Summary: Background & Aims: Overweight and obesity in children are a public health problem worldwide. There are few studies about nutritional interventions with different diet macronutrient distribution and their potential application in regulating food consumption in this age group. This study aimed to assess the impact of a high protein diet over satiety, energy intake, and body composition in children diagnosed with overweight (Ov) or obesity (Ob). Methods: School-age children (6–10 years) diagnosed Ov or Ob were randomized to receive three different dietary interventions for two months: standard diet (SD), high protein (HP) diet, and HP diet with calcium caseinate (HPC); BMI (Z-score and percentiles), body composition, indirect calorimetry (REEIC), energy intake (24-h recall questionnaire) and satiety (visual analog scale) were evaluated before and two-months after intervention. Results: Sixty-four children diagnosed with overweight (12.5%) and obesity (87.5%) were evaluated. There were no changes in the perception of satiety between groups (p>0.05). There was a tendency for a reduction in waist circumference in the HPC group after treatment (p=0.05). There were no significant differences in body composition, and children's growth was homogeneous between groups. However, intragroup Z-score values for BMI were significantly reduced in all groups (p<0.05). Conclusions: Calcium caseinate as a part of a high protein diet is secure in a short time, but children's perception of satiety did not change between groups. All interventions showed to have a reduction in BMI z-core. More clinical studies evaluating protein consumption and molecular indicators of satiety are needed.

As emulsões lipídicas (EL) são componentes importantes da nutrição parenteral (NP), servindo como fonte condensada de energia e ácidos graxos essenciais. Além disso, os lipídios modulam uma variedade de funções biológicas, incluindo respostas inflamatórias e imunológicas, coagulação e sinalização celular. Um conjunto crescente de evidências sugere que EL com óleo de peixe (OP) confere benefícios clínicos importantes, por meio de supressão de mediadores inflamatórios e ativação de vias envolvidas na resolução do quadro inflamatório. Esta revisão apresenta evidências de que a inclusão de EL com OP, em pacientes que necessitem NP, determina resultados estatisticamente significativos e clinicamente relevantes sobre marcadores bioquímicos e desfechos clínicos, tais como redução do risco de infecção e duração da ventilação mecânica, assim como diminuição do tempo de permanência na unidade de terapia intensiva (UTI) e no hospital, em pacientes cirúrgicos e críticos que necessitam de NP. Resultados similares são reportados em enfermos que necessitam de NP domiciliar. Dados de recentes de metanálises avaliando farmacoeconomia indicam que EL com OP versus EL padrão, em adultos gravemente enfermos ou cirúrgicos, são custo efetivas.

The initial colonization of the human microbiota is of paramount importance. In this context, the oropharyngeal administration of colostrum is a safe, viable, and well-tolerated practice even by the smallest preterm infants. Therefore, this study evaluated the effects of oropharyngeal administration of colostrum on the establishment of preterm infants' oral microbiota. A longitudinal observational study was carried out with 20 premature neonates, divided into two groups: one receiving the protocol (Oropharyngeal Administration of Colostrum; OAC) and the other one receiving Standard Caare (SC). Saliva samples were collected from the newborns weekly during the study period (from the day of birth until the 21st day of life) for analysis of oral microbiota through 16S rRNA gene sequencing. We observed that the colonization of the oral microbiota of preterm newborns preseanted a higher relative abundance of Staphylococcus on the 7th day of life, mainly in the OAC group. Additionally, an increased abundance of Bifidobacterium and Bacteroides was observed in the OAC group at the first week of life. Regarding alpha and beta diversity, time was a key factor in the oral modulation of both groups, showing how dynamic this environment is in early life.

Introducción: La desnutrición continúa siendo una causa frecuente de aumento de la morbimortalidad, especialmente en pacientes hospitalizados. Objetivo: Evaluar la tasa de desnutrición infantil observada al ingreso hospitalario en nueve países latinoamericanos y estimar el impacto de diversas condicionantes que pueden incidir en su desarrollo. Materiales y Métodos: Estudio descriptivo, transversal de niños de ambos sexos, de 0 a 18 años de edad, hospitalizados en nueve países latinoamericanos (Argentina, Chile, Cuba, Guatemala, México, Panamá, Paraguay, Uruguay y Venezuela). La información se obtuvo mediante encuesta y antropometría efectuada durante las primeras 48 horas de ingresados. Para la evaluación nutricional se evaluó el peso y la talla de los niños de acuerdo a los estándares de la Organización Mundial de la Salud (OMS). El análisis estadístico se realizó en el programa SPSS versión 24. Resultados: Del total de 5.366 pacientes, 45,2% eran mujeres y 46,5% menores de 2 años. Un 50,2% eran eutróficos, un 15,4% presentaba riesgo de desnutrir o desnutrición leve, un 12,5% desnutrición, un 14,2% sobrepeso o riesgo de obesidad, y un 7,7% obesidad. El 20,5% eran de talla baja. Los niños con 4 o más hospitalizaciones previas tuvieron mayor riesgo de presentar malnutrición por déficit (OR = 1,7). Las patologías cardiológicas presentaron un OR = 1,8 de presentar malnutrición por déficit. Conclusiones: La prevalencia de desnutrición en niños al ingreso hospitalario es moderada y se relaciona especialmente a patología cardiológica y a los antecedentes de varias hospitalizaciones previas. Conflicto de interés: Los autores declaran no tener conflictos de interés Fuente de financiamiento: No hay financiamiento involucrado. Recibido: 29/07/2021 Aceptado: 04/11/2021

Introduction: Malnutrition continues to be a frequent cause of increased morbidity and mortality, especially in hospitalized patients. Objective: To evaluate the observed infant malnutrition rate at hospital admission in nine Latin American countries and to estimate the impact of various conditions that may affect their development. Materials and Methods: This was a descriptive, cross-sectional study of children of both sexes, from 0 to 18 years of age, hospitalized in nine Latin American countries (Argentina, Chile, Cuba, Guatemala, Mexico, Panama, Paraguay, Uruguay and Venezuela). The information was obtained through a survey and anthropometry carried out during the first 48 hours after admission. For the nutritional evaluation, the weight and height of the children were evaluated according to the standards of the World Health Organization (WHO). Statistical analysis was performed using SPSS version 24. Results: Of the total of 5,366 patients, 45.2% were female and 46.5% were under 2 years of age. 50.2% were eutrophic, 15.4% had a risk of malnutrition or mild malnutrition, 12.5% malnutrition, 14.2% overweight or at risk of obesity, and 7.7% were obese. 20.5% were short. Children with 4 or more previous hospitalizations had a higher risk of presenting deficiency malnutrition (OR = 1.7). Patients with cardiological pathologies presented an OR = 1.8 of presenting deficiency malnutrition. Conclusions: The prevalence of malnutrition in children at hospital admission is moderate and is especially related to cardiac pathology and a history of several previous hospitalizations.

A growing, global conversation, regarding realities and challenges that parents experience today is ever-present. To understand recent parent’s attitudes, beliefs, and perceptions regarding infant feeding, we sought to systematically identify and synthesize original qualitative research findings. Following the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) framework, electronic databases were searched with a priori terms applied to title/abstract fields and limited to studies published in English from 2015 to 2019, inclusive. Study quality assessment was conducted using the Critical Appraisal Skills Programme (CASP) checklist, and thematic analyses performed. Of 73 studies meeting inclusion criteria, four major themes emerged. (1) Breastfeeding is best for an infant; (2) Distinct attitudes, beliefs, and perceptions of mothers that breastfeed, and those that could not or chose not to breastfeed, are evident; (3) Infant feeding behaviors are influenced by the socio-cultural environment of the family, and (4) Parent’s expectations of education and support addressing personal infant feeding choices from health care providers are not always met. This systematic review, guided by constructs within behavioral models and theories, provides updated findings to help inform the development of nutrition education curricula and public policy programs. Results can be applied within scale-up nutrition and behavioral education interventions that support parents during infant feeding.

BackgroundNutrition markers may be useful for diagnosis and monitoring and, also, as additional indicators of estimating death risk. We tested the association of body composition indicators (mid-upper arm circumference and phase angle) with pediatric intensive care unit (PICU) length of stay and mortality in critically ill pediatric patients. MethodsData from children aged 2 months-18 years were collected, and bioelectrical impedance was performed to obtain phase angle. Severity was evaluated by scoring the Pediatric Index of Mortality. Descriptive statistics were reported for nominal variables. Receiver operating characteristic curve was used to analyze the association of phase angle with 30-day mortality and to find the best cutoff. Survival probabilities and PICU length of stay were estimated using the Kaplan-Meier method. ResultsWe evaluated 247 children with a median age of 4.8 years whose main cause of admission was sepsis. Survival curves showed higher survival in patients with phase angle >2.8 degrees compared with patients with phase angle 2.8 degrees (P<.0001). Kaplan-Meier time-to-event analysis showed that children with lower phase angle values were more likely to remain in the PICU (hazard ratio, 1.84; P=.003). Lower survival was also observed in patients who presented mid-upper arm circumference values 5th percentile (P<.03). ConclusionsMid-upper arm circumference and phase angle were associated with mortality and morbidity in critically ill children, suggesting that these parameters may be useful not only for nutrition diagnosis and monitoring, but also as an additional indicator in estimating prognosis.

Rationale: Phase angle (PA) is still poorly studied in pediatrics where reference values are lacking. The objective of study was to determine PA cutoff associated with mortality in critically ill children admitted to the pediatric intensive care unit (PICU).

Rationale: Intestinal microbiota in the neonate is highly susceptible to perturbations of the luminal environment. Severe newborn infants admitted to Neonatal Intensive Care Units (NICUs), especially those with gastrointestinal (GI) complications, are even more susceptible to environmental influences, which can lead to disorders of the intestinal microbiota and possible proliferation of pathogenic bacteria.

Introduction: Obesity affects more than half of the adult population and correlates with the development of chronic and psychosocial diseases. The consumption of fruits and vegetables (FV) is a protective factor for obesity, but their consumption is often below the recommendations. Objective: To identify the level of fruit consumption in human development cycles, as well as the data on the association of fruit consumption with excess weight in Brazil. Methods: A non-systematic literature review on the Virtual Health Library (VHL) databases for the period 2005 to 2015. A total of 23 studies were selected in the English and Portuguese languages, according to the study design and population group. Only cohorts and cross sections studies in Brazil were selected. Appropriate FV consumption was considered to be 400 g/day or a frequency of 5 servings/day (3 servings/day of fruits), and overweight was evaluated according to each age group and development cycle. Results: The average consumption for pregnant women was found to be 350 g/day; an inverse relationship was found between total fi bre consumption and gestational weight gain. The average consumption of FV for children and adolescents has remained between 30% and 40%, consumption falling with increasing age. Vigitel data between 2006 and 2014 shows an increase in the prevalence of adequate consumption of FV for adults and seniors according to gender, age and education. Appropriate consumption tripled during this period. There was an association between fruit consumption and weight loss, increased risk of obesity, abdominal obesity, hypertriglyceridemia and presence of metabolic syndrome (SM). Conclusions: The prevalence of adequate consumption of FV is low in all regions of Brazil and among all age groups, the highest prevalence is among women and increases with the advance of age, higher education level and higher socioeconomic status. Adequate fruit consumption correlates to weight loss and/or weight gain control of individuals.

LA OBESIDAD ES LA EPIDEMIA DEL SIGLO XXI POR LAS DIMENSIONES ADQUIRIDA A LO LARGO DE LAS ULTIMAS DECADAS, SU IMPACTO SOBRE LA MORBIMORTALIDAD, LA CALIDAD DE VIDA Y EL GASTOSANITARIO. SEGUN LA ENCUESTA DE FACTORES DE RIESGO CARDIOVASCULAR DEL 2011, REFLEJA QUE EL PORCENTAJE DE SEDENTARISMO EN LA POBLACION ES DEL 74,5%

Introduction: Congenital malformations are major diseases observed at birth. They are the second most common cause of death in the neonatal population, the fi rst one being prematurity. Objective: To characterise the clinical outcome of newborns with gastroschisis (GS) in a neonatal intensive care unit. Methods: A retrospective observational clinical study in 50 infants with GS using the association of intestinal abnormalities, impossibility of primary closure of the abdominal defect and reoperation necessity as classifi cation criteria for the disease. The signifi cance level was p < 0.05. Results: The hospitalisation to primary surgery occurred with a median age of 2 hours. Fourteen percent of children were subjected to a primary silo interposition and 24% had associated intestinal malformation. Nineteen newborns (NB) required more than one surgery. The median length of stay was 33 days, higher in patients with complex GS (56 days). All NB recovered from urine output 48 hours after surgery and 40% had hyponatraemia and oligoanuria in this period. There was no difference between the natraemia and fasting time (p = 0.79). Weight gain was similar in both groups with total parenteral nutrition and became signifi cantly higher in patients with simple GS after enteral feeding (p = 0.0046). These NB evolved 2.4 times less cholestasis. Late-onset sepsis occurred in 58% of patients and was related to the infection of the central venous catheter in 37.9% of cases. Mortality was higher in infants infected with complex GS and the overall mortality rate was 14%. Conclusion: Clinical characterisation of newborns with gastroschisis depends on the complexity and the knowledge and conduct of morbidities to reduce mortality.