Introdução - O sobrepeso e a obesidade são doenças de características endêmicas, tanto em países desenvolvidos como em países em desenvolvimento e podem coexistir com a desnutrição, principalmente, nas camadas sociais de baixa renda. Objetivo - Estimar as prevalências de desnutrição, sobrepeso e obesidade, segundo sexo e idade, bem como os fatores associados à sua ocorrência em adolescentes de 10 a 14,9 anos de idade, matriculados na rede de ensino público da cidade de Piracicaba, São Paulo, Brasil. Material e Métodos - Este foi um estudo transversal. A amostra foi composta por 269 adolescentes de ambos os sexos (118 meninos e 151 meninas). Foram aplicados questionários para obtenção do consumo alimentar, maturação sexual, nível de atividade física e características demográficas e feita a mensuração de peso e altura. Para a análise estatística utilizou-se o teste de associação pelo qui-quadrado e modelos de regressão multinomial univariados e múltiplos para verificar a relação entre o estado nutricional e as variáveis independentes. Resultados - As prevalências de desnutrição para meninos e meninas foram, respectivamente, 5,1% e 4,0%. As prevalências de sobrepeso foram de 15,3% entre os meninos e de 13,2% entre as meninas. A obesidade apresentou prevalências de 18,6% em meninos e 11,9% em meninas. O fator que apresentou associação com a presença de desnutrição nos meninos foi a idade, verificando-se que a faixa etária de 13,0 a 14,9 anos apresentou maior proporção de desnutridos em relação a faixa etária de 10,0 a 12,9 anos (respectivamente 14,3% x 0,0%; p= 0,028). Os fatores que mostraram associação com a desnutrição para as meninas foram o estágio puberal (OR= 10,20; p=0,005) e horas diante da televisão por dia (OR= 6,13; p= 0,019). Para o sobrepeso e obesidade, a ingestão de energia mostrou associação com a obesidade, ajustada pela idade e tempo em minutos por dia de prática de atividade física (ORajustada=6,74; p= 0,013) no grupo masculino. Nas adolescentes a obesidade foi associada ao números de horas diante de televisão por dia, ajustada pela idade ingestão de energia e tempo em minutos por dia de prática de atividade física (ORajustada=5,39; p= 0,006). Conclusões - Os achados do presente estudo evidenciaram que as prevalências de desnutrição são baixas, enquanto que, as prevalências de sobrepeso e obesidade são preocupantes, demonstrando o processo de transição nutricional no qual a cidade de Piracicaba se encontra. Dentre os fatores associados à estes agravos, destacam-se aqueles passíveis de modificação, ao se adotar hábitos de vida saudáveis como evitar o consumo excessivo de alimentos com alto valor calórico, bem como a redução do número de horas assistindo televisão. / Background - The overweight and obesity are occurring in developed as in developing countries. It can coexist with the undernutrition, mainly, in the lower social class. Objective – To estimate the prevalences of undernutrition, overweight and obesity, according to sex and age, and to determine demographics, of lifestyle characteristics and dietary intake associated to nutritional status in adolescents aged 10 to 14,9 years who were attending a public school in Piracicaba (SP - Brazil). Material and Methods - This was a cross-sectional study. The sample was composed by 269 adolescents of both sex (118 boys and 151 girls). Demographic and anthropometric data, dietary habits, sexual maturation, physical activity, physical inactivity were collected using questionnaires. The statistical analyses were done using chi-square test and univariate and multiple multinomial regression models. Results - The prevalences of undernutrition on boys was 5,1% and on girls was 4.0%. Prevalence of overweight in boys and girls were 15.3% and 13.2%, respectively. The prevalence of obesity was 18.6% in boys and 11,9% in girls. The undernutrition was associated with age on boys (respectively, 14,3% x 0,0%; p= 0,028). The undernutrition was associated with pubertal status (OR= 10,20; p=0,005) and hours of television watching (OR= 6,13; p= 0,019) among girls. The factors associated with obesity was energy intake in boys (ORadjusted=6,74; p= 0,013) and hours of television watching in girls (ORadjusted=5,39; p= 0,006). Conclusions - The prevalence of undernutrition are low and the prevalences of overweight and obesity were high in adolescents; demonstrating the process of nutrition transition in Piracicaba. The results showed that undernutrition determinants are age, on boys and pubertal status and hours of television watching, on girls. The obesity determinants were energy intake among boys and hours of television watching among girls. These findings indicate that the preventive intervention programmes should emphasize the healthy practices.

Fatores nutricionais e metabólicos são capazes de comprometer o desenvolvimento pleno dos tecidos dentários, especialmente quando impingidos em períodos críticos. Estudos revelam que condições derivadas da subnutrição precoce e também tardia, interferem na atividade da insulina e do sistema IGF, demonstrando possível envolvimento com algumas patologias e apontando, em sua maioria, caráter permanente em alto grau, se não imediato, prospectivo e comprometedor da performance morfológica e funcional dos tecidos. Desta maneira, o presente estudo teve o propósito de avaliar os efeitos da subnutrição proteica pré e pós-natal e da renutrição pós-natal sobre o desenvolvimento da polpa dentária e do epitélio juncional do periodonto de ratos wistar, visando encontrar possível correspondência entre as alterações metabólicas e morfofuncionais decorrentes da subnutrição proteica, previamente relacionadas em estudos relativos à ação desses hormônios. Para tanto, formou-se grupos de animais heterogênicos (n=3) que, de acordo com a ração oferecida, normoproteica ou hipoproteica, e as respectivas idades, foram divididos nos seguintes grupos experimentais: nutridos (N) e subnutridos (S) com 60 dias de vida (fase na qual o período púbere termina) e renutridos (R), recuperados a partir de 22 até alcançarem 60 dias de vida. Após a eutanásia, os espécimes foram submetidos às técnicas de microscopia de luz (coradas com Azo-Carmim, Hematoxilina-Eosina e Picro-Sirius, esta última para a avaliação do componente colágeno) e imunohistoquímica para a identificação da expressão do IGF-I, insulina e respectivos receptores. A polpa dentária apresentou-se debilitada sob subnutrição o que foi verificado através da desorganização da camada odontoblástica e da estagnação dos componentes colágenos nos animais subnutridos. A renutrição não foi capaz de promover a recuperação de nenhum dos dois parâmetros. O estudo morfométrico permitiu verificar que a porcentagem média do número de expressões ao IGF-I foi maior nos animais do grupo N e que houve diferenças estatísticas significantes entre estes e os animais dos grupos S e R. Da mesma forma, a maior expressão de seus receptores (IGF-IR) foi encontrada nos animais do grupo N com indicação de diferença estatística apenas entre este e o grupo de animais subnutridos. A maior porcentagem média das expressões de insulina ocorreu nos animais nutridos (N), mas estatisticamente não foi detectada diferença significativa entre os grupos. Já em relação ao receptor de insulina (IR), foram constatadas diferenças estatísticas significativas entre o grupo N em relação aos grupos S e R. No epitélio juncional, a subnutrição determinou modificações no padrão das células e camadas epiteliais nos animais subnutridos, além de uma maior quantidade de colágeno do tipo III no tecido conjuntivo que o sustenta, caracterizando um atraso no desenvolvimento desses tecidos. A renutrição não foi capaz de recuperar satisfatoriamente os seus componentes estruturais. Sobre as expressões imunohistoquímicas a todos os anticorpos utilizados (para IGF-I, IGF-IR, I e IR), a análise estatística demonstrou não haver diferenças significativas entre os valores encontrados nos diferentes grupos N, S e R no epitélio juncional. / Nutritional and metabolic factors can cause serious injury of the development of dental tissue, especially when occurred in critical periods. Several studies reveal that conditions derived from early and later under nutrition interfere in insulin and IGF system activities; in these studies has been demonstrated the possible involvement of some pathologies most of them pointing to permanent in high degree (if not immediate) prospective and \"possible dangerous\" morphological and functional performance of tissues. Thus, the present study aimed to evaluate the effects of the pre and post-natal protein under nutrition, and, post-natal refeeding on the development of the dental pulp and periodontal junctional ephitelium of wistar rats, in order to find possible correlation between the metabolic and morph-functional changes arising from protein under nutrition, previously associated with studies related to the effects of these hormones. For this purpose, heterogenic animal groups were formed (n=3) divided in accordance of their diets (protein or hypo protein) and their ages into the following experimental groups: nourished (N) under nourished (S) aged 60 days (final of pubescent l periods) and renourish (R), recovered from the 22nd to 60th day old. After euthanasia, the specimens were analyzed by light microscopy (stained with Azo-carmine, Hematoxylin-Eosin and Picro Sirius, the later for collagen component analysis) and immunohistochemistry examination for identification of IGF-I expression, Insulin and respective receptors. The dental pulp turned out to be impaired in the context of undernutrition. This phenomenom was seen through disorganization of the odontoblastic layer and the stagnation of collagen components in undernourished animals. The refeeding procedure was unable to promote the recovery from any of the two parameters. With the immunohistochemistry on the dental pulp, it was found that the number of IGF-I expression was higher in group N and that there were significant differences involving these animals and those from groups S and R. Similarly, the highest expression of their receptors (IGF-IR) was found in group N, demonstrating statistical difference between this one and the group of undernourished animals. The highest average percentage of the expressions of insulin occurred in nourished animals (N), but no statistically significant difference was detected among the groups. In regard to the insulin receptor (IR), statistically significant differences were found when the group N was compared to groups S and R. In the junctional ephitelium, the undernutrition determined changes in the pattern of epithelial cells in undernourished animals and the prevalence of type III collagen fibers in the connective tissue that supports it, featuring a delay in the development of these tissues. The refeeding was not able to satisfactorily recover their structural components. About immunohistochemical expressions of all antibodies used for IGF-I, IGF-IR, I e IR in the junctional ephitelium, the statistical analysis showed no significant differences among the values found in the groups N, S and R.

A subnutrição tem sido ao longo dos anos um dos maiores problemas de saúde pública do mundo, que acomete principalmente crianças de países em desenvolvimento. Estima-se que em Moçambique na África Oriental, cerca de 40% das crianças são acometidas pela desnutrição crônica que resulta dentre outras afecções em baixa estatura e diminuição da capacidade física. Este estudo visa avaliar a estrutura óssea de ratos wistar submetidos à dieta básica da população de Moçambique (DM) reproduzida em laboratório. Para isso a DM foi oferecida aos animais em fase pré e pós-natal durante 42 dias. Para alguns desses animais foi fornecida a DM acrescida de 20% de caseína (DMC) subsequentemente os grupos subnutrido de Moçambique (SM) e nutrido de Moçambique (NM). Foi formado também um grupo denominado renutrido (RM) composto por animais que receberão a DMC a partir do 22&ordm; dia e até completarem 42 dias de vida. Após o desmame foram mensurados os parâmetros metabólicos da ingestão alimentar e hídrica, excreção de urina e fezes. A tíbia e o úmero do lado direito foram macerados quimicamente a fim de verificar as medidas ósseas. Esses ossos do lado esquerdo foram processados com técnicas rotineiras histológicas e corados de forma a evidenciar as estruturas cartilagineas. Os dados obtidos foram submetidos a análise de variância paramétrica seguida por comparações múltiplas pelo método de Tukey, com nível de significância p&lt;0,05. Os resultados apontam que a Subnutrição é capaz de modificar a espessura da CA e da LE e os componentes de sua MEC. Embora a inserção de caseína na dieta dos animais SM, tenha reestabelecido parâmetros da osteometria, na LE e na CA a melhora apresentada, não foi o suficiente para atingir seus parâmetros normais apresentados no grupo NM / Undernutrition has been over the years one of the major public health problems worldwide, which affects mainly children in developing countries. It is estimated that in Mozambique in East Africa, about 40% of children are affected by chronic undernutrition resulting from other conditions in stature and diminished physical capacity. This study aims to evaluate the bone structure of Wistar rats submitted to the staple diet of the population of Mozambique (DM) reproduced in the laboratory. To this DM was given to the animals in pre and postnatal 42 days. For some of these animals was provided to DM plus 20% casein (DMC) subsequently the undernourished groups of Mozambique (SM) and nursed Mozambique (NM). Also it has formed a group called renutrido (RM) consists of animals that receive the DMC from the 22nd day until completing 42 days of life. After weaning metabolic parameters were measured food and water intake, urine output and feces. The tibia and the humerus on the right side were chemically macerated in order to verify the bone measurements. These bones on the left side were processed with routine histological techniques, and stained to show the form cartilage structures. The data were subjected to parametric analysis of variance followed by multiple comparisons by the Tukey method, with significance level of p <0.05. The results show that the Malnutrition is able to modify the thickness of the CA and LE and the components of its MEC. Although the inclusion of casein in the diet of animals SM, has reestablished osteometria parameters in LE and CA improvement presented, was not enough to achieve their normal parameters presented in NM group

Introdução: Distúrbios nutricionais são frequentes em pacientes com insuficiência cardíaca (IC) e associados a pior prognóstico. Entretanto, a grande variabilidade de critérios diagnósticos e a diversidade das populações estudadas tornam pouco reprodutíveis os resultados. São escassos os dados a respeito da ocorrência de distúrbios nutricionais em pacientes com IC no âmbito nacional. Objetivo: Estudar a ocorrência da desnutrição e caquexia em pacientes com insuficiência cardíaca descompensada (ICD) e sua influência no prognóstico hospitalar. Metodologia: Trata-se de uma coorte prospectiva de pacientes com idade superior a 18 anos internados com descompensação de IC e fração de ejeção do ventrículo esquerdo (FEVE) inferior a 50%. Os pacientes foram submetidos a avaliação nutricional que incluiu anamnese, avaliação nutricional subjetiva global (ASG), medidas antropométricas e foram diagnosticados quanto a presença de desnutrição, caquexia, baixo teor muscular e baixa força muscular. Dados bioquímicos, clínicos e de função ventricular foram obtidos por revisão do prontuário. Foram estudados os desfechos: alta hospitalar, óbito ou necessidade de transplante cardíaco em regime de urgência. Resultados: Foram analisados 131 pacientes, 64,9% eram do sexo masculino, a mediana de idade foi de 56 anos (IQ25-75: 45-64), 40,5% apresentavam cardiomiopatia dilatada, 32,1% doença de Chagas e 19,1% cardiomiopatia isquêmica. Os pacientes apresentaram mediana de FEVE de 25% (20-30) e de BNP de 1093pg/ml (591-2149). Quanto à avaliação nutricional a mediana de IMC foi de 23,3kg/m2 (20,6-26,7), 25,2% apresentaram baixo peso segundo o IMC, 41,2% baixo teor muscular, 49,6% baixa força muscular, 61,8% receberam diagnóstico de desnutrição e 48,1% de caquexia. Quanto ao desfecho hospitalar, 26% foram a óbito e 29% foram submetidos ao transplante cardíaco. A presença de distúrbios nutricionais esteve relacionada com algumas características clínicas, de forma que foi encontrado um pior perfil nutricional em indivíduos do sexo masculino, com doença de Chagas, adultos e que apresentavam maior severidade da IC. Os pacientes que tiveram os piores desfechos apresentavam menor FEVE, menor IMC, menos massa muscular, maiores níveis séricos de peptídeo natriurético tipo B e eram mais frequentemente desnutridos e caquéticos, porém na análise multivariada essa relação não se mostrou de forma independente. Conclusões: Nossos achados revelam que há uma alta ocorrência de desnutrição e caquexia entre pacientes internados com ICD em nosso meio, e que variáveis indicativas de pior status nutricional estão associadas com piores desfechos durante a internação / Introduction: Nutritional disorders are common among patients with heart failure (HF) and associated with poor prognosis. However, the great variability of the diagnostic criteria and the diversity of the populations studied make results poorly reproducible. There are few data about nutritional disorders in patients with HF at the national level. Objective: To study the occurrence of undernutrition and cachexia in patients with decompensated HF and its influence on hospital prognosis. Methods: Prospective cohort study of adults and elderly patients hospitalized with decompensated HF and left ventricular ejection fraction (LVEF) less than 50%. The patients were submitted to nutritional evaluation including anamnesis, Subjective Global Nutritional Assessment (SGA), anthropometric measurements and were diagnosed for the presence of undernutrition, cachexia, low muscle mass and low muscle strength. Biochemical, clinical and ventricular function data were obtained by reviewing the medical record. We studied the outcomes: hospital discharge, death or need for heart transplantation during hospitalization. Results: 131 patients were analyzed, 64.9% were male, the median age was 56 years (IQR: 45-64), 40.5% had dilated cardiomyopathy, 32.1% Chagas disease and 19.1% ischemic cardiomyopathy. Patients had a median LVEF of 25% (20-30) and B-type natriuretic peptide (BNP) of 1093pg/ml (591-2149). Regarding nutritional assessment, the median Body Mass Index (BMI) was 23.3 kg/m2 (20.6-26.7), 25.2% presented low body weight according to BMI, 41.2% low muscle mass, 49.6% low strength muscle, 61.8% were diagnosed as undernourished and 48.1% were cachectic. Regarding the hospital outcome, 26% died and 29% received cardiac transplantation. The presence of nutritional disorders was related to some clinical characteristics, in order that a worse nutritional profile was found in patients that was male, with Chagas\' cardiomyopathy, adults and who presented a higher severity of HF. Patients who had the worst outcomes had lower LVEF, BMI, lower muscle mass, higher serum levels of BNP and were more often undernourished and cachectic, but in the multivariate analysis, this relationship was not shown independently. Conclusions: Our findings show that there is a high occurrence of undernutrition and cachexia among hospitalized patients with decompensated HF in our setting, and that variables indicative of poor nutritional status are associated with worse outcomes during hospitalization

The overall aim of this thesis was to develop, test and use a simple, clinically useful instrument for the nutritional screening of older patients. Four studies were performed, with a quantitative approach, in a geriatric rehabilitation ward in western Sweden. The number of patients who par-ticipated was: 56 (I), 114 (II), 147 (III) and 144 (IV) older patients. A nutritional screening instrument, the Nutritional Form For the Elderly (NUFFE), was constructed (I) and tested regarding reliability and validity (I, II). NUFFE was used in a screening, and the screening results were related to the patients’ perceived health and compared to the nurses’ nutritional notes in the nursing documentation (III). The screened patients’ self-care ability and sense of coherence (SOC) were investigated and the patients’ perceived health was related to selfcare ability and SOC (IV). The collection of data was done through interviews with the instruments NUFFE (I-IV), the Selfcare Ability Scale for the Elderly (SASE) (IV), Antonovsky’s SOC scale (IV), a question about perceived health, healthrelated ques-tions (III, IV) and background variables (I-IV). Weight and height were measured (I-III). The nurses’ nutritional notes in the nursing documentation were collected (III). The screening instrument contains 15 threepoint items on ordinal level. The total score ranges between zero and 30 and a higher score indicates higher risk for undernutrition. Evidence of reliability and validity was shown (I, II). The determined cut-off points of NUFFE for identification of patients at low, medium and high risk for undernutrition were set to scores of &lt;6, ≥6 and ≥13 (III). The screening results showed that 31% of the patients were identified to be at low risk for undernutrition, 55% at medium risk and 14% at high risk. When the screening results were compared to nurses’ nutritional notes in the nursing documentation, it was shown that important nutritional issues were absent in many patient records (III). The patients at high risk were more likely to perceive ill health than were those at low risk for undernutrition (p=0.03) (III). Those at medium or high risk were more likely to perceive ill health (p=0.014) and to have lower self-care ability (p&lt;0.001) and weaker SOC (p=0.007) than were those at low risk for undernutrition. To perceive good health was associated with higher self-care ability (p&lt;0.001) and stronger SOC (p&lt;0.001). Lower self-care ability, being single and having been admitted from another hospital ward were three obtained predictors for being at medium or high risk for undernutrition (IV). In conclusion, NUFFE is a simple, useful screening instrument for identification of older nutritional at-risk patients. The instrument has sufficient evidence of reliability and validity. Using NUFFE in a screening of older patients, the prevalence of patients at medium or high risk for undernutrition was found to be high. Nurses’ nutritional notes showed deficiencies, indicating that all medium or high risk patients were not identified. Using NUFFE, associations were found between older patients’ nutritional risk and their perceived health, and their self-care ability and SOC, respectively. These associations indicate that being at low risk for undernutrition is concomitant with perceived good health, higher self-care ability and stronger SOC. Conversely, being at medium or high risk for undernutrition is concomitant with perceived ill health, lower self-care ability and weaker SOC.

Bakgrund: Studier visar att ungefär var fjärde patient som vårdas på sjukhus har riskför att utveckla undernäring. Komplikationer av undernäring orsakar lidande förindividen samt förlänger vårdtiden vilket leder till ökade kostnader för vården.Problematiken med undernäring väntas öka då antalet äldre i samhället ökar. Äldre är enutsatt grupp där risk för undernäring, ätproblem och sömnlöshet är vanligtförekommande. Frågan är om risk för undernäring och ätproblem är vanligare hos äldresom lider av sömnbrist. Syftet: Var att undersöka om det finns ett samband mellansömnlöshet och risk för undernäring samt mellan sömnlöshet och ätproblem hos äldrepatienter. Metod: Studien genomfördes som en kvantitativ tvärsnittsstudie. Materialetkom från en tidigare studie genomförd av sjuksköterskestudenter på Högskolan Kristianstad. Urvalet var äldre patienter som vårdades på sjukhus. Resultat: Resultatetvisar att risk för undernäring och ätproblem i kategorin energi/aptit är vanligare hospatienter med sömnlöshet än hos patienter utan sömnlöshet. Slutsats: Även omresultatet visar på att det finns ett samband mellan sömnlöshet och risk för undernäringråder det osäkerhet kring huruvida det är ett egentligt samband eller om depression kanvara orsaken till både sömnlöshet och undernäring. / Background: Studies show that one fourth of every patient in a hospital setting is inrisk of developing undernutrition. Complications of undernutrition are suffering for theindividual and prolonged hospital stay leading to increased healthcare costs.Undernutrition is expected to increase in the future when the elderly population grows.Undernutrition, eating difficulties and insomnia are common problems in the elderlypopulation. The question is whether undernutrition and eating difficulties are morecommon in elderly with insomnia or not. Aim: Was to investigate if there is acorrelation between insomnia and risk for undernutrition and between insomnia andeating difficulties. Method: The study was performed as a cross-sectional study. Thedata was obtained from a previous study performed by students at Kristianstad University. The sample consisted of elderly patients in a hospital setting. Findings:The study shows that risk for undernutrition and eating difficulties in the categoryenergy/appetite is more common in patients with insomnia than in patients withoutinsomnia. Conclusion: Although the study shows that there is a correlation betweeninsomnia and risk for undernutrition, there is an uncertainty if it’s a true correlation or ifdepression can be used as an explanation for both undernutrition and insomnia.

Objectives: The goal of this project was to determine the nutritional needs of preschool age children to help guide intervention development. The research aims were 1) to examine and describe young child (ages one to five) nutritional status as it relates to key nutrients associated with stunting and wasting; 2) to determine what key macro- and micro-nutrient deficiencies (primarily iron and zinc) are associated with wasting and stunting. Methodology: Study sample: Sixty-seven families with children ages one to five who participating in routine health care clinic visits during the UK Shoulder to Shoulder Global health brigade visits. Study design: A cross-sectional survey was conducted collecting demographic data, medical history, and dietary intake. Objective measures of height/length and weight were completed; and blood samples were drawn to measure serum micronutrient levels. Nutrition Data System for Research (NDSR) identified nutrient intakes for analytical comparison based on growth parameters. Nutritional and health status were compared to food security and World Health Organization growth reference points of standard deviations on Z-scores of height-for-age and weight-for-age. Analyses: Chi Square, ANOVA, and binary logistic regression tests were run using Statistical Analysis System (SAS) Results: Low serum levels of zinc and iron corresponded to low levels of dietary intake of zinc and iron, limited food security and moderate stunting z = -0 to 1.99 Standard Deviation. Conclusion: This study will inform a comprehensive nutritional intervention for this population. The evidence that specific nutrients are limiting will focus the health promotion objectives.

Eating problems and nutritional status were studied in a consecutive series of 104 stroke patients admitted to emergency hospital care. During their stay in hospital eating problems were observed in 46 patients. Certain common types of eating problems were identified: aberrant eating behaviour as regards chewing,lokalization or swallowing, eating small amounts, hoarding of food in the mouth, leakage of food from the mouth and unawareness of eating problems. Poor nutritional status occurred in 16 % of the patients on admission and in 22 % on discharge from the stroke unit. A subgroup of 32 patients hospitalized for 21 days or longer was studied for three weeks. On at least one occasion during these three weeks a poor nutritional status was observed in 18 patients, of whom 17 had eating problems. All subjects who had eating problems during their hospital stay, plus those patients without eating problems but with neurological deficits and those living in a nursing home one year after the stroke (n=36) were selected for a longitudinal study 18 months after the onset of stroke. Eating problems were identified in 23 of these patients during their hospital stay while 21 had such problems when they were followed up. Two patients who could not eat due to severe dysphagia (after a stroke) for three years and 18 months respectively, were successfully trained to eat normally. One patient exhibited impaired oral and hypopharyngeal function and the other impaired hypo- pharyngeal function and a spastic crico-pharyngeal muscle. In both patients training in swallowing was the main remedical measure and one of them also had a myotomy of the spastic muscle. / <p>[2] s., s. 1-45: sammanfattning, s. 49-130: Härtill 6 uppsatser</p> / digitalisering@umu

Malnutrition, when it is chronic disease in childhood, causes a reduction in growth and endocrine adaptive changes to ensure the maintenance of life. In this regard, the IGF-1 and cortisol have been identified as markers of nutritional status of children with growth deficiency. These high levels of cortisol and low levels of IGF-1 favor gliconoegenese and release of fatty acids by adipose tissue and inhibit the action of GH-dependent somatomedin-C on the growth. For these reasons, it is also important to investigate levels of total cholesterol, and triglycerides. Associated with energy deficiency, observed in these malnourished children, there is a lack of vitamins and minerals. Anemia due to iron deficiency is currently the most common nutritional deficiency in the world, followed by vitamin A deficiency. The iron and vitamin A are essential for normal growth and development. In addition to inadequate food intake, intestinal parasites have been considered important factors in the etiology of the anemia and the malnutrition. In this context, this study found a population with a poor and homogeneous socio-economic status, where the number of children was associated with the degree of malnutrition presented by the children studied (p = 0.03). Most of the children had between 12 and 36 months, was poly-infected (79.7%) and anemic (44.3%), the latter also highly associated with the degree of malnutrition (p = 0.01). For the levels of cortisol, the majority of children were in normal limits. Moreover, most of the levels of IGF-1 was next to the lower limit, showing its fall during the chronic malnutrition and its association with the same (p = 0.02). The results of lipid profile revealed that the vast majority of children had at least one type of dyslipidemia (98.9%) and low levels of HDL was associated with the degree of malnutrition (p = 0.02). It is, therefore, that chronic malnutrition presented by the children studied generates endocrine adaptations that cause permanent changes in lipid profile. / Conselho Nacional de Desenvolvimento Científico e Tecnológico / A desnutrição, quando ocorre de forma crônica na infância, causa redução no crescimento e alterações endócrinas adaptativas para garantir a manutenção da vida. Neste sentido, o IGF-1 e o cortisol têm sido indicados como marcadores do estado nutricional dessas crianças com déficit de estatura. Os altos níveis de cortisol e os baixos níveis de IGF-1 favorecem a gliconoegênese e a liberação de ácidos graxos pelo tecido adiposo e inibem a ação do GH dependentes de IGF-1 no crescimento. Por estes motivos, é importante investigar também o perfil lipídico. Associada a deficiência energética, verificada nessas crianças desnutridas, observa-se a carência de vitaminas e minerais. A anemia por carência de ferro é, atualmente, a deficiência nutricional mais freqüente no mundo, seguida pela hipovitaminose A. O ferro e a vitamina A são essenciais para o crescimento e desenvolvimento normais. Além da inadequada ingestão de alimentos, as parasitoses intestinais têm sido consideradas importantes fatores na etiologia das anemias carênciais e da DEP. Dentro deste contexto, o presente estudo objetivou estudar o perfil sócio-econômico, nutricional e bioquímico de crianças atendidas no Centro de Recuperação e Educação Nutricional (CREN/AL). Para tal foram selecionadas 79 crianças com idades entre 12 e 71 meses. Os dados sócio-econômicos e a avaliação antropométrica foram realizados em consulta nutricional. As dosagens bioquímicas foram realizadas entre os meses de junho e julho de 2008. Nesta época, foi coletada uma amostra de 10 ml de sangue em jejum de 12 horas, para dosagens de IGF-1, vitamina A sérica, hemograma e lipidograma completos. A dosagem do cortisol salivar foi realizada em um segundo momento para que o estresse da retirada do sangue não interferisse no resultado do mesmo. A presente pesquisa encontrou uma população com uma condição sócio-econômica precária e homogênea, onde o número de filhos encontrou-se associado ao grau de desnutrição apresentado pelas crianças estudadas (p= 0,03). A maior parte das crianças tinha entre 12 e 36 meses, encontrava-se poliparasitada (79,7%) e apresentaram anemia (44,3%), esta última altamente associada também ao grau de desnutrição (p= 0,01). As dosagens de vitamina A demonstraram um resultado surpreendente, pois não foi encontrado nenhum caso de hipovitaminose A, revelando que a suplementação de vitamina A implementada pelo Governo Federal tem sido eficiente. Com relação aos níveis de cortisol, a maioria das crianças encontrava-se dentro da normalidade. Por outro lado, a maior parte dos níveis de IGF-1 permearam o limite inferior, revelando sua queda durante a desnutrição crônica e sua forte associação com a mesma (p= 0,02). Os resultados do lipidograma revelaram que quase a totalidade das crianças apresentou pelo menos um tipo de dislipidemia (98,9%), sendo os níveis baixos de HDL associados ao grau de desnutrição (p= 0,02). Conclui-se, portanto, que a desnutrição crônica apresentada pelas crianças estudadas gera adaptações endócrinas que provocam modificações permanentes no perfil lipídico.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Neste estudo investigamos as consequências da restrição protéica materna durante a lactação sobre a resposta de timócitos da prole jovem de ratos Wistar (grupo D), identificando o papel da leptina nas alterações encontradas. Observamos que, quando comparados ao grupo controle, os animais do grupo D apresentaram, aos 30 dias de vida, uma diminuição significativa tanto do peso corporal quanto do timo. Contudo, não observamos alterações no número de timócitos, no perfil de células CD4/CD8 ou na resposta proliferativa destas células. Sistemicamente, o grupo D não apresentou alterações nos níveis séricos de corticosterona ou no conteúdo nuclear do seu receptor (GR) em timócitos. Apesar dos animais D não apresentarem alterações nos níveis circulantes de leptina, a expressão do seu receptor, ObRb, estava aumentada nos timócitos. Esta alteração foi acompanhada pela amplificação da resposta de sinalização da leptina nestas células, observada por um aumento na ativação de JAK2 e STAT3 após a incubação com leptina. Os timócitos isolados do grupo D apresentaram uma diminuição significativa na taxa de apoptose espontânea quando comparados ao grupo controle. Corroborando estes resultados, demonstramos que os timócitos dos animais D apresentam um aumento na expressão da proteína antiapoptótica Bcl-2 e uma redução da expressão da proteína próapoptótica Bax, além de um maior conteúdo de Pró-caspase-3, entretanto, não encontramos alterações no conteúdo de Bad. Além disso, timócitos do grupo D apresentaram um maior conteúdo da subunidade p65 do NF&#312;B no núcleo, associado a uma menor expressão de I&#312;B&#945; no citoplasma. Finalmente, observamos um aumento na expressão do RNAm para o gene ob (leptina) mas não para o gene db (receptor) no microambiente tímico dos animais D. Em conjunto, nossos dados mostram que a restrição protéica durante a lactação afeta a homeostase tímica, induzindo uma maior atividade de leptina, que protege os timócitos da apoptose na prole jovem, sugerindo que esses animais poderiam ser mais suscetíveis a alterações na resposta imune na vida aduta. / In this study, we investigated the consequences of maternal protein deprivation during lactation on thymocyte responses of the offspring Wistar rats (PD group) and the role of leptin in these alterations. Compared to group C, PD animals showed at 30 days of age, lower body and thymus weights, with no alteration in the thymocyte number or any difference in the profile of T cell subsets, or in their proliferative response. Similar circulating levels of corticosterone and GR nuclear contents were detected in thymic cells of PD or control groups. In contrast, despite the rats from PD group did not present alterations in leptin circulating levels, the expression of leptin receptor ObRb was enhanced in their thymocytes. This change was accompanied by an amplification in leptin signaling response of thymocytes from PD rats, which showed an increase in JAK2 and STAT3 phosphorylation after stimulation with leptin. Moreover, the thymic cells from PD rats presented a decreased rate of spontaneous apoptosis when compared to controls. Accordingly, higher expression of both the anti-apoptotic protein Bcl-2 and Procaspase-3 and lower expression of pro-apoptotic protein Bax were detected in PD thymocytes, however, the pro-apoptotic protein bad expression was similar between the groups. Thymocytes from PD group also exhibited a constitutive higher nuclear content of p65 NFkB associated to a lower IkB content in the cytoplasm. Finally, although there was no change in db genic (leptin receptor) expression in PD thymocytes, a higher expression of mRNA for ob gene (leptin) was observed in the thymic microenvironment from PD animals. Taken together, the results show that maternal protein deprivation during lactation affects thymic homeostasis, inducing leptin activity, which protect thymocytes from apoptosis in young progeny and, perhaps,may prone these animals for alterations in immune response in adult life.