Atualmente reagrupou-se sob o nome de subnutrição calórico-protéica uma série de afecções de carência antigamente descritas com diversos nomes e que tinham uma etiologia comum, a insuficiência alimentar, acarretando, ao mesmo tempo um emagrecimento e um esgotamento progressivo do estoque de proteínas do organismo. A partir de alterações na quantidade e qualidades dos alimentos ingeridos, o organismo busca regular seu metabolismo visando atingir a homeostase, na qual os hormônios desempenham papel fundamental. Dessa maneira, a desnutrição protéica e a secreção de insulina foram aqui correlacionados na avaliação morfológica e funcional do epitélio oral, representando, respectivamente, grave alteração nutricional (à semelhança da que acomete a população, especialmente, de países subdesenvolvidos e em desenvolvimento) e resposta produzida pela alteração do metabolismo energético das células. Os fatores de crescimento insulino-símile tipos 1 e 2 (IGF-I e IGF-II) são os principais fatores endócrinos determinantes do crescimento fetal. A maioria das ações conhecidas do IGF-I é mediada via um receptor tirosina-quinase, conhecido como IGF-IR. Recentemente, a insensibilidade ao IGF-I foi identificada como uma das causas de retardo de crescimento sem recuperação espontânea do desenvolvimento na vida pós-natal. Sendo assim, o presente trabalho tem o objetivo de estudar, através de métodos morfométricos, na mucosa palatina de ratos Wistar na fase púbere submetidos à desnutrição protéica pré e pós-natal e a renutrição pós-natal, o padrão celular e o componente colágeno da lâmina própria, bem como a expressão do IGF-I, do IGF-IR e da insulina e seu receptor, no intuito de encontrar possível correspondência entre as alterações metabólicas e morfofuncionais, decorrentes da depleção protéica. Para tanto, foram formados os seguintes grupos experimentais constituídos por animais heterogênicos (n=3) de acordo com a ração oferecida, protéica ou hipoprotéica: nutridos (N) e desnutridos (D) com 60 dias de idade, por ser essa a fase do final do período púbere, e renutridos (R), formado por animais do grupo D que, a partir do 21º dia (época do desmame) foram submetidos à ração protéica até atingirem 60 dias de idade. Os espécimes foram processados rotineiramente para microscopia de luz (HE, Azo-carmin e Pircro-sírius) e para imunohistoquímica (IGF-I, IGF-IR e insulina e seu receptor) e os dados morfoquantitativos analisados estatisticamente. Os resultados demonstraram que os parâmetros metabólicos tais como: alimentar, massa corporal, excreção de fezes, urina e ingestão de água, diferiram em todos os grupos semana após semana (S1&#8800;S2&#8800;S3&#8800;S4&#8800;S5&#8800;S6). A densidade de células epiteliais fora constatada pelo método de coloração H.E. e imunomarcadas com insulina e IGF-I e seus respectivos receptores. A subnutrição determinou um aumento significativo de células reativas a insulina (I) e seu receptor (IR) em relação ao grupo renutrido e nutrido (I: S &#8800;R; p<0.05) e (IR: S&#8800;N; S&#8800;R; p<0.05). O grupo R não obeteve aumento significativo de células imunomarcadas, assim, diferiu significativamente em relação ao grupo N para os hormônios IGF-I e seu receptor IGF-IR (R&#8800;N;p<0.05). O número de células da mucosa palatina modifica-se pouco na fase púbere e o seu desenvolvimento normal é sensível à depleção protéica, de modo que o tecido não é capaz de responder ao restabelecimento protéico. / Currently it has been grouped and named protein-caloric under nutrition a series of deficiency described in the past under several denominations with similar etiology, the food deficiency which leads simultaneously to a weight loss and progressive decrease of protein storage in the body. From the changes in the quantity and quality of ingested food, the organism tries to regulate its metabolism in order to homeostasis, in which the hormones play a fundamental role. This way, the protein under nutrition and the insulin secretion were here correlated in the morphological and functional evaluation of the oral epithelium representing high nutritional change (similarly to one which affect people specially from under developed countries) and response produced by changes in the energetic metabolism of the cells respectively. The grown factors insuline-símile type 1 and 2 (IGF-I and IGF-II) are the principal endocrine factors which determine the fetal growth. Many known actions of the IGF-I are mediated via tyrosine-kinase receptor known as IGF-IR. Recently, the insensibility to IGF-I was identified as one of the reason for the regrowth without abrupt recovery of the development in the post-natal life. Therefore, the present work aims to study, the cellular standard and the collagen of lamina propria, as well as the expression of the IGF-I, of the IGF-IR and the insulin and its receptor, using morphometric methods in the palatine mucosa of wistar rats in the pubertal phase subject to protein under nutrition pre and post natal and post-natal re-feeding with the objective of finding possible association between metabolic and morph functional changes coming from protein depletion. For this purpose, the following experimental groups were formed: heterogenic animals (n=3) according to the diet offered protein or hyperprotein diet: nourished (N) and undernourished (D) with 60 days of age (finish of pubertal phase), and re-nourished (R), formed by animals of D group that, from the 21st day (weaning day) were subject to protein diet up to 60 days of age. The specimens were processed routinely for light microscopy (HE, Azo-carmin and Pircro-sírius) and for immunohistochemistry (IGF-I, IGF-IR and insulin and its receptor) and the morph quantitative data statistically analyzed. The results demonstrate that the metabolic parameters such as: food, body mass, feces excretion, urine and water ingestion differ in all groups weekly (S1&#8800;S2&#8800;S3&#8800;S4&#8800;S5&#8800;S6). The density of epithelial was observed by HE method and immune-marked with insulin and IGF-I and their respective receptors. The under nutrition determined a significant increase of the cells reacting to insulin (I) and its receptor (IR) in relation to re-nourished and nourished groups (I: S &#8800;R; p<0.05) and (IR: S&#8800;N; S&#8800;R; p<0.05). No significant increase of immune-marked cells was observed in the R group, thus, differing significantly when comparing to N group for the hormones IGF-I and its receptor IGF-IR (R&#8800;N;p<0.05). The number of palatine mucosal cells has changed little in the pubertal phase and its normal development is sensitive to protein depletion, so the tissue cannot respond to the protein replacement.

<p>This secondary analysis aimed to develop dietary scores to assess the dietary intake of pregnant women in the West Coast/ Winelands region and determine the association with LBW. Further to determine the association between the dietary scores and maternal socioeconomic and socio-demographic characteristics and maternal smoking and/or alcohol consumption during pregnancy.</p>

<p>This secondary analysis aimed to develop dietary scores to assess the dietary intake of pregnant women in the West Coast/ Winelands region and determine the association with LBW. Further to determine the association between the dietary scores and maternal socioeconomic and socio-demographic characteristics and maternal smoking and/or alcohol consumption during pregnancy.</p>

Atualmente reagrupou-se sob o nome de subnutrição calórico-protéica uma série de afecções de carência antigamente descritas com diversos nomes e que tinham uma etiologia comum, a insuficiência alimentar, acarretando, ao mesmo tempo um emagrecimento e um esgotamento progressivo do estoque de proteínas do organismo. A partir de alterações na quantidade e qualidades dos alimentos ingeridos, o organismo busca regular seu metabolismo visando atingir a homeostase, na qual os hormônios desempenham papel fundamental. Dessa maneira, a desnutrição protéica e a secreção de insulina foram aqui correlacionados na avaliação morfológica e funcional do epitélio oral, representando, respectivamente, grave alteração nutricional (à semelhança da que acomete a população, especialmente, de países subdesenvolvidos e em desenvolvimento) e resposta produzida pela alteração do metabolismo energético das células. Os fatores de crescimento insulino-símile tipos 1 e 2 (IGF-I e IGF-II) são os principais fatores endócrinos determinantes do crescimento fetal. A maioria das ações conhecidas do IGF-I é mediada via um receptor tirosina-quinase, conhecido como IGF-IR. Recentemente, a insensibilidade ao IGF-I foi identificada como uma das causas de retardo de crescimento sem recuperação espontânea do desenvolvimento na vida pós-natal. Sendo assim, o presente trabalho tem o objetivo de estudar, através de métodos morfométricos, na mucosa palatina de ratos Wistar na fase púbere submetidos à desnutrição protéica pré e pós-natal e a renutrição pós-natal, o padrão celular e o componente colágeno da lâmina própria, bem como a expressão do IGF-I, do IGF-IR e da insulina e seu receptor, no intuito de encontrar possível correspondência entre as alterações metabólicas e morfofuncionais, decorrentes da depleção protéica. Para tanto, foram formados os seguintes grupos experimentais constituídos por animais heterogênicos (n=3) de acordo com a ração oferecida, protéica ou hipoprotéica: nutridos (N) e desnutridos (D) com 60 dias de idade, por ser essa a fase do final do período púbere, e renutridos (R), formado por animais do grupo D que, a partir do 21º dia (época do desmame) foram submetidos à ração protéica até atingirem 60 dias de idade. Os espécimes foram processados rotineiramente para microscopia de luz (HE, Azo-carmin e Pircro-sírius) e para imunohistoquímica (IGF-I, IGF-IR e insulina e seu receptor) e os dados morfoquantitativos analisados estatisticamente. Os resultados demonstraram que os parâmetros metabólicos tais como: alimentar, massa corporal, excreção de fezes, urina e ingestão de água, diferiram em todos os grupos semana após semana (S1&#8800;S2&#8800;S3&#8800;S4&#8800;S5&#8800;S6). A densidade de células epiteliais fora constatada pelo método de coloração H.E. e imunomarcadas com insulina e IGF-I e seus respectivos receptores. A subnutrição determinou um aumento significativo de células reativas a insulina (I) e seu receptor (IR) em relação ao grupo renutrido e nutrido (I: S &#8800;R; p<0.05) e (IR: S&#8800;N; S&#8800;R; p<0.05). O grupo R não obeteve aumento significativo de células imunomarcadas, assim, diferiu significativamente em relação ao grupo N para os hormônios IGF-I e seu receptor IGF-IR (R&#8800;N;p<0.05). O número de células da mucosa palatina modifica-se pouco na fase púbere e o seu desenvolvimento normal é sensível à depleção protéica, de modo que o tecido não é capaz de responder ao restabelecimento protéico. / Currently it has been grouped and named protein-caloric under nutrition a series of deficiency described in the past under several denominations with similar etiology, the food deficiency which leads simultaneously to a weight loss and progressive decrease of protein storage in the body. From the changes in the quantity and quality of ingested food, the organism tries to regulate its metabolism in order to homeostasis, in which the hormones play a fundamental role. This way, the protein under nutrition and the insulin secretion were here correlated in the morphological and functional evaluation of the oral epithelium representing high nutritional change (similarly to one which affect people specially from under developed countries) and response produced by changes in the energetic metabolism of the cells respectively. The grown factors insuline-símile type 1 and 2 (IGF-I and IGF-II) are the principal endocrine factors which determine the fetal growth. Many known actions of the IGF-I are mediated via tyrosine-kinase receptor known as IGF-IR. Recently, the insensibility to IGF-I was identified as one of the reason for the regrowth without abrupt recovery of the development in the post-natal life. Therefore, the present work aims to study, the cellular standard and the collagen of lamina propria, as well as the expression of the IGF-I, of the IGF-IR and the insulin and its receptor, using morphometric methods in the palatine mucosa of wistar rats in the pubertal phase subject to protein under nutrition pre and post natal and post-natal re-feeding with the objective of finding possible association between metabolic and morph functional changes coming from protein depletion. For this purpose, the following experimental groups were formed: heterogenic animals (n=3) according to the diet offered protein or hyperprotein diet: nourished (N) and undernourished (D) with 60 days of age (finish of pubertal phase), and re-nourished (R), formed by animals of D group that, from the 21st day (weaning day) were subject to protein diet up to 60 days of age. The specimens were processed routinely for light microscopy (HE, Azo-carmin and Pircro-sírius) and for immunohistochemistry (IGF-I, IGF-IR and insulin and its receptor) and the morph quantitative data statistically analyzed. The results demonstrate that the metabolic parameters such as: food, body mass, feces excretion, urine and water ingestion differ in all groups weekly (S1&#8800;S2&#8800;S3&#8800;S4&#8800;S5&#8800;S6). The density of epithelial was observed by HE method and immune-marked with insulin and IGF-I and their respective receptors. The under nutrition determined a significant increase of the cells reacting to insulin (I) and its receptor (IR) in relation to re-nourished and nourished groups (I: S &#8800;R; p<0.05) and (IR: S&#8800;N; S&#8800;R; p<0.05). No significant increase of immune-marked cells was observed in the R group, thus, differing significantly when comparing to N group for the hormones IGF-I and its receptor IGF-IR (R&#8800;N;p<0.05). The number of palatine mucosal cells has changed little in the pubertal phase and its normal development is sensitive to protein depletion, so the tissue cannot respond to the protein replacement.

Magister Scientiae - MSc / This secondary analysis aimed to develop dietary scores to assess the dietary intake of pregnant women in the West Coast/ Winelands region and determine the association with LBW. Further to determine the association between the dietary scores and maternal socioeconomic and socio-demographic characteristics and maternal smoking and/or alcohol consumption during pregnancy. / South Africa

<p>The aim of this thesis was to explore the impact of physical, sexual and emotional violence against women of reproductive age and the level of controlling behaviour in marriage on child health and survival in two different cultural settings: Bangladesh and Nicaragua. </p><p>Data were acquired from four quantitative community-based studies. In two studies, a cohort including a prospective two year follow-up of 3164 mother-infant pairs in rural Bangladesh was investigated. A third study was a case-referent study in Nicaragua including mothers of 110 cases of under-five deaths and 203 referents, and in a forth study an other cohort of 1048 rural Bangladeshi women and their 2691 children was followed until 5 years of age. </p><p>Maternal exposure to any form of violence, including physical, sexual, emotional, and controlling behaviour was independently associated with lower body size at birth, increased risk of stunting and under-weight at 24 months of age, slower growth velocity during the first two years of life and a higher incidence of diarrhoeal episodes and respiratory tract infections. In the Nicaraguan setting, the children of women who experienced any history of physical violence had a two-fold increase in risk of death before the age of 5 years, and those whose mothers experienced both physical and sexual violence had a six-fold increase in risk of death. In Bangladesh, an association between violence against women and under-five mortality was found among daughters of educated mothers who were exposed to severe physical violence or a high level of controlling behaviour in marriage. In all four studies, lifetime violence experience among participating mothers was high (37-69%), and the timing was less relevant than the exposure to violence <i>per se</i>. </p><p>In conclusion, this investigation revealed that violence against women severely affects child health and survival. The findings are especially relevant in a context of high level of child under-nutrition, morbidity and under-five mortality. Efforts for protecting women from all forms of violence are needed as part of the interventions for improved child health.</p>

The aim of this thesis was to explore the impact of physical, sexual and emotional violence against women of reproductive age and the level of controlling behaviour in marriage on child health and survival in two different cultural settings: Bangladesh and Nicaragua. Data were acquired from four quantitative community-based studies. In two studies, a cohort including a prospective two year follow-up of 3164 mother-infant pairs in rural Bangladesh was investigated. A third study was a case-referent study in Nicaragua including mothers of 110 cases of under-five deaths and 203 referents, and in a forth study an other cohort of 1048 rural Bangladeshi women and their 2691 children was followed until 5 years of age. Maternal exposure to any form of violence, including physical, sexual, emotional, and controlling behaviour was independently associated with lower body size at birth, increased risk of stunting and under-weight at 24 months of age, slower growth velocity during the first two years of life and a higher incidence of diarrhoeal episodes and respiratory tract infections. In the Nicaraguan setting, the children of women who experienced any history of physical violence had a two-fold increase in risk of death before the age of 5 years, and those whose mothers experienced both physical and sexual violence had a six-fold increase in risk of death. In Bangladesh, an association between violence against women and under-five mortality was found among daughters of educated mothers who were exposed to severe physical violence or a high level of controlling behaviour in marriage. In all four studies, lifetime violence experience among participating mothers was high (37-69%), and the timing was less relevant than the exposure to violence per se. In conclusion, this investigation revealed that violence against women severely affects child health and survival. The findings are especially relevant in a context of high level of child under-nutrition, morbidity and under-five mortality. Efforts for protecting women from all forms of violence are needed as part of the interventions for improved child health.

AIM Poor iron status and under–nutrition among children are of concern not only in South Africa but worldwide. Both independent and combined associations between poor iron status, under–nutrition and cognitive development and function have been investigated. This mini–dissertation investigated possible associations between iron status indicators, anthropometric nutritional status and cognitive performance in the Beverage Fortified with Micronutrients (BeForMi) study population (black South African children aged 6–11 years in the North–West province of South Africa). METHODS The study was cross–sectional and based on the BeForMi study baseline data. Primary school children (n = 414) with the highest serum transferrin receptor (STR) and zinc protoporphyrin (ZnPP) levels were included. Anthropometric z–scores - BMI–for–age (BAZ), height–for–age (HAZ), and weight–for–age (WAZ) - and iron status indicators - haemoglobin (Hb), serum ferritin (SF), STR and ZnPP - were determined. The Kaufman Assessment Battery for Children, Second edition (KABC–II) was used to generate cognitive scores. RESULTS Fourteen percent of children were underweight (WAZ <= 2 SDs), 12.8% stunted (HAZ <= 2 SDs) and 8.4% wasted (BAZ <= 2 SDs). Of the children, 7.1% were anaemic (Hb < 11.5 g/dL), 13% iron depleted (Hb < 11.5 g/dL and SF < 12 ug/L) and 2.7% had iron deficiency anaemia (Hb < 11.5 g/dL and SF < 12 ug/L). Low iron stores (SF < 12 ug/L) were observed in 15.7% of the children. Positive correlations were found between SF and WAZ (r = 0.1, p = 0.047), Hb and HAZ (r = 0.13, p = 0.007) and WAZ (r = 0.13, p = 0.009). Positive correlations with small effect sizes were observed between some cognitive scores and z–scores (p < 0.05, r–value range 0.10 – 0.24). Negative correlations with small effect sizes were observed for the subtests Triangles and Rover (both subtests on simultaneous processing) with Hb (p = 0.008, r = –0.13) and SF (p = 0.04, r = –0.1) respectively. Higher HAZ, WAZ and education level of the head of household were all significantly associated with the likelihood that a child would fall within the upper quartile of Hb values in our study group (p = 0.036, p = 0.032 and p = 0.036 respectively). CONCLUSION The results suggested that under–nutrition was positively associated with poor iron status and lower cognitive scores in this study population. Further research, investigating specific effects of poor iron status at different stages of growth and the relationship with cognitive function later in life may help explain the negative correlations observed between current iron status indicators and cognitive scores. / Thesis (M.Sc (Dietetics))--North-West University, Potchefstroom Campus, 2011.

AIM Poor iron status and under–nutrition among children are of concern not only in South Africa but worldwide. Both independent and combined associations between poor iron status, under–nutrition and cognitive development and function have been investigated. This mini–dissertation investigated possible associations between iron status indicators, anthropometric nutritional status and cognitive performance in the Beverage Fortified with Micronutrients (BeForMi) study population (black South African children aged 6–11 years in the North–West province of South Africa). METHODS The study was cross–sectional and based on the BeForMi study baseline data. Primary school children (n = 414) with the highest serum transferrin receptor (STR) and zinc protoporphyrin (ZnPP) levels were included. Anthropometric z–scores - BMI–for–age (BAZ), height–for–age (HAZ), and weight–for–age (WAZ) - and iron status indicators - haemoglobin (Hb), serum ferritin (SF), STR and ZnPP - were determined. The Kaufman Assessment Battery for Children, Second edition (KABC–II) was used to generate cognitive scores. RESULTS Fourteen percent of children were underweight (WAZ <= 2 SDs), 12.8% stunted (HAZ <= 2 SDs) and 8.4% wasted (BAZ <= 2 SDs). Of the children, 7.1% were anaemic (Hb < 11.5 g/dL), 13% iron depleted (Hb < 11.5 g/dL and SF < 12 ug/L) and 2.7% had iron deficiency anaemia (Hb < 11.5 g/dL and SF < 12 ug/L). Low iron stores (SF < 12 ug/L) were observed in 15.7% of the children. Positive correlations were found between SF and WAZ (r = 0.1, p = 0.047), Hb and HAZ (r = 0.13, p = 0.007) and WAZ (r = 0.13, p = 0.009). Positive correlations with small effect sizes were observed between some cognitive scores and z–scores (p < 0.05, r–value range 0.10 – 0.24). Negative correlations with small effect sizes were observed for the subtests Triangles and Rover (both subtests on simultaneous processing) with Hb (p = 0.008, r = –0.13) and SF (p = 0.04, r = –0.1) respectively. Higher HAZ, WAZ and education level of the head of household were all significantly associated with the likelihood that a child would fall within the upper quartile of Hb values in our study group (p = 0.036, p = 0.032 and p = 0.036 respectively). CONCLUSION The results suggested that under–nutrition was positively associated with poor iron status and lower cognitive scores in this study population. Further research, investigating specific effects of poor iron status at different stages of growth and the relationship with cognitive function later in life may help explain the negative correlations observed between current iron status indicators and cognitive scores. / Thesis (M.Sc (Dietetics))--North-West University, Potchefstroom Campus, 2011.

Background Nutrition is a fundamental pillar of human life. Women have an increased risk of undernutrition than men. Undernutrition can result in adverse pregnancy outcomes and intergeneration cycle of undernutrition. The aim of this study is to determine the prevalence of undernutrition and the associated socio-economic determinants among adult women of reproductive age in Uganda.  Methods A population based cross-sectional survey was conducted and 4,640 non-pregnant and non-post-partum women aged 20 to 49 were analyzed. Two stage stratified sampling was used to select study participants and data were collected using validated questionnaires. Multivariable logistic regression was used to model the association between socio-economic determinants and stunting and underweight using weighted data in SPSS version 24.  Results The prevalence of underweight and stunting were 6.9% and 1.3% respectively. Women who belonged to middle (aOR = 2.49, 95% CI 1.25-4.99), poorer (aOR = 3.07, 95%CI 1.57–5.97) and poorest wealth index (aOR = 3.60, 95% CI 1.85–7.00) were more likely to be underweight compared to the richest. Belonging to rural residence (aOR = 0.63, 95%CI 0.41–0.96), Western (aOR = 0.30, 95% CI 0.20–0.44), Eastern (aOR = 0.42, 95% CI 0.28–0.63) and Central regions (aOR = 0.42, 95% CI 0.25–0.72) was associated with less odds of being underweight. Region was the only variable significantly associated with stunting. Wealth index was not significantly associated with stunting.  Conclusion The prevalence of undernutrition in Uganda among women is less compared to most of the neighboring countries. There is need to address the socio-economic determinants including poverty, residence and reducing regional inequalities.