante que recibe LV diluida son las de hierro, cinc, vitaminas A, D, C y E, aminoácidos y ácidos grasos esenciales.