90
EVOLUÇÃO DO ÍNDICE DE MASSA CORPORAL (IMC) E DO CILINDRO
BRAQUIAL EM MENINAS DA CIDADE DE PAULÍNIA, SP BRASIL (1979/80 - 1993/94).
Zambon Mp1, Marmo Db1, Morcillo Am1, Guimarey Lm2
1universidade Estadual De Campinas (Unicamp). Brasil. 2 Comision De Investigaciones
Cientificas, Provincia De Bsas (Cic). Argentina.
A avaliação da composição corporal em
estudos populacionais pode ser feita por parâmetros antropométricos.
Objetivo: analisar a evolução do IMC, e do cilindro braquial
-área de gordura (AG) e músculo (AM)- de meninas de Paulínia-SP
(Brasil) entre 1979/80 (estudo e1) e 1993/94 (estudo e2). População
e Método: estudou-se 923 meninas de 6,5 a 9,5 anos, 230 no e1
e 693 no e2. Calculou-se a média e o desvio padrão do
IMC, da AG e da AM. Na análise estatística utilizou-se
o teste de Kolmogorov-Smirnov. Resultados: Nas meninas a AG apresentou
aumento significativo em todas as faixas etárias. O IMC tendência
de alta e a área muscular braquial diminuiu a partir dos sete
anos, porém sem diferença estatística. Tabela
1
Idade
|
IMCe1
|
IMCe2
|
AGe1
|
AGe2
|
AMe1
|
AMe2
|
|
6,5
|
4,6±0,7
|
115,8±2,6
|
5,3±0,9
|
10,4±7,0*
|
16,1±2,4
|
16,4±2,5
|
|
7
|
15,7±1,7
|
15,9±2,3
|
7,0±2,7
|
10,8±6,3*
|
16,6±2,5
|
16,9±2,5
|
|
7,5
|
15,5±1,8
|
16,0±2,6
|
7,1±4,1
|
12,2±7,0*
|
17,9±3,7
|
16,6±2,7
|
|
8
|
15,4±1,1
|
16,1±2,1
|
6,4±1,3
|
11,3±7,8*
|
19,1±3,0
|
17,8±2,6
|
|
8,5
|
15,4±1,2
|
16,2±2,2
|
7,5±3,6
|
12,7±7,3*
|
18,8±2,7
|
18,0±2,4
|
|
9
|
15,9±2,0
|
16,5±2,4*
|
8,2±3,9
|
13,8±8,1*
|
19,1±3,2
|
17,9±3,3
|
|
9,5
|
16,0±1,6
|
16,4±2,3
|
7,5±2,6
|
13,3±7,2*
|
21,8±9,2
|
18,9±3,8
|
* p=0,05
Conclusões: Nas meninas, ocorreu aumento na quantidade relativa de gordura,
sem atingir índices de obesidade.
 |
90
Zambon Mp1, Marmo Db1, Morcillo Am1, Guimarey Lm2
1universidade Estadual De Campinas (Unicamp). Brazil. 2 Comision
De Investigaciones Cientificas, Provincia De Bsas (Cic). Argentina
Body composition has been studied with anthropometric measurements
in population studies.
Background: the purpose of this study was to evaluate female schoolchildren BMI,
upper arm fat area (UAFA) and upper arm muscle area (UAMA) from Paulínia,
São Paulo, Brazil between 1979/80 (study1 s1) and 1993/94 (study2 s2).
Material and methods: trends in BMI, UAC, UAFA and UAMA were studied in 923 girls
ranging from 6,5 to 9,5 years old; 230 in s1 and 693 in s2. Median and standard
deviation were calculated in both studies, according to gender and age. Kolmogorov-Smirnov
test was studied. Results: For females, UAFA showed bigger values in 1993/94
in all age classes, BMI data are getting higher, but aren't statistically different.
UAMA data became lower after seven years old, but they were not statistically
significant.
BMI s1
|
BMI s2
|
UAFA s1
|
UAFA s2
|
UAMA s1
|
UAMA s2
|
|
|
6,5
|
4,6±0,7
|
115,8±2,6
|
5,3±0,9
|
10,4±7,0*
|
16,1±2,4
|
16,4±2,5
|
|
7
|
15,7±1,7
|
15,9±2,3
|
7,0±2,7
|
10,8±6,3*
|
16,6±2,5
|
16,9±2,5
|
|
7,5
|
15,5±1,8
|
16,0±2,6
|
7,1±4,1
|
12,2±7,0*
|
17,9±3,7
|
16,6±2,7
|
|
8
|
15,4±1,1
|
16,1±2,1
|
6,4±1,3
|
11,3±7,8*
|
19,1±3,0
|
17,8±2,6
|
|
8,5
|
15,4±1,2
|
16,2±2,2
|
7,5±3,6
|
12,7±7,3*
|
18,8±2,7
|
18,0±2,4
|
|
9
|
15,9±2,0
|
16,5±2,4*
|
8,2±3,9
|
13,8±8,1*
|
19,1±3,2
|
17,9±3,3
|
|
9,5
|
16,0±1,6
|
16,4±2,3
|
7,5±2,6
|
13,3±7,2*
|
21,8±9,2
|
18,9±3,8
|
* p=0,05
Conclusions: girls recover fat mass, but didn't become obese.
|
|
91
AVALIAÇÃO E COMPARAÇÃO DO DIMORFISMO
SEXUAL DA COMPOSIÇÃO CORPORAL EM ESCOLARES BRASILEIROS
NO PERÍODO DE 1979/80 E 1993/94
Zambon Mp1, Marmo Db1, Morcillo Am1, Guimarey Lm2
1universidade Estadual De Campinas (Unicamp). Brasil. 2 Comision De Investigaciones
Cientificas, Provincia De Bsas (Cic). Argentina
O estresse ambiental pode acarretar alterações no crescimento
e desenvolvimento das crianças diminuindo as diferenças
entre os sexos, isto é o dimorfismo sexual.
Objetivo: avaliar a evolução do dimorfismo sexual na composição
corporal de escolares da cidade de Paulínia.
População e Método: estudou-se em conjunto 2.098 crianças
de 6,5 a 10,5 anos de idade, 540 (310 M e 230 F) em 1979/80 e 1.558 (865 M e
693 F) em 1993/94. Com as medidas de peso e altura calculou-se o índice
de massa corporal (IMC), e com o perímetro braquial (PB) e a prega cutânea
tricipital (PCT) as áreas de gordura (AG) e muscular (AM) braquial. Calcularam-se
as respectivas médias destas variáveis considerando idade e sexo.
Para a avaliação do dimorfismo sexual (DS) utilizou-se uma fórmula
que estuda a diferença relativa entre as médias:
DS=(50*(x1-x2)) / (x1+x2)(DP1+DP2)
Onde: x1=média da variável estudada (ve) do sexo masculino, x2=média
ve do sexo feminino, DP1=desvio padrão ve do sexo masculino e DP2=desvio
padrão ve do sexo feminino.
Resultados: O dismorfismo sexual para o IMC não se modificou neste período.
No PB observamos que os meninos que apresentavam valores superiores ao das meninas,
passaram a ter valores inferiores, o mesmo ocorrendo em relação à AG,
porém de maneira mais significante. Para a AM os valores que no primeiro
estudo eram semelhantes para ambos os sexos ficaram maiores nos meninos após
13 anos.
Conclusões: nesta população observou-se aumento do dimorfismo
sexual da composição corporal no segundo estudo em relação
ao primeiro. Este se caracteriza pelo aumento relativo da massa gorda nas meninas
e da área muscular braquial dos meninos em menor grau.
|
|
91
SEXUAL DIMORPHISM IN BODY COMPOSITION IN BRAZILIAN SCHOOLCHILDREN
FROM 1979/80 TO 1993/94
Zambon Mp1, Marmo Db1, Morcillo Am1, Guimarey Lm2
1universidade Estadual De Campinas (Unicamp). Brazil. 2 Comision De Investigaciones
Cientificas, Provincia De Bsas (Cic). Argentina
Nutritional stress can be seen in several catastrophic events like
wars and when socio-economic differences are very important. Nutritional
stresses can affect growth and development, changing body composition
and minimizing sexual dimorphism.
Background: the purpose of this study was to evaluate the sexual dimorphism in
BMI, upper arm circumference (UAC), upper arm fat area (UAFA) and upper arm muscle
area (UAMA) from Paulínia, São Paulo, Brazil between 1979/80 and
1993/94, a city that had good development, low under nutrition rate and positive
growth secular trends in this period.
Material and methods: BMI, UAC, UAFA and UAMA were calculated for 2098 children
ranging from 6,5 to 10,5 years old; 540(310M:230F) in 1979/80 and 1558 (865M:693F)
in 1993/94. Sexual dimorphism was measured by relative differences between means
with a formula:
DS = (50*(x1-x2)) / (x1+ x2) (SD1+ SD2)
Where: x1= mean for males, x2= mean for females, SD1= standard deviation for
males and SD2= standard deviation for females.
Results: Sexual dimorphism showed similar BMI, but UAC and UAFA that were higher
in boys in the first study became smaller. These changes were bigger in UAFA.
UAMA data were similar in both sex in the first study and became higher in males
in the other one.
Conclusions: These trends showed a recovery in sexual dimorphism. Girls recover
fat mass and boys got muscle mass in a lower degree.
|
|
92
CRECIMIENTO DIARIO DEL PERIMETRO CEFALICO EN NIÑOS SANOS
MENORES DE DOS AÑOS DE EDAD
Caino S*, Lejarraga H*, Kelmansky D**
*Crecimiento y Desarrollo. Hospital Garrahan. **Instituto de Calculo. UBA. Buenos
Aires.
En las últimas décadas, estudios basados en mediciones diarias o semanales de estatura en niños de diferentes edades proponen que el crecimiento es un proceso no-lineal y discontinuo. Hay muy pocos datos en la literatura sobre el patrón de crecimiento diario del perímetro cefálico. Con el objetivo de analizar el patrón de crecimiento diario del perímetro cefálico (PC) en niños sanos menores de un año de edad realizamos mediciones replicadas del PC de lunes a viernes durante 150 días en 9 niños de 0,32 a 0,84 años de edad al inicio del estudio. El error técnico de medición (ETM) en cada niño tuvo un rango de: 0,08 - 0,15 cm. Se realizó un suavizado de los datos teniendo en cuenta el ETM. Se definió crecimiento a todo incremento entre dos valores suavizados consecutivos mayor a 6 veces el desvío esperado, de dicho incremento, bajo el supuesto de no crecimiento. Arbitrariamente se definió cambio brusco de crecimiento (salto) a todo incremento entre dos valores suavizados consecutivos mayor a 0,3 cm en un día. Resultados: En 8 de los 9 niños se observaron cambios bruscos de estatura separados por días de no crecimiento (estasis) y/o períodos de crecimiento continuo. El porcentaje de días de estasis sobre el total de días medidos (150 días) fue 68,5%. El promedio de duración de los períodos de estasis fue 4,4 días, la duración máxima fue 45 días consecutivos. El promedio de número de saltos fue 2,5 con una amplitud máxima de 0,80 cm. El crecimiento a expensas de saltos representó el 37,2 % del total del crecimiento ocurrido durante el estudio. Conclusiones: Nuestros resultados sugieren que el crecimiento del perímetro cefálico, en la mayoría de los niños estudiados, es un proceso discontinuo e irregular formado por tres fases: estasis, crecimiento continuo y saltos. Ésto es consistente con el patrón de crecimiento diario de estatura y longitud de la pantorrilla descripto y puede contribuir a comprender mejor el programa de control y regulación del crecimiento de los distintos segmentos corporales.
|
|
92
SHORT-TERM GROWTH OF HEAD CIRCUMFERENCE IN HEALTHY INFANTS
Caino S*, Lejarraga H*, Kelmansky D**
*Crecimiento y Desarrollo. Hospital Garrahan. **Instituto de Calculo. UBA. Buenos
Aires.
In the last decade, studies based on daily or weekly measurements of stature in children suggest that growth is a non-linear and discontinuous process. There are few data about the daily growth on head circumference in the literature. With the purpose of evaluating the head circumference patterns in healthy infants, we took replicated measurements in head circumference five times a week over a period of 150 days in 9 infants aged 0,32 to 0,84 years at the onset of the study. The technical error (TEM) varied between 0,08 and 0,15 cm. The smoothing technique used was based on the TEM, with a hard rejection criterion. We defined growth as any increment between two consecutive smoothed values higher than 6 times the expected deviation of such difference. Abrupt changes in head circumference (saltation) were arbitrarily defined as any daily increment greater than 0,3 cm. Results: Eight of 9 infants showed saltatory growth. The number of days of stasis accounted for 68,5% of the total measurement period (150 days). The mean duration of each stasis period between growth episodes was 4,4 days and the longest period was of 45 consecutive days. The mean number of saltation periods was 2,5 and the largest amplitude was 0,80 cm in one single day. Saltation accounted for the 37,2 % of the total growth during the study period. Conclusion: Our findings suggest that the head circumference growth is a discontinuous and irregular process with three phases: stasis, continuous growth and saltation. This is consistent with short-term growth of stature and lower leg length, and should contribute to the understanding of mechanisms of the control and regulation of infants growth.
|
|
93
COMPORTAMIENTO DE LAS HORMONAS TIROIDEAS EN EL TRATAMIENTO DE
PACIENTES HIPOTIROIDEOS CON T4 EN DOSIS UNICA.
Benitez A, Chamoux A, Brunetto O, Cresto JC.
Htal. de Niños P. Elizalde, Endocrinología, Buenos Aires, Argentina.
Es conocido que la T4 transcurre en plasma asociada a una proteína
transportadora (TBG) que amortigua sus variaciones. Dosis únicas
administradas por razones médicas o accidentales no se asocian
a cuadros de intoxicación aguda. Es por eso que nos propusimos
estudiar la respuesta de las hormonas tiroideas en niños en
tratamiento hormonal diario (convencional) por hipotiroidismo congénito
o adquirido con una dosis única semanal con un aumento del 20%
sobre la dosis de mantenimiento convencional. Los niños eran
eutiroideos y se encontraban en equilibrio metabólico desde
hacía un mínimo de 3 años. En total se estudiaron
10 niños con edades entre 6.9 a 13 años (7 mujeres y
3 varones) durante 15 meses, determinándose las hormonas tiroideas
en sangre y su respuesta sobre la sobre el eje tiroideo cada 8 semanas
(6 vidas medias de T4). En el cuadro adjunto están descriptas
las variaciones hormonales durante el estudio.
ESTUDIO DE LAS MEDIAS
N**
|
Dosis*
|
TSH
|
T4
|
T3
|
T4L
|
T3L
|
T3R
|
TBG
|
|
Basal
|
1.93
|
1.956
|
10.13
|
128.3
|
1.32
|
3.23
|
16.9
|
24.38
|
|
1ra
|
2.20
|
4.518
|
10.54
|
125.7
|
1.43
|
3.31
|
19.65
|
24.17
|
|
2da.
|
3.39
|
4.073
|
9.6
|
116.9
|
1.29
|
3.02
|
17.33
|
27.3
|
|
3ra.
|
2.06
|
2.694
|
9.59
|
115.5
|
1.22
|
3.05
|
16.69
|
26.98
|
|
4ta.
|
2.17
|
0.918
|
9.77
|
125.9
|
1.29
|
3.05
|
13.37
|
26.53
|
**Numero de determinaciones
* Dosis de T4 (µg/Kg/peso)
Las determinaciones del ECG, colesterol y triglicéridos no mostraron variaciones
durante el estudio y clínicamente los pacientes permanecieron eutiroideos.
Podemos concluir que el aporte de una dosis única de T4 con un incremento
del 20% sobre las dosis inicial, permitio a los niños del estudio permanecer
eutiroideos y sin modificaciones en sus valores de hormonas tiroideas.
|
|
93
THYROID HORMONES BEHAVIOR IN HYPOTHYROIDISM TREATMENT
USING A SINGLE WEEKLY THYROXIN DOSE.
Benitez A, Chamoux A, Bruneto O, Cresto JC.
Htal. P.Elizalde, Endocrinology, Buenos Aires, Argentina.
It is widely known that thyroxin in serum is bound to a transporter
protein, which softens its changes. It has been observed that a single
dose given for medical reasons or accidentally are not associated to
acute reaction. Our objective was to study the thyroid hormone response
to a single weekly dose in children with congenital or acquired hypothyroidism,
given a 20% increase over the previous, conventional dose. We select
children with congenital or acquired hypothyroidism who were treated
with conventional daily hormonal doses and were in good control (euthyroidism)
for at least three years. Seven girls and 3 boys between 6.9 and 13
years old were followed for 15 months and thyroid hormones were measuring
every 8 weeks during this treatment (every six T4 half-lives). Results
are described in the enclose table.
MEANS' STUDIES
N**
|
Doses*
|
TSH
|
T4
|
T3
|
T4L
|
T3L
|
T3R
|
TBG
|
|
Basal
|
1.93
|
1.956
|
10.13
|
128.3
|
1.32
|
3.23
|
16.9
|
24.38
|
|
1ra
|
2.20
|
4.518
|
10.54
|
125.7
|
1.43
|
3.31
|
19.65
|
24.17
|
|
2da.
|
3.39
|
4.073
|
9.6
|
116.9
|
1.29
|
3.02
|
17.33
|
27.3
|
|
3ra.
|
2.06
|
2.694
|
9.59
|
115.5
|
1.22
|
3.05
|
16.69
|
26.98
|
|
4ta.
|
2.17
|
0.918
|
9.77
|
125.9
|
1.29
|
3.05
|
13.37
|
26.53
|
** Number of determinations
* T4 doses (µg/Kg/weight)
Patients remained clinically euthyroid during the study and the cholesterol and
triacylglycerol levels ramain constants. Tthe EKG did not show variations during
this time. We conclude that a single dose with an increment of 20% over the initial
dose may allow children to remain euthyroid without changes on their thyroid
hormone levels.
|
|
94
ANÁLISIS DE LA RESPUESTA SUPRARRENAL DURANTE LA PRUEBA DE ACTH EN BAJAS
DOSIS EN NIÑOS Y ADOLESCENTES.
Brunetto O, Hernández C, Fernández I, Bre M, Chamoux A, Leiva
F, Cresto JC.
División Endocrinología. Htal de Niños Pedro de Elizalde.
Buenos Aires. Argentina.
La evaluación del eje adrenal mediante la prueba de ACTH a
dosis bajas representa un estimulo más fisiológico de
la función suprarrenal que la evaluación con dosis convencionales
(250 ug). El objetivo del siguiente estudio es analizar en una población
compuesta de pacientes prepuberales y puberales sanos la respuesta
en la producción de cortisol plasmático durante la prueba
de ACTH y las posibles diferencias según sexo o estadio puberal.
Material y métodos: se analizaron 42 niños prepuberales
y puberales (edad media ±
SEM: 8,27 ± 0,5630; rango:0,75 - 16,8 años), 22 varones
y 20 mujeres, en los cuales se descarto patología endocrina.
Previo consentimiento informado de los padres y los pacientes, se les
realizo a los mismos prueba de ACTH a dosis bajas (ACTH 1- 24,dosis
de 0,5 ug/m2 S.C),determinándose en forma basal y post estimulo
cortisol plasmático a los 10,20,30,50,50 y 60 minutos post ACTH).La
determinación de cortisol se realizo mediante inmunoquimioluminiscencia.
Para el análisis estadístico de las diferencias entre
los distintos tiempos de la prueba se utilizo un test de T para muestras
pareada. Resultados (cortisol plasmático expresado en ug/dl):
n= 42
|
Basalm
|
Cort 10'
|
Cort 20'
|
Cort 30'
|
Cort 40'
|
Cort 60 '
|
Pico
|
Delta
|
|
| Media |
11,82
|
15,86
|
20,04
|
22,24
|
19,51
|
16,32
|
23,79
|
11,84
|
| SEM |
0,7443
|
0,7289
|
0,6678
|
0,7108
|
0,8826
|
0,8428
|
0,6891
|
0,8196
|
| Rango |
4,05-23,5
|
3,0-24,5
|
12,5-29,8
|
11,2-31,6
|
10,2-33
|
7,5-27,7
|
16,7-33
|
2,20-26
|
| Perc 3 |
4,47
|
4,58
|
12,9
|
11,54
|
10,24
|
8,02
|
16,72
|
2,25
|
| 50 |
10,9
|
15,3
|
19,35
|
22,7
|
20,35
|
15,9
|
24,2
|
10,9
|
|
97
|
23,07
|
24,34
|
29,61
|
31,28
|
32,01
|
27,09
|
32,59
|
24,8
|
Cuando se dividió por sexo a la muestra y se comparo la respuesta
en ambos sexos se obtuvieron diferencias significativas en el pico
máximo de cortisol durante el estudio (25,63 ± 0,9323
vs 22,12 ±
0,8805 p <0,009) .Conclusiones: los niveles alcanzados durante la
prueba de ACTH a dosis bajas son comparables a los valores históricos
alcanzados durante la prueba a dosis convencionales (pico de 18 ug/dl
de cortisol plasmático).Cuando se analizo la respuesta comparando
los sujetos de ambos sexos se observo una respuesta significativamente
mayor en el pico de cortisol de las mujeres estudiadas.
|
|
94
ANALYSIS OF THE ADRENAL RESPONSE DURING THE ACTH LOW DOSE TEXT IN CHILDREN AND
ADOLESCENT.
Brunetto O, Hernandez C, Fernandez I, Bre M, Chamoux A, Leiva F, Cresto JC.
Division Endocrinología. Htal. de Niños Pedro de Elizalde. Buenos
Aires. Argentina
The study of the adrenal function using the ACTH low dose test, represent a more
physiological stimulus of the adrenal function than the conventional dose test
(250 ug). The aim of this study was to analyze the adrenal response during ACTH
low dose test in prepuberal and puberal patients, and the differences in the
adrenal response between sexes. .Subjects and methods: 42 children and adolescents
( 22males, 20 females; age: mean ± SEM: 8,27 ± 0,5630 , range:0,75
- 16,8 years) discarding adrenal disorders and corticosteroid users during the
last two years. These patients received 1-24 ACTH (0,5 ug/1,73 m2):Blood samples
were obtained at - 15,0,10,20,30,40 y 60 minutes after the injection. Plasma
cortisol concentrations were measured at each time point with inmunoquimiolumisnicence.
Statistical analysis was performed by paired two tailed Student T test.
Results (plasmatic cortisol ug/dl) n:42 SEM: standard error
|
Basalm
|
Cort 10'
|
Cort 20'
|
Cort 30'
|
Cort 40'
|
Cort 60 '
|
Peak
|
Delta
|
|
| Mean |
11,82
|
15,86
|
20,04
|
22,24
|
19,51
|
16,32
|
23,79
|
11,84
|
| SEM |
0,7443
|
0,7289
|
0,6678
|
0,7108
|
0,8826
|
0,8428
|
0,6891
|
0,8196
|
| Range |
4,05-23,5
|
3,0-24,5
|
12,5-29,8
|
11,2-31,6
|
10,2-33
|
7,5-27,7
|
16,7-33
|
2,20-26
|
| Perc 3 |
4,47
|
4,58
|
12,9
|
11,54
|
10,24
|
8,02
|
16,72
|
2,25
|
| 50 |
10,9
|
15,3
|
19,35
|
22,7
|
20,35
|
15,9
|
24,2
|
10,9
|
|
97
|
23,07
|
24,34
|
29,61
|
31,28
|
32,01
|
27,09
|
32,59
|
24,8
|
When the sample was divided by sex and the responses were compared
in both sexes ,the females had significative differences at the maximum
cortisol peak (25,63±0,9323 vs. 22,12±0,8805 p< 0,009).
Conclusions: The cortisol levels reached during the test were similar to the
ones obtained during the
standard dose ACTH test (cortisol peak 18 ug/dl ).The studied female patients
had a significative mayor response to cortisol peak.
|
|
95
CORTISOL SALIVAR: VALORES DE NORMALIDADE NA AVALIAÇÃO ADRENAL EM
CRIANÇAS SAUDÁVEIS, MENORES DE TRÊS ANOS
Silva ML, Ferrari GF, Mallozi MC.
Pós-graduação do Departamento de Pediatria da Universidade
de Botucatu (UNESP) - São Paulo, Brasil e Faculdade de Medicina Fundação
ABC - São Paulo, Brasil.
OBJETIVO: Establecer nível de normalidade de cortisol salivar
em crianças menores de três anos, saudáveis, assim
como identificar período etário possível de ritmo
e maturidade do eixo.
JUSTIFICATIVA: A dosagem de cortisol salivar é um método que permite
avaliar a função adrenal de forma prática, não invasiva
e sem "stress". Apesar dos inúmeros estudos a respeito da dosagem
do cortisol salivar, ainda não há estabelecido, por este método,
o valor de normalidade para crianças. Este dado é muito importante
para ser utilizado como referência no estudo do eixo hipotálamo-hipofisário-adrenal
durante a corticoterapia, que aliás é freqüentemente prescrita,
em especial nas doenças respiratórias da infância.
MÉTODO: Noventa e uma crianças de 45 dias a 30 meses de idade foram
submetidas à coleta domiciliar de saliva (manhã
e tarde) para a dosagem de cortisol por radioimunoensaio. Selecionados
os casos de ausência de patologia, de febre e de corticoterapia
prévia (2 semanas).
RESULTADOS: Além da constatação da homogeneidade das variáveis
de estudo, foi observado que todas as crianças apresentaram produção
elevada de cortisol pela manhã
e reduzida à tarde. A diferença das medidas de cortisol
cedo e tarde foi superior à 30% a partir dos 12 meses de vida.
CONCLUSÕES: O valor de normalidade de cortisol salivar no percentil 50
para menores de três anos, sem patologias no período da manhã foi
de 160 ng/dl e da tarde, 101ng/dl. A partir de 45 dias de vida, a criança
tem a capacidade de produzir um ritmo circadiano, com maturidade completa do
eixo aos 12 meses.
Palavras chave: Cortisol salivar; insuficiência adrenal; eixo hipotálamo-hipofisário-adrenal;
radioimunoensaio
|
|
95
SALIVARY CORTISOL: REFERENCE VALUES TO STUDY THE ASSESSING ADRENAL
FUNCTION IN HEALTHY CHILDREN OF THREE YEARS OLD AND BELOW
Silva ML, Ferrari GF, Mallozi MC.
Postgraduate Course - Department of Paediatrics, University of Medicine (UNESP),
Botucatu - São Paulo- Brazil and University of Medicine (Fundação
ABC), Santo André - São Paulo - Brazil.
OBJECTIVE: To establish normal salivary cortisol levels in healthy
children of 3 years old and below and also, to notice the possible
age of maturity of the hypothalamic-pituitary-adrenal axis.
JUSTIFICATIVE: The assessment of adrenal function by cortisol determination in
saliva represents an attractive, reliable and non invasive diagnostic procedure
in children. Multiple saliva samples can be obtained stress-free from one individual
to establish the hypothalamus-pituitary-adrenal axis activity. Despite extensive
studies with salivary cortisol, however, in children have not been found the
values of normality cortisol, yet. It's very important to evaluate the suppression
on the hypothalamic- pituitary-adrenal axis during the therapy of systemic or
inhaled glucocorticoid, which is frequently used on disease of tract respiratory.
METHODS: Saliva samples of ninety one children of 45 days old to 30 months old
were collected in the morning and in the afternoon. Cortisol was measured in
samples of saliva by radioimmunoassay. Only children without pathologies, without
fever and those which were not taken systemic or inhaled glucocorticoid therapy
in the two weeks prior to collection.
RESULTS: There were no significant differences in the dosage of salivary cortisol
between the ages studied. All the groups showed higher cortisol production in
the morning than in the afternoon. The differences of levels between early salivary
cortisol and late salivary cortisol were 30 percent higher in the over 12 months
old.
CONCLUSIONS: The normal median value was considered 160 ng/dl (early salivary
cortisol) and 101 ng/dl (late salivary cortisol). Starting at 45 days old, the
children were able to produce normal circadian rhythm and they showed complete
maturity axis after 12 months old.
Key words: Salivary cortisol; adrenal failure; hypothalamic-pituitary-adrenal
axis; radioimmunoassay
|
|
96
ES LA ACANTOSIS NIGRICANS UN MARCADOR DE INSULINORESISTENCIA EN
ADOLESCENTES - OBESOS?
Hirschler V, Aranda C, Oneto A, Gonzalez C, Jadzinzky M.
Hospital Durand de Buenos Aires Argentina.
La AN es considerado un marcador de insulino-resistencia. Escasos estudios han relacionado independientemente AN y obesidad como marcadores de insulino-resistencia. Objetivo El propósito de este estudio fue de establecer la relación entre AN y a) diversos marcadores de insulino-resistencia, como Insulinemia Basal, Homa/IR, y IGFBPI b)BMI. c)HDL-C, Triglicéridos y otros factores de riesgo para DBT2. Material y Métodos. Se evaluaron 1250 adolescentes que concurrieron al Hospital General de Agudos, para un control programado y obligatorio de Salud, entre 2/4/01 y el 2/11/01, 288 fueron obesos (BMI> p 95). De estos se obtuvo una muestra randomizada de 74 adolescentes obesos de 12.4+1.4 años,(40fem). Se obtuvieron los siguientes datos: antecedentes familiares de obesidad y/o diabetes 2 (DBT2), peso de nacimiento del sujeto, BMI, presencia de AN, Tensión arterial, Estadio de Tanner. Se realizó una prueba de tolerancia oral a la glucosa, según criterios de la ADA. Se realizaron las siguientes determinaciones: glucemia en ayunas y 120 min. , insulinemia basal y 120 min., perfil lipídico, IGFBPI. Análisis Estadístico: El intervalo de confianza (95%) del rango relativo de la AN fue calculado usando el método de Fleiss. Se usó el test de chi cuadrado para diferencias estadísticamente significativas y el análisis de regresión múltiple para correlaciones no paramétricas.. Resultados. De los 78 adolescentes obesos, 41 presentaron AN(55.4%). Todos los sujetos tenían un Tanner ³ 2 e historia familiar positiva. En el grupo con AN (41+), 4 presentaron intolerancia a los hidratos de carbono y en el grupo sin AN (33-) sólo 2. Ninguno presentó DBT2. Se observó una asociación univariada entre AN y: BMI (rS0.45; p=0.00038), peso de nacimiento (rS -0.37 p0.0021), glucemia basal (rS 0.30; p0.009), HDL (rS-0.25; p=0.03). No hubo asociación univariada ni multivariada entre AN y todos los marcadores de insulino-resistencia: insulinemia basal (rS 0.16 p=0.16), Homa/IR (rS0.02; p=0.06), IGF1BP1(rS 0.07; p=0.69). La AN, en el análisis multivariado presentó una asociación estadísticamente significativa con el BMI(OR 1.30 p=0.018) y con el peso al nacer (OR 0.23 p= 0.03). Conclusiones:La presencia de AN mostró una fuerte asociación con el BMI. No encontramos asociación significativa entre AN y los marcadores de insulino-resistencia estudiados. Esto sugiere que la AN es un marcador de obesidad pero no un signo clínico confiable de insulino-resistencia en nuestra muestra.
|
|
96
IS AN A CLINICAL SIGN OF INSULIN RESISTANCE ?
Hirschler V, Aranda C, Oneto A, Gonzalez C, Jadzinzky M.
Hospital Durand de Buenos Aires Argentina.
Acanthosis Nigricans (AN) was proposed as an insulin resistance marker and an
independent Risk Factor for type 2 diabetes (T2DM) in obese adolescents. The
purpose of this study was to determine the association between AN and: a) Several
markers of insulin-resistance (HOMA-IR, IGFBP1 levels, basal insulinemia), b)
BMI (% body fat), c) HDL, triglycerides and other predictors of insulin-resistance
or type 2 diabetes mellitus. Study design: One thousand two hundred and fifty
Hispanic adolescents, mean age 12.4 ± 1.4 years, who consulted the adolescent
department for routine check up, between April and November 2001, were evaluated.
Two hundred eighty eight were obese, (BMI > percentile 95), of these we took
a randomize sample of 74 obese adolescents (40 females). Data for: birth weight,
positive family history for obesity and/or T2DM, BMI, presence of AN, blood pressure
and Tanner stage, were obtained. An OGTT test, a lipid profile, an insulinemia
and an IGF1BP1 test were performed. Results: Of 74 obese adolescents, all of
them were Tanner
³ 2, and had a positive family history for obesity or T2DM. Forty
one (55.4%) presented AN. There was no statistical difference on age
and sex between the group AN (41+) and AN (33-). Four were glucose
intolerant in the group with AN and in the other only 2. None of the
adolescents presented type 2 diabetes. A t test was used to compare
adolescents with and without AN. There was no difference for all the
insulin index: HOMA IR (6.6vs 4.9 p=0.19), base insulinemia (27.3 vs
21.5 p=0.27), IGFBP1 (8.2 vs 8.3 p= 0.98)between the 2 groups The group
with AN showed a statistical difference with the other group in BMI
(30.6 vs 27.3 p=0.00039), Basal glucose( 5.3 vs 5 p=0.01), HDL cholesterol
(39.2 vs 45.1 p=0.02) and birth weight(3.23 vs 3.61 p=0.0021) (Table
1 p< 0.05).There was an univariate association with BMI (rS 0.45;
p=0.00038), birth weight (rS -0.37; p=0.0021), basal glucose (rS 0.30;
p=0.009) and HDL-C (rS -0.25; p=0.03). There was neither univariate
nor multivariate association between AN and the markers of insulin
resistance: base insulinemia (rS 016; p=0.16), HOMA IR (rS 0.2; p=0.06)
and IGF1BP1 (rS 0.07; p=0.69). The presence of AN showed a positive
correlation with BMI (OR:1.30 p=0.018) and a negative one with birth
weight ( OR:0.23 p=0.03) in the multivariate analysis. Conclusions:
There was a high rate of AN in our population (55.4%) of obese adolescents.
There was not a statistical difference in insulin resistance between
obese adolescents with or without AN. There was a positive correlation
between AN and BMI. This suggests that AN is a clinical sign for severe
obesity, but not a reliable marker for insulin resistance in our population.
|
|
97
CARACTERÍSTICAS DO VOCABULÁRIO DE CRIANÇAS ENTRE
22 E 36 MESES: ESTUDO EXPLORATÓRIO
Affonso L, Marcondes Pedromônico M, Sañudo A.
Universidade Federal de São Paulo. São Paulo - Brasil
Resumo: O objetivo deste estudo foi descrever o vocabulário
de uma amostra de crianças de 22 a 36 meses, inseridas no Programa
de Puericultura do Centro de Saúde de Vila Mariana (SP), por
meio de entrevista com o cuidador primário. Para tanto, foram
entrevistadas 30 mães de crianças, sendo 17 (57%) do
sexo masculino e 13 (43%) do sexo feminino, e destas 15 (50%) entre
22 e 28 meses e 15 (50%) entre 29 e 36 meses. Utilizamos a Lista de
Avaliação de Vocabulário Expressivo - LAVE - (Capovilla,
Capovilla, 1997), sob a forma de entrevista com a mãe de cada
criança. Foram calculadas medidas descritivas e empregada para
tratamento estatístico a ANOVA. As crianças da amostra
falaram em média 195 palavras. As crianças do sexo feminino
produziram em média, a mais do que as do sexo masculino, 43
palavras e 2 palavras por frase. Verificamos que houve um acréscimo
estatisticamente significante no vocabulário de acordo com o
aumento da faixa etária. As categorias mais faladas por crianças
da faixa etária estudada foram Pessoas, Partes do Corpo, Ações,
Casa e Objetos. Com isto pôde-se concluir que é possível
caracterizar e detectar crianças de risco para atrasos de emissão
através de informações dos pais.
|
|
97
CHARACTERISTICS OF THE CHILDREN'S VOCABULARY BETWEEN 22 AND 36 MONTHS:
STUDY EXPLORATORY
Affonso L, Marcondes Pedromônico M, Sañudo A.
Universidade Federal de São Paulo. São Paulo - Brasil
Abstract: The aim of this study was describe the vocabulary of children
between twenty-two to thirty-six months, inserted into the toddlers
pediatrician program of the Health Center of Vila Mariana-Sao Paulo,
by interview. 30 children's mothers were interview, 17 (57%) male and
13 (43%) female, and 50%(15) between 22 and 28 months and 50% (15)
between 29 to 36 months. We used the Checklist Assessment of Expressive
Vocabulary (Capovilla, Capovilla, 1997) to interview the mothers. We
calculated the descriptive measures and statistical
The results showed that around two years the children speak 195 words. The girls
speak more 43 words and 2 ords/utterance than the boys. According the growth
of the age the words numbers growth 70% and the MLU growth 1 word. Name of the
Persons, Body, Actions, House and Objects were often spooked. We concluded that
it is possible to characterize the language and detected child in risk to language
delay with two years old by parent's concerns.
|
|
98
MUCOPOLISSACARIDOSES: ESTUDO DESCRITIVO DO VOCABULÁRIO
Diniz CF, Sakata ET, Martins AM, Pedromônico MRM.
UNIFESP-EPM
Justificativa: As mucopolissacaridoses (MPS) fazem parte de um grupo
heterogêneo de doenças crônicas e progressivas,
caracterizadas pelo acúmulo de glicosaminoglicanos em vários órgãos.
O acúmulo desta substância determina sete diferentes quadros
clínicos. Os portadores podem apresentar estatura baixa, hepatomegalia,
opacidade córnea, deficiência auditiva, disfunção
na válvula cardíaca, oclusão da artéria
coronariana, envolvimento articular, deformidades esqueléticas
e retardo mental. A estimativa da incidência de MPS é cerca
de 1:10,000 nascidos vivos.Existem poucos estudos com relação
ao desenvolvimento lingüistico dessas crianças. Objetivo:
Descrever o vocabulário receptivo e expressivo de oito crianças
portadoras de MPS. Casuística: 8 crianças portadoras
de diferentes tipos de MPS, sendo 6 (75%) meninos e 2 (25%) meninas,
com idades entre 5 e 12 anos, selecionadas aleatoriamente entre as
atendidas no Ambulatório Multidisciplinar de Doenças
Metabólicas Hereditárias da UNIFESP-EPM. Destas, 3 (37.5%)
freqüentam escola; 2 (25%) apresentaram problemas perinatal; 7
(87.5%) tiveram otites recorrentes e 5 (62.5%) tiveram atraso de emissão
referidos. Instrumentos: Lista de Avaliação do Vocabulário
Expressivo (LAVE) e Teste de Vocabulário por Imagens Peabody
(TVIP), traduzidos e padronizados para o português brasileiro
(Capovilla & Capovilla,1997). Procedimentos: LAVE preenchida pelos
pais e TVIP aplicado na criança. Resultados classificados como
de acordo ou inferior a idade e analisados descritivamente. Resultados:
4 (50%) crianças realizaram TVIP e foram classificadas como "extremamente
abaixo da idade", sendo 255 o número médio de palavras
obtido na LAVE. As outras 4 (50%) crianças que não realizaram
TVIP, tinham diagnóstico neurológico alterado; 1 com
visão subnormal e hidrocefalia, 1 com deficiência auditiva
e 2 com ausência de emissão oral. Comentários conclusivos:
Crianças com MPS apresentam vocabulário extremamente
empobrecido, o que de maneira geral é apontado como indicador
de déficits cognitivos. Estes resultados correlacionaram-se
com os da Escala de Maturidade Mental Columbia-CMMS (Alves, 2001),
na qual ficou evidenciado o comprometimento da capacidade de raciocínio
geral. Outras formas de avaliação estão sendo
testadas, visando melhor caracterização da linguagem
destas crianças. Embora possamos questionar a validade das aplicações
de instrumentos de avaliação em crianças portadores
de quadros de extrema gravidade, vale ressaltar que o diagnóstico
de MPS não deve interferir negativamente na decisão de
intervenção, buscando qualidade de vida de seu portador.
|
|
98
MUCOPOLYSACCHARIDOSES: DESCRITIVE STUDY OF VOCABULARY
Diniz CF, Sakata ET, Martins AM, Pedromônico MRM.
UNIFESP-EPM
Justified: The mucopolysaccharidoses (MPS) are a heterogeneous group
of chronics and progressives diseases, characterized by the acumulation
of glycosaminoglycans in various organs. The incidence of the MPS disorders
may be as high as 1:10,000 live births. The MPS have been designated
in seven differents clinical findings. They could have short stature,
hepatosplenomegaly, corneal clouding, deafness, cardiac valve dysfunction,
coronary artery occlusion, joint contractures occur, skeletal abnormalities
and mental retard. There are few studies about language development
of these children. Objective: Describing the receptive and expressive
vocabulary of eight children with MPS. Cases: 8 children with differents
types of MPS, 6 (75%) of whom are boys and 2 (25%) of whom are girls
with ages from 5 to 12 years, who are attended in Hereditaries Metabolics
Illness Multi-disciplinary Outpatient Departament at UNIFESP-EPM. Three
(37.5%) of them are studing; 2 (25%) presented perinatal problems;
7 (87.5%) had otitis frequently and 5 (62.5%) had speech delay. Instruments:
The Language Development Survey (LDS) and Peabody Picture Vocabulary
Test (PPVT). These tests were translated and standardized to Portuguese
(Capovilla & Capovilla, 1997). Procedures: LDS filled by parents
and PPVT applied to the child. The results of these tests were classified
in accord with or below age. The analysis was descritive. Results:
The PPVT was executed in 4 (50%) children, who were classified as "extremely
under the age"
and the words medium number in their vocabulary is 255. The others
4 (50%) children who did not make the PPVT, they had altered neurological
diagnostic; 1 with subnormal vision and hydrocephalus; 1 with deafness
and 2 without oral emission. Conclusives commentaries: Children with
MPS present extremely impoverished vocabulary, that on the whole it
is appointed like cognitive deficits indicator. These results are connected
with the Columbia Mental Maturity Scale-CMMS (Alves,2001), in which
was showed the incapacity of general reasoning. Other evaluation ways
are being tested to improve the characterization of language development
with these children. Although we can ask the aplication validity of
evaluation instruments in MPS'children with differents clinical types
of the extreme gravity, we can emphasized that the MPS'diagnostic must
not interfere negatively in the decision of clinical intervention in
search of the life quality of their bearers.
|
|
99
CRIANÇAS NASCIDAS PRÉ-TERMO: DESENVOLVIMENTO AOS 2 ANOS
DE IDADE
Isotani S, Pedromônico M, Perissinoto J, Kopelman B.
Universidade Federal de São Paulo - Escola Paulista de Medicina
JUSTIFICATIVA: A prematuridade e o baixo peso vêm se constituindo
em indicadores de risco para o desenvolvimento infantil.
Existem controvérsias quanto à existência de uma recuperação
no desenvolvimento de recém-nascidos pré-termo, geralmente relatado
por volta dos 24 meses de vida.
OBJETIVO: Caracterizar o desenvolvimento de crianças nascidas pré-termo
e de baixo peso, aos 2 anos de idade, através da comparação
de desempenho com nascidos a termo. Foi também de interesse verificar
os efeitos do sexo e do diagnóstico neurológico neste desenvolvimento.
CASUÍSTICA: 60 crianças, 30 nascidas pré-termo e com peso
ao nascimento inferior a 2000 gramas, constituindo o GPT, e 30 nascidas a termo,
com peso ao nascer superior a 2500 gramas, constituindo o GT.
INSTRUMENTO: TEPSI - Teste de desenvolvimento Psicomotor 2 a 5 anos (Haeussler & Marchant,
1991), que avalia as áreas de Coordenação, Linguagem e Motricidade.
TRATAMENTO ESTATÍSTICO: Utilizou-se o teste "t de student"e
o teste Qui-quadrado para a análise das variáveis numéricas
e categóricas, respectivamente. Os testes Kappa e McNemar foram utilizados
para verificar a concordância entre diagnóstico neurológico
e a classificação do desenvolvimento. Fixou-se em 0,05 ou 5% o
nível de rejeição da hipótese de nulidade.
RESULTADOS: O GPT obteve desempenhos significativamente piores que o GT, nas áreas
de Coordenação (p=0,020), Linguagem (p<0,001) e no teste Total
(p=0,007), independente do diagnóstico neurológico.
O sexo não interferiu no resultado da avaliação de desenvolvimento
(p=0,460). Foi verificada concordância entre o diagnóstico neurológico
e a avaliação do desenvolvimento na área de Motricidade
(Kappa p=0,004).
CONCLUSÃO: A prematuridade e o baixo peso se constituem em risco para
o desenvolvimento da criança nascida pré-termo, sugerindo a necessidade
de acompanhamento multiprofissional visando a intervenção essencial.
|
|
99
PRETERM CHILDREM: DEVELOPMENT AT 2 YEARS OLD
Isotani S, Pedromônico M, Perissinoto J, Kopelman B.
Universidade Federal de São Paulo - Escola Paulista de Medicina
INTRODUCTION: The prematurity and low birth weight have been stablishing
risk indicators to the child development.
There are controversies regarding the existence, and the time of catch up period,
on the preterm newborn development, generally reported around 24 months.
OBJECTIVE: This present research has the objective of pointing out the children
development born preterm and with low birth weight, on the third year of life,
through the comparation of their performance with the ones born on term. It was
also of interest to verify the effects of the gender and neurological diagnoses
on this development.
SAMPLE: 60 children, 30 preterm born weighing less than 2000 grams constituting
the PTG (preterm group), and 30 term born, weighing over 2500 grams, constituting
the TG (term group) constituted the sample.
INSTRUMENT: TEPSI - Psychomotor Development Test 2 to 5 years (Haeussler
& Marchant, 1991),which can be used to assess Coordination, Language
and Motricity.
STATISTICAL METHOD: The t student test and chi-square test were used to analyse
the numerical and categorical variables. And Kappa test and McNemar test were
utilized to show an agreement between the neurological diagnosis and classification
on the developmental test. The significance level was fixed in 0,05 or 5%.
RESULTS: The PTG had meaninful performances worse than the TG, on the Coordination
(p=0,020), Language (p<0,001) and on the whole test (p=0,007), independently
of the neurological diagnosis.
The gender didn't interfere on the results of development (p=0,460). It was verified
an agreement between the neurological diagnosis and the development evaluation
on the Motricity field (Kappa p=0,004).
CONCLUSIONS: There is a need of the multiprofessional program, accompanying or
interfering on the preterm newborns development, once the alteration can manifest
in any field.
|
|
100
PERFIL DA CAPACIDADE DE RACIOCÍNIO GERAL EM CRIANÇAS COM
MUCOPOLISSACARIDOSES
Sakata ET, Presto ACC, Sousa ALT, Martins AM, Pedromônico MRM
Universidade Federal de São Paulo - UNIFESP
Introdução As Mucopolissacaridoses (MPS) decorrem do
acúmulo de glicosaminoglicanos (GAG´s) no interior dos
lisossomos. O diagnóstico é
feito a partir do quadro clínico e da dosagem urinária
de GAG´s sendo confirmado pela demonstração da
deficiência enzimática e estudos moleculares. Existem
sete fenótipos distintos de MPS conforme a deficiência
enzimática específica. A MPS é estimada em 1:10.000
nascidos vivos e a herança
é autossômica recessiva com exceção da MPS
tipo II que tem herança ligada ao X. Em 2002, o levantamento
do número de casos atendidos nos diferentes centros de genética
do Estado de São Paulo, indicou aproximadamente 150 portadores.
A literatura médica especializada refere que nem todos os tipos
de MPS cursaram com retardo mental.
Objetivo Investigar a capacidade de raciocínio geral em crianças
com MPS.Método:15 crianças com MPS, foram aleatoriamente selecionadas
no Ambulatório Multidisciplinar de Doenças Metabólicas Hereditárias
da Universidade Federal de São Paulo (UNIFESP) - Escola Paulista de Medicina
(EPM).As idades variaram entre quatro a nove anos, sendo 11 meninos e 4 meninas.
Todas foram avaliadas por meio da Escala de Maturidade Mental Columbia - CMMS
padronizada para a população brasileira (Alves, 2001) e analisada
qualitativamente ( Kamhi, 1990). Os dados obtidos foram analisados descritivamente.
Resultados Do total avaliado, 10 crianças (66,67%) não compreenderam
a natureza da tarefa, e apenas 5 (33,33%) das crianças, 2 meninas e 3
meninos, realizaram as tarefas propostas pelo CMMS. As classificações
obtidas no Resultado Padrão de Idade (RPI) situou-as dentro da média
esperada em relação
à idade cronológica.Na análise qualitativa das
respostas emitidas aos diferentes itens pelas 5 crianças não
ficaram evidenciadas características próprias a MPS de
menor gravidade da criança.
Conclusões
A CMMS empregada não se aplica a todos os quadros de MPS indicando necessidade
de utilizar outros instrumentos com o objetivo de investigar as habilidades específicas
daqueles com quadros de maior gravidade, visando sempre a qualidade de vida.
|
|
100
PROFILE OF GENERAL REASONING CAPACITY IN MUCOPOLYSACCHARISODIS CHILDREN
Sakata ET, Presto ACC, Sousa ALT, Martins AM, Pedromônico MRM
Universidade Federal de São Paulo - UNIFESP
Introduction:
The MPS (mucopolysaccharidoses), characterized by the accumulation of the substance
glicosaminoglicanus (GAG's) inside lysosomes. Diagnostic is made from the clinic
symptoms and the urine dose of GAG's, being confirmed by the demonstration
of the enzymatic deficiency and molecular studies. Its incidence is estimated
in 1:10.000 born alive, and its inheritance is recessive autosomic, except
MPS II, which has a recessive X-linked inheritance. Recently, different genetic
centers of São Paulo (2002) reported one hundred fifty individuals with
MPS. None of the types reported mental retard. There are seven different phenotypes
of MPS known as responsible for enzymatic specific. The early diagnostic is
necessary for a genetic counseling, a suitable follow-up to provide enzymatic
reposition, willing to decrease the clinical symptomatology of these patients
and the multidisciplinary suitable support, to improve their life quality.Objective
:Investigate the general reasoning capacity in MPS children.Method: Among fifteen
MPS children were randomly selected those in treatment in the Multidisciplinary
Ambulatory for Inherited Metabolic Diseases from Universidade Federal de São
Paulo (UNIFESP) - Escola Paulista de Medicina (EPM).
Eleven boys (73,33%) and four girls (26,66%) from 4 to 9 years old were assessed
with Columbia Mental Maturity Scale (CMMS), standardized for the Brazilian population,
and qualitatively analyzed the data we calculated the descriptive measures
Results: Of all children tested, 10 (66,67%) couldn't understand the task. Only
5 (33,33%) 2 girls and 3 boys, of the MPS children performed the task proposed
by CMMS. The Age-Pattern Results ranked those children in the expected average
related to chronological age, and the Maturity Index showed that their performance
was inferior in 3 and superior in 2 (13,33%) when compared to the pattern children
groups.Qualitative analysis showed that the patients had specific abilities and
difficulties, not related to MPS.Conclusions:Differences in answers involving
specific cognitive abilities were observed. The CMMS used is not useful in all
cases of MPS, showing the need of adaptation in another test, to evaluate the
abilities of those with more serious symptoms of MPS, in order to improve their
life quality.
|
|
101
APORTE Y BIODISPONIBILIDAD POTENCIAL DE MINERALES EN ALIMENTOS COMPLEMENTARIOS
COMERCIALES.
Binaghi M, Ainciburu M, Baroni A, Valencia M, Ronayne de Ferrer Patricia.
Cátedra de Bromatología, Facultad de Farmacia y Bioquímica,
Universidad de Buenos Aires.
Alrededor del sexto mes de vida comienza la introducción de
alimentos complementarios. En el mercado existen diferentes productos
para lactantes que aportarían adecuadas cantidades de diversos
minerales. Sin embargo, la información sobre su biodisponibilidad
es escasa.
El objetivo de nuestro trabajo fue determinar los niveles totales y la dializabilidad
(D%), como estimación de la biodisponibilidad potencial, de calcio (Ca),
hierro (Fe) y zinc (Zn) de trece alimentos comerciales, diez de los cuales están
específicamente diseñados como alimentos complementarios y tres,
que no lo están, pero son de uso habitual. El aporte calórico se
determinó
por combustión en una bomba calorimétrica. Los minerales
se determinaron por espectrometría de absorción atómica,
previa mineralización. La D% de Ca, Fe y Zn fue determinada,
en los alimentos reconstituidos, por medio de un método in vitro
modificado, trabajando en condiciones controladas de pH, luego de una
digestión que simula los procesos fisiológicos. Dado
que ninguno de los productos está fortificado con Zn, se determinó
su D% in vitro sólo en los preparados con leche, ya que ésta
sería la aportadora de Zn.
La adecuación de los niveles de minerales se evaluó según
el enfoque propuesto por la OMS, basado en que, para niños amamantados,
los alimentos complementarios deberían aportar la diferencia entre las
recomendaciones y los niveles presentes en la leche materna. En este contexto,
los valores de Ca fueron cercanos a los recomendados (125mg/100kcal). Los niveles
de Fe, en la mayoría, se encontraron muy por debajo de lo recomendado
(7,7mg/100kcal). Además la D% para este mineral fue muy baja (<5%).
Con respecto al Zn, estos alimentos no están fortificados, y presentan
una baja D% (3,3-6,6%) del Zn aportado por la leche.
Estos resultados constituyen un llamado de atención en cuanto al aporte
de micronutrientes. Es de destacar que los niveles de hierro no fueron adecuados,
a pesar de tratarse de alimentos fortificados. Por lo tanto, sería recomendable
reevaluar los niveles de fortificación con este mineral, así como
contemplar la posibilidad de fortificación con zinc. (Proyectos PICT 0473
y UBACYT B062)
|
|
101
MINERAL LEVELS AND POTENTIAL BIOAVAILABILITY IN COMPLEMENTARY FOODS.
Binaghi M, Ainciburu M, Baroni A, Valencia M, Ronayne de Ferrer
Patricia.
Cátedra de Bromatología, Facultad de Farmacia y Bioquímica,
Universidad de Buenos Aires.
The introduction of complementary foods begins around the sixth month
of age. In the market, there are different products for infants which
would supply adequate amounts of diverse minerals. However, information
about their bioavailability is scarce.
The objective of the present study was to determine calcium (Ca), iron (Fe) and
zinc (Zn) total levels and their dializability (D%), as an estimation of potential
bioavailability, in thirteen commercial products, ten of which are especially
designed as complementary foods, and three, which are not, but are usually consumed.
Caloric value was determined by combustion in a calorimetric bomb. Minerals were
determined by atomic absorption spectrometry (previous digestion). Ca, Fe and
Zn D% was determined, in the reconstituted foods, by a modified in vitro method,
working in pH controlled conditions, after a digestion simulating physiological
processes. Since none of the products is(are) fortified with Zn, its (their)
in vitro D% was determined only in the products prepared with milk, because it
is the supplier of Zn.
The adequacy of mineral levels was evaluated according to the approach proposed
by the WHO, based on the fact that, for breastfed infants, complementary foods
should supply the difference between the recommendations and the levels in human
milk. In this context, Ca values were close to those recommended (125mg/100kcal).
Fe levels, in most cases, were well below the recommended values (7,7mg/100kcal).
Besides, its D% was very low (<5%). Regarding Zn, these products are not fortified
and show a low Zn D% (3,3-6,6%) from milk. Regarding Zn, these are no fortified
products and they even decrease the ZnD% (3.3-6.6%) of milk.
These results constitute an alert regarding micronutrients supply. It is remarkable
that Fe levels were not adequate, even though these products are iron-fortified.
Consequently, it would be advisable to reevaluate iron fortification levels,
as well as consider the possibility of Zn fortification.
(Projects PICT 0473 and UBACYT B062)
|
|
102
VALORACION DEL ESTADO NUTRICIONAL EN NIÑOS EN RIESGO
Clacheo RJ, Cabrera AJ.
El presente trabajo describe la prevalencia del bajo peso y la baja talla existente
en niños de 1 - 6 años que conviven con la pobreza en zonas de
alto riesgo (villas de emergencia) de la ciudad de Buenos Aires. El objetivo
fué conocer la situación nutricional haciendo hincapié en
la prevalencia de bajo peso y baja talla teniendo en cuenta los indicadores
Peso para la Edad (P/E), porcentaje de adecuación de Peso para la Talla
(%P/T) y Talla para la Edad (T/E). Se realizo evaluación antropométrica
a 140 niños de 1-6 años de edad mediante un muestreo consecutivo
sistemático. Se utilizaron los indicadores P/E y T/E de acuerdo a la
población de referencia nacional según la cuantía del
puntaje Z. Dado que se trabajo sobre una población en riesgo se establecieron
puntos de corte sensibles como limite de inclusión (+ 1 SD). Para el
%P/T se utilizó la clasificación de Waterlow con estándares
nacionales. Los resultados mostraron; según el indicador P/E la prevalencia
de bajo peso fue de 25,7 % y según el %P/T el 13,5% de la muestra presenta
una relación disarmónica entre ambas medidas. Según el
indicador T/E existe un 33,6% de niños que se hallan por debajo del
punto de corte establecido, lo que denota un compromiso nutricional sostenido
en el tiempo que influye sobre el crecimiento y el desarrollo del potencial
alcanzable. Dichos resultados observados describen la prevalencia del retardo
del crecimiento de los niños en Argentina; por lo tanto creemos conveniente
implementar una estratégia que se focalice en la atención primaria
de la salud con el fin de captar estos casos con la mayor precocidad posible
y evitar daños irreparables y de alto impacto sobre lo que no muchas
personas saben; que los niños de hoy serán en un futuro no muy
lejano los adultos del mañana.
|
|
102
NUTRITIONAL STATUS VALUATION IN CHILDREN LIVING UNDER RISK SITUATION
Clacheo RJ, Cabrera AJ.
This study describes the distribution of low weight (warsing) and low height
(stunting) in children between 1 and 6 years old living in shantytowns of Buenos
Aires city.
The aim of the study was to know the nutritional status of children, by measuring
the prevalence of growth retardation (low weight -warsing- and low height -stunting-)
using three anthropometric indicators: weight for age, weight for height and
height for age.
An anthropometric evaluation was done over 140 children under 6 years old, 54%
male (75) and 46% female (65) using a systematic consecutive (sequential) pattern.
The indicators weight for age and height for age were expressed in units of standard
deviation from a mean national reference standard with Z score. This study use
sensitive cut-off point because the inmediatly risk situation (+ 1 SD).
The indicator weight for height was used under Waterlow classification with national
reference.
Mean height and weight were of 98 cm (+ 14) and 16 kg (+4) respectively.
According to the W/A indicator, the prevalence of children falling below the
-1 SD cut-off point was 25,7% (wasting); 13,5% of children are inharmonic between
height and weight and 33,6% fall bellow -1SD cut-off point according heigt for
age indicator (stunting).
The results shows the prevalence of growth retardation in Argentina. That's why
we consider it is necessary to perform an strategy focused on the primary health
attention, in order to detect this cases as soon as possible, avoiding irreparable
damages.
|
|
103
ALIMENTOS PARA LACTANTES Y NIÑOS EN LA 1ra. INFANCIA: EVALUACIÓN
DE LA CALIDAD PROTEICA E IDENTIFICACIÓN DE PROTEÍNAS
POR ELECTROFORESIS.
López LB §, Pallaro A ©, Fernandez I©, Langini
S ©, Feliu MS ©, Vidueiros SM ©, Slobodianik N©
© Cátedra de Nutrición. § Cátedra de Bromatología.
Facultad de Farmacia y Bioquímica. Universidad de Buenos Aires.
El objetivo del presente trabajo fue conocer la composición
y calidad proteica de un producto infantil de origen
comercial a base de harina de trigo que declara leche entre sus ingredientes
y en el frente de la caja. Para ello se analizaron muestras de dicho producto
adquiridas en el comercio a lo largo de tres años consecutivos (M1: año
2000, M2: año 2001 y M3: año 2002).
La calidad proteica se evaluó por dos métodos biológicos:
método de la Utilización Proteica Neta (UPN, Binder y Miller) y
el método rápido de Curvas de consumo (CC), expresado este último
como Valor Biológico (VB). Se utilizaron ratas de la cepa Wistar, siguiendo
la metodología estandarizada para cada método. Se realizó además
la identificación de las materias primas proteicas presentes en dichos
productos mediante electroforesis en gel de poliacrilamida con dodecilsulfato
de sodio, utilizando dos solventes de extracción. Los valores obtenidos
para M1 fueron: UPN 67 + 8,5; VB: 76, para M 2: UPN 52 + 14; VB: 50 y para M3:
UPN 59,4 + 4,5; VB: 66,5. La calidad proteica de M1 fue semejante independientemente
del método biológico utilizado; lo mismo se observó para
M2 y para M3. Mediante el cálculo teórico de las posibles mezclas
de harina de trigo: leche y a partir de los datos experimentales, se estimó una
proporción 60:40 para M1, 80:20 para M2 y 70:30 para M3. La separación
electroforética de las proteínas permitió corroborar la
presencia de proteínas de trigo y de proteínas lácteas en
las tres muestras analizadas, sin embargo a través del cálculo
de áreas de picos de proteínas lácteas se observó que
la muestra M2 tiene el 50 % de las mismas con respecto a M1 y que la muestra
M3 tiene un 40 % más que la M2. Ambos métodos biológicos
permitieron evaluar modificaciones de la calidad proteica en las muestras analizadas,
datos corroborados por la metodología electroforética. La información
obtenida sugiere que las modificaciones observadas se deberían al agregado
de distintas cantidades de leche en los tres años en que se efectuó el
estudio.
|
|
103
INFANT FOODS: PROTEIN QUALITY EVALUATION AND ELECTROPHORETICAL
IDENTIFICATION.
López LB, Pallaro A, Fernandez I, Langini S, Feliu MS,
Vidueiros SM, Slobodianik N
Department of Nutrition and Bromatology. School of Pharmacy and Biochemistry.
University of Buenos Aires.
The aim of this study was to evaluate the protein composition and
protein quality of a commercial product elaborated with wheat; also
this product declares milk among its components and in the front of
the box. Samples adquired in the market were analized along three years
consecutively (M1: year 2000, M2: year 2001 y M3: year 2002).
Protein quality was evaluated using Net Protein Utilization Method (NPU, Bender
and Miller) and a Rapid Method (CC),described by Farina et al expressed as Biological
value (BV). Wistar rats of the breeding unit of the Department of Nutrition and
Bromatology, School of Pharmacy and Biochemistry, University of Buenos Aires,
were used; standarized conditions were followed. The identification of proteins
present in the commercial product were determined by poliacrylamide gel electrophoresis
using two extraction solvents.
The data obtained was: M1: NPU 67+8,5; BV: 76; M2: NPU 52+14; B: 50 and M3: NPU
59,4+4,5; BV: 66,5. M1 protein quality was approximately the same for both methods;
the same behaviour was observed for M2 and M3. Using the possible theorical proportions
of Wheat flour : Milk and the experimental data, it was stimated a proportion
of proteins of 60:40 for M1, 80:20 for M2 and 70:30 for M3. The electrophoretic
separation of proteins showed the presence of milk and wheat proteins in the
three samples; moreover, milk protein of M2 was the 50% of M1 and milk protein
of M3 was 40% more than M2.
Both biological methods (NPU and CC) allow the evaluation of protein quality
changes in the analized samples, data confirmed by electrophoretic methodology.
These results suggest that the observed modifications would be due to different
proportions of milk incorporated in the commercial product along the studied
three years.
|
|
104
ESTUDIO COMPARATIVO ENTRE CANASTA BÁSICA DE ALIMENTOS, PIRÁMIDE
ALIMENTARIA Y RECOMENDACIONES PARA PREESCOLARES Y ESCOLARES CHILENOS.
Díaz X, Neri D, Moraga F, Rebollo M, Olivares S, Castillo
CD.
S. Pediatría H. San Borja-Arriarán, Dpto. de Pediatría,
Fac. Medicina e INTA - U. de Chile, Santiago - Chile.
Las canastas básicas de alimentos (CBA) se han elaborado para
evaluar pobreza y patrón mínimo de consumo de macronutrientes;
como guía alimentaria se han propuesto alternativas, como una
pirámide alimentaria (PA). No se conoce la relación entre
ambos instrumentos.
OBJETIVO: Analizar el consumo de nutrientes de preescolares (PE) y escolares
(ES) de una familia de referencia chilena de nivel socioeconómico bajo,
de acuerdo a la CBA urbana y compararla con las recomendaciones internacionales
y con la PA chilena.
METODOLOGÍA: Se asumió para los efectos alimentarios una familia
con 2 hijos (4 y 10 años) y una estimación de consumo proporcional
a la canasta según recomendaciones de energía (E). Se asumió una
frecuencia de consumo semanal diferente para los grupos de alimentos por la familia
de referencia. Los estándares utilizados fueron RDA 1989; RDI 2000; OMS
1996 para zinc y FAO-OMS 2002 para energía.
RESULTADOS: El consumo de E fue 122% para el PE y 89% para el ES comparado con
el estándar. El % de energía proveniente de las grasas de la canasta
estuvo de acuerdo con las recomendaciones (22%; 7% de grasa saturada). La fibra
dietaria estuvo basada en elevado consumo de pan (70% del total). El consumo
de Calcio fue 31% del recomendado para PE y 29% para ES; con Zinc fueron 76%
para PE y 73% para ES de la recomendación.
CONCLUSIONES: La canasta básica de alimentos presenta deficiencias en
aportes de calcio y zinc; la pirámide de alimentos está
excedida en proteínas y deficiente en zinc. Se justifica reanalizar
ambos instrumentos.
|
|
104
COMPARATIVE STUDY BETWEEN BASIC FOOD BASKET, FOOD PYRAMID AND RECOMMENDATIONS
FOR CHILEAN PRESCHOOL AND SCHOOL CHILDREN.
Díaz X, Neri D, Moraga F, Rebollo M, Olivares S, Castillo
CD.
S. Pediatría H. San Borja-Arriarán, D. Pediatría Fac. Medicina
e INTA U. de Chile.
The basic food baskets (BFB) have been developed to evaluate poverty
and minimum pattern of food consumption in many countries, including
Chile. Different alternatives, such as a food pyramid (FP), have been
proposed as nutritional guides. The relationship among both tools is
unknown.
OBJECTIVE: To analyze the nutrient intake of children belonging to a Chilean
family reference from low income groups, and to compare it with the recommendations
and the Chilean FP.
METHODOLOGY: A family having 2 children, 4 and 10 years old (preschool-PS, and
school-SC, respectively) was taken to analyze the feeding based on the BFB. We
assumed a proportional rate of intake according to normal energy (E) recommendations
by age and gender. The standards for nutrient consumption were those of RDA 1989,
RDI 2000, FAO-WHO 2002 for energy and WHO 1996 for zinc.
RESULTS: The E consumption with the BFB was 122% for the PS and 89% for the SC
in relation to the recommendations. The rate of energy provided by fats was in
agreement with the recommendations (22%, with 7% from saturated fats). The dietary
fiber intake was based on a high bread consumption (70% of the total). The intake
of calcium was 31% of the recommendations for PS and 29% for SC; zinc intake
was 76% for PS and 73% for SC as compared to the WHO 1996 recommendations.
CONCLUSIONS: The basic food basket does not provide adequate amounts of calcium
and zinc; the Chilean food pyramid for children is exceeded in proteins and deficient
in zinc. The reanalysis of both tools is recommended.
|
|