Resposta metabólica de pacientes cirróticos (Child A) ao aumento da ingestão protéica e/ou calórica. Estudo do balanço nitrogenado.

The dietary protein assimilation by cirrhotic undernourished patients (lower lean body mass and plasma TBPA and RBP levels) was investigated in five-adult male subjects suffering from histologically diagnosed liver cirrhosis, in its clinically mild stage (Child-Turcotte-Pugh grade A). During the 9 day-dietary study the patients received orally a sequence of complete-regional diets containing different protein-energy compositions identified as (g prot/Cal/kg/day): D0 = 0.42/20.9; D1 = 0.91/37.5; D2 = 0.99/47.9 and D3 = 1.60/40.5. The respective N-balance values (g/day) found were (mean +/- SD): low protein calorie (D0) = -4.24 +/- 2.46; normal protein calorie (D1) = 0.66 +/- 1.99; normal protein-high calorie (D2) = 1.14 +/- 2.54; high protein normal calorie (D3) = 5.12 +/- 2.48. The correspondent urea-N output (g/kg/day) were D0 = 0.22 +/- 0.100; D1 = 0.238 +/- 0.099; D = 0.20 +/- 0.063 and D3 = 0.310 +/- 0.121. The present data thus suggest that protein rather than energy intake would be the limited factor for increasing the N-retention in (mild) cirrhotic patients whom tolerate well dietary protein at either normal or elevated levels.

Anemia em crianças menores de dois anos atendidas nas unidades básicas de saúde no Estado de São Paulo, Brasil

The present study sought to determine the prevalence of anemia in 2,992 children, aged between 6 and 23 months, who voluntarily attended 160 Basis Health Care Units, located in 63 cities of the 5 Regional Health Coordinating areas of the State of S. Paulo, Brazil. Blood samples were collected by venous puncture and hemoglobin was measured by the cianometahemoglobin method. The WHO criteria for the diagnosis of anemia (Hb < 11.0 g/dl) were used: 59.1% of the children were shown to be anemic, with prevalence varying from 47.8% to 68.7% in the 5 RHCs. RHC 1, which comprises the Greater S. Paulo Region, presented a prevalence of anemia significantly lower than the other 4 RHCs, which cover the rest of the State. Hemoglobin levels 9.5 g/dl were found in 25.1% of the children. Anemia was more frequent in male children in male children, in those born, with a weight of less than 3,000 gr, in those who were breastfed for less than 2 months and in those that who presented some degree of energy deficient proteic malnutrition, according to Gomez's criteria. This is the first of a series of 4 articles whose purpose is the determining the prevalence of anemia in the State of S. Paulo and of testing the intervention alternatives with a view to curtailing the incidence of this pathology which today is the most prevalent nutritional disturbance in the world.

Antropometria de atletas culturistas em relacao a referencia populacional

Body builders have as their training goals the maximum muscle hypertrophy with minimum adiposity. However, the scarcity of specific standards implies often in framing wrongly those athletes either as overweight (by their BMI) or energy malnourished (by their fat stores). The objective of this study was to compare the body composition of body builders with population standards. Thirty-six adults, 26 male (27.2 ± 7.2 years) and 10 female (30 ± 6.1 years) nationwide competitive body builders, were assessed considering weight, height, body mass index, adiposity, arm and leg circumferences and skinfolds. The data were referred either as percentile or standard deviations (Z score) of population standards. Body weight and height were among the closest values from the populational mean whereas upper arm muscle circumference (for men) and body adiposity (for women) were the farterest. By using fat parameters as indicators of their protein-energy status, the undernourishment was found in 88.5% of men and 100.0% of women. Thus, it seems that body builders deserve their own anthropometric standards to avoid nutritional status misplacements.

Phosphorus foliar fertilization in guava trees

Currently there is very little information on the response of fruiting perennial plants to applied P. This is especially true for tropical production areas where soils have a high capacity of P fixation, and are poor in native phosphorus. An alternative to soil P fertilization, which is inefficient in fixing soils, is to apply phosphorus as a foliar spray. P is quickly absorbed by leaves, and is redistributed quite well through the plants because its phloem mobility, and foliar application may be a viable practice. The purpose of this present work, is to determine the effectiveness of foliar P application on the nutritional status and yield of guava. The experiment was done in a Typic Hapludox, for three consecutive agricultural years, in an adult orchard of 'Paluma' guava. Five treatments were tested: four rates leaf applications of P (0-0.5-1.0 and 2.0% of P2O5) and a control where P was applied to soil (200 g of P2O5/plant). Through the results it was verified that the foliar application of P altered the concentration of the nutrient in the soil (13 to 48 mg dm-3 P-resin), and in the guava leaves (1.2 to 1.8 g of P kg-1), but did not affect the production of fruits. In conclusion, in field conditions, it is viable to combine the phosphorus foliar fertilization with disease control, without increasing the operations and, consequently, the production cost.

Nutrients foliar content for high productivity cultivars of guava in Brazil

Commonly grown in tropical and sub-tropical regions, guava (Psidium guajava L.) is an important fruit crop of Brazil. It is cultivated on a large scale in São Paulo state, and covers about 6,500 hectares. As a result of the guava selection program developed at FCAV/UNESP, two new cultivars were created: 'Rica' and 'Paluma' with a high productivity, and also with higher nutritional requirement. Leaves analysis has become a powerful tool in mineral-nutrition research with fruit crops, not only to determine response to different nutrients, but also for diagnostic techniques in making fertilizer recommendations and assessing deficiency symptoms. Nutrient composition of the leaves varies depending on the leaf maturity, tree age, variety and nutrient supply. For the interpretation of analytical values, selection of the index tissue is important. The results of experiments conducted in the field during 1989-2000 were studied. The nutritional status was evaluated by annual leaf sampling, carried out at full bloom. Recent fully developed leaves, corresponding to the third pair (with the petiole) were collected, starting at the end of the branch, all around the tree, at a height of 1.5 m from the soil, with a total of 30 leaf pairs per sample. The yield was evaluated by weighing all the fruits in the useful area of each lot. Foliar chemical analysis showed excellent correlation with the fruit production. Through the results it was verified that the maximum yield was associated to the following levels: N = 22-26; P = 1.5-1.9; K = 17-20; Ca = 11-15; Mg = 2.5-3.5; S = 3.0-3.5 g kg -1; B = 20-25; Cu = 10-40; Fe = 50-150; Mn = 180-250; Zn = 25-35 mg kg-1 DW in the leaves of the 'Rica' guava and to N = 20-23; P = 1.4-1.8; K = 14-17; Ca = 7-11; Mg = 3.4-4.0; S = 2.5-3.5 g kg-1; B = 20-25; Cu = 20-40; Fe = 60-90; Mn = 40-80; Zn = 25-35 mg kg-1 DW in the leaves of the 'Paluma' guava.

Cytokines and dietary energy restriction in stable chronic obstructive pulmonary disease patients

Tumour necrosis factor (TNF)-α has been found to be increased in malnourished chronic obstructive pulmonary disease (COPD) patients; however, the main cause of this phenomenon remains undetermined. In normal subjects, TNF-α production may be induced by dietary energy deprivation. The aim of this study was to investigate if stable COPD patients present alterations of inflammatory mediators after 48 h of dietary energy restriction. Fourteen COPD patients were admitted to the hospital while receiving an experimental diet with an energy content of approximately one-third of their energy needs. Clinical evaluation, nutritional assessment and serum levels of interleukin (IL)-6, TNF-α and C-reactive protein, and secretion of TNF-α by peripheral blood monocytes were assessed on admission and after the experimental diet. For reference values of the laboratory parameters, blood was collected from 10 healthy, elderly subjects. COPD patients showed significantly higher serum concentrations of IL-6 than control subjects, however, the experimental diet was not associated with statistically significant changes in the inflammatory mediators. The findings of this study, although preliminary because of the limited degree and duration of the energy restriction, suggest that the elevated levels of tumour necrosis factor-α, previously described in undernourished or weight-losing chronic obstructive pulmonary disease patients, may not be linked to a decrease of dietary energy intake.

Evaluation of a protein deficient diet in rats through blood oxidative stress biomarkers

Protein malnutrition leads to functional impairment in several organs, which is not fully restored with nutritional recovery. Little is known about the role of oxidative stress in the genesis of these alterations. This study was designed to assess the sensitivity of blood oxidative stress biomarkers to a dietary protein restriction. Male Wistar rats were divided into two groups, according to the diet fed from weaning (21 days) to 60 day old: normal protein (17% protein) and low protein (6% protein). Serum protein, albumin, free fatty acid and liver glycogen and lipids were evaluated to assess the nutritional status. Blood glutathione reductase (GR) and catalase (CAT) activities, plasma total sulfhydryl groups concentration (TSG) as well as plasma thiobarbituric acid reactive substances (TBARs) and reactive carbonyl derivatives (RCD) were measured as biomarkers of the antioxidant system and oxidative damage, respectively. The glucose metabolism in soleus muscle was also evaluated as an index of stress severity imposed to muscular mass by protein malnutrition. No difference was observed in muscle glucose metabolism or plasma RCD concentration between both groups. However, our results showed that the low protein group had higher plasma TBARs (62%) concentration and lower TSG (44%) concentration than control group, indicating increased reactive oxygen species production in low protein group. The enhancement of erythrocyte GR (29%) and CAT (28%) activities in this group also suggest an adaptation to the stress generated by the protein deficiency. Taken together, the results presented here show that the biomarkers used were able to reflect the oxidative stress level induced by this specific protein deficient diet.

The influence of sardine consumption on the omega-3 fatty acid content of mature human milk

Objectives: The purpose of this study was to investigate what effect the ingestion of sardines, rich in omega-3 series polyunsaturated fatty acids, has on the composition of breastmilk. Methods: This was a prospective study of 31 nursing mothers under observation at the Hospital Guilherme Álvaro. Each was given 2 kg of fresh sardines twice with a 15-day interval. Milk was sampled and a 24-hour dietary recall questionnaire was applied on days 0, 15 and 30. Milk was assayed for fatty acid content by gas chromatography. Statistical analysis of the results was performed using nonparametric tests with significance set at p < 0.05. Results: The results demonstrate that the nutritional intake of the nursing mothers was adequate at all three sample points. With regard to the omega-3 series fatty acid content of the breastmilk, it was observed that regular consumption and shorter intervals between ingestion and milk collection resulted in higher concentrations of docosapentaenoic acid and docosahexaenoic acid at 15 and 30 days into the study. Fatty acids from the omega-3 and omega-6 series exhibited a significant correlation, r 2 was 0.58 and 0.59 at 15 and 30 days, respectively. Conclusion: These results suggest that incorporating fish into the diets of nursing mother during lactation, in the form of 100 g of sardines two or three times a week, contributes to an increase in omega-3 series fatty acids. Copyright © 2006 by Sociedade Brasileira de Pediatria.

Manifestações sistêmicas na doença pulmonar obstrutiva crônica

Chronic obstructive pulmonary disease is progressive and is characterized by abnormal inflammation of the lungs in response to inhalation of noxious particles or toxic gases, especially cigarette smoke. Although this infirmity primarily affects the lungs, diverse extrapulmonary manifestations have been described. The likely mechanisms involved in the local and systemic inflammation seen in this disease include an increase in the number of inflammatory cells (resulting in abnormal production of inflammatory cytokines) and an imbalance between the formation of reactive oxygen species and antioxidant capacity (leading to oxidative stress). Weakened physical condition secondary to airflow limitation can also lead to the development of altered muscle function. Chronic obstructive pulmonary disease presents diverse systemic effects including nutritional depletion and musculoskeletal dysfunction (causing a reduction in exercise tolerance), as well as other effects related to the comorbidities generally observed in these patients. These manifestations have been correlated with survival and overall health status in chronic obstructive pulmonary disease patients. In view of these facts, the aim of this review was to discuss findings in the literature related to the systemic manifestations of chronic obstructive pulmonary disease, emphasizing the role played by systemic inflammation and evaluating various therapeutic strategies.

Estudo morfológico do tecido hepático de Leporinus macrocephalus

The objective of this work was to analyze the liver of Leporinus macrocephalus at the macroscopic and histologic level by evaluating the characteristics of the hepatic tissue. The fishes from a fishery in Bauru, S.P., were collected and sacrificed by destroying the spinal cord; afterwards the collected hepatic tissue was fixed and followed by histological routine. Macroscopic analysis of L. macrocephalus liver showed an organ of homogeneous structure, with red-brown color, located in the medial region of the body, caudal to heart and after the gills. It showed 3 pyramidal lobes, one central and two lateral right and left. The histological analysis showed the hepatic tissue constituted by hepatocytes cords surrounded by sinusoids, named muralium duplex. It yet revealed the diffused, distribution bile system by hepatic parenchyma, showing ducts with simple cubic epithelium, surrounded by muscular fibres and connective tissue. Cells of the exocrine pancreatic tissue were observed surrounding blood vessels in acinar arrangement as zymogen granules. Furthermore, there are melanomacrophages centers distributed along the hepatic parenchyma, preferably next to the blood vessels, constituted by cells accumulating material, such as melanin and lipofucsin, whose presence may be related to the nutritional status of the fish.

Dietary restriction abrogates antibody production induced by a DNA vaccine encoding the mycobacterial 65 kDa heat shock protein

Background: Protein-calorie malnutrition (PCM) is the most common type of malnutrition. PCM leads to immunodeficiency and consequent increased susceptibility to infectious agents. In addition, responses to prophylactic vaccines depend on nutritional status. This study aims to evaluate the ability of undernourished mice to mount an immune response to a genetic vaccine (pVAXhsp65) against tuberculosis, containing the gene coding for the heat shock protein 65 from mycobacteria. Methods: Young adult female BALB/c mice were fed ad libitum or with 80% of the amount of food consumed by a normal diet group. We initially characterized a mice model of dietary restriction by determining body and spleen weights, hematological parameters and histopathological changes in lymphoid organs. The ability of splenic cells to produce IFN-gamma and IL-4 upon in vitro stimulation with LPS or S. aureus and the serum titer of specific IgG1 and IgG2a anti-hsp65 antibodies after intramuscular immunization with pVAXhsp65 was then tested. Results: Dietary restriction significantly decreased body and spleen weights and also the total lymphocyte count in blood. This restriction also determined a striking atrophy in lymphoid organs as spleen, thymus and lymphoid tissue associated with the small intestine. Specific antibodies were not detected in mice submitted to dietary restriction whereas the well nourished animals produced significant levels of both, IgG1 and IgG2a anti-hsp65. Conclusion: 20% restriction in food intake deeply compromised humoral immunity induced by a genetic vaccine, alerting, therefore, for the relevance of the nutritional condition in vaccination programs based on these kinds of constructs. © 2009 Ishikawa et al; licensee BioMed Central Ltd.

Deficiências de macronutrientes em plantas de soja cv. BRSMG 68 (Vencedora) cultivada em solução nutritive

Soybean is a crop of great importance for Brazil, and knowledge of their nutritional status allows production and high quality products. Thus, the present work aimed to evaluate the culture of the soybean cv. BRSMG 68 (Vencedora), submitted to macronutrients omission on the development, nutritional status and the visual symptomatology of nutrient deficiency. The design used was completely randomized, with seven treatments that corresponded to the complete (macro and micronutrients) solution and the individual omission of N, P, K, Ca, Mg and S. The treatments were applied two weeks after the emergency of the soybean. The nutrient solution was constantly oxygenated and replaced weekly, and the pH monitored daily remained around 5. After six weeks of application of the treatments, the height of the plants, number of leaves, stem diameter was evaluated, matter dry accumulated in the roots, it leaves aerial and the nutritional state and the characterization of the visual symptoms. The macronutrient deficiency promoted a decrease in production of root and shoot dry mass of soybean cultivar BRSMG 68 (Vencedora) in nutrient solution, for the full treatment. The most limiting nutrient for dry matter production of soybean compared to complete treatment were N, S and K, with decreases of 90, 76 and 73%, respectively. Individual omissions resulted in morphological changes, which were translated by characteristic visual symptoms of nutritional deficiency of the respective nutrient.

Comparação entre as necessidades energéticas prescritas e administradas a pacientes em terapia nutricional enteral

Objective: evaluating the adequacy, prescription and energy supply of enteral nutrition therapy in hospitalized patients. Methods: was performed a retrospective survey of the evolution of TNE protocol of 59 patients hospitalized in a general hospital in Marília / SP / BR. Data collected included gender, age, clinical diagnosis, anthropometric and dietary data related to the prescribed dietary formula, route and method of administration of the enteral nutrition, the daily volume prescribed and administered, the daily amount of energy required and offered in the diet, as well as possible complications. Body mass index (BMI), triceps skinfold (TSF) and arm muscle circumference (AMC) were used to establish the nutritional status of the patients. The adequacy of ENT was done according to the daily energy requirement compared to the average energy received during the daily use of ENT. Results: The average found to the BMI was 21.4 kg/m 2, and no differences were found comparing male and female. The data for TSF and AMC were different between genders (p<0.05) and suggest a more severe muscle mass in relation to adipose tissue. The averaged to the energy requirements was 1642 kcal/day but the average of energy prescribed was 1045 kcal/day and the amount offered was 1035 kcal/day. There was a significant difference between the necessity and the supplied energy offered through enteral nutrition (p=0.00) as well between the energy required and prescribed (p =0.00), both were shorter than the necessity. There was no significant difference (p>0.05) in energy supply, volume of enteral nutrition prescribed and administered among eutrophic, underweight or overweight patients. Conclusion: The results of this study indicate that the prescription and energy supply were not based on the needs of these patients, causing a significant energy deficit, which can lead to worsening of the nutritional status of the same. In hospitalized patients in use of ENT, the energy requirement must be made by a qualified professional within the multidisciplinary team, based on the needs of each patient.

Associação entre doenças crônicas em adultos e redução dos níveis de atividade física

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)