Minerals in the nutrition of extremely low birth weight infants

Objective: To review the literature on the role of calcium, phosphorus and trace elements in the nutrition of extremely low birth weight infants, considering their importance for metabolism, bone mineralization and as dietary components. Sources of data: MEDLINE, the Cochrane Database of Systematic Reviews and books on nutrition were searched between 1994 and 2004. Original research studies and reviews were selected. Summary of the findings: Extremely preterm infants are frequently growth-restricted at hospital discharge as a consequence of difficulties in the provision of adequate nutrition. The long-term effects of this growth restriction need to be determined. There is a paucity of studies about the role of minerals, especially micronutrients, in the nutrition of extremely preterm infants. The principal focus of this review was on calcium and phosphorus metabolism, bone mineralization and parenteral and enteral supplementation. A critical evaluation of post-discharge nutrition and its influence upon growth and bone mineralization was presented. Selenium and zinc requirements and the role of selenium as an antioxidant with possible effects on free radical diseases of the preterm infant were discussed. Conclusions: Extremely preterm infants have low mineral reserves and, as a consequence, may have deficiencies in the postnatal period if they do not receive parenteral or enteral supplementation. More studies are needed to elucidate the actual requirements and the appropriate supplementation of micronutrients. There are controversies about the outcome and the influence of post-discharge nutrition on bone disease of prematurity. Copyright © 2005 by Sociedade Brasileira de Pediatria.

Analisando conhecimentos e práticas de agentes educacionais e professoras relacionados à alimentação infantil

Objetivou-se identificar os conhecimentos e as práticas relacionados à alimentação de crianças entre zero e três anos, a fim de complementar a formação das profissionais que trabalham com crianças, na área da educação nutricional. O procedimento metodológico seguiu as orientações do estudo de caso, com abordagem qualitativa. Os saberes e as práticas das participantes do estudo foram analisados por meio de questões abertas e fechadas e das observações dos tópicos relacionados à nutrição infantil, juntamente com os dados sobre a formação dessas profissionais. Pode-se concluir que tanto as agentes educacionais quanto as professoras de Ensino Infantil são detentoras de um conhecimento sobre Nutrição Infantil, porém a preocupação maior destas foi atender as necessidades nutricionais das crianças por meio de uma boa alimentação, deixando, em segundo plano, as atividades pedagógicas, as quais poderiam ser realizadas em um programa de educação nutricional, construído coletivamente e inserido no projeto político-pedagógico da escola.

Evolução e determinantes de incremento de peso (por altura e idade) em crianças de dois a 72 meses em Sorocaba, São Paulo: evidências a partir de estudo quase-experimental seriado.

OBJETIVOS: recupera-se síntese dos principais aspectos das publicações referentes a projeto conduzido pela equipe, na década passada, com o objetivo de subsidiar a avaliação de política pública setorial de suplementação alimentar na infância. MÉTODOS: acompanharam-se trimestralmente, durante um ano, indicadores de crescimento e desenvolvimento em populações periféricas de dois a 72 meses de idade, em Sorocaba, São Paulo. Após realização do censo infantil de duas regiões da cidade, as crianças freqüentes a creches (em número de 164) foram comparadas às demais (280). O impacto nutricional foi quantificado através de análises univariadas (testes inferenciais Kappa e de Goodman) e multivariadas. Vieses e confundimento foram averiguados e controlados. RESULTADOS: observou-se, entre muitas outras informações obtidas, que o grupo assistido apresentou: 1) idade média superior; 2) menor taxa de aleitamento natural; 3) menores valores de peso/altura à admissão, com maiores ganhos durante a evolução; 4) essa melhora aumentou com a duração da exposição e foi maior entre os mais velhos. CONCLUSÕES: avalia-se que assistir apropriadamente pré-escolares constitui hoje, em nosso meio, relevante imperativo de ordem social.

Capacidade materna de cuidar e desnutrição infantil

OBJETIVOS: Identificar e medir a magnitude do risco de desnutrição associada a fatores determinantes da capacidade materna de cuidado infantil: estrutura familiar, escolaridade, trabalho, saúde física e saúde mental maternas. MÉTODOS: Delineou-se um estudo de casos e controles. Foram selecionados 101 casos (crianças com peso/idade abaixo do percentil 5) e 200 controles (crianças com peso/idade acima do percentil 25) mediante inquéritos antropométricos realizados durante três Dias Nacionais de Vacinação, em 1996 e 1997. Os dados foram obtidos em entrevistas realizadas nos domicílios com as mães das crianças. Para detectar o efeito-líquido de cada fator em estudo, realizou-se análise de regressão logística multivariada e hierarquizada. Tais fatores e as possíveis variáveis de controle foram agrupados em blocos, ordenados segundo a precedência com que influiriam sobre o estado nutricional infantil. Adotaram-se p<0,20 para seleção das variáveis de controle (mediante análise univariada) e p<0,05 para identificação de associação estatisticamente significativa entre fatores de estudo e desnutrição infantil. RESULTADOS: Foram identificados como fatores de risco de desnutrição: (a) estrutura familiar adversa indicada pela ausência de companheiro (odds ratio [OR] = 2,2; IC95%, 1,1-4,5); (b) internação materna durante a gravidez (OR=3,5; IC95%, 1,6-7,7); (c) precária saúde mental materna expressa pela presença de três a quatro sintomas de depressão (OR=3,1; IC95%, 0,9-10,3); (d) fatores de estresse familiar, no caso, indícios de alcoolismo em pelo menos um membro da família (OR=2,1; IC95%, 1,2-3,9). A idade da criança no início/retorno da mãe ao trabalho também se associou de modo independente à presença de desnutrição, porém os efeitos variaram: retorno precoce (criança com menos de quatro meses) não significou risco ou proteção; volta da mãe ao trabalho quando a criança tinha entre quatro meses e 12 meses constituiu fator de proteção. CONCLUSÕES: Evidenciou-se que fatores potencialmente definidores da capacidade materna de cuidado exercem efeito independente sobre o estado nutricional infantil.

Prácticas de alimentación complementaria en niños dentro del primer año de vida

This study aimed to investigate complementary feeding practices during children's first year of life in Botucatu, SP, Brazil. Practices were described according to the age range and the breastfeeding (BF) practice. Data were collected during a multi-vaccination campaign through the interview of 1,238 individuals who accompanied children younger than one year old being vaccinated. Differences associated with the BF situation were identified by the chi-square test and Fisher's exact test. The early introduction of complementary food was observed, which led to the low frequency of exclusive breastfeeding (36.9% <4 months). Children younger than 4 months old consumed tea (30.7%); children between 4 and 6 months old consumed fruits (54.1%), soups (39.9%) and home-made food (19.2%). Juice was offered only to 15.2% of children younger than 4 months old who were completed weaned, 60% of the children was offered water. Data show that the consistence of the food consumed was inappropriate: children between 6 and 8 months old were offered the family's regular food (48.8%) and children older than 8 months (71.6%) were offered soup. Therefore, interventions focused on complementary feeding are justified on the city.

Social support and infant malnutrition: a case-control study in an urban area of Southeastern Brazil

The relationship between malnutrition and social support was first suggested in the mid-1990s. Despite its plausibility, no empirical studies aimed at obtaining evidence of this association could be located. The goal of the present study was to investigate such evidence. A case-control study was carried out including 101 malnourished children (weight-for-age National Center for Health Statistics/WHO 5th percentile) aged 12-23 months, who were compared with 200 well-nourished children with regard to exposure to a series of factors related to their social support system. Univariate and multiple logistic regressions were carried out, odds ratios being adjusted for per capita family income, mother's schooling, and number of children. The presence of an interaction between income and social support variables was also tested. Absence of a partner living with the mother increased risk of malnutrition (odds ratio 2.4 (95 % CI 1.19, 4.89)), even after adjustment for per capita family income, mother's schooling, and number of children. The lack of economic support during adverse situations accounted for a very high risk of malnutrition (odds ratio 10.1 (95 % CI 3.48, 29.13)) among low-income children, but had no effect on children of higher-income families. Results indicate that receiving economic support is an efficient risk modulator for malnutrition among low-income children. In addition, it was shown that the absence of a partner living with the mother is an important risk factor for malnutrition, with an effect independent from per capita family income, mother's schooling, and number of children.

Growth and developmental outcomes of the extremely preterm infant

Objetive: To provide information for pediatricians and neonatologists to create realistic outcome expectations and thus help plan their actions. Sources of data: Searches were made of the Cochrane Library, MEDLINE, and Lilacs databases. Summary of the findings: The assessment of growth and development over the first 2-3 years must adjust chronological age with respect of the degree of prematurity. There is special concern regarding the prognoses of small for gestational age preterm infants, and for those with bronchopulmonary dysplasia. Attention must be directed towards improving the nutrition of extremely low birth weight infants during their first years of life; these infants have high prevalence levels of failure to catch-up on growth, diseases and rehospitalizations during their first 2 years. They are frequently underweight and shorter than expected during early childhood, but delayed catch-up growth may occur between 8 and 14 years. Extremely low birth weight infants are at increased risk of neurological abnormalities and developmental delays during their first years of life. Educational, psychological, and behavioral problems are frequent during school years. Teenage and adult outcomes show that although some performance differences persist, social integration is not impaired. Conclusions: The growth and neurodevelopment of all ELBW infants must be carefully monitored after discharge, to ensure that children and their families receive adequate support and intervention to optimize prognoses. Copyright © 2005 by Sociedade Brasileira de Pediatria.

Selenium and vitamin A and E in the nutrition of very low-birth weight preterm infants

Deficient antioxidant defenses in preterm infants have been implicated in diseases such as bronchopulmonary dysplasia, retinopathy of prematurity, necrotizing enterocolitis, periventricular leukomalacia, and intraventricular hemorrhage. The antioxidant properties of selenium, vitamin A, and vitamin E make these elements important in the nutrition of Very Low-Birth Weight (VLBW) infants. Selenium is a component of glutathione peroxidase, an enzyme that prevents the production of free radicals. The decrease in plasma selenium in VLBW infants in the first month after birth makes evident that preterm infants have low selenium store and require supplementation by parenteral and enteral nutrition. A meta-analysis, with only three trials, showed that selenium supplementation did not affect mortality, and the incidence of neonatal chronic lung disease or retinopathy of prematurity, but was associated with a reduction in lateonset sepsis. Most VLBW infants and extremely Low-Birth Weight Infants (ELBW) are born with low vitamin A stores and need vitamin A supplementation by intramuscular or enteral route. Low plasma retinol concentrations increase the risk of chronic lung disease/bronchopulmonary dysplasia and long-term respiratory disabilities in preterm infants. There is evidence that vitamin A supplementation decreases the mortality or oxygen requirement at one month of age, and oxygen requirement at 36 weeks’ postmenstrual age. Vitamin E blocks natural peroxidation of polyunsaturated fatty acids from lipid layers of cell membranes. VLBW infants have a decrease in plasma concentrations in the first month after birth suggesting the need of vitamin E supplementation. A meta-analysis on vitamin E supplementation concluded that vitamin E did not affect mortality, risk of bronchopulmonary dysplasia, and necrotizing enterocolitis but reduced the risk of intraventricular hemorrhage and increased the risk of sepsis. Serum vitamin E concentrations higher than 3.5 mg/dL are associated with a decrease in the risk of severe retinopathy of prematurity, and blindness, but also with an increase in neonatal sepsis. Caution is recommended with the supplementation of high doses of parenteral vitamin E and supplementation that increases serum levels above 3.5 mg/dL. In conclusion: although it is known that preterm infants are deficient in selenium, vitamin A and E, more studies are required to determine the best way to supplement and the impact of supplementation on neonatal outcome.

EFFECTS of MINERAL NUTRITION on INTER- and INTRASPECIFIC INTERFERENCE of PEANUT (Arachis hypogaea L.) and HAIRY BEGGARTICKS (Bidens pilosa L.)

The present work was carried out to study the effects of mineral nutrition on peanut (Arachis hypogaea L) cv. IAC Runner-886 and hairy beggarticks (Bidens pilosa L) growth, when submitted to inter- and intraspecific competition. The treatments consisted of two peanut plants per pot, two hairy beggarticks per pot and one plant of each species per pot. The plants were nourished with Hoagland and Arnon (1950) complete solution, or without potassium, or without phosphorus or without nitrogen. Sixty days after planting, no inter- or intraspecific competition effect on growth characteristics of peanut was verified and nutrition was not a limiting factor to the culture. No interaction between competition and nutrition effects was observed for both species. The weed suffered more negative effects from intraspecific competition and nutrition. The absence of N had a pronounced effect compared to the other elements, resulting in a reduction in all the evaluated characteristics. The deficiency of nutrients and competition affected the weed more than the crop, showing that peanut was more competitive than hairy beggarticks.

Growth and mineral nutrition of Solanum americanum

Um experimento em casa de vegetação foi conduzido entre novembro de 1995 e abril de 1996 na FCAV/UNESP, Brasil, objetivando estudar a produção de matéria seca, a distribuição e o acúmulo de macronutrientes por Solanum americanum - uma importante planta infestante de culturas anuais e perenes no Brasil. As plantas foram cultivadas em vasos de 7 L com substrato de areia, os quais foram irrigados diariamente com solução nutritiva de Hoagland & Arnon. O delineamento experimental foi inteiramente casualizado, com quatro repetições. Os tratamentos corresponderam às épocas de avaliação, em intervalos de 14 dias, iniciando-se 21 dias após a emergência (DAE). em cada avaliação, as plantas de quatro vasos foram analisadas quanto à produção de matéria seca e ao conteúdo de macronutrientes. S. americanum apresentou pequeno acúmulo de matéria seca e de macronutrientes no início da fase experimental. Esses acúmulos intensificaram-se após 77 DAE, atingindo o máximo valor teórico aos 142, 142, 164, 149, 140, 149 e 152 DAE, para matéria seca, N, P, K, Ca, Mg e S, respectivamente. K e N foram os macronutrientes acumulados em maior quantidade por plantas de S. americanum.

Growth and mineral nutrition of Ipomoea quamoclit

Um experimento em casa de vegetação foi conduzido entre novembro de 2006 e abril de 2007, na FCAV/UNESP, Brasil, objetivando estudar a produção de massa seca, a distribuição e o acúmulo de macronutrientes por Ipomoea quamoclit, uma importante planta infestante de culturas anuais e perenes no Brasil. As plantas foram cultivadas em vasos de 7 L com substrato de areia, que foram irrigados diariamente com solução nutritiva de Hoagland & Arnon. O delineamento experimental foi inteiramente casualizado, com quatro repetições. Os tratamentos corresponderam às épocas de avaliação, em intervalos de 14 dias, iniciando-se 21 dias após a emergência (DAE). em cada avaliação, as plantas de quatro vasos foram analisadas quanto à produção de massa seca e ao conteúdo de macronutrientes. I. quamoclit apresentou pequeno acúmulo de massa seca e de macronutrientes no início da fase experimental. Esses acúmulos intensificaram-se após 77 DAE, atingindo o máximo valor teórico aos 146, 143, 140, 149, 142, 153 e 124 DAE, para massa seca, N, P, K, Ca, Mg e S, respectivamente. K e N foram os macronutrientes acumulados em maior quantidade por plantas de I. quamoclit.

Balancing guava nutrition with liming and fertilization

A resposta da goiabeira à calagem e à adubação pode ser monitorada por análises de tecido vegetal. O perfil nutricional é definido em relação a padrões de teores de nutrientes. No entanto, os teores de nutrientes-padrão são constantemente criticados por não considerarem as interações que ocorrem entre nutrientes e por gerarem tendências numéricas, decorrentes da redundância dos dados, da dependência de escala e da distribuição não normal. As técnicas de análise composicional de dados podem controlar esses dados tendenciosos, equilibrando os grupos de nutrientes, tais como os envolvidos na calagem e na adubação. A utilização das relações log isométricas (ilr) ortonormais, sequencialmente dispostas, evita tendências numéricas inerentes aos dados de composição. Os objetivos do trabalho foram relacionar o balanço de nutrientes dos tecidos vegetais com a produção de goiabeiras em pomares de 'Paluma' diferentemente corrigidos e adubados, e ajustar os atuais padrões de nutrientes com a faixa de equilíbrio das goiabeiras mais produtivas. Um experimento de calagem de sete anos e três, experimentos de três anos com doses de N, P2O5 e K2O, foram conduzidos em pomares de goiabeiras 'Paluma' em um Latossolo Vermelho-Amarelo. Os teores de N, P, K, Ca e Mg na planta foram monitorados anualmente. Selecionaram-se os balanços [N, P, K | Ca, Mg], [N, P | K], [N | P] e [Ca | Mg] para separar os efeitos da calagem (Ca-Mg) e dos fertilizantes (N-K) nos balanços de macronutrientes. Os balanços foram mais influenciados pela calagem do que pela fertilização. A produtividade das goiabeiras e seu balanço nutricional permitiram a definição de faixas de equilíbrio de nutrientes e sua validação com as faixas de concentrações críticas atualmente utilizadas no Brasil e combinadas em coordenadas ilr.

Effect of liming on the mineral nutrition and yield of growing guava trees in a typic hapludox soil

High soil acidity influences the availability of mineral nutrients and increases that of toxic aluminium (Al), which has a jeopardizing effect on plant growth. The objective of this research was to evaluate the effects of soil liming on the development of guava (Psidium guajava L.) plants, on soil chemical characteristics, and on fruit yield. The experiment was carried out at the Bebedouro Citrus Experimental Station, state of São Paulo, Brazil, in a Typic Hapludox soil, from August 1999 to March 2003. The treatments consisted of limestone dose: D0 = zero; D1 = half dose; D2 = total dose; D3 = 1.5 times the dose, and D4 = 2 times the dose to raise the V value to 70%. The doses corresponded to zero, 1.85, 3.71, 5.56, and 7.41tha(-1) applied to the upper soil layer (0-30cm deep) before planting. The results showed that liming caused an improvement in the evaluated soil chemical characteristics up to a depth of 60cm in soil samples both in the line and between lines. The highest fruit yields were obtained when the base saturation reached a value of 55% in the line and 62% between the lines. Foliar levels of calcium (Ca) and magnesium (Mg) were 8.8 and 2.5gkg-1, respectively. The highest limestone dose maintained the soil base saturation (at the layer of 0-20cm) in the line close to 55% during at least 40 months after the incorporation of limestone.

PHOSPHORUS EFFECTS IN THE NUTRITION and GROWTH of DEVELOPING MANGO PLANTS

The objective was to study the effects of phosphorous (P) fertilization on nutritional and developmental aspects of growing mango plants. The mango plants were evaluated by soil chemical analyses, leaf chemical analyses, biological examination of plant growth, and the starting point of fruit production. Having this in view, an experiment was set up on 2 January 2003, at Flora, a farm in Uberlandia, state of Minas Gerais, Brazil. The soil was a clayish Oxisol. The doses at planting were: D0 = zero, D1 = 40, D2 = 100, D3 = 200, and D4 = 300 g of P2O5 plant-1. These doses at the beginning of the second year were multiplied by 1.5 and at the beginning of the third year by 2.0 and applied to the plants. The fertilizer used in this experiment was triple superphosphate (44% of P2O5.). During August of 2004, 2005, and 2006, soil samples were taken at a depth of 20 cm in between the plant rows. Leaf samples were taken during August of 2004 and 2005 to determine macro- and micronutrient contents in the leaves. Plant stem diameter was measured during January of 2004 and 2005. Plant height and crown radius were measured during January of 2005 and fruit production in 2005 and 2006. Fertilizer applications increased the level of P in the soil but significantly influenced plant performance only after the second year. The effects of phosphorus on mango plants take place slowly leading to increments in plant stem diameter only at the third year. Fruit set was not influenced by phosphorous fertilization.

Nutrition, dry matter accumulation and partitioning and phosphorus use efficiency of potato grown at different phosphorus levels in nutrient solution

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)