Orientadores: Maria Angela Bellomo Brandão, Elizete Aparecida Lomazi / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-27T18:16:33Z (GMT). No. of bitstreams: 1 Caselli_ThaisaBarboza_M.pdf: 1210230 bytes, checksum: fefb27a92c9a78c50d6fb8a873b60a38 (MD5) Previous issue date: 2015 / Resumo: A tetraparesia espástica é um tipo de Encefalopatia crônica não progressiva ou não evolutiva (ECNE) que corresponde a uma condição neurológica associada a anormalidades motoras graves, ingestão alimentar deficiente, comprometimento da composição corporal e desnutrição frequente. A gastrostomia tem sido indicada para crianças com dificuldades em se alimentar decorrente da ECNE. O objetivo do trabalho foi avaliar o estado nutricional de crianças e adolescentes portadores de ECNE tetraespástica, por meio de curvas específicas e das dobras cutâneas, identificar a frequência das disfunções da motilidade digestiva e a comparar o estado nutricional daquelas alimentadas via gastrostomia (SGT) e via oral (VO). Também foi verificada a concordância entre curvas de crescimento utilizadas para população pediátrica no geral e as curvas específicas para pacientes com ECNE. Estudo transversal em que foram incluídos 54 pacientes. Foram obtidos os dados de: altura do joelho, estatura estimada, peso, dobras cutâneas e circunferências do braço. Os valores de dobras e circunferências foram comparados com a referência de Frisancho. As curvas de Brooks et al. foram utilizadas como padrão referencial e foram definidos como desnutridos aqueles que se encontravam abaixo do percentil 25 de peso para idade. A diferença dos parâmetros nutricionais entre o grupo SGT e grupo VO foi calculada por testes Qui-Quadrado e Exato de Fisher, enquanto que a relação entre curva de crescimento para crianças saudáveis (representada pelo Escore-Z calculado) e curva adotada como referencial foi verificada através do teste exato de Fisher. O nível de significância adotado foi de 5%. Dos 54 pacientes, 34 eram do sexo masculino e a média da idade foi de 10,2 anos. Vinte e cinco pacientes eram alimentados por SGT e 29 por VO. Observou-se que 70% (38/54) dos pacientes foram considerados eutróficos nos parâmetros de peso e Índice de Massa Corpórea (IMC) para idade, enquanto que 100% (54/54) estavam com estatura adequada para idade. A desnutrição em relação à dobra cutânea triciptal foi observada em 30% (26/54) enquanto que 52% (28/54) apresentaram depleção de massa magra através da circunferência braquial. Foi verificado que as disfunções da motilidade digestiva, como refluxo gastroesofágico, distúrbio de deglutição e constipação intestinal foram mais frequentes no grupo SGT, sendo possivelmente um dos fatores para indicação da cirurgia. O grupo VO apresentou mais indivíduos na faixa da desnutrição (24,14% ou 7/12), além de maior depleção de massa magra e adiposa quando comparado ao grupo SGT. Em relação às curvas, 14,3% dos pacientes que foram classificados como eutróficos no parâmetro peso para idade de acordo com a curva referencial, o Escore-Z os classificou como desnutridos e o mesmo ocorreu em 10% em relação ao IMC. A curva referencial classificou todos como tendo estatura adequada para idade, enquanto que o Escore-Z apontou baixa ou muito baixa estatura para idade. O estudo permitiu concluir que os parâmetros antropométricos indicam que os pacientes do grupo VO apresentam maior comprometimento do estado nutricional do que aqueles que se alimentam via SGT / Abstract: Spastic Quadriplegic cerebral palsy is a sort of a non-progressive chronic encephalopathy, which is related to a neurological condition linked to serious motor abnormalities, deficient food intake, body composition compromising and frequent malnourishment. Gastrostomy is being indicated to children who have difficulties in feeding due to the non-progressive chronic encephalopathy. The aim was to evaluate nutritional status of children and teenagers carriers of non-progressive chronic encephalopathy with spastic quadriplegic cerebral palsy (through comparison with specifics curves and skinfolds), dysfunctions frequency of digestive motility and the nutritional status comparison of those who feed via gastrostomy and via oral. It was also verified the accordance between growth curves used to pediatric people in general, and specifics curves for patients with non-progressive chronic encephalopathy. Sectional study which were included 54 patients. The following data were obtained: knee height, estimated stature, weight, skin folds and arm circumference. Skin folds and circumferences values were compared to Frisancho¿s reference values. Brooks curves at al. were used as referential standards, and were defined as malnourished those who were below the 25th percentile to the age. Nutritional parameters¿ difference between the group feed via gastrostomy and via oral was measured by Chi-square test and Fisher exact test. Significance level adopted was 5%. From 54 patients, 34 were male and the average age was 10.2 years old. Twenty five patients were feed via gastrostomy and 29 via oral. It was observed that 70% (38/54) of all patients were considered as eutrophic as weight and body mass parameters for the age, while 100% (54/54) had the ideal stature for the age. Malnourishment related to triceps skinfold was observed in 30% (26/54), while 52% (28/54) presented lean mass depletion through arm circumference. Was also verified that digestive motility, such as gastroesophageal reflux, swallowing disorders and intestinal constipation were frequent in group feed via gastrostomy, and a probable factor for surgery indication. Via oral group presented more individuals in malnourishment range (24,24%, or 7/12), besides higher levels of lean mass depletion, and also of adipose mass when compared to in group feed via gastrostomy. In 14,3% of patients who were classified as eutrophic in weight/age parameters in according to referential curve, Z-Score classified them as malnourished and the same happened in 10% on their body mass index. The reference curve has classified all patients as suitable stature to their ages. This study allowed to conclude that anthropometric parameters indicates that patients from via oral group present a higher compromising of nutritional status than patients of gastrostomy group / Mestrado / Saude da Criança e do Adolescente / Mestra em Ciências

A desnutrição freqüentemente está presente em pacientes com insuficiência cardíaca (IC), podendo trazer aumento de complicações e mortalidade. O objetivo do estudo foi o de avaliar o estado nutricional de pacientes portadores de IC refratária, aguardando a realização de transplante cardíaco. Avaliação nutricional foi realizada utilizando-se da avaliação subjetiva global, avaliação antropométrica completa [índice de massa corpórea (IMC), circunferência do braço (CB), prega cutânea tricipital (PCT), circunferência muscular do braço (CMB) e área gordurosa do braço (AGB)], avaliação laboratorial e realização de anamnese alimentar em dois momentos: no momento de admissão na fila de transplante (1a avaliação) e 4 meses após (2a avaliação). Na 1ª avaliação foram estudados 56 pacientes, idade média de 46±12 anos, 67,8% homens, 33,9% com miocardiopatia chagásica. Análise de dados antropométricos revelou com base no IMC: 73,2% eutróficos e 5,3% com baixo peso; CMB: 66% apresentavam depleção. Houve correlação negativa e significativa entre IMC e fator de necrose tumoral (r= - 0,305; p= 0,022). Análise laboratorial demonstrou: baseado na albumina, 50% dos pacientes apresentavam-se com algum grau de depleção, na transferrina 40% e na contagem de linfócitos 80%. Houve correlação negativa e significativa entre albumina e interleucina-6 (r = - 0,464; p< 0,001), transferrina e interleucina-6 (r= -0,269; p= 0,047) e contagem de linfócitos e interleucina-6 (r= - 0,394; p=0,003). Na 2ª avaliação 18 pacientes foram estudados. Não foram observadas diferenças significativas entre as duas avaliações quanto aos parâmetros estudados. Com base na realização da anamnese alimentar os pacientes atingiram aproximadamente 85% e 84% de suas necessidades calóricas na 1ª e 2ª avaliações, e com relação à ingestão protéica, tanto na 1ª como na 2ª avaliação mais de 70% dos pacientes apresentaram consumo adequado de proteínas. Foi observado consumo abaixo das necessidades nutricionais de cálcio, potássio, magnésio, zinco, folato e vitamina E. Quanto ao sódio verificamos um consumo acima do recomendado. Foram transplantados 14 pacientes com idade de 44 ± 21 anos, 57,1% do sexo masculino, quatro pacientes morreram no pós operatório. Não houve diferenças significativas quanto aos dados antropométricos, laboratoriais, de adequação alimentar e idade entre o grupo de transplantados que sobreviveram (n=9) comparados com os que faleceram (n=4). Concluímos que a desnutrição é comum em pacientes com IC grave aguardando transplante cardíaco. A avaliação nutricional baseada no IMC não mostrou ser um bom método, necessitando ser complementada com as medidas de CB, CMB, PCT e AGB. A avaliação laboratorial permitiu a detecção de comprometimento nutricional. A participação das citocinas inflamatórias no processo de desnutrição foi evidenciada em nossa população. Portanto, a avaliação nutricional completa deve fazer parte do atendimento em pacientes com IC crônica, particularmente aqueles com IC refratária à espera por um transplante cardíaco / Malnutrition is frequently present in patients with heart failure (HF) and is associated with an increase in morbidity and mortality. The objective of this study was to evaluate nutritional status of patients with refractory HF waiting for cardiac transplantation. Nutritional evaluation was done with the use of subjective global assessment, complete anthropometric measurements (body mass index (BMI), mid-arm circumference (MAC), triceps skinfold thickness (TSF), mid-arm muscle circumference (MAMC) and arm fat area), laboratory evaluation and food intake assessment in two moments: at the admission to the cardiac transplantation waiting list (1st evaluation) and after 4 months (2nd evaluation). On the 1st evaluation, we studied 56 patients, mean age 46±12 years, 67.8% were men, and 33.9% had Chagas disease. Analyzing anthropometric measurements, we found that, based on BMI 73.2% of patients were normal and 5.3% had underweight; MAMC revealed 66% with depletion. There was a negative and significant correlation between BMI and tumor necrosis factor-a (r= - 0.305; p<0.022). Laboratory evaluation showed that based on albumin levels, 50% of patients had some degree of depletion, based on transferrin 40% and on lymphocyte count 80%. There were negative and significant correlations between albumin and interleukin-6 (r= - 0.464; p<0.001), transferrin and interleukin-6 (r= -0.269; p<0.047) and lymphocyte count and interleukin-6 (r= -0.394; p<0.003). On the 2nd evaluation 18 patients were studied. There were no significant differences in the studied parameters between the 1st and 2nd evaluations. Based on the food intake assessment, percentage of adequacy of calories intake was 85% and 84% on 1st and 2nd evaluations, and more than 70% of patients had adequate protein intake on both evaluations. Low intake of calcium, potassium, magnesium, zinc, folate and vitamin E was detected. Daily sodium intake was found to be above the recommended levels. Fourteen patients were submitted to cardiac transplantation, mean age 44±21 years, 57.1% were men. Four patients died in post operative period. No relation was observed between anthropometric, laboratory, alimentary adequacy and age variables between patients transplanted that survive (n=9) and that died (n=4). We concluded that malnutrition is common in patients with refractory HF listed for cardiac transplantation. Nutritional assessment based on BMI did not show to be a good index to detect nutritional disorders and need to be used together with MAC, TSF, MAMC and arm fat area. Laboratory evaluation permitted the detection of compromised nutritional status. The participation of inflammatory cytokines in the process of malnutrition was evidenced in our population. Therefore, a complete nutritional evaluation should be part of routine care of patients with chronic HF, particularly in those with refractory HF waiting for cardiac transplantation

Este estudo foi realizado na Clínica Obstétrica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, com cento e oitenta e sete gestantes sem comorbidades, para conhecer o perfil nutricional de gestantes que receberam orientação dietética e avaliar o ganho ponderal materno total, o tipo de parto e os resultados perinatais. Foi realizada pesquisa retrospectiva e descritiva, por meio de consulta dos formulários de anamnese alimentar, dos bancos de dados clínicos e prontuários das pacientes. As gestantes foram classificadas de acordo com o IMC prégestacional: 23 (12,2%) eram de baixo peso (IMC < 19,8 kg/m2); 84 (45%), eutróficas (IMC de 19,8 a 26,0 kg/m2); 37 (19,8%), sobrepeso (IMC de 26,1 a 29,0 kg/m2) e 43 (23%), obesas (IMC > 29,0 kg/m2). No consumo energético, não se constatou diferença entre os grupos. A média de porcentagem de carboidratos, proteínas e lipídeos ingerida foi semelhante entre os grupos. Sobre o perfil da ingestão de micronutrientes, a de cálcio, vitamina A e vitamina C foi semelhante entre os grupos; a de ferro foi maior nas gestantes eutróficas quando comparadas às com sobrepeso e com obesidade (p<0,001); a de folatos foi maior nas gestantes eutróficas quando comparadas às obesas (p=0,002); a de fibras foi menor nas gestantes de baixo peso quando comparadas às eutróficas (p=0,042). O ganho de peso excessivo (acima do recomendado) foi significativamente maior (p=0,009) nas gestantes com sobrepeso e obesidade, porém o ganho ponderal materno médio foi significativamente menor nas obesas (p<0,001). Não foi observada diferença entre os grupos quanto à idade gestacional no parto e o tipo de parto. O peso dos recém-nascidos das gestantes de baixo peso apresentou média significativamente menor (p=0,005) que dos demais grupos. As gestantes com sobrepeso apresentaram maior porcentagem de recém-nascidos com mais de 4000g (p=0,037) que os demais grupos. A proporção de recém-nascidos grandes para a idade gestacional foi significativamente maior (p=0,006) nas gestantes com sobrepeso e com obesidade quando comparadas aos demais grupos. Os índices de Apgar não apresentaram diferença significativa entre os grupos. A indicação de cesárea por vício pélvico foi significativamente mais frequente em gestantes com baixo peso (p = 0,006) quando comparadas aos outros grupos / This study was carried out at Clínica Obstétrica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, with one hundred eighty-seven pregnant women without comorbidities. This study aimed to know the nutrition profile of pregnant women who received dietary counseling and to evaluate the maternal total weight gain, type of delivery and perinatal outcome. A retrospective and descriptive research was carried out through consultation of forms of dietary anamnesis, the clinical databases and medical records. The women were classified according to pre-gestational body mass index (BMI): 23 (12.2%) were underweight (BMI < 19.8 kg/m2), 84 (45%) normal weight (BMI 19.8 to 26.0 kg/m2), 37 (19.8%) overweight (BMI 26.1 to 29.0 kg/m2) and 43 (% 23) obese (BMI > 29.0 kg/m2). No difference was observed in energy consumption between the groups. The averages percentage of carbohydrates, protein and lipid intake were similar between groups. Regarding the profile of micronutrient intake, calcium intake, vitamin A and vitamin C was similar between groups; iron intake was higher in normal weight pregnant women compared to overweight and obese (p<0.001); folate intake was higher in normal weight pregnant women compared to obese (p=0.002); fiber intake was lower in underweight pregnant women compared to normal weight (p=0.042). Excessive weight gain (above the recommended) was significantly higher (p=0.009) in pregnant women with overweight and obesity, however the mean of total maternal weight gain was significantly lower in obese women (p<0.001). No difference was observed between the groups regarding gestational age at delivery and mode of delivery. The weight of newborns of underweight pregnant women had a mean significantly lower (p=0.005) compared to other groups. The overweight pregnant women had a higher percentage of newborns with more than 4000g (p=0.037) compared to other groups. The proportion of newborns large for gestational age was significantly higher (p=0.006) in pregnant women with overweight and obesity compared to other groups. The Apgar scores did not differ significantly between groups. Indication of cesarean for contracted pelvis was significantly more frequent in underweight pregnant women (p=0.006) when compared to other groups

by Luo Hsiang Ying. / Thesis submitted in: June 1998. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1999. / Includes bibliographical references (leaves 96-106). / Abstract also in Chinese. / Acknowledgments / Summary / List of Abbreviations / List of Tables / List of Figures Introduction and aim of the study --- p.1 / Chapter Chapter 1 --- The nutritional status of vegetarian children-a literature review --- p.6 / Chapter Chapter 2 --- Vegetarianism- past and present --- p.6 / Chapter 2.1 --- Definitions and Classification of vegetarian --- p.6 / Chapter 2.1.1 --- Vegetarianism-past and present --- p.7 / Chapter 2.1.2 --- Potential benefit of vegetarian diet to health --- p.7 / Chapter 2.1.3 --- Nutritional considerations --- p.8 / Chapter 2.2 --- Energy --- p.9 / Chapter 2.2.1 --- Protein --- p.10 / Chapter 2.2.2 --- Calcium --- p.12 / Chapter 2.2.3 --- Iron --- p.14 / Chapter 2.2.4 --- Vitamin --- p.16 / Chapter 2.2.5 --- "Sources of ""important nutrients in vegetarian diet" --- p.17 / Chapter 2.2.6 --- Growth and development of vegetarian children --- p.18 / Chapter 2.3 --- Growth of omnivorous children --- p.18 / Chapter 2.3.1 --- Growth of vegetarian children --- p.18 / Chapter 2.3.2 --- Long term effect of vegetarian diet --- p.21 / Chapter 2.4 --- A reviews of local studies on Nutritional Status of Hong Kong Chinese children --- p.23 / Chapter Chapter 3 --- Nutritional intake of omnivorous children --- p.23 / Chapter 3.1 --- Calcium intake and Bone Mineral Content of Hong Kong Children --- p.24 / Chapter 3.2 --- Growth Standards for Hong Kong children --- p.25 / Chapter 3.3 --- An overview of the present nutritional status of Hong Kong children --- p.26 / Chapter 3.4 --- A reviews of the methods of dietary assessment and anthropometric evaluation --- p.27 / Chapter Chapter 4 --- Dietary assessment --- p.27 / Chapter 4.1 --- Methods for collecting dietary intake data --- p.27 / Chapter 4.1.1 --- Selecting an appropriate method --- p.34 / Chapter 4.1.2 --- Food composition tables --- p.34 / Chapter 4.1.3 --- Anthropometric assessment of growth --- p.35 / Chapter 4.2 --- Measurement of height --- p.36 / Chapter 4.2.1 --- Measurement of weight --- p.36 / Chapter 4.2.2 --- Body fatness evaluation --- p.37 / Chapter 4.3 --- Using of skinfold thickness measurement to assess body fat --- p.38 / Chapter 4.3.1 --- Mid-upper arm circumference ratio --- p.39 / Chapter 4.4 --- Calculation of body fat from skinfold measurement --- p.40 / Chapter Chapter 5 --- Subjects and Methods --- p.44 / Chapter 5.1 --- Subjects --- p.44 / Chapter 5.2 --- Methods --- p.44 / Chapter 5.2.1 --- Anthropometric Measurements --- p.45 / Chapter 5.2.2 --- Weight (wt) --- p.45 / Chapter 5.2.3 --- Height (ht) --- p.46 / Chapter 5.2.4 --- Skinfold Thickness --- p.46 / Chapter 5.2.5 --- Obesity identification --- p.48 / Chapter 5.3 --- Evaluation of bone mass in vivo --- p.48 / Chapter 5.4 --- Dietary Assessment --- p.49 / Chapter 5.4.1 --- Estimation of food quantity --- p.51 / Chapter 5.4.2 --- Nutrient intake data --- p.52 / Chapter 5.5 --- Blood test --- p.53 / Chapter 5.6 --- Data analysis --- p.54 / Chapter Chapter 6 --- Results --- p.55 / Chapter 6.1 --- Sample size --- p.55 / Chapter 6.2 --- Anthropometric Measurement --- p.55 / Chapter 6.2.1 --- Weight and height data --- p.55 / Chapter 6.2.2 --- Skinfold thickness --- p.56 / Chapter 6.2.3 --- Prevalence of obesity in study children --- p.56 / Chapter 6.2.4 --- Bone mineral density (BMD) --- p.56 / Chapter 6.2.5 --- Haematological and biochemical data --- p.57 / Chapter 6.3 --- Serum lipid profiles --- p.58 / Chapter 6.4 --- Diet assessment --- p.58 / Chapter 6.4.1 --- Diet --- p.58 / Chapter 6.4.2 --- Food consumed --- p.59 / Chapter 6.4.3 --- Seasonal variation of food --- p.60 / Chapter 6.4.4 --- Energy and Nutrient --- p.60 / Chapter 6.4.5 --- Comparison with UK vegetarian children --- p.65 / Chapter 6.4.6 --- Relationship between body fatness and current diet --- p.66 / Chapter Chapter.7 --- Discussion --- p.67 / Chapter 7.1 --- Lacto-ovo-vegetarian children have normal growth --- p.67 / Chapter 7.2 --- Vegetarian children can be obese --- p.67 / Chapter 7. 3 --- Advantages and disadvantages of Chinese vegetarian diets --- p.68 / Chapter 7.3.1 --- Calcium --- p.68 / Chapter 7.3.2 --- Iron --- p.68 / Chapter 7.3.3 --- Vitamin B12 --- p.69 / Chapter 7.3.4 --- Folate --- p.70 / Chapter 7.3.5 --- Fibre --- p.70 / Chapter 7.4 --- Conclusion --- p.71 / Chapter Chapter.8 --- Limitation of the Study --- p.72 / Chapter 8.1 --- Dietary record method --- p.72 / Chapter 8.2 --- Sample Size --- p.72 / Tables --- p.74-86 / Figure --- p.87-95 / References --- p.96-106 / Appendix I Dietary survey food frequency questionnaire / Appendix II Daily intake of individual food items

Introdução: Atualmente, existem vários métodos úteis para a avaliação nutricional (AvN) de crianças hospitalizadas, contudo ainda não há um método considerado padrão-ouro para classificação do estado nutricional da população pediátrica, assim como para a identificação da desnutrição. Objetivo: Comparar diferentes métodos de AvN não invasiva em crianças hospitalizadas. Métodos: Estudo transversal com pacientes de 4 a 8,9 anos internados em um hospital pediátrico do Sul do Brasil. A amostragem foi realizada por conveniência, e a coleta de dados ocorreu entre dezembro de 2014 a fevereiro de 2016. Excluíram-se pacientes internados em unidade de terapia intensiva e sem condições de alimentação por via oral. Foram coletadas informações gerais, socioeconômicas e dados antropométricos. Também foram aplicados os questionários de Avaliação Subjetiva Global pediátrica (ASGped) e STRONGkids. Os dados clínicos foram coletados do prontuário eletrônico do paciente. O protocolo de estudo foi aprovado pelo Comitê de Ética em Pesquisa da Universidade Federal do Rio Grande do Sul (parecer número 657.000), e pelo Comitê de Ética em Pesquisa da Irmandade da Santa Casa de Misericórdia de Porto Alegre (parecer número 906.461). Resultados: Um total de 455 crianças foi incluído no estudo, com média de idade de 75,0 ± 17,2 meses. A mediana do tempo de internação foi de 6 dias (4–10). As enfermidades que mais motivaram a internação foram: cirúrgicas (22,3%, n=103), pulmonares (19,3%, n=88), neurológicas (13,8%, n=63), oncológicas (7,9%, n=36) e gastroenterológicas (6,8%, n=31). Ao redor de 76% (341 de 455) das crianças encontravam-se eutróficas de acordo com o indicador índice de massa corporal/idade (IMC/I), 19,8% (n=89) apresentavam excesso de peso e 4,4% (n=20) estavam desnutridas. Conforme a ferramenta de triagem nutricional STRONGkids, 27,3% (n=124) das crianças apresentaram risco nutricional (RN) baixo, 64,8% (n=295) RN médio e 7,9% (n=36) RN alto. Por outro lado, ASGped classificou 86,8% (n=393) dos pacientes como bem nutridos, 12,4% (n=56) como moderadamente desnutridos e 0,9% (n=4) como gravemente desnutridos. Constatou-se que a desnutrição pela ASGped se associou de forma significativa com o maior tempo de permanência hospitalar (p <0,001). Óbito e reinternação hospitalar em 6 meses não se associaram com a desnutrição pela ANSGped. O tempo de internação hospitalar mostrou-se maior à medida que o RN aumentava, assim como a probabilidade de óbito e reinternação foi maior nas crianças com RN alto (p = <0,001) pela STRONGkids. Observou-se associação significativa entre a desnutrição moderada e grave, pela ASGped, e risco nutricional alto, através da STRONGkids, com EMAP reduzida (p<0,001). Quanto aos desfechos clínicos, observou-se tempo de internação maior nos pacientes com EMAP diminuída (p=0,001). Conclusão: Levando-se em consideração a antropometria e a ASGped, a maioria das crianças avaliadas encontrava-se eutrófica no momento da admissão hospitalar. A desnutrição e o RN estiveram associados a um maior tempo de internação hospitalar. A EMAP mostrou-se um método eficiente na detecção de desnutrição em pacientes pediátricos internados. / Introduction: Currently, there are several useful methods for nutritional assessment of children; however, there still is no gold-standard method for assessing the nutritional status of the pediatric population and for identifying malnutrition. Objective: To compare different methods of non-invasive nutritional assessment of hospitalized children. Methods: Cross-sectional study with 4-8.9-years old patients admitted to a pediatric hospital in Southern Brazil. The method used was convenience sampling, and the data was collected between December 2014 and February 2016. Patients in the intensive care unit and incapable of being orally fed were excluded from the research. General and socioeconomic information, as well as anthropometric data were collected. The Pediatric Subjective Global Assessment (SGA) and STRONGkids questionnaires were also applied. The clinical data were collected from the patients' digital medical records. The study protocol was approved by the Research Ethics Committee of the Federal University of Rio Grande do Sul (protocol 657,000) and by the Research Ethics Committee of the Santa Casa de Misericórdia of Porto Alegre (protocol 906,461). Results: A total of 455 children were included in the study, with a mean age of 75.0 ± 17.2 months. The median of hospital stay was 6 days (4–10). The most frequent reasons for hospitalization were surgical procedures (22.3%, n=103), and pulmonary (19.3%, n=88), neurological (13.8%, n=63), oncological (7.9%, n=36) and gastroenterological (6.8%, n=31) diseases. Of these, 75.8% (n=341) were eutrophic, according to the body mass index/age (BMI/A) parameter, 19.8% (n=89) were overweight, and 4.4% (n=20) were malnourished. According to the nutritional screening tool STRONGkids, 27.3% (n=124) of the children showed low nutritional risk (NR), 64.8% (n=295) moderate NR, and 7.9% (n=36) high NR. On the other hand, the GSNA ranked 86.8% (n=393) of the patients as eutrophic, 12.4% (n=56) as moderately malnourished, and 0.9% (n=4) as severely malnourished. In addition, it was found that malnutrition by pediatric SGA was significantly associated with a longer hospital stay. Death and hospital readmission at six months were not associated with malnutrition by pediatric SGA (p <0,001). The hospital stay was higher as the NR increased, as well as the probability of death and re-hospitalization was higher in children with high NR (p = <0.001) by STRONGkids. There was also a significant association between moderate and severe malnutrition, by SGA Ped, and high nutritional risk, through STRONGkids, with reduced EMAP (p <0.001). Regarding clinical outcomes, a longer hospital stay was observed in patients with impaired EMAP (p = 0.001). Conclusion: When considering anthropometry and pediatric SGA, most children evaluated were eutrophic at the time of hospital admission. Malnutrition and NR were associated with longer hospital stay. The use of EMAP has proven to be an efficient method for the detection of malnutrition in hospitalized pediatric patients.

Ng Kenway. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2003. / Includes bibliographical references (leaves 169-189). / Abstracts in English and Chinese ; questionnaire also in Chinese. / ABSTRACT --- p.I / 摘要 --- p.IV / ACKNOWLEDGEMENT --- p.V / TABLE OF CONTENTS --- p.VII / ABBREVIATION --- p.XI / LIST OF TABLES --- p.XIII / LIST OF FIGURES --- p.XIV / Chapter CHAPTER 1 --- INTRODUCTION --- p.1 / Chapter CHAPTER 2 --- LITERATURE REVIEW --- p.4 / Chapter 2.1 --- SIDE EFFECTS OF RADIATION THERAPY IN HEAD & NECK CACNER PATIENTS --- p.6 / Chapter 2.2 --- NUTRITIONAL ALTERATIONS IN CANCER PATIENTS --- p.9 / Chapter 2.3 --- FACTORS INFLUENCING ALTERATION IN CALORIE INTAKE IN CANCER PATIENTS --- p.12 / Chapter 2.3.1 --- Evidence for impaired calorie intake in cancer patients --- p.12 / Chapter 2.3.2 --- Anorexia --- p.13 / Chapter 2.3.2.1 --- Mucositis of upper food passage --- p.13 / Chapter 2.3.2.2 --- "Change in saliva and taste, food aversions" --- p.14 / Chapter 2.3.2.3 --- Psychological and emotional factors --- p.14 / Chapter 2.3.2.4 --- Cytokines --- p.15 / Chapter 2.4 --- FACTORS INFLUENCING ENERGY EXPENDITURE IN CANCER PATIETNS --- p.17 / Chapter 2.4.1 --- Introduction --- p.17 / Chapter 2.4.2 --- Components of total energy expenditure --- p.22 / Chapter 2.4.2.1 --- Measurement of Basal metabolic rate --- p.22 / Chapter 2.4.2.2 --- Energy cost of physical activity --- p.25 / Chapter 2.4.2.3 --- Thermic effect of food (TEF) --- p.26 / Chapter 2.5 --- METHODS FOR NUTRITIONAL ASSESSMENT --- p.27 / Chapter 2.5.1 --- Body weight and body composition --- p.27 / Chapter 2.5.2 --- Dietary intake --- p.30 / Chapter 2.6 --- METHODS FOR ENERGY EXPENDITURE MEASUREMENT --- p.35 / Chapter 2.7 --- CYTOKINES AND LEPTIN CHANGES IN CANCER PATIENTS --- p.40 / Chapter 2.7.1 --- Cytokines --- p.40 / Chapter 2.7.1.1 --- Tumor necrosis factor --- p.40 / Chapter 2.7.1.2 --- Interleukin 1 and interleukin 6 --- p.44 / Chapter 2.7.2 --- Leptin --- p.45 / Chapter 2.8 --- THE IMPACT OF MALNUTRITION ON CANCER SURVIVAL --- p.49 / Chapter CHAPTER 3 --- OBJECTIVES OF STUDY --- p.53 / Chapter CHAPTER 4 --- METHODS --- p.55 / Chapter 4.1 --- RETROSPECTIVE STUDY --- p.56 / Chapter 4.1.1 --- Patients --- p.56 / Chapter 4.1.2 --- Cancer staging --- p.56 / Chapter 4.1.3 --- Cancer treatment --- p.57 / Chapter 4.1.4 --- Outcome endpoints --- p.57 / Chapter 4.1.5 --- Determinants --- p.58 / Chapter 4.1.6 --- Statistical analysis --- p.58 / Chapter 4.2 --- PROSPECTIVE STUDY --- p.59 / Chapter 4.2.1 --- "Patients, oncological treatment, and assessment time points" --- p.59 / Chapter 4.2.2 --- Assessment of nutritional intake by food record --- p.60 / Chapter 4.2.3 --- Assessment of radiotherapy-induced symptoms --- p.61 / Chapter 4.2.4 --- Assessment of Basal metabolic rate --- p.62 / Chapter 4.2.5 --- Assessment of total energy expenditure and energy balance --- p.63 / Chapter 4.2.6 --- Assessment of body composition --- p.65 / Chapter 4.2.7 --- Measurement of cytokines --- p.68 / Chapter 4.2.7.1 --- Serum TNF-α --- p.69 / Chapter 4.2.7.2 --- Serum Human Leptin --- p.72 / Chapter CHAPTER 5 --- RESULTS --- p.80 / Chapter 5.1 --- RETROSPECTIVE STUDY --- p.81 / Chapter 5.1.1 --- The 5-year profile of bodyweight change during and after the end of radiotherapy --- p.81 / Chapter 5.1.2 --- Analysis on relation between weight loss and survival --- p.82 / Chapter 5.1.2.1 --- Patient and cancer stage --- p.82 / Chapter 5.1.2.2 --- Percentage of patients with weight loss at end of radiotherapy --- p.82 / Chapter 5.1.2.3 --- Cancer treatment outcome --- p.82 / Chapter 5.1.2.4 --- Univariate analysis --- p.82 / Chapter 5.1.2.5 --- Multivariate analysis --- p.83 / Chapter 5.2 --- PROSPECTIVE STUDY --- p.84 / Chapter 5.2.1 --- The profile of nutritional measurements during radiotherapy --- p.84 / Chapter 5.2.1.1 --- Bodyweight and body composition before and during RT --- p.84 / Chapter 5.2.1.2 --- Calorie intake before and during RT --- p.85 / Chapter 5.2.1.3 --- Energy expenditure before and during RT --- p.86 / Chapter 5.2.1.4 --- Energy balance before and during RT --- p.88 / Chapter 5.2.2 --- The profile of nutritional measurements during the 6-month period after radiotherapy --- p.88 / Chapter 5.2.2.1 --- Body weight and body composition during the 6 months after radiotherpay --- p.88 / Chapter 5.2.2.2 --- Calorie intake during the 6 months after radiotherapy --- p.90 / Chapter 5.2.2.3 --- Energy expenditure during the 6 months after radiotherapy --- p.91 / Chapter 5.2.2.4 --- Energy balance during the 6 months after radiotherapy --- p.92 / Chapter 5.2.3 --- Radiotherapy-induced Symptoms --- p.92 / Chapter 5.2.3.1 --- Profile of symptoms after RT --- p.92 / Chapter 5.2.3.2 --- Detailed profile of symptoms during RT --- p.95 / Chapter 5.2.4 --- The profile of cytokines during and after completion of RT --- p.95 / Chapter 5.2.4.1 --- SerumTNF-α --- p.96 / Chapter 5.2.5.2 --- Serum leptin --- p.96 / Chapter CHAPTER 6 --- DISCUSSION --- p.144 / Chapter 6.1 --- RETROSPECTIVE STUDY --- p.145 / Chapter 6.2 --- PROSPECTIVE STUDY --- p.147 / Chapter 6.2.1 --- The magnitude of the problem --- p.147 / Chapter 6.2.2 --- The potential determinants of weight loss --- p.147 / Chapter 6.2 3 --- Is weight loss due to the cancer or due to its treatment? --- p.148 / Chapter 6.2.4 --- "Is the weight loss influenced by pre-treatment factors, i. e. anthropometrical data?" --- p.148 / Chapter 6.2.5 --- "Is the pattern weight loss compatible with the model of calorie-protein malnutrition, similar to a starvation state?" --- p.149 / Chapter 6.2.6 --- Is the weight loss due to increased energy expenditure? --- p.150 / Chapter 6.2.7 --- Is the weight loss due to reduced calorie intake? --- p.151 / Chapter 6.2.8 --- Is weight loss during radiotherapy due to negative energy balance? --- p.151 / Chapter 6.2.9 --- What causes reduced calorie intake: Are radiotherapy-induced symptoms contributive? --- p.152 / Chapter 6.2.10 --- What are the observations on and implications of cytokine changes? --- p.155 / Chapter 6.2.11 --- What determines the recovery of body weight during 6 months after end of radiotherapy? --- p.158 / Chapter 6.2.12 --- Is the weight loss in the post RT recovery period due to negative energy balance? --- p.159 / Chapter 6.2.13 --- What are the implications on nutritional intervention? --- p.159 / Chapter 6.2.14 --- Limitations and future studies --- p.164 / Chapter CHAPTER 7 --- CONCLUSIONS --- p.166 / REFERENCES --- p.169 / APPENDIX 1 CONSENT FORM I (IN ENGLISH) --- p.190 / APPENDIX 2 CONSENT FORM I (IN CHINESE) --- p.193 / APPENDIX 3 CONSENT FORM II (IN ENGLISH) --- p.196 / APPENDIX 4 CONSENT FORM II (IN CHINESE) --- p.199 / APPENDIX 5 3-DAY DIET RECORD --- p.202 / APPENDIX 6 24-HOUR DIETARY RECALL --- p.206 / APPENDIX 7 SUBJECTIVE NUTRITIONAL ASSESSMENT --- p.208 / APPENDIX 8 PHYSICAL ACTIVITY QUESTIONNAIRE --- p.210 / APPENDIX 9 BONE SCAN REPORT --- p.215

Este estudo foi realizado na Clínica Obstétrica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, com cento e oitenta e sete gestantes sem comorbidades, para conhecer o perfil nutricional de gestantes que receberam orientação dietética e avaliar o ganho ponderal materno total, o tipo de parto e os resultados perinatais. Foi realizada pesquisa retrospectiva e descritiva, por meio de consulta dos formulários de anamnese alimentar, dos bancos de dados clínicos e prontuários das pacientes. As gestantes foram classificadas de acordo com o IMC prégestacional: 23 (12,2%) eram de baixo peso (IMC < 19,8 kg/m2); 84 (45%), eutróficas (IMC de 19,8 a 26,0 kg/m2); 37 (19,8%), sobrepeso (IMC de 26,1 a 29,0 kg/m2) e 43 (23%), obesas (IMC > 29,0 kg/m2). No consumo energético, não se constatou diferença entre os grupos. A média de porcentagem de carboidratos, proteínas e lipídeos ingerida foi semelhante entre os grupos. Sobre o perfil da ingestão de micronutrientes, a de cálcio, vitamina A e vitamina C foi semelhante entre os grupos; a de ferro foi maior nas gestantes eutróficas quando comparadas às com sobrepeso e com obesidade (p<0,001); a de folatos foi maior nas gestantes eutróficas quando comparadas às obesas (p=0,002); a de fibras foi menor nas gestantes de baixo peso quando comparadas às eutróficas (p=0,042). O ganho de peso excessivo (acima do recomendado) foi significativamente maior (p=0,009) nas gestantes com sobrepeso e obesidade, porém o ganho ponderal materno médio foi significativamente menor nas obesas (p<0,001). Não foi observada diferença entre os grupos quanto à idade gestacional no parto e o tipo de parto. O peso dos recém-nascidos das gestantes de baixo peso apresentou média significativamente menor (p=0,005) que dos demais grupos. As gestantes com sobrepeso apresentaram maior porcentagem de recém-nascidos com mais de 4000g (p=0,037) que os demais grupos. A proporção de recém-nascidos grandes para a idade gestacional foi significativamente maior (p=0,006) nas gestantes com sobrepeso e com obesidade quando comparadas aos demais grupos. Os índices de Apgar não apresentaram diferença significativa entre os grupos. A indicação de cesárea por vício pélvico foi significativamente mais frequente em gestantes com baixo peso (p = 0,006) quando comparadas aos outros grupos / This study was carried out at Clínica Obstétrica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, with one hundred eighty-seven pregnant women without comorbidities. This study aimed to know the nutrition profile of pregnant women who received dietary counseling and to evaluate the maternal total weight gain, type of delivery and perinatal outcome. A retrospective and descriptive research was carried out through consultation of forms of dietary anamnesis, the clinical databases and medical records. The women were classified according to pre-gestational body mass index (BMI): 23 (12.2%) were underweight (BMI < 19.8 kg/m2), 84 (45%) normal weight (BMI 19.8 to 26.0 kg/m2), 37 (19.8%) overweight (BMI 26.1 to 29.0 kg/m2) and 43 (% 23) obese (BMI > 29.0 kg/m2). No difference was observed in energy consumption between the groups. The averages percentage of carbohydrates, protein and lipid intake were similar between groups. Regarding the profile of micronutrient intake, calcium intake, vitamin A and vitamin C was similar between groups; iron intake was higher in normal weight pregnant women compared to overweight and obese (p<0.001); folate intake was higher in normal weight pregnant women compared to obese (p=0.002); fiber intake was lower in underweight pregnant women compared to normal weight (p=0.042). Excessive weight gain (above the recommended) was significantly higher (p=0.009) in pregnant women with overweight and obesity, however the mean of total maternal weight gain was significantly lower in obese women (p<0.001). No difference was observed between the groups regarding gestational age at delivery and mode of delivery. The weight of newborns of underweight pregnant women had a mean significantly lower (p=0.005) compared to other groups. The overweight pregnant women had a higher percentage of newborns with more than 4000g (p=0.037) compared to other groups. The proportion of newborns large for gestational age was significantly higher (p=0.006) in pregnant women with overweight and obesity compared to other groups. The Apgar scores did not differ significantly between groups. Indication of cesarean for contracted pelvis was significantly more frequent in underweight pregnant women (p=0.006) when compared to other groups

Vitamin D plays an important role in over-all health. Few data exist on vitamin D deficiency related with intake for a Canadian population. The purpose of this study is to assess vitamin D intake and status in healthy young adults of diverse ancestry during the wintertime.<p> One hundred and seven young healthy adults living in Southern Ontario were recruited during the late winter of 2007. Their serum 25-hydroxyvitamin D [25(OH)D], skin melanin and anthropometric measures were determined. They completed a food frequency questionnaire (FFQ) (twice) and a 7-day food diary. Correlation analyses and t-test were used to validate the FFQ against the 7-day diary and 25(OH)D; one way ANOVA was used to determine ethnic group differences in vitamin D intake and status.<p> The results indicated that the FFQ used in this study was valid. Vitamin D deficiency [25(OH)D<50 nmol/L] was widespread and more apparent in the East and South Asian groups than in the European group (P<0.05). The dairy products were the greatest food source of vitamin D for each of the three groups and the European group exhibited higher total vitamin D intake (P<0.05). There was a trend for the European group to have higher consumption of dairy products, especially cow¡¯s milk (0.05<P<0.10). Combining subjects in the three ethnic groups, vitamin D intake but not BMI was closely related with serum 25(OH)D concentrations (r= 0.520, P<0.001; r=-0.018, P>0.05, respectively). The 25(OH)D levels were inversely related with parathyroid hormone (PTH) levels (r= -0.273, P= 0.009). With adequate calcium intake (¡Ý1000 mg/d), PTH levels were significantly lower when vitamin D was not deficient (P<0.05).<p> This study provides evidence that vitamin D deficiency is prevalent in healthy young adults living in Canada during wintertime, and non-European groups have a higher prevalence of this deficiency. Vitamin D intake varies with ethnicity, and dietary intake plays an important role in maintenance of serum vitamin D in wintertime. Compared with calcium intake, serum vitamin D levels may be a more important factor suppressing PTH levels.

Vitamin D plays an important role in over-all health. Few data exist on vitamin D deficiency related with intake for a Canadian population. The purpose of this study is to assess vitamin D intake and status in healthy young adults of diverse ancestry during the wintertime.<p> One hundred and seven young healthy adults living in Southern Ontario were recruited during the late winter of 2007. Their serum 25-hydroxyvitamin D [25(OH)D], skin melanin and anthropometric measures were determined. They completed a food frequency questionnaire (FFQ) (twice) and a 7-day food diary. Correlation analyses and t-test were used to validate the FFQ against the 7-day diary and 25(OH)D; one way ANOVA was used to determine ethnic group differences in vitamin D intake and status.<p> The results indicated that the FFQ used in this study was valid. Vitamin D deficiency [25(OH)D<50 nmol/L] was widespread and more apparent in the East and South Asian groups than in the European group (P<0.05). The dairy products were the greatest food source of vitamin D for each of the three groups and the European group exhibited higher total vitamin D intake (P<0.05). There was a trend for the European group to have higher consumption of dairy products, especially cow¡¯s milk (0.05<P<0.10). Combining subjects in the three ethnic groups, vitamin D intake but not BMI was closely related with serum 25(OH)D concentrations (r= 0.520, P<0.001; r=-0.018, P>0.05, respectively). The 25(OH)D levels were inversely related with parathyroid hormone (PTH) levels (r= -0.273, P= 0.009). With adequate calcium intake (¡Ý1000 mg/d), PTH levels were significantly lower when vitamin D was not deficient (P<0.05).<p> This study provides evidence that vitamin D deficiency is prevalent in healthy young adults living in Canada during wintertime, and non-European groups have a higher prevalence of this deficiency. Vitamin D intake varies with ethnicity, and dietary intake plays an important role in maintenance of serum vitamin D in wintertime. Compared with calcium intake, serum vitamin D levels may be a more important factor suppressing PTH levels.

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