Dissertations / Theses on the topic 'Nutritional disorders'

Undernutrition and dysphagia in the institutionalized elderly are well documented in the literature. However, the clinical efficacy of diets to treat dysphagia have not been established. To offer a better understanding of the textural characteristics of the new Sainte-Anne's Hospital (SAH) modified texture reformed foods, rheological evaluations were performed. Apparent viscosity, consistency coefficient, flow behavior index and yield stress values were calculated for the thickened beverages. Texture profile analyses were performed on the reformed foods. Secondly, to evaluate the impact of SAH's reformed foods on nutritional intake and weight, a 12-week clinical trial was undertaken. Dysphagic frail elderly subjects (n = 17) of a long-term care facility of Montreal were randomly assigned to receive SAH reformed foods or traditional care. The experimental group demonstrated a significant increase in nutritional intake resulting in significant weight gain. These findings suggest that dysphagic frail elderly could reach healthy weight when adequately fed.

Thesis (M.S.)--University of Florida, 2004.<br>Typescript. Title from title page of source document. Document formatted into pages; contains 44 pages. Includes Vita. Includes bibliographical references.

Women with exercise associated amenorrhea display a disturbance in basal and exercise levels of reproductive, anti-reproductive and stress hormones. Co-incident with chronic exercise are other factors, which alone, also affect the menstrual cycle. Therefore, amenorrheic runners (AR), regularly menstruating runners (RMR) and regularly menstruating sedentary controls (RMSC) were compared for plasma progesterone levels, plasma lipid levels, menstrual cycle characteristics, physical characteristics and nutritional adequacy to determine if the difference in menstrual status could be explained, and to determine whether exercise alone could be attributed as the cause of menstrual cycle disturbances.Plasma progesterone levels were significantly lower in the AR group (. 28 + .02 ng/ml) than in the RMR group (.41 + .06 ng/ml) and the RMSC group (.49 + .06 ng/ml) in the follicular phase. Regularly menstruating runners demonstrated lower plasma progesterone levels in the luteal phase (9.76 + 1.05 ng/ml) than RMSC subjects (10.24 + 2.21 ng/ml). Regularly menstruating runners had a significantly shorter luteal phase length relative to their cycle length (.35 + .01) than RMSC subjects (.46 + .01). Mean age, incidence of parity, age of menarche, height, weight, body composition, max V02 and number of miles run per week did not differ between the RMR and AR subjects. Amenorrheic runners took in significantly less fat, red meat, phosphorous and total calories than the RMR subjects. Serum LDL-C was significantly higher in the AR subjects (89.2 + 9.7 mg/dl) than in the RMR subjects in both the luteal (67.8+ 3.4 mg/dl) and follicular (66.8+ 5.6 mg/dl) phases. Serum HDL-C was significantly higher in the RMR subjects in both the luteal (62.9+ 4.1 mg/dl) and follicular (59.2+ 2.9 mg/dl) phase, and in the AR subjects (63.9+ 4.2 mg/dl), than in the RMSC subjects in the luteal (49.2+ 5.9 mg/dl) and follicular (47.2+ 2.4 mg/dl) phase. Serum VLDL-C did not differ between any groups.This investigation demonstrates that hormonal and lipid level alterations with exercise are significantly different in the amenorrheic runner. However, regularly menstruating runners display alterations which may represent and intermediate or potential phase of menstrual cycle disturbances. The nutritional inadequacy or energy imbalance separates amenorrheic runners from regularly menstruating runners. Thus, it appears that exercise alone is not enough to cause the hormonal disturbances that trigger amenorrhea, and, that exercise associated amenorrhea is not unlike other amenorrheas of hypothalamic origin.

Providing adequate nutrition to children with severe neurological disabilities is extremely difficult due to the high prevalence of oral-motor dysfunction in this group. Short stature and light weight for height are common in disabled children and undernutrition is believed to play a role in this poor growth. This programme of study investigated the effect of gastrostomy-tube feeding in disabled children with oral-motor dysfunction and evaluated the energy balance and body composition of disabled children fed both orally and via gastrostomy-tube over twelve months. The Quality of Life of the children and their carers was also evaluated. Energy intake was measured using three-day dietary diaries and energy expenditure with indirect calorimetry and doubly labelled water. Total body water using oxygen-18 dilution was used to evaluate body composition along with standard anthropometry. Improved growth, nutritional status and general health were seen at six and twelve months after gastrostomy-tube placement. The Quality of Life of the children and their carers also significantly increased. Both energy intake and energy expenditure were found to be lower than reference standards, but energy balance was positive indicating that inadequate nutrition was not the sole cause of poor growth. Body composition was also found to be significantly different from reference. Fat-free mass was significantly low for age and for height. Fat mass was higher in gastrostomy-tube fed children, but lower or normal in disabled children fed orally. Physical activity levels were low for the entire group of disabled children yet the gastrostomy-tube fed children displayed much higher levels of disability. Gastrostomy-tube feeding has a positive impact upon the growth, health and Quality of Life of disabled children and their carers. Careful follow-up is critical in order to optimize health and body composition.

In the last two decades several studies have been trying to explore a possible role for gut microbiota in Autism Spectrum Disorders (ASD), supported by the high incidence of gastrointestinal disorders among ASD children and by the now well recognized existence of the brain-gut-microbiota axis (the complex system of bidirectional interactions between central nervous system, gastrointestinal tract and microorganisms inhabiting the gut). Nevertheless, results about alterations in gut microbiota composition and/or activity in ASD are to date strongly contrasting. A possible explanation could be that these studies tend to treat ASD as a unique pathology, whereas it includes different cognitive-behavioural phenotypes. Moreover, they do not consider factors which are important for children’s gut flora development, such as type of delivery, nutritional history (e.g. formula milk during lactation) and medical history (e.g. antibiotics intake) as well as factors that may affect the present composition of microbiota, such as the current diet (e.g. the strong food selectivity that often occurs in ASD children) and the presence of gastrointestinal disorders. In this study, I developed an interview to parents to assess whether there are differences related to the above mentioned aspects between ASD children and typically developing children and among ASD themselves, considering differences in cognitive level and severity of autistic traits. I also explored the use of special diets such as gluten-, lactose and casein free diets, the reasons for their adoption and the possible benefits for the child. Moreover, I decided to include in this interview also a section dedicated to parental difficulties in managing mealtime in order to collect information useful to plan future interventions. I found differences between ASD- and typical children in the incidence of gastrointestinal disorders and food selectivity. Especially, some children initially eat everything and then switch to a more and more restricted diet. This could be considered an early symptom of the pathology. I also found an association between gastrointestinal disorders and severity of autistic traits. Furthermore, I collected faecal samples from ASD families (two parents, an ASD child and a typically developing sibling) and analysed them with metaproteomics and bioinformatics techniques in order to assess microbiota activity and evaluate it in light of ASD phenotype, nutritional habits, gastrointestinal disorders and genetic proximity. Demonstrating the existence of a different microbiota composition in ASD or at least in a subgroup could allow to identify a biomarker of a possible development of ASD and to design preventive interventions, even through probiotics intake. Moreover, it could help to better understand the molecular mechanism underlying this pathology.

In the last two decades several studies have been trying to explore a possible role for gut microbiota in Autism Spectrum Disorders (ASD), supported by the high incidence of gastrointestinal disorders among ASD children and by the now well recognized existence of the brain-gut-microbiota axis (the complex system of bidirectional interactions between central nervous system, gastrointestinal tract and microorganisms inhabiting the gut). Nevertheless, results about alterations in gut microbiota composition and/or activity in ASD are to date strongly contrasting. A possible explanation could be that these studies tend to treat ASD as a unique pathology, whereas it includes different cognitive-behavioural phenotypes. Moreover, they do not consider factors which are important for children’s gut flora development, such as type of delivery, nutritional history (e.g. formula milk during lactation) and medical history (e.g. antibiotics intake) as well as factors that may affect the present composition of microbiota, such as the current diet (e.g. the strong food selectivity that often occurs in ASD children) and the presence of gastrointestinal disorders. In this study, I developed an interview to parents to assess whether there are differences related to the above mentioned aspects between ASD children and typically developing children and among ASD themselves, considering differences in cognitive level and severity of autistic traits. I also explored the use of special diets such as gluten-, lactose and casein free diets, the reasons for their adoption and the possible benefits for the child. Moreover, I decided to include in this interview also a section dedicated to parental difficulties in managing mealtime in order to collect information useful to plan future interventions. I found differences between ASD- and typical children in the incidence of gastrointestinal disorders and food selectivity. Especially, some children initially eat everything and then switch to a more and more restricted diet. This could be considered an early symptom of the pathology. I also found an association between gastrointestinal disorders and severity of autistic traits. Furthermore, I collected faecal samples from ASD families (two parents, an ASD child and a typically developing sibling) and analysed them with metaproteomics and bioinformatics techniques in order to assess microbiota activity and evaluate it in light of ASD phenotype, nutritional habits, gastrointestinal disorders and genetic proximity. Demonstrating the existence of a different microbiota composition in ASD or at least in a subgroup could allow to identify a biomarker of a possible development of ASD and to design preventive interventions, even through probiotics intake. Moreover, it could help to better understand the molecular mechanism underlying this pathology.

Folate deficiency, a prevalent vitamin deficiency in America, can stem from environmental and/or genetic causes. The most common inborn error of folate metabolism is deficiency of methylenetetrahydrofolate reductase (MTHFR), which catalyzes the reduction of 5,10-methylenetetrahydrofolate to 5-methyltetrahydrofolate. Severe MTHFR deficiency results in hyperhomocysteinemia and homocystinuria; patients present with developmental delay, and various neurological and vascular disorders. This thesis describes three mutations identified in the MTHFR locus in patients with severe deficiency: 1025T&rarr;C (M&rarr;T), 1027T&rarr;G (W&rarr;G), and 1768G&rarr;A (E&rarr;K). Genotype-phenotype correlations are described, along with biochemical characterization of three mutations (983A&rarr;G (N&rarr;S), 1025T&rarr;C, 1027T&rarr;G). All three mutations exert their effect by decreasing Vmax without changing the enzyme's affinity for its substrate, 5-methyltetrahydrofolate. The 983A&rarr;G variant also conferred decreased affinity for FAD, a cofactor.<br>The more common and mild deficiency observed in the general healthy population is probably due in part to insufficient dietary intake of folate. Folate deficiency has been associated with increased risk for colon cancer. In a pilot study presented here, the impact of altered folate intake on tumor multiplicity in the Min mouse, a model for multiple intestinal neoplasia, was assessed. Folate deficient diets did not produce a consistent change in tumor numbers. However, a linear correlation between S-adenosylmethionine and S-adenosylhomocysteine content of preneoplastic tissue and tumor multiplicity was identified.<br>This thesis contributes to our understanding of the impact of genetic- and/or dietary-induced folate deficiency on cellular and organismal functions.

[EN] In recent years, persimmon crop has become very relevant in Mediterranean Spain, where the production of this fruit centres on only one variety, persimmon cv. Rojo Brillante, majorly located in the Valencian Community. The main postharvest disorders manifested by 'Rojo Brillante' persimmons are flesh browning, which is associated with mechanical damage and chilling injury displayed after low-temperature storage. Previous research has determined the postharvest conditions that lead fruit to develop such alterations. However, the biochemical process behind flesh browning and chilling injury disorders is still unknown. Currently, there is special interest in introducing cultivars from other countries to broaden the varietal range. Besides, prolonging the fruit storage period to supply the markets according to the demand is one of the main challenges. In this context, the present Thesis approached three main objectives: 1) Studying the biochemical process implied in the main physiological postharvest disorders manifested in persimmon fruits by focusing on changes in the fruit redox state; 2) Evaluating postharvest treatments to preserve fruit quality during cold storage; 3) Assessing the physico-chemical and nutritional quality of persimmon cultivars introduced from other countries to increase the varietal range. Biochemical, chromatographic and microstructural studies have revealed that flesh browning manifested by fruits submitted to mechanical damage after removing astringency is associated with a tannins oxidation process caused by a stress oxidative situation. A new flesh disorder, "pinkish bruising", has been described on fruits submitted to mechanical impacts while showing high astringency levels. Sensitiveness to the flesh browning disorder has also been evaluated on different cultivars introduced from other countries. The implication of the redox system in the chilling injury manifestation on 'Rojo Brillante' persimmon has been determined. Moreover, we described the changes in this system associated with chilling injury alleviation by 1-MCP treatment. The effect of a controlled atmosphere based on 4-5% O2 + N2 to prolong the storage of cultivars 'Rojo Brillante' and 'Triumph' has been seen to strongly depend on variety. The results were highly positive on cultivar 'Triumph', in which the evaluated atmosphere extended the storage period up to 3 months. The use of short-term high CO2 treatments was another technology assayed to alleviate chilling injury in non-astringent cultivar 'Fuyu'. This treatment significantly reduced the main chilling injury symptom manifested by this cultivar, which is flesh gelling. This effect was related to cell structure preservation. Recent studies have shown that ethyl formate treatment is highly effective for pest control of persimmon 'Fuyu'. However, this treatment induces fruit softening, which causes quality loss. This Thesis revealed that ethyl formate treatment induces the activity of ethylene synthesis-related genes and that flesh softening is mediated by this hormone. It also demonstrated that by applying 1-MPC pretreatment, fruit softening associated with ethyl formate can be controlled. Therefore, the combined used of both treatments is seen as a potential treatment to disinfect persimmon fruits while preserving quality. Finally, the study of ten cultivars introduced from other countries helped select the most interesting cultivars to broaden the varietal range according to their maturation date and their response to deastringency treatment. The main nutritional compounds of persimmon and how they are affected by CO2 deastringency treatment are described.<br>[ES] El caqui es un cultivo de gran relevancia en el área mediterránea de España, estando la producción centrada en una única variedad, el cv. Rojo Brillante, y localizada principalmente en la Comunidad Valenciana. Las principales alteraciones presentadas por el caqui 'Rojo Brillante' durante el periodo postcosecha son el pardeamiento de la pulpa asociado a los daños mecánicos y los daños por frío manifestados tras la conservación a bajas temperaturas. Las investigaciones previas han determinado las condiciones de manejo bajo las cuales se desarrollan dichas alteraciones, sin embargo los procesos bioquímicos involucrados en la manifestación de estos desórdenes no se conocen en profundidad. Actualmente uno de los principales retos es la introducción de nuevas variedades que permitan ampliar la gama varietal, así como prolongar los periodos de conservación del caqui con el fin de poder escalonar la puesta en el mercado en función de la demanda. En la presente Tesis se han abordado tres objetivos principales: 1) Estudiar los procesos bioquímicos implicados en los principales desórdenes postcosecha del caqui, prestando especial atención a los cambios en el sistema redox del fruto; 2) Evaluar diferentes tratamientos postcosecha para preservar la calidad del fruto durante la conservación frigorífica; 3) Evaluar la calidad físico-química y nutricional de diferentes variedades de caqui introducidas desde otros países para ampliar la gama varietal. Estudios bioquímicos, cromatográficos y microestructurales, han revelado que el pardeamiento de la pulpa o "browning", manifestado por la fruta que ha sufrido daños mecánicos tras la eliminación de la astringencia está asociado a un proceso de oxidación de taninos motivado por una situación de estrés oxidativo. Además se ha descrito una nueva alteración de la pulpa, "pinkish bruising", manifestada por los frutos sometidos a daño mecánico con alto nivel de astringencia. También se ha evaluado la sensibilidad al pardeamiento de diferentes variedades introducidas desde otros países. Con el objetivo de prolongar la conservación del fruto se ha ensayado el uso de la atmósfera controlada basada en 4-5% O2 + N2 sobre las variedades 'Rojo Brillante' y 'Triumph', observándose que la respuesta a esta tecnología depende de manera muy importante de la variedad. Los resultados fueron especialmente positivos en el caso del cultivar 'Triumph', en el que la atmósfera ensayada permitió prolongar la conservación frigorífica hasta tres meses. Otra tecnología ensayada para el control de los daños por frío fue la aplicación de choques con altas concentraciones de CO2 en el cultivar no astringente 'Fuyu'. Este tratamiento alivió el principal síntoma de daño por frío manifestado por esta variedad, la gelificación de la pulpa. Este efecto se ha relacionado con la preservación de la estructura celular de la pulpa del fruto. Estudios recientes han mostrado que el tratamiento con etil formato es altamente efectivo en el control de insectos durante la conservación y comercialización del caqui 'Fuyu', sin embargo este tratamiento provoca un ablandamiento del fruto mermando su calidad. En esta Tesis se ha demostrado que las aplicaciones de etil formato activan los genes de síntesis de etileno, siendo está hormona mediadora del ablandamiento. Los estudios también revelaron que la aplicación de un tratamiento previo con 1-MCP reduce el ablandamiento del fruto asociado al etil formato, por lo que el uso combinado de ambos tratamientos puede ser considerado una alternativa para la desinfección de los frutos sin detrimento de su calidad. Por último, el estudio de diez variedades introducidas desde otros países permitió seleccionar en base a su momento de maduración y respuesta al tratamiento de desastringencia aquellas variedades de mayor interés para ampliar la gama varietal. Además, se identificaron los principales compuestos nutricionales del caqui y<br>[CAT] El caqui s'ha convertit en els últims anys en un cultiu de gran rellevància en l'àrea mediterrània d'Espanya, estant la producció centrada en una única varietat, el cv. Rojo Brillante, i localitzada principalment a la Comunitat Valenciana. Les principals alteracions presentades pel caqui 'Rojo Brillante' durant el període postcollita són l'enfosquiment de la polpa associat als danys mecànics i els danys per fred manifestats després de la conservació a baixes temperatures. Les investigacions prèvies han determinat les condicions de maneig sota les quals es desenvolupen estes alteracions, però els processos bioquímics involucrats en la manifestació d'estos desordres no es coneixen en profunditat. D'altra banda, actualment un dels principals reptes és la introducció de noves varietats que permetin ampliar la gamma varietal, així com prolongar els períodes de conservació del caqui per tal de poder escalonar la posada en el mercat en funció de la demanda. En este context, en la present Tesi s'han abordat tres objectius principals: 1) Estudiar els processos bioquímics implicats en els principals desordres postcollita del caqui, posant especial atenció als canvis en el sistema redox del fruit; 2) Avaluar diferents tractaments postcollita per preservar la qualitat del fruit durant la conservació frigorífica; 3) Avaluar la qualitat fisicoquímica i nutricional de diferents varietats de caqui introduïdes des d'altres països per ampliar la gamma varietal. Estudis bioquímics, cromatogràfics i microestructurals, han revelat que l'enfosquiment de la polpa o "Browning", manifestat per fruita que ha patit danys mecànics després de l'eliminació de l'astringència està associat a un procés d'oxidació de tanins motivat per una situació d'estrès oxidatiu. A més s'ha descrit una nova alteració de la polpa, "pinkish bruising", manifestada pels fruits sotmesos a dany mecànic amb alt nivell d'astringència. També s'ha avaluat la sensibilitat a l'enfosquiment de diferents varietats introduïdes des d'altres països. Amb l'objectiu de perllongar la conservació del fruit s'ha assajat l'ús de l'atmosfera controlada basada en 4-5% O2 + N2 sobre les varietats 'Rojo Brillante' i 'Triumph', observant-se que la resposta a esta tecnologia depèn de manera molt important de la varietat. Els resultats van ser especialment positius en el cas del cultivar 'Triumph', en què l'atmosfera assajada va permetre prolongar la conservació frigorífica fins a tres mesos. Una altra tecnologia assajada per al control dels danys per fred va ser l'aplicació de xocs amb altes concentracions de CO2 en el cultivar no astringent 'Fuyu'. Este tractament va alleujar el principal símptoma de dany per fred manifestat per esta varietat, la gelificació de la polpa. Este efecte s'ha relacionat amb la preservació de l'estructura cel¿lular de la polpa del fruit. Estudis recents han mostrat que el tractament amb etil format és altament efectiu en el control d'insectes durant la conservació i comercialització del caqui 'Fuyu', però este tractament provoca un estovament del fruit minvant la seua qualitat. En esta Tesi s'ha demostrat que les aplicacions d'etil format activen els gens de síntesi d'etilè, sent esta hormona mediadora de l'estovament. Els estudis també van revelar que l'aplicació d'un tractament previ amb 1-MCP redueix l'estovament del fruit associat a l'etil format, per la qual cosa l'ús combinat de tots dos tractaments pot ser considerat una alternativa per a la desinfecció dels fruits sense detriment de la seua qualitat. Finalment, l'estudi de deu varietats introduïdes des d'altres països va permetre seleccionar en base al seu moment de maduració i resposta al tractament de desastringència aquelles varietats de més interès per ampliar la gamma varietal. A més, es van identificar els principals compostos nutricionals del caqui i es va avaluar l'efecte del tractament de desastringència amb CO2 sobre els mat<br>Novillo Borrás, P. (2015). HARVEST AND POSTHARVEST QUALITY OF PERSIMMON FRUIT:PHYSICOCHEMICAL AND NUTRITIONAL ASPECTS [Tesis doctoral no publicada]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/58270<br>TESIS

A community based survey to determine the nutritional status using anthropometric methods, of children and mothers and to assess certain socio-economic factors was carried out during November and December 1986 in Philippi, a predominantly vegetable farming area. Twenty-one (43%) of the 49 vegetable farms which were included in the study were selected by stratified random sampling. All children in the 0-6 year age group and their parents on the selected farms were included in the sample which consisted of 129 children and 212 parents. Questionnaires were administered and subjects' weights and heights were measured. It was found that 47% of children were below the National Centre for Health Statistics 5th percentile weight for age and 58% were under the 5th percentile height for age. There were 47 child deaths out of 279 births over a six-year period, thirty-four of which had occurred in the first year of life. Twenty eight percent of children had a birth weight of less than 2.5 kg. The number of cases of tuberculosis (10%) and severe diarrhoea (31%) contracted within the first year of life is unacceptably high. Twenty four percent of mothers were malnourished in terms of body mass index and fifty five percent of mothers were illiterate. Fifty nine percent of mothers were regular farm workers who worked for an average of 10.2 hours per day and a wage of R0.44 per hour. Grossly inadequate facilities existed for the care of children while the mothers worked. The average amount spent on food was insufficient to maintain normal nutrition. Although 91.5% of mothers breast fed their children and fed for a mean duration of 13.4 months, breast feeding was not exclusive. Supplementary feeding was introduced on average at 3 months of age. The long working hours of working mothers made it difficult for them to breast feed their children satisfactorily. Acceptance of the family planning services was high and immunisation cover was good. These statistics reflect the effects of extreme poverty and neglect of a community which is totally reliant on its employers for its livelihood. The parents poor educational level, coupled with their meagre financial and other physical resources gives them and their children little opportunity to improve their station in life and leaves them open to the scrounge of malnutrition and disease. Similarly, the dearth of educational and other child care facilities will ensure that this disastrous trend continues. A multidisciplinary approach, including active community involvement of both farmers and workers, to the many physical and social problems is urgently needed if the unacceptable human suffering is to be stopped.

Thesis (MScMedSc) -- Stellenbosch University, 2001.<br>ENGLISH ABSTRACT: Osteopenia is a well documented complication of anorexia nervosa (AN). The pathogenesis of this bone loss is presently poorly defined in the literature. Pathogenetic mechanisms that have been implicated include certain nutritional factors, exercise abuse, hypogonadism, hypercortisolism and/or vitamin 0 deficiency. We studied, 59 Caucasian eating disorder patients aged 15-45yr. The eating disorder was classified by a single, qualified psychiatrist according to OSM IV R criteria as either anorexia nervosa (AN: n =25), bulimia nervosa (BN: n = 17) or eating disorder not otherwise specified (EONOS: n = 17). All patients were subjected to a detailed dietary and general history. We assessed the prevalence and severity (OEXA), the nature (osteocalcin, deoxypyridinoline) and site (vertebral versus hip) of osteopenla in these patients. he role of nutritional factors (energy intake, weight, height, BMI, plasma albumin, lipids), physical activity, hypercortisolemia (plasma and urinary free cortisol), vitamin 0 deficiency (plasma 250HD) and hypogonadism (amenorrhoea, E2, LH, FSH) in the pathogenesis of bone loss were also evaluated. Mild osteopenia (BMO decreased by more than 1SO below age-matched controls) was documented in 46% of the total study population, with more marked osteopenia (Z-Score < -2 SO) present in 15%. Both vertebral and hip osteopenia were documented. In the study population those patients with AN (Lumbar BMO (q/cm") = 0.869 ± 0.121) were most likely to develop osteoporosis, although a significant percentage of patients with BN (Lumbar BMO (q/crn") = 0.975 ± 0.16) and EONOS (Lumbar BMO (g/cm2) = 0.936 ± 0.10) were also osteopenic (29% and 35% respectively). Twenty four percent (24%) of the total patient population had a history of fragility fractures. These fractures were reported more commonly amongst patients with AN and EONOS (28% and29.4%). Fracture prevalence was however similar in patients with normal and low bone mass. Conventional risk factors were similar in patients with normal and low bone mass, except for a significantly longer duration of amenorrhoea (p = 0.009), a lower BMI (p = 0.0001) and greater alcohol consumption (p = 0.05) in the osteopenic patients. Nutritional parameters (S-albumin, protein, Ca, and P04 intakes), physical activity, as well as 25(OH) vitamin D levels were similar in AN and BN subjects, as well as in patients with a low versus normal BMD. Plasma and urine cortisol levels were also similar in these subgroups. With the exception of two patients with borderline osteopenia, significant bone loss was only documented in those patients with a past or current history of amenorrhoea. In the total patient population the duration of amenorrhoea was significantly (p<0.009) longer in patients with osteopenia versus those with a normal bone mass. A significant negative correlation between BMD (Z-Score) and duration of amenorrhoea was also documented in the total patient population (r = -0.4, P = 0.001) as well as in all three eating disorder groups (AN r - -0.4, P = 0.03; BN r = - 0.6, P = 0.008; EDNOS r = -0.6, P = 0.005). In the total patient population, those patients with amenorrhoea, had lower BMD and BMI values and lower estrogen levels compared to those with a normal menstrual cycle. We conclude that osteopenia commonly attends AN, as well as BN and EDNOS. Nutritional (with the exception of alcohol consumption) and mechanical factors as well as hypercortisolemia did not appear to contribute significantly to bone loss in this study population. Hypogonadism appeared to be the main cause of the bone loss observed in these patients.<br>AFRIKAANSE OPSOMMING: Osteopenie is In welbekende komplikasie van anorexia nervosa (AN). Die patogenese van hierdie beenverlies is swak in die huidige literatuur omskryf en nutrisiele faktore, 'n vita mien 0 gebrek, oormatige oefening, hiperkortisolemie en hipogonadisme word onder andere qeimpliseer. Vir die doel van die studie is In totaal van 59 Kaukasier eetsteurnis pasiente patients volledig ondersoek. Die tipe eetsteurnis is deur In enkel gekwalifiseerde psigiater volgens die DSM IV R kriteria geklassifiseer as anorexia nervosa (AN: n =25) of bulimia nervosa (BN: n = 17) of eetsteurnis nie anders gespesifiseer (EDNOS: n = 17). Elke pasient is ook aan In gedetailleerde dieet en algemene risikofaktor vraelys vir osteoporose onderwerp. Die voorkoms en graad (DEXA), die aard (osteokalsien, deoksipiridinolien) asook die tipe (werwelkolom/heup) osteopenie is ondersoek. Die rol van nutrisiele faktore (totale kalorie-inmame, gewig ,Iente LMI, plasma albumien, lipiede) en vitamien 0 gebrek, oefening, hiperkortisolemie (plasma en urinere kortisol) en hipogonadisme (amenoree, plasma E2, LH,FSH) in die patogenese van die beenverlies is ook evalueer. Matige osteopenie (BMD meer as 1 SO onder die van ouderdomskontrole) is in 46% van die totale pasientpopulasie gedokumenteer, met erge osteopenie (Z-Telling < -2) in 15%. Aantasting van beide werwelkolom en heup is aangetoon. In hierdie studiepopulasie kom osteopenie meer algemeen voor in die AN (Lumbaal BMD (g/cm2) = 0.869 ± 0.121) groep (64%) in vergelyking met BN (Lumbaal BMD (g/cm2) = 0.975 ± 0.16) (29%) en (EDNOS) (Lumbaal BMD (g/cm2) = 0.936 ± 0.10) (32%). Vier-en-twintig persent van die totale pasientpopulasie het In geskiedenis van frakture gehad. Frakture het meer algemeen in AN en EDNOS pasiente voorgekom (28% en 29%). Pasiente met 'n lae beenmassa was gekenmerk deur In betekenisvolle laer LMI (p = 0.0001), hoer alkolholverbruik (p = 0.05) en langer duurte van amenoree(p = 0.009). Nutrisiele parameters (s-albumien, protetene, Ca, P04 inname) oefening, asook 25(OH) vitamien 0 vlakke was soortgelyk in AN en BN pasiente. Hierdie parameters het ook nie verskil tussen pasiente met osteopenie en die met In normale BMD nie. Plasma en urinere vry kortisolvlakke was ook soortgelyk in hierdie twee groepe. Betekenisvolle beenverlies (met die uitsondering van twee pasiente met grenslyn osteopenie) het slegs voorgekom in pasiete met 'n huidige of In vorige geskiedenis van amenoree. In die totale pasientpopulasie was die duurte van amenoree (p< 0.009) betekenisvollanger in die pasiente met osteopenie. In Betekenisvolle negatiewe korrelasie tussen BMD (Z-Telling) en die duurte van amenoree in die toale pasient populasie (r = -0.4; P = 0.001) asook in al drie eetsteurnis groepe (AN: r = -0.4; P = 0.03; BN: r = -0.06; P = 0.008; EDNOS: r = - 0.6, P = 0.005) is aangetoon. In die groep as 'n geheel, het die amenoree pasiente In laer LMI, E2vlakke en BMD gehad in vergelyking met die pasiente met normale menses. Opsommend dus, kom osteopenie algemeen in pasiente met AN, asook BN en EDNOS voor. In Betekenisvolle bydrae van nutrisiele (met die uitsondering van alkoholinname) en meganiese faktore asook hiperkortisolemie tot been verlies, kon nie in hierdie tudie populasie gedemonstreer word nie. Hipogonadisme is as die hoofoorsaak van osteopenie in die pasiente qefdentifiseer.

Basant-nos en les dades d’un estudi longitudinal de tres anys, el nostre objectiu va ser valorar l’efecte de la psicopatologia emocional sobre la ingesta dietètica i l’adipositat en una mostra escolar de la preadolescencia a la adolescència, observant l’influencia factors genètics. Valorarem la depressió, l’ ansietat, l’ antropometria, la composició corporal, el consum alimentari, l’activitat física i els polimorfismes MAOA-uVNTR i 5-HTTLPR. A més, hem desenvolupat un model conceptual de prevenció i tractament de l’obesitat infantil . Els nostres resultats mostren que la psicopatologia emocional en la preadolescencia es va associar amb un major increment de pes i de greix abdominal, encara que amb certes diferencies en la relació amb cada tipus d’ansietat i depressió segons el gènere. Quan els símptomes emocionals es mantingueren o aparegueren en la adolescència, vam observar que les noies eren més propenses d’adherir-se a un patró de dolços i d’aliments greixosos i a presentar una baixa adherència a la dieta mediterrània. Així mateix, les noies amb MAOA-uVNRT d’alta activitat i símptomes emocionals, mostraren comportaments no saludables associats amb l’obesitat, mentre que, el nois presentaren una disminució del pes. A més, les noies amb el polimorfisme 5-HTTLPR SS/SL, amb o sense símptomes emocionals, mostraren una major adherència al patró de dolços i aliments greixosos. Addicionalment, el nostre model conceptual va indicar que la desregulació emocional en la infantesa podria ser la unió entre l’estrès i l’obesitat. En conclusió, els símptomes emocionals i els factors genètics durant l’adolescència tenen una influencia sobre l’estat nutricional, principalment en les noies, conduint-les cap a comportaments no saludables relacionats amb l’obesitat. Per tant, fomentar la regulació emocional podria ser un nou enfoc efectiu en la prevenció i tractament de l’obesitat infantil.<br>Basándonos en datos de un estudio longitudinal de tres años, nuestro objetivo fue valorar el efecto de la psicopatología emocional sobre la ingesta dietética y la adiposidad en una población escolar de la preadolescencia a la adolescencia, observando la influencia de los factores genéticos. Valoramos depresión, ansiedad, antropometría, composición corporal, consumo alimentario, actividad física y los polimorfismos MAOA-uVNTR y 5-HTTLPR. Hemos desarrollado un modelo conceptual de prevención y tratamiento de la obesidad infantil. Nuestros resultados muestran que la psicopatología emocional en la preadolescencia se asoció con un incremento de peso y de grasa abdominal en la adolescencia, aunque con ciertas diferencias en la relación con cada tipo de ansiedad y depresión según el género. Cuando los síntomas emocionales se mantuvieron o aparecieron en la adolescencia, observamos que las chicas eran más propensas a adherirse a un patrón de dulces y alimentos grasos y a presentar una baja adherencia a la dieta Mediterránea. Asimismo, las niñas con MAOA-uVNRT de alta actividad y síntomas emocionales mostraron comportamientos no saludables asociados con la obesidad, mientras que los niños presentación una disminución de peso. También, las niñas con el polimorfismo 5-HTTLPR SS/SL, con o sin síntomas emocionales, mostraron una mayor adherencia al patrón de dulces y alimentos grasos. Adicionalmente, en el modelo conceptual se indicó que la desregulación emocional en la infancia podría ser la unión entre el stress y la obesidad. En conclusión, los síntomas emocionales y los factores genéticos durante la adolescencia tienen una influencia sobre el estado nutricional, principalmente entre las chicas, conduciéndolas hacia comportamientos no saludables relacionados con la obesidad. Por lo tanto, fomentar la regulación emocional podría ser un nuevo enfoque efectivo en la prevención y el tratamiento de la obesidad infantil.<br>Based on data from a three-year longitudinal study, our aim was to assess the effect of emotional psychopathology on dietary intake and adiposity in a school-based population from preadolescence to adolescence, according to the gender; taking into account the influence of genetic factors. Depression and anxiety, anthropometric and body composition parameters, food consumption, physical activity, and MAOA-uVNTR and 5-HTTLPR polymorphisms data were assessed. In addition, we developed a conceptual model for prevention and treatment of childhood obesity. Our results showed that emotional psychopathology in preadolescence was associated with increased weight gain and abdominal fat in adolescence, albeit with certain differences in the relationship with each anxiety and depression disorder according to gender. When emotional symptoms were maintained or appeared in adolescence, we observed that girls were more likely to have a high adherence to a sweet and fatty foods pattern and showed low adherence to the Mediterranean Diet. Furthermore, girls with high activity of MAOA-uVNRT and emotional symptoms showed unhealthy obesity related behaviour, whereas boys presented lower weight. Moreover, girls with 5-HTTLPR SS/SL polymorphism, with or without emotional symptoms, showed higher adherence of sweet and fatty pattern. In addition, our conceptual model indicated that childhood emotional dysregulation could be a link between stress and obesity. In conclusion, the emotional symptoms and genetic factors during adolescence have an influence on nutritional status, mainly among girls, pushing them towards unhealthy behaviours related to obesity. Encouraging emotion regulation could therefore be an effective new approach in the prevention and treatment of childhood obesity.

INTRODUÇÃO: O cuidado nutricional é parte essencial para o acompanhamento integral da crescente população idosa, principalmente quando na presença de doenças crônicas e neurodegenerativas e morbidades psiquiátricas. A Mini Avaliação Nutricional (MAN®), tem sido utilizada para este fim, e em algumas situações, informações adicionais a essa ferramenta são necessárias. OBJETIVOS: Caracterizar o estado nutricional de idosos acompanhados em ambulatório de neuropsiquiatria geriátrica. MÉTODOS: Foi obtida uma amostra de conveniência selecionada aleatoriamente entre pacientes idosos com diagnóstico de depressão (DEP), doença de Alzheimer (DA) e outros transtornos psiquiátricos (OTP). O estado nutricional foi avaliados através da MAN®, pelo índice de massa corporal (IMC= peso/altura2) e pelas circunferências do braço (CB) e panturrilha (CP). Os dados referentes ao consumo de medicamentos também foram obtidos, considerando-se como polifarmácia o consumo de mais de três medicamentos/dia. Os dados de diagnóstico médico e exames laboratoriais foram obtidos do prontuário médico. Foram avaliados 217 indivíduos no total, distribuídos conforme o diagnóstico clínico: grupo DEP= 107 (49,3%); grupo DA=59 (27,2%) e grupo OTP=51 (23,5%). RESULTADOS: O escore da MAN® identificou risco nutricional em 67,3%, 69,5% e 54,9%, e desnutrição em 14,0%, 13,6% e 27,5% dos pacientes em DEP, DA e OTP respectivamente. O baixo peso, avaliado pelo IMC foi observado em 29,0% (DEP), 24,1% (DA) e 45,1% (OTP) dos avaliados. A prevalência de anemia foi de 11,2% (DEP), 10,2% (DA) e 19,6% (OTP); sendo mais frequente em mulheres em DEP e OTP e em homens em DA. A média para vitamina D em todos os grupos encontrava-se na insuficiência. A presença de colesterol total acima dos intervalos de normalidade foi de 47,0% (DEP), 36,3% (DA) e 31,8% (OTP). Foi observada hiperglicemia em 52,9% (DEP), 48,1% (DA) e 41,6% (OTP) dos pacientes. A polifarmácia foi observada em 18,7% (DEP), 15,2% (DA) e 19,6% (OTP). Não houve associação significativa entre o uso de medicamentos e o estado nutricional, embora tenha sido apontado um direcionamento ao risco de desnutrição com o uso de medicamentos para o tratamento da depressão (inibidores seletivos de receptação de serotonina), demências (inibidores de colinesterase), cloridrato de omeprazol e indutores do sono. CONCLUSÕES: o risco nutricional e a desnutrição são prevalentes na população estudada, independente do grupo específico de doença neuropsiquiátrica ou demência. Esses achados demandam e justificam um monitoramento nutricional permanente para esses indivíduos, uma vez que vem acompanhados de outras deficiências específicas que comprometem a saúde de forma geral, como a anemia e insuficiência de vitamina D. A elaboração de planos educativos envolvendo os pacientes, cuidadores e a equipe médica, poderá contribuir para a melhora dessas condições.<br>INTRODUCTION: Nutritional care is an essential part for the integral follow - up of the growing elderly population, especially in the presence of chronic and neurodegenerative diseases and psychiatric morbidities. The Mini Nutrition Assessment (MAN®) has been used for this purpose, and in some situations, additional information to this tool is necessary. OBJECTIVES: To characterize the nutritional status of elderly patients in a geriatric neuropsychiatry clinic. METHODS: A randomly selected convenience sample was obtained among elderly patients diagnosed with depression (DEP), Alzheimer\'s disease (AD) and other psychiatric disorders (OTP). The nutritional status was evaluated through MAN®, body mass index (BMI = weight / height2) and circumference of arm (CB) and calf (CP). The data referring to the consumption of medicines were also obtained, considering as polypharmacy the consumption of more than three medications/day. The data of medical diagnosis and laboratory tests were obtained from the medical record. A total of 217 individuals were evaluated, distributed according to the clinical diagnosis: DEP = 107 (49.3%); Group DA = 59 (27.2%) and OTP group = 51 (23.5%). RESULTS: The MAN® score identified nutritional risk in 67.3%, 69.5% and 54.9%, and malnutrition in 14.0%, 13.6% and 27.5% of the patients in DEP, DA and OTP respectively. Low weight, evaluated by BMI, was observed in 29.0% (DEP), 24.1% (AD) and 45.1% (BTP) of the evaluated patients. The prevalence of anemia was 11.2% (DEP), 10.2% (AD) and 19.6% (OTP); Being more frequent in women in DEP and OTP and in men in AD. The mean for vitamin D in all groups was in the insufficiency. The presence of total cholesterol above the normality intervals was 47.0% (DEP), 36.3% (DA) and 31.8% (OTP). Hyperglycemia was observed in 52,9% (DEP), 48,1% (AD) and 41,6% (OTP) of the patients. Polypharmacy was observed in 18.7% (DEP), 15.2% (DA) and 19.6% (OTP). There was no significant association between drug use and nutritional status, although there was a trend towards malnutrition with the use of drugs to treat depression (selective serotonin reuptake inhibitors), dementias (cholinesterase inhibitors), Omeprazole hydrochloride and sleep inducers. CONCLUSIONS: nutritional risk and malnutrition are prevalent in the population studied, regardless of the specific group of neuropsychiatric disease or dementia. These findings demand and justify a permanent nutritional monitoring for these individuals, since they are accompanied by other specific deficiencies that compromise health in general, such as anemia and insufficiency of vitamin D. The elaboration of educational plans involving patients, caregivers and The medical team, could contribute to the improvement of these conditions.

Postprandial urea production in subjects with insulin dependent diabetes mellitus (IDDM) on conventional insulin therapy is normal when the previous diet is high in protein, but there is an incomplete adaptive reduction in urea production following protein restriction. To evaluate the nutritional implications of restricted protein intake in human diabetes mellitus, it is first necessary to establish a reliable method to measure changes in urea production and amino acid catabolism in response to changes in dietary protein intake. We therefore tested (1) the accuracy of the urea production rate (Ra) to depict changes in urea production, (2) whether sulfate production can be accurately depicted using tracer or nontracer approaches, after establishing the use of electrospray tandem mass spectrometry to measure sulfate concentrations and 34SO4 enrichments following administration of the stable isotope tracer sodium [34S]sulfate, (3) the reproducibility of urea and sulfate measurements following a test meal low in protein (0.25 g/kg) in subjects previously adapted to high (1.5 g/kg.d) and low (0.3 g/kg.d) protein intakes, and compared the metabolic fate of [ 15N]alanine added to the test meal with that of [15N] Spirulina platensis, a 15N-labeled intact protein, and (4) whether we could identify the differences in postprandial urea and sulfate productions between normal subjects and persons with IDDM receiving conventional insulin therapy previously adapted to high protein intake, when the test meal was limiting in protein. Under basal conditions, steady state urea Ra is an accurate measure of urea production. Following changes in urea production, both the tracer and nontracer methods seriously underestimated total urea Ra. The tracer method overestimated sulfate production by 20%, but the nontracer method provided an accurate measure of sulfate production and, hence, sulfur amino acid catabolism. Postprandial changes in urea and sulfate productions following normal ada

Both diabetes and behavioral health disorders (mental and substance use disorders) are significant health issues in the United States. While previous studies have shown worse health outcomes in people with diabetes and co-occurring behavioral health disorders (BHDs) than those with diabetes alone, it is unclear whether the quality of diabetes care was poorer in the presence of co-occurring BHDs. Although previous research has observed a trend of positive outcomes in people with comprehensive diabetes care, there is a lack of evidence about whether that mode of care delivery can improve outcomes in people with co-occurring BHDs. Therefore, further studies are necessary. Using a combined dataset from Medicare and Medicaid claims for Massachusetts residents, this study compared the quality of diabetes care (e.g., having at least 1 hemoglobin A1c test) and diabetes outcomes (e.g., eye complications) among Medicare and Medicaid beneficiaries with diabetes and co-occurring BHDs to those with diabetes alone in Massachusetts in 2005. The results showed a mixed picture on the relationships between BHDs and diabetes outcomes. While substance use disorders had adverse impact on adherence to quality measures (e.g., 20% less likely to attain full adherence, p0.05). Findings from this dissertation research suggest that disparities exist in the quality of diabetes care and health outcomes between people with substance use disorders and those without. The mode of care delivery needs to be further examined so that interventions can be designed to improve the outcomes of people with diabetes.

O acidente vascular encefálico (AVE) pode ser considerado uma das principais doenças que resultam em quadros de disfagia orofaríngea, sendo os distúrbios da deglutição considerados um dos fatores que contribui para maior incidência de complicações respiratórias e nutricionais. A relação entre disfagia orofaríngea e a condição nutricional é pouco descrita na literatura, em que a maioria dos estudos aborda indivíduos na fase aguda do AVE, não tendo sido encontradas pesquisas que contemplem os acometidos por AVE em fase tardia. O objetivo do presente estudo foi verificar a influência do grau da disfunção da deglutição orofaríngea sobre o nível de ingestão oral e o estado nutricional em idosos acometidos por AVE na fase tardia após ictus. Realizado estudo retrospectivo transversal, por meio da análise do banco de dados do projeto de pesquisa intitulado Deglutição, fala e voz em indivíduos acometidos por doenças neurológicas. A disfagia orofaríngea foi classificada por três juízes, fonoaudiólogos de acordo com The Dysphagia Outcome and Severity Scale (DOSS) a partir da análise das imagens da avaliação videoendoscópica da deglutição (VED). A classificação do nível de ingestão oral (FOIS) foi realizada por meio da revisão dos padrões usuais de consumo alimentar referido no recordatório alimentar de 24 horas, e a avaliação do estado nutricional foi realizada por meio da Mini Avaliação Nutricional (MAN) e medidas antropométricas: peso, altura, índice de massa corporal (IMC), circunferências (braquial CB; panturrilha CP), pregas cutâneas (tricipital PCT; bicipital PCB; subescapular PCSE; suprailiaca PCSI). Foram incluídos no estudo os dados de 25 idosos (14 homens e 11 mulheres), idade média de 72 anos. De acordo com a avaliação VED, a maioria dos indivíduos (72%) apresentou deglutição com limitações funcionais, seguido da disfagia em grau leve a moderado, verificada em 24% dos indivíduos. No que se refere classificação da escala FOIS, 56% dos indivíduos apresentou nível de ingestão oral V, seguido dos níveis VI (36%) e VII (8%). Em relação à avaliação do estado nutricional, baseado no protocolo MAN, bem como no IMC, verificou-se que a maioria dos indivíduos apresentou-se bem nutridos. No que se refere à composição corporal a partir das pregas cutâneas e circunferências, foi verificado acúmulo de gordura corporal e valores adequados de massa muscular em ambos os gêneros. Foi verificada correlação positiva entre o grau da disfagia orofaríngea e FOIS (p=0,051), escore de triagem (p=0,011) e escore total (p=0,006) do protocolo MAN, bem como entre a classificação dos níveis da FOIS com o IMC (p=0,029) e as medidas antropométricas referentes à massa muscular, CB (p=0,021), CMB (p=0,010) e AMB (p=0,023). Dessa forma, pode-se concluir que embora a maioria dos indivíduos incluídos na pesquisa apresentassem deglutição funcional ou disfagia em grau leve, o quadro de disfagia orofaríngea influenciou o nível de ingestão oral e o estado nutricional desses indivíduos.<br>The stroke can be considered one of the major diseases that result in oropharyngeal dysphagia, swallowing disorders being considered one of the factors contributing to higher incidence of respiratory complications and nutritional. The relationship oropharyngeal dysphagia and nutritional status is rarely described in the literature, where most studies addresses individuals in the acute phase of stroke, were not found studies that include those affected by stroke in late stage. The purpose of this study was to verify the influence of the degree of oropharyngeal swallowing dysfunction on the level of oral intake and nutritional status in elderly patients with stroke in the late phase after stroke. Conducted retrospective study, through the analysis of the database of the research project entitled \"Swallowing, speech and voice in individuals affected by neurological diseases.\" Oropharyngeal dysphagia was rated by three judges speech according to The Dysphagia Outcome and Severity Scale (DOSS) from the image analysis of endoscopic evaluation of swallowing (VED). Conducted retrospective study, through the analysis of the database of the research project entitled \"Swallowing, speech and voice in individuals affected by neurological diseases.\" Oropharyngeal dysphagia was rated by three judges, speech according to The Dysphagia Outcome and Severity Scale (DOSS) from the image analysis of endoscopic evaluation of swallowing (VED). The classification of the level of oral intake (FOIS) was conducted by reviewing the usual patterns of food consumption in that 24-hour dietary recall, and nutritional status assessment was performed by using data from the Mini Nutritional Assessment (MNA) and measures anthropometric weight, height, body mass index (BMI), circumferences (arm - CB; calf - CP), skinfolds (triceps - PCT; biceps - PCB; subscapularis - SBB; suprailiac - PCSI). Were included in the study, data from 25 elderly subjects (14 men and 11 women), mean age of 72 years. According to the evaluation FEES, the majority of individuals with functional limitations presented swallowing, followed by dysphagia in mild to moderate occurred in 24% of subjects. As regards rating scale levels FOIS, 56% of subjects had level V oral ingestion, followed VI levels (36%) and VII (8%), respectively. Regarding the assessment of nutritional status protocol based MAN and BMI was found that the majority of individuals presented themselves well nourished. With regard to body composition from skinfolds and circumferences, was observed accumulation of body fat and adequate amounts of muscle mass in both genders. Positive correlation was found between the degree of oropharyngeal dysphagia - DOSS and FOIS (p=0.051), screening score (p=0.011) and total score (p=0.006) protocol MAN, well as between the classification levels of FOIS with BMI (p=0.029) and anthropometric measurements related to muscle mass, CB (p=0.021), CMB (p=0.010) and AMB (p=0.023). Thus, we can conclude that although the majority of individuals included in the study presented functional swallowing or dysphagia was mild, the oropharyngeal dysphagia influenced the level of oral intake and nutritional status of these individuals.

Research indicates the existence of an eating disorder continuum. The two-component model of disordered eating suggests that certain personality traits may increase an individual's vulnerability to develop more severe variants of disordered eating symptomatology. The present study investigates pre-clinical elevations on a measure of personality based on the Five-Factor Model (FFM) and pre-clinical elevations on a measure of eating disorder symptomatology in a sample of nonclinical undergraduates. The personality dimensions Neuroticism, Extraversion, and Agreeableness accounted for 7% of the variability in Body Dissatisfaction. Subcomponents comprising the personality dimensions of the FFM as determined by Saucier (1998) (see Appendix A) were analyzed. The Self-Reproach and Intellectual Interests subcomponents were the strongest predictors of Drive for Thinness and Body Dissatisfaction. The subcomponent Sociability was the strongest predictor of Bulimia. Findings present implications for prevention and treatment interventions. Longitudinal studies are needed to determine the temporal directionality of personality and disturbed eating.

Orientadores: Luiz Roberto Lopes, Nelson Adami Andreollo<br>Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas<br>Made available in DSpace on 2018-08-20T04:23:57Z (GMT). No. of bitstreams: 1 Pereira_MaricildaRegina_D.pdf: 5651954 bytes, checksum: 24a42e9163bce75ebfbe2412960e9f8f (MD5) Previous issue date: 2012<br>Resumo: O adenocarcinoma (Adenoca) possui etiologia diferente do carcinoma de células escamosas (CEC) e nenhum trabalho investigou se existe diferença na qualidade de vida (QV) e no estado nutricional no pós-operatório de doentes submetidos à esofagectomia por câncer ao comparar estes dois tipos histológicos. Os Objetivos deste estudo foram: 1) Avaliar e comparar a QV entre os doentes submetidos à esofagectomia por Adenoca e por CEC; 2) Avaliar e comparar o estado nutricional destes doentes e correlacionar com os resultados referentes à QV. Métodos: 24 doentes submetidos à esofagectomia, 10 por Adenoca e 14 devido ao CEC, no período de setembro de 2004 a agosto de 2008, foram avaliados com no mínimo cinco meses de pós-operatório por meio de questionário SF-36, da Avaliação Subjetiva Global (ASG), do Índice de Massa Corporal (IMC), da porcentagem de adequação do peso atual/habitual, do questionário de frequência alimentar qualitativo e de medidas bioquímicas. Também foi investigada a presença dos sintomas de disfagia, anorexia, dificuldade de mastigação, náuseas, vômitos, diarréia e constipação. Resultados: As avaliações aconteceram em média a 2 anos, 4 meses e 26 dias de pós-operatório, com a maioria do sexo masculino (91,6%), caucasiano (70,8%), casado (83,3%), média de idade de 58,79 anos (DP=10,3) e com média de estudo de 4,94 anos. O IMC médio para o grupo Adenoca foi 21,5 (DP=2,7) e para o CEC 21,0 (DP=2,8). Na avaliação do questionário SF- 36, a capacidade funcional destes doentes mostrou diferença significativa com um melhor resultado para o grupo Adenoca e nos demais domínios houve igualdade entre os grupos. Houve correlação entre a variável "saúde mental" e "limitação por aspectos emocionais" e entre "dor" e "limitação por aspectos físicos", em ambos os grupos. Estes doentes sofrem com sintomas clínicos de disfagia, anorexia, dificuldade de mastigação, náuseas, vômitos, diarréia e constipação, que não se relacionaram com a QV. Não houve diferença significativa entre o estado nutricional dos doentes ao se comparar os dados de IMC (p=0,6602), da ASG (p=0,9493), porcentagem de adequação do peso atual em relação ao habitual (p=0,1505) e presença de sintomas clínicos (p->0,05). No grupo Adenoca e no CEC, o estado nutricional segundo os aspectos dietéticos, a presença de sintomas clínicos e a contagem de linfócitos totais, mostrou-se comprometido. Houve associação significativa entre a ASG e o sintoma de disfagia (p=0,0232) e entre o IMC e o escore de dor (p=0,0361). Conclusão: O escore mais alto para capacidade funcional indicou que o doente com Adenoca foi capaz em um nível maior que o doente com CEC de realizar todo tipo de atividade física, incluindo as mais vigorosas. A disfagia mostrou-se como um importante sintoma clínico no pós-operatório e embora o estado nutricional destes doentes seja de eutrofia antropométrica, há risco nutricional em ambos os grupos<br>Abstract: Adenocarcinoma (AdenoCa) has different etiology when compared to squamous cell carcinoma (SCC), but no studies were found in the literature comparing these two histologic types of Ca regarding differences in quality of life (QOL) and nutritional status during the postoperative period of patients with esophagectomy for cancer. The Objectives of this study were twofold: 1) to evaluate and compare QOL among patients with esophagectomy for Adenoca and for SCC; and 2) to evaluate and compare patient's nutritional status against the results of their quality of life (QOL). Methods: 24 patients with esophagectomy, 10 for Adenoca and 14 for SCC, from September 2004 to August 2008 were evaluated after at least five months postoperatively using SF-36 Questionnaire, the Subjective Global Assessment (SGA), the Body Mass Index (BMI), percentage of adequacy between current and usual weight, the qualitative Food Frequency Questionnaire (FFQ) and biochemical test results. Also investigated were the presence of symptoms such as dysphagia, anorexia, difficulty chewing, nausea, vomiting, diarrhea and constipation. Results: The assessments took place at an average of 2 years, 4 months and 26 days postoperatively, being the patients mostly males (91.6%), Caucasian (70.8%), married (83.3%) and mean age of 58.79 years (SD=10.3), with an average of 4.94 years of study. The mean BMI for the Adenoca group was 21.5 (SD=2.7) and for SCC 21.0 (SD=2.8). The SF-36 results showed a significant difference in the "Functional Capacity" of these patients, with a better outcome for the Adenoca group while all other areas were equal for both groups. There was a correlation between the variables "Mental Health" and "Limitation on Emotional Aspects", as well as between "Pain" and "Limitation on Physical Aspects" in both groups. These patients suffered from clinical symptoms of dysphagia, anorexia, difficulty chewing, nausea, vomiting, diarrhea and constipation, which did not correlate with QOL. There was no significant difference between the nutritional status of patients when compared to the data for BMI (p=0.6602), the SGA (p=0.9493), percentage of adequacy between their current weight in relation to their usual weight (p=0.1505) and the presence of clinical symptoms (p>0.05). In both the Adenoca and SCC groups, nutritional status according to the nutritional value was compromised, as indicated by the total lymphocyte count and the presence of clinical symptoms. There was a significant correlation between SGA and dysphagia symptom (p=0.0232), as well as between BMI and the "Pain" score (p=0.0361). Conclusion: The higher score for "Functional Capacity" indicated that patients with Adenoca were able to perfom at a higher level all kinds of physical activity, including the most vigorous activities. Dysphagia appeared as an important clinical symptom in the postoperative period and, although the nutritional status of these patients is eutrophic anthropometric, there are nutritional risks for both groups<br>Doutorado<br>Fisiopatologia Cirúrgica<br>Doutor em Ciências

O objetivo do estudo foi avaliar o estado nutricional, ingestão alimentar, perfis lipídico e glicêmico além de marcadores inflamatórios de pacientes com Imunodeficiências Primárias (IDPs) e descrever possíveis distúrbios metabólicos associados. Estudo descritivo transversal, realizado com 24 pacientes imunodeficientes (10 Doença Granulomatosa Crônica - DGC; 6 Ataxia-Telangiectasia - AT; 5 Agamaglobulinemia - A; 3 Hiper IgM - HIgM) entre 20 meses a 18 anos acompanhados no ambulatório de Alergia e Imunologia do Instituto da Criança - HCFMUSP, São Paulo, Brasil. Foram realizadas avaliações bioquímicas, antropométricas e dietéticas, longe de processos infecciosos, incluindo peso, altura, Dobra Cutânea Tricipital (DCT), Circunferência Muscular do Braço (CMB) e Circunferência do Braço (CB) (software WHO Antro e WHO Antro Plus e classificados por Frisancho). Para a avaliação do consumo alimentar utilizou-se Recordatório 24h e Registro alimentar de 3 dias (software Virtual - Nutri Plus e Dietary Reference Intakes). A desnutrição ocorreu em 39,2%, 69,5%, 47,9% e 43,5% quando analisadas por Índice de Massa Corporal, CMB, CB, DCT respectivamente, observando-se maior prevalência nos pacientes com DGC e AT. 22 pacientes apresentaram alguma dislipidemia, sendo HDL baixo o mais prevalente. Consumo energético abaixo do recomendado ocorreu em 33,3% dos pacientes enquanto valores inadequados para micronutrientes como Vitamina C, E, Cálcio e Zinco em 41,7%, 70,8%, 62,5% e 41,6% respectivamente; o ácido graxo saturado se mostrou acima do recomendado em metade dos pacientes. O estudo concluiu que todos os grupos de IDPs avaliados apresentaram algum grau de comprometimento nutricional, metabólico ou dietético. Novos estudos de intervenção nutricional em pacientes com imunodeficiências primárias podem determinar uma conduta nutricional individualizada para estes pacientes nos diferentes tipos de imunodeficiência primária<br>Objective: To evaluate the nutritional status, feeding, lipid and glycemic profile and inflammatory markers of Primary Immunodeficiency (PIDs) patients and describe possible metabolic disorders associated. Methods: This is a crosssectional studies performed with 24 immunodeficiency patients (10-Chronic Granulomatous Disease -CGD; 6- Ataxia-Telangienctasia -AT; 5- Agammaglobulinemia-A; 3-Hyper IgM -HIgM) under 20 months and 18 ages followed at the Children Institute, Allergy and Immunology Unit - HCFMUSP. Biochemical, anthropometric and dietary evaluation were performed out of infectious processes, including weight, body height, Triciptal Skinfold (TSF), Arm Circumference (AC) and Arm Muscle Circumference (AMC) (software WHO Antro and WHO Antroplus and classified according Frisancho). To evaluate the feeding consumption it was used a 24 hours Record and a 3-Day Feeding Record (Software Virtual-Nutri Plus and DRIs). Results: Malnutrition occurred in 39.2%, 69.5%, 47.9% and 43.5% respectively when was analyzed by Body Mass Index (BMI), AMC, AC and TSF being a higher prevalence detected in DGC and AT patients. 22 patients presented some dyslipidemia with higher prevalence to low HDL. Dietary analysis demonstrated that 33.3% of patients were under recommended energy consumption. Regarding micronutrients 41.7%, 70.8%, 62.5% and 41.6% were inappropriate to Vitamin C, Vitamin E, Calcium and Zinc respectively; saturated fatty acids were above recommended levels in 50% of the patients. Conclusions: All types of PIDs assessed had some degree of nutritional, metabolic or food intake disturbances. New studies of nutritional intervention in patients with primary immunodeficiency can determine an individualized nutritional intervention for these patients in different types of primary immunodeficiency

The parasitosis in the tropical countries like Ecuador, are found in the different population groups of all ages, sexes, social conditions, ethnic groups, especially in those without hygienic conditions, pertaining to different geographic zones and the prevalence varies in agreement with the ecology, the human factors and the social economic characteristics. The fecal contamination on land and water where an adequate disposition of excretes, the surrounding conditions, the deficient living conditions, the rural life, the absence of bathrooms, the custom to not use shoes and to have contact with the water. The deficiency of hygienic education, contamination of foods and human migration all favor intestinal parasites. The parasitic plague in Ecuador and especially in the province of Imbabura is not very well known, this is because of the little attention and economical means that are given to an investigation. This investigation clearly points out the different concepts, definitions, consequences, treatments and prophylaxis that the community should take into account. This investigative work was done in the rural area of the Imbabura province for the following ethnic groups: Indigenous, Black, and Mestizo, with children younger than five years old and it is directed to the health personnel, and students It is estimated that in the whole world more than 20 million people are infected by the "himenolepsis" parasite. The Intestinal parasite has a direct relation with the Nutritional state of any given country, as well as the basic services, like water, collection of trash, elimination of excretes, illiteracy, bad family hygiene habits, and a healthy environment. This is how 40 thousand children die of hunger in the world daily, the difference here is an American child eats 500 times more than third world child. The lack of interest by the governments both international and national in health Programs in rural zones, impedes a solution being found. 50% of investigations are dedicated to the advancements in military, which also influences the lack of water, 3 billion people in the world lack drinkable water. There are many forms of exposure to the parasite, including, ground (garbage or trash left on floor) or contaminated water, contaminated food, biting insects, domestic or wild animals which have the parasite, another person, and their clothes or bed sheets. The most common of these being contaminated water. There are many reasons these parasites are found in higher numbers in third world countries. The lack of healthiness in the rural population increases the intestinal parasite in children under five years old, the lack of knowledge by part of the mothers on the consequences of the intestinal parasites. Bad hygiene habits that the mothers have as well as the children under five years old in not washing their hands before eating and after using the restroom add to the rapid spread of the parasite. The nutritional state of the children greatly increases exposure, mostly concerning food preparation. The presence of intestinal parasites in the children under five years old does the same damage with no importance to age, race, or sex. The bad form in which excretes are eliminated in the town also contributes to parasite spreading. To fight against further parasite spreading it is advised that a program of investigation is applied with many disciplinary teams including: Doctors, Epidemists, Microbiologists, Anthropologist, Nutritionists, and nurses to study and help find solution for the well-being of the areas that most need it. To also help, it is advised that Nutritionists, Nurses, Doctors, and people who have direct knowledge of what is health, capacitate the leaders of the community and citizens on the basic hygiene norms, including preparation and manipulation of foods, consequences and ways to prevent parasites. This would help slow the rapid spread of parasites among youth as well as adults. Have meetings teaching proper use of bathrooms both private and public in rural areas, to avoid massive parasite contamination. It is important to teach families that they should treat the water before drinking it because water has a direct link with parasite spreading. Demand that government pay more attention to health issues in rural communities.

Cette thèse est divisée en deux parties l'une consiste une revue de la littérature et la deuxième comprend quatre manuscrits. Peu d'études sur la MC ont été réalisées en Europe, aucune donnée n'est actuellement disponible sur les aspects cliniques et biologiques de la MC au Liban ou dans la région du Moyen-Orient. La pathologie MC reste mal recherchée et mal comprise. Cette première étude évaluant l'héritabilité du MC est menée dans deux cohortes de familles françaises et libanaises de MC a démontré que MC est un caractère héritable. La transmission génétique de ce caractère semble le plus souvent être autosomique récessive.La deuxième étude visée a caractériser plusieurs caractéristiques métaboliques et nutritionnelles dans une cohorte libanaise de sujets MC. L'étude est la première du genre dans la région du Moyen-Orient et peut être considérée comme une base pour une comparaison multinationale de cet état de sous-poids. Il a démontre pour la première fois que les libanaises n'ont pas de signes de déficit et confirme les principales caractéristiques nutritionnelles décrites précédemment dans les cohortes françaises. Les petites différences décrites doivent être confirmées par des cohortes plus grandes.La troisième étude était la première étude validant la forme arabe du DEBQ. Ce n'est pas un simple travail de validation, les facteurs associés au DEBQ ont également été étudiés. DEBQ est un outil pratique pour catégoriser les facteurs comportementaux liés aux habitudes alimentaires individuelles, y compris ceux impliqués dans les troubles de l'alimentation. Le manuscrit de la revue de la littérature a été construit et structuré comme complément au manuscrit évaluant l'héritage de la MC. Finalement, la MC est un nouveau sujet et la plupart des études ont été menées sur les jeunes femmes CT à Saint-Etienne, France. Il est de grande importance de conduire plus de recherches sur la MC pour comprendre les mécanismes et l'héritabilité de l'extrême minceur et trouver l'explication de ce phénomène pourrait être une étape dans le traitement de l'obésité et pour répondre à la demande de la MC et satisfaire leur désir de prendre du poids<br>This thesis is divided into two parts one consisting of a review of the literature and the second one involves four manuscripts. few studies on CT were done in Europe, no data is currently available on clinical and biological aspects of constitutional thinness in Lebanon or the middle east region. CT pathology remains poorly researched and understood. This first study evaluating the heritability of CT and conducted in two cohorts of french and lebanese CT families demonstrated that CT runs in families and is a heritable trait. The genetic transmission of this trait seem to be most often autosomal recessive. The second study aimed to characterize several metabolic and nutritional features in a lebanese cohort of CT subjects. the study is the first of its kind in the middle east region and can be considered as a base for a multinational comparison of this underweight state. It demonstrated for the first time that lebanese CT persons have no signs of deficits and confirmed the major nutrition features previously described in french cohorts. Small differences described for the first time need to be confirmed by larger cohorts. The third study was the first study validating the arabic form of DEBQ. It’s not just a simple validation work, factors associated with DEBQ were also studied. DEBQ is a convenient tool to categorize behavioral factors related to individual eating patterns, including those implicated in eating disorders.The literature review manuscript was constructed and structured as a complement to the manuscript evaluating the inheritability in constitutional thinness. Overall, CT is a new topic and most studies were conducted on CT young women in Saint-Etienne - France. It is of high importance to conduct more research on CT to understand the mechanisms and heritability of extreme thinness and finding the explanation behind this phenomenon might be a step in the treatment of obesity and to meet the ct's demand and satisfy their desire to gain weight

INTRODUÇÃO: O presente estudo justifica-se, inicialmente, pela elevada prevalência de excesso de peso na infância em nosso país e por suas consequências a curto e longo prazo. Porto Alegre possui 34 escolas infantis com cerca de 4.000 crianças, que permanecem na instituição em turno integral. A grande maioria dessas escolas situa-se em locais de grande vulnerabilidade social e praticamente a totalidade das crianças reside próximo às escolas. OBJETIVO: O objetivo deste estudo foi verificar a associação entre a prevalência de excesso de peso em pré-escolares de escolas públicas e condições socioeconômicas da região de localização das escolas. MÉTODOS: As medidas de peso e altura foram provenientes de avaliação antropométrica realizada em todas as crianças matriculadas em escolas públicas de educação infantil de Porto Alegre em 2011. O excesso de peso foi definido como índice de massa corporal para idade > 1 escore z das curvas de crescimento da Organização Mundial de Saúde (WHO, 2006). Os dados socioeconômicos da região de moradia (alfabetização e renda mensal) foram coletados do Censo IBGE 2010, definidos a partir do setor censitário onde se localiza a escola e todos os setores que o circundam. Análise multinível foi utilizada para verificar as associações entre o desfecho e as variáveis de exposição. RESULTADOS: Foram avaliadas 3.756 crianças, com média de idade de 51,6 meses (dp = 16,4). A prevalência de excesso de peso foi de 35,5%. Em nível individual, maior idade esteve associada a um efeito protetor, uma vez que a cada incremento de 12 meses de vida, as chances de IMC-para-idade acima do adequado foram 7% menores (RC ajustada = 0,93; IC 95% 0,89-0,98). Em relação à região de moradia, o incremento de ¼ de salário mínimo na renda per capita média da região esteve associado a um aumento de 7% nas chances de excesso de peso (RC ajustada = 1,07; IC 95% 1,03-1,11). CONCLUSÕES: O presente estudo apresenta elevada prevalência de excesso de peso na população de crianças atendidas em escolas municipais de educação infantil, particularmente naquelas mais jovens e com maior renda. Assim, percebe-se a necessidade de planejamento de políticas públicas de educação alimentar infantil e familiar, promoção de aleitamento materno e alimentação complementar saudável considerando aspectos socioeconômicos do território.<br>INTRODUCTION: This study is justified due to the high prevalence of overweight in children in our country and its consequences in short and long term. Porto Alegre has 34 elementary schools with about 4,000 children, who remain in the institution fulltime. The vast majority of these schools are located in neighborhood of high social vulnerability and almost all children live near the school. OBJECTIVE: The aim of this study was to investigate the association between socioeconomic conditions of the region of location of schools and the prevalence of overweight among preschool children in public schools. METHODS: Measurements of weight and height are from anthropometric measurements performed in all children enrolled in public child care centers in Porto Alegre in 2011. Overweight was defined as body mass index for age > 1 z score of the growth curves of the World Health Organization. The socioeconomic data of the region of residence (literacy and monthly income) were collected from the IBGE Census 2010, defined as the census tract where the school is located and the all the census tracts that surround it. Multilevel analysis was used to determine associations between the outcome and exposure variables. RESULTS: There were evaluated 3,756 children with an average age 31,6 months (SD 16.4). The prevalence of overweight was 35.5%. At the individual level, higher age was associated with a protective effect, once for each 12 months, 7% lower were the chances of being above appropriate BMI-for-age (adjusted OR = 0.93, 95% CI 0.89 to 0.98). With regard to region of residence, the increment of 1/4 of minimum wage in average per capita income in the region was associated with a 7% increase in the odds of overweight (adjusted OR = 1.07, 95% CI 1.03 -1.11). CONCLUSIONS: This study shows a high prevalence of overweight in children enrolled in public schools in early childhood education, particularly those younger and with higher income. These results show the necessity of planning specific actions as public education policies for infant and family feeding, promotion of breastfeeding and healthy complementary feeding.

O processo inflamatório subclinico encontra-se associado à prevenção e controle de um agrupamento de fatores de risco (FR) nutricionais, entre eles, dislipidemia e aumento de depósito de gordura visceral. Indicadores nutricionais, inflamatórios e metabólicos parecem estar associados com o estilo de vida. A semente de linhaça tem sido reconhecida como um alimento rico em fibras e -3, entretanto, um novo constituinte de sua composição nutricional tem merecido atenção, pelo seu papel antiinflamatório e antioxidante. Este componente é chamado de lignanas, um polímero complexo e o principal constituinte não-carbohidrato de plantas vasculares. Está ligado a fibras de celulose, e é responsável por reforçar a estrutura das paredes celulares, o que previne o colapso das mesmas. Lignanas, em contato com a microflora intestinal humana transformam-se em enterolignanas, especialmente, enterodiol e enterolactona. O presente trabalho tem por hipótese que o teor de lignanas dietético pode interferir no perfil metabólico, e alterar fatores de riscos envolvidos no estado nutricional, e consequentemente na saúde. O conhecimento de que diferentes características na composição nutricional de macronutrientes da dieta poderiam modificar o perfil inflamatório, independentemente, da presença das enterolignanas provenientes da semente de linhaça também constituíram o objetivo deste estudo. Por 42 dias, foram avaliados 52 funcionários, pertencentes ao sexo masculino, com idade média de 37± 9 anos, de uma indústria de grande porte, na cidade de Itu-SP. Os voluntários foram divididos em 4 grupos de pesquisa, sendo, um grupo controle, e três grupos com dietas isocalóricas e diferentes proporções no % de carboidratos (CH), e acréscimo de semente de linhaça em pó ou arroz cru triturados (protocolo duplo cego). Foi preenchida ficha de coleta de informações sobre dados pessoais e conhecimento de fatores de risco (hipertensão, dislipidemia e diabetes), comportamentos de risco (tabagismo e sedentarismo) e antecedentes familiares. Foi também realizada avaliação clinico - laboratorial, no qual se obteve o registro de medidas antropométricas, medida da pressão arterial e coleta de sangue venoso em jejum de 12 h para avaliação de indicadores bioquímicos referentes à FR cardiovascular, tais como, colesterol total e frações (LDL-c e HDL-c), triglicérides, glicemia, insulina, Homa-beta e Homa-IR, ácido úrico, bem como, para avaliação de indicadores inflamatórios (Proteína C Reativa (PCR), Fator de Necrose Tumoral (TNF-) e Isoprostane Sérico), hormonais (Leptina e Adiponectina) e nutricionais (Enterodiol e Enterolactona séricas e urinárias). Observou-se que para redução significativa das medidas antropométricas estudadas e indicador de estresse oxidativo não houve diferenças entre os grupos que receberam intervenção dietética. Entretanto, para a melhora do perfil bioquímico, inflamatório, hormonal e nutricional, diferentes respostas foram encontradas. Os grupos que receberam dietas com redução de CH total (32% e 35%) mostraram benefícios, no que se refere ao perfil bioquímico, especialmente, colesterol total, LDL-c e ácido úrico, como também, para o perfil hormonal, referente aos níveis de adiponectina (p <0,05). Com relação aos níveis de PCR e TNF-, apenas os grupos que tiveram acréscimo de semente de linhaça na dieta apresentaram redução significativa (p<0,05). Para os níveis de triglicérides, somente o grupo com adição de semente de linhaça e 32 % de CH total apresentou diminuição significativa (p<0,05). Foi observado que com 32 % de CH total ingerido e adição de um alimento rico em lignanas constituiu-se uma estratégia nutricional relevante, para prevenção primária de fatores de risco metabólicos e controle da inflamação subclinica, o que pode contribuir na redução da morbi-mortalidade a eles associada.<br>The control of subclinical inflammatory process is associated with the prevention nutritional RF (risk factor), such as dislipidemia and the increase of visceral fat deposition. Nutritional, inflammatory and metabolic indicators seem also to related to life style. The linseed has been recognized as rich in fibers and -3. However, a new component in its nutritional composition has deserved the attention for its anti- inflammatory and antioxidant roles. This component is called lignans, a complex polymer and the main non-carbohydrate constituent of vascular plants. It is binded to cellulose fibers and is responsible for reinforcing cell walls structure, preventing them from collapsing. Plant lignans, in contact with the human intestinal flora, become enterolignans, specially enterodiol and enterolactone. This present work hypothetically that the amount of dietetic plant lignans interfere in the metabolic profile, altering the risk factors involved in the nutritional health state and consequently, the welfare state. Therefore, the objective of this study is to know if different diet nutritional composition characteristics can change the inflammatory profile, independently of the presence of enterolignans from the linseed. For 42 days, 52 male volunteers, average 37±9 years old, from a industrial city of Itu-SP, were evaluated. The volunteers were divided into 4 research groups; one control group and 3 groups on isocaloric diets with different proportion of carbohydrate (CH) and the addition of powdered linseed or ground raw rice (a double blind protocol). Personal data, RF (hypertension, dislipidemia and diabetes), habits (smoking and sedentary) and family antecedents were collected. A nutritional-laboratorial evaluation was performed in order to get anthropometric data; blood pressure checked and blood samples (after 12 hours fast) for total cholesterol and fractions (LDL-c and HDL-c ), triglycerides, glycemia, insulin, Homa-beta and Homa-IR, uric acid, inflammatory indicators (Reactive-C Protein (PCR) , Tumoral Necrosis Factor (TNF-a) and Seric Isoprostane ), hormonal (Leptin and Adiponectin), enterodiol and enterolactone seric and urinary enterolignins. It was observed a reduction of the studied anthropometric measures and for the oxidative stress indicators. A significant change occurred in the anthropometric measurements and the oxidative stress marker evaluated for all groups, but no difference among them was noted. On the other hand, biochemical, inflammatory, hormonal and nutritional profile significant differences among groups was observed. The groups that received diets with the reduction of the total CH (32% and 35% ) showed improvements in the biochemical profile, specially in the total cholesterol, LDL-c and uric acid, as well as the hormonal profile, in the levels of adiponectin (p< 0,05) . The levels of PCR and TNF-a, only the groups that had the linseed, showed a reduction (p< 0,05). For the triglycerides levels, only the group with the addition of linseed and 32% of total CH showed a decrease. It was observed with 32% of CH and the addition of food lignans constitute a nutritional relevant strategy for the primary prevention of metabolic risk factors and control of subclinical inflammation, contributing to the reduction of the associated morbi-mortality.

For the purposes of this study, eating disturbances were placed on a continuum ranging from disordered to normal, and family factors were examined via this framework. Research on anorectics and bulimics indicates that a variety of family variables contribute to the etiology of eating disorders. Research suggests the presence of a subgroup of persons who experience some disturbance in their relationships with food but not to the severity observed among eating disordered individuals. This study examined the relationship between family factors and eating disturbances.

The rehab in neurogenic dysphagia based on evidences imply in the relation between interventions and the results. Aim: evaluate the efficacy of speech therapy intervention in swallowing of carrier patients of swallowing disorders after stroke, examine the grade of swallowing, the level of anxiety and the nutritional state of carrier patients of swallowing disorders after stroke, before and after speech therapy treatment. Methods: Exploratory study, transverse of quantitative character. The sample consisted in 12 patients, media of age 64.6 years with medical diagnosis of hemorrhagic and ischemic stroke without cognitive disorders. It was realized clinical assessment of dysphagia with the partial use of the Protocol of Risk Assessment for Dysphagia (PARD), application of the Functional Oral Intake Scale for Dysphagia in Stroke Patients FOIS, videofluoroscopy assessment of swallowing, questionnaire about perception swallowing, application of Beck Anxiety Scale(BAI) and application of mini nutritional assessment MNA®. All tests were applied before and after speech therapy (15 sessions) Results: Statistically significant changes in the degree of dysphagia through clinical assessment (p=0,017) and oral intake through FOIS (p=0,003).On videofluoroscopy assessment and perception of swallowing it wasn`t observed statistics results, but it was possible to observe an evolution in their scores, 33% showed functional swallowing and 25% characterized swallowing with excellency after the therapy sessions. It was observed during assessments pre speech therapy that 47.1% of the patients showed picture of malnutrition and 35.3% of patients had a mild degree of anxiety. After fifteen treatment sessions it was found that 16.7% were malnourished and 50% of patients had minimal degree of anxiety. Conclusion: It was observed therapy efficacy on dysphagias after stroke on this sample, evolution on the level of oral intake and in the grade of dysphagia, also confirmed by videofluoroscopy. In relation to the grade of anxiety and to the nutritional state of this sample, there was an considerable evolution after therapeutic procedure. Although the sample number is small, the reached progress in all variables showed importance of use of a therapeutic program, providing benefits in life quality of the dysphagic patient.<br>A reabilitação em disfagia orofaríngea baseada em evidências implica a relação entre as intervenções e os seus resultados. Objetivo: avaliar a eficácia da intervenção fonoaudiológica na deglutição de pacientes portadores de disfagia orofaríngea pós-AVC, analisar o grau de disfagia, o nível de ansiedade e o estado nutricional de pacientes portadores de disfagia orofaríngea pós-AVC, antes e após o tratamento fonoaudiológico. Método: estudo exploratório, transversal de caráter quantitativo. A amostra foi constituída por 12 pacientes, média de idade de 64,6 anos com diagnóstico médico de AVC hemorrágico e isquêmico e sem distúrbios cognitivos. Foi realizada a avaliação clínica da disfagia com o uso parcial do Protocolo de Avaliação do Risco para a Disfagia - PARD, aplicação da escala Funcional Oral Intake Scale for Dysphagia in Stroke Patients FOIS, avaliação videofluoroscópica da deglutição, questionário sobre a percepção da deglutição, aplicação da Escala de Ansiedade de Beck (BAI) e utilização da miniavaliação nutricional MNA®. Todos os exames foram aplicados pré e pós-terapia fonoaudiológica (15 sessões). Resultados: evolução estatisticamente significativa no grau de disfagia através da avaliação clínica (p=0,017) e da ingesta oral através da FOIS (p=0,003). Nas avaliações videofluoroscópica e da percepção da deglutição, não foram observados resultados estatisticamente significativos, porém foi possível verificar uma evolução em seus escores, 33% apresentaram deglutição funcional e 25% caracterizaram a deglutição com excelente após as sessões terapêuticas. Observou-se também, durante as avaliações pré-terapia fonoaudiológica, que 47,1% dos pacientes evidenciaram quadro de desnutrição, e 35,3% dos pacientes apresentaram o grau de ansiedade leve. Após as sessões terapêuticas, verificou-se que 16,7% estavam desnutridos, e 50% dos pacientes apresentaram grau mínimo de ansiedade. Conclusão: observou-se eficácia terapêutica nas disfagias orofaríngeas após AVC nesta amostra, evolução no nível de ingestão oral e no grau de disfagia, confirmado também pela videofluoroscopia. Em relação ao grau de ansiedade e ao estado nutricional desta amostra, verificou-se evolução considerável pós-procedimento terapêutico. Embora o número da amostra seja pequeno, o progresso obtido em todas variáveis demonstra a importância da utilização de um programa terapêutico, proporcionando benefícios na qualidade de vida do paciente disfágico.

Background. Emerging evidence suggests that youth with attention deficit/hyperactivity disorder (ADHD) may engage in sub-optimal health behaviors including high levels of screen time, low physical activity participation, and consumption of poor diets. These are independent risk factors for adverse health outcomes, and health-related behavior patterns established in childhood can track into adulthood. Thus, identifying and addressing dietary and physical activity habits in sub-populations of youth have important implications for health over the lifespan. The specific aims of this dissertation were to: (1) compare screen time between youth with and without ADHD and to assess its relationship to ADHD symptomatology; (2) compare participation in physical activity (PA) between adolescents with and without ADHD and to assess the relationship of PA participation to ADHD symptomatology; and (3) evaluate the association of diet quality and dietary patterns to ADHD symptomatology among youth ages 8-15 years. Methods. The aforementioned outcomes of interest were analyzed using data from the continuous National Health and Nutrition Examination Survey (NHANES) 2001-2004. These waves of NHANES included a structured DSM-IV-based interview administered to parents that identified youth with ADHD and also yielded symptom counts for hyperactivity/impulsivity and inattention. Screen time and physical activity data were obtained from questionnaires that queried the amount of time spent watching television, playing videos, or using the computer outside of school time, and also surveyed the types, frequency, and duration of PA in which youth participated. Diet quality and dietary patterns, which included consumption of sugar-sweetened beverages (SSBs), total calorie intake, and eating frequency, were obtained by a 24-hour dietary recall using the Automated Multiple Pass Method of interviewing. Linear and logistic regression models adjusted for sociodemographic factors and anxiety/depression were employed to address the specific aims. Results. The findings suggest that youth with ADHD are at the same, if not higher, risk for engaging in suboptimal health behaviors. Overall, youth participating in NHANES engaged in excessive amounts of screen time, failed to acquire sufficient physical activity, and consumed diets of poor quality. However, our findings suggest that ADHD symptomatology places youth at higher risk for sedentary behavior and poor diet quality. Relative to screen time, youth with ADHD showed a trend toward increased screen time, as did youth who took medication. ADHD symptoms were also associated with over two hours of daily TV viewing and overall increased screen time, and this was particularly true for children ages 8-11 years. Relative to physical activity, the outcomes did not differ between youth with and without ADHD, but the majority of youth did not meet the recommended guidelines of 60 minutes or more of moderate-to-vigorous PA each day. Diet quality was poor across the population of youth who participated in NHANES, and hyperactive/impulsive symptoms were associated with an even greater decrease in diet quality in both children and adolescents. In males, the presence of hyperactive/impulsive symptoms was associated with a decrease in diet quality, whereas in females, inattentive symptoms accounted for a decrease in diet quality. No differences in the other dietary patterns (i.e., SSB consumption, total energy intake, and eating frequency) were observed. Conclusions. The diagnosis of ADHD and/or its symptoms are associated with less-than-recommended levels of screen time and poor diet quality, though youth in general were found to be engaging in suboptimal sedentary, physical activity, and dietary behaviors. The mechanisms for why youth with ADHD may have increased vulnerability to poorer health behaviors are not yet well understood. The findings from this dissertation support the need for ongoing efforts to address lifestyle factors among the nation’s youth generally, but may also stimulate new hypotheses about the needs of youth with ADHD from both public health and clinical perspectives, and encourage research on the implications of ADHD symptomatology on health-related behaviors and lifestyle factors.

Background. Emerging evidence suggests that youth with attention deficit/hyperactivity disorder (ADHD) may engage in sub-optimal health behaviors including high levels of screen time, low physical activity participation, and consumption of poor diets. These are independent risk factors for adverse health outcomes, and health-related behavior patterns established in childhood can track into adulthood. Thus, identifying and addressing dietary and physical activity habits in sub-populations of youth have important implications for health over the lifespan. The specific aims of this dissertation were to: (1) compare screen time between youth with and without ADHD and to assess its relationship to ADHD symptomatology; (2) compare participation in physical activity (PA) between adolescents with and without ADHD and to assess the relationship of PA participation to ADHD symptomatology; and (3) evaluate the association of diet quality and dietary patterns to ADHD symptomatology among youth ages 8-15 years. Methods. The aforementioned outcomes of interest were analyzed using data from the continuous National Health and Nutrition Examination Survey (NHANES) 2001-2004. These waves of NHANES included a structured DSM-IV-based interview administered to parents that identified youth with ADHD and also yielded symptom counts for hyperactivity/impulsivity and inattention. Screen time and physical activity data were obtained from questionnaires that queried the amount of time spent watching television, playing videos, or using the computer outside of school time, and also surveyed the types, frequency, and duration of PA in which youth participated. Diet quality and dietary patterns, which included consumption of sugar-sweetened beverages (SSBs), total calorie intake, and eating frequency, were obtained by a 24-hour dietary recall using the Automated Multiple Pass Method of interviewing. Linear and logistic regression models adjusted for sociodemographic factors and anxiety/depression were employed to address the specific aims. Results. The findings suggest that youth with ADHD are at the same, if not higher, risk for engaging in suboptimal health behaviors. Overall, youth participating in NHANES engaged in excessive amounts of screen time, failed to acquire sufficient physical activity, and consumed diets of poor quality. However, our findings suggest that ADHD symptomatology places youth at higher risk for sedentary behavior and poor diet quality. Relative to screen time, youth with ADHD showed a trend toward increased screen time, as did youth who took medication. ADHD symptoms were also associated with over two hours of daily TV viewing and overall increased screen time, and this was particularly true for children ages 8-11 years. Relative to physical activity, the outcomes did not differ between youth with and without ADHD, but the majority of youth did not meet the recommended guidelines of 60 minutes or more of moderate-to-vigorous PA each day. Diet quality was poor across the population of youth who participated in NHANES, and hyperactive/impulsive symptoms were associated with an even greater decrease in diet quality in both children and adolescents. In males, the presence of hyperactive/impulsive symptoms was associated with a decrease in diet quality, whereas in females, inattentive symptoms accounted for a decrease in diet quality. No differences in the other dietary patterns (i.e., SSB consumption, total energy intake, and eating frequency) were observed. Conclusions. The diagnosis of ADHD and/or its symptoms are associated with less-than-recommended levels of screen time and poor diet quality, though youth in general were found to be engaging in suboptimal sedentary, physical activity, and dietary behaviors. The mechanisms for why youth with ADHD may have increased vulnerability to poorer health behaviors are not yet well understood. The findings from this dissertation support the need for ongoing efforts to address lifestyle factors among the nation’s youth generally, but may also stimulate new hypotheses about the needs of youth with ADHD from both public health and clinical perspectives, and encourage research on the implications of ADHD symptomatology on health-related behaviors and lifestyle factors.

Orientadores: Maria Beatriz Duarte Gavião, Paula Midori Castelo<br>Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba<br>Made available in DSpace on 2018-08-24T06:10:58Z (GMT). No. of bitstreams: 1 Lucas_BarbaradeLima_D.pdf: 5263603 bytes, checksum: 3895df2cd02cd6dc67e284528af30e3c (MD5) Previous issue date: 2013<br>Resumo: Este estudo buscou identificar as possíveis relações dos padrões antropométricos nutricionais com as caracrerísticas morfológicas e funcionais do sistema mastigatório e níveis de biomarcadores salivares. Três estudos foram conduzidos, apresentados na forma de capítulos. As amostras foram compostas por sujeitos saudáveis, com idade entre 15 e 30 anos. Capítulo 1: Objetivou comparar a antropometria e a composição corporal e verificar se o padrão antropométrico nutricional estaria associado à disfunção temporomandibular (DTM). Foram avaliados 110 mulheres e 60 homens distribuídos em grupos controle, desordem muscular (MD) ou deslocamento de disco (DD), de acordo com o Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). As medidas antropométricas foram peso, altura e perímetros da cintura, abdomen e quadril. A composição corporal foi avaliada por meio da porcentagem de gordura corporal (BF%), e das massas adiposa, óssea, muscular e residual. A intensidade da dor (CPI) e os sintomas físicos não específicos incluíndo dor facial (NSPSP) foram considerados. Observação: O resumo, na íntegra, poderá ser visualizado no texto completo da tese digital.<br>Abstract: The aim of this study was to identify possible associations of nutritional anthropometric patterns with morphologic and functional characteristics of the masticatory system as well as with salivary biomarkers. Three studies were developed and reported in three chapters. Samples consisted of health subjects aged between 15 and 30 years. Chapter 1: To compare body characteristics and composition and to verify if nutritional anthropometric patterns are associated with temoromandibular dysfunctions (TMD). 110 females and 60 males were classified into Control, Muscle disorders (MD) or Disc displacements (DD) groups according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Anthropometric measurements recorded were weight, height and perimeters of waist, abdomen and hip. Body composition was evaluated with values of body fat percentage (BF%) as well as with values of fat, muscle, bone and residual mass. Pain intensity (CPI) and nonspecific physical symptoms including facial pain (NSPSP) were considered. ...Note: The complete abstract is available with the full electronic document.<br>Doutorado<br>Fisiologia Oral<br>Doutora em Odontologia

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior<br>Apesar do declínio dos déficits nutricionais em menores de cinco anos nas últimas décadas, a desnutrição infantil ainda se configura como problema de saúde pública, apresentando altas prevalências em algumas regiões do Brasil e em outros países em desenvolvimento, além de inúmeras repercussões negativas na morbi-mortalidade. A saúde mental materna (SMM) tem sido cada vez mais considerada como um aspecto relevante para a saúde infantil. Apesar disso, pouco enfoque tem sido dado às suas repercussões sobre o estado nutricional infantil. Investigar a associação entre SMM e estado nutricional infantil no sexto mês de vida. Conduziu-se um estudo seccional inserido em uma coorte prospectiva com 235 crianças aos seis meses advindas de unidades básicas de saúde do município do Rio de Janeiro. Para formar os desfechos, médias de peso-para-comprimento e peso-para-idade foram expressas em escores z usando a nova curva de referência da OMS (2006) para menores de cinco anos. Aplicou-se a versão em português do General Health Questionnaire com 12 itens (GHQ-12) e 4 opções de resposta para aferição da SMM. Utilizou-se sistemas de pontuação de forma a gerar duas variáveis discretas: GHQ-bimodal (zero a 12 pontos) e GHQ-Likert (zero a 36 pontos). Tomando como referência a variável GHQ-bimodal, foram empregados os pontos de corte >3 para detecção de transtornos mentais comuns (TMC), >5 para transtornos mentais mais graves e >9 para sintomas depressivos. A análise da associação entre SMM e desfechos nutricionais se baseou em modelos de regressão linear. A amostra revelou escores z médios de 0,23 para peso-para-comprimento e de 0,05 para peso-para-idade. As prevalências de TMC, transtornos mentais mais graves e sintomas depressivos foram de 39,9%, 23,7% e 8,3%, respectivamente. Após ajuste pelo peso ao nascer, maiores pontuações no GHQ-bimodal e GHQ-Likert estiveram associadas a menores médias de peso-para-comprimento. Para este desfecho, os filhos de mulheres com transtornos mentais mais graves tinham, em média, 0,37 escores-z mais baixos em relação aos filhos de mulheres sem estes agravos (p = 0,026). Observou-se, também, uma média de 0,67 escores-z mais baixos em filhos de mulheres com sintomas depressivos em relação aos filhos de mulheres não deprimidas (p = 0,010). Apenas sintomas depressivos na mãe estiveram associados significativamente com valores médios mais baixos de escore-z de peso-para-idade (p = 0,041). Não se observou associação significante entre TMC e os desfechos avaliados. A SMM esteve relacionada à inadequação do estado nutricional de crianças aos seis meses. O reconhecimento precoce e tratamento destes agravos durante o puerpério poderiam ser estratégias adjuvantes para melhorar a situação nutricional infantil e, por fim, reduzir a morbi-mortalidade associada aos déficits nutricionais.<br>Despite the decline of nutritional deficits in children under five years in the last decades, infant malnutrition remains a public health problem, with high prevalence in some regions of Brazil and other developing countries and numerous adverse effects on morbidity and mortality. Maternal mental health (MMH) is being increasingly considered a relevant aspect in the context of child health. Nevertheless, little focus has been given to the MMH impact on nutritional status. To investigate the association between maternal mental health and child nutritional status at six months of life. A cross-sectional study inserted in a prospective cohort was conducted with 235 children at six months of age recruited in primary health care centers in Rio de Janeiro, Brazil. To form the outcomes, means of weight-for-length and weight-for-age were expressed in z scores using the new WHO growth standards (2006) for children under five years of age. The Portuguese version of the General Health Questionnaire with 12 items and four answer options (GHQ-12) was applied to measure MMH. Two scoring systems were used to create discrete variables: GHQ-bimodal score (zero to 12 points) and GHQ-Likert score (zero to 36 points). Using the GHQ-bimodal score a cut-off point of >3 was used for the detection of common mental disorders (CMD), a cut-off of >5 for more severe mental disorders, and a cut-off of >9 for depressive symptoms. Analysis of association between MMH and nutritional outcomes was based on linear regression models. The sample showed average z scores of 0.23 for weight-for-length and 0.05 for weight-for-age. The prevalence of CMD, more severe mental disorders and depression was 39.9%, 23.7% and 8.3%, respectively. After adjusting for birth weight, higher scores of GHQ-bimodal and GHQ-Likert were associated with lower mean z scores of weight-for-length. For this outcome, children of women with more severe mental disorders had, on average, 0.37 z-scores lower when compared to children of women without these disorders (p = 0.026). Also, children of women with depressive symptoms had, on average, 0.67 z-scores lower than those from non-depressive mothers (p = 0.010). Only maternal depressive symptoms showed significantly association with lower weight-for-age (p = 0,041). There was no statistically significant association between TMC and both nutritional outcomes. MMH was related to inadequate nutritional status of children at six months of age. Early recognition and treatment of mental health problems in the postpartum period might be an adjuvant strategy to improve child nutritional status and ultimately reduce the morbidity and mortality associated with nutritional deficits.

Orientadores: Elizete Aparecida Lomazi Da-Costa-Pinto, Antonio de Azevedo Barros Filho<br>Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas<br>Made available in DSpace on 2018-08-17T03:05:14Z (GMT). No. of bitstreams: 1 Tamega_IzildadasEiras_D.pdf: 2217221 bytes, checksum: e9d4c3645d56bdb073deb9ab2debb4f7 (MD5) Previous issue date: 2010<br>Resumo: Desvios nutricionais e disfagia são comumente relatados nas avaliações de crianças com encefalopatia crônica não progressiva. Apesar da importância do diagnóstico precoce, da estimulação neuro-psico-motora, da prevenção de co-morbidades e acompanhamento nutricional, são escassos os trabalhos longitudinais que avaliaram o crescimento em lactentes de risco para ECNP. O objetivo geral deste estudo foi acompanhar, prospectivamente, o crescimento de lactentes com antecedentes de fatores de risco para ECNP e exame neurológico alterado (N= 132). Os pacientes foram examinados aos 6, 12, 18 e 24 meses de idade, enquanto atendidos em ambulatório universitário. Foram registradas situação sócio-demográfica, condições de vida e saúde e realizado exame neurológico e fonoaudiológico no 6º e 24º meses. O grupo controle incluiu lactentes saudáveis (N= 125) acompanhados em unidade básica de saúde e de mesmas características sócio-econômicas. Os objetivos específicos foram mensurar indicadores antropométricos: peso, comprimento, perímetro cefálico e compará-los com os dados do grupo controle; analisar no grupo caso os valores de circunferência braquial, prega tricipital e os respectivos escores Z; descrever: aspectos sócio-demográficos, hábitos e condições alimentares, condições de nascimento, internações, morbidades, sintomas gastrintestinais, terapias auxiliares, uso de medicamentos e cuidados maternos; identificar a prevalência de distúrbios da deglutição, constipação intestinal e de erros alimentares e investigar a existência de associação entre distúrbios de deglutição e alterações neurológicas. Na análise estatística foram utilizados os testes Qui quadrado e exato de Fisher, o teste de Mann-Whitney e de Kruskal-Wallis. Para comparar as medidas longitudinais entre os 2 grupos foi utilizada a análise de variância para medidas repetidas, seguida do teste de comparação múltipla de Tukey e o teste de perfil por contraste. Os fatores de risco mais frequentes foram os do período perinatal, observados em 121 crianças (92%), prematuridade ocorreu em cerca da metade dos casos e esteve associada a outros fatores de risco. Apenas 7 crianças foram amamentadas após os 6 meses e em 50% dos pacientes observou-se erros alimentares e duração prolongada da alimentação. Sintomas de RGE ocorreram em 44 casos (33%), constipação em 17 (13%) e ambos em 65 casos (49%); metade das crianças seguiu irregularmente as terapias auxiliares e 78% utilizava medicamentos antirefluxo e anticonvulsivos. O grau de acometimento nos resultados dos exames neurológico e fonoaudiológico apresentou correlação positiva aos 6 e 24 m. Ao nascimento, os valores de peso, comprimento e perímetro cefálico dos pacientes encefalopatas foram significativamente inferiores aos valores das crianças saudáveis. A partir do 12º mês, a diferença estatística não se manteve, embora, no grupo caso, os dados absolutos permanecessem inferiores. Esse grupo apresentou incremento positivo ao longo do tempo, nos escores Z da circunferência braquial e prega tricipital, indicando acúmulo da massa gordurosa. A gravidade da disfagia correlacionou-se a maior comprometimento antropométrico. No grupo caso, a comparação do crescimento entre nascidos a termo e prematuros mostrou valores significativamente inferiores para os prematuros. Concluindo, os lactentes com agravo neurológico apresentaram comprometimento antropométrico significativo ao nascimento e aos 6 meses, sendo que o antecedente de prematuridade esteve associado a efeito negativo significativo no crescimento dessas crianças<br>Abstract: Nutritional disorders and dysphagia are frequently reported in children with non progressive chronic encephalopathy (NPCE). Despite the importance of early diagnosis, neuro-psycho-motor stimulation, prevention of co-morbidities and need of nutritional advising, longitudinal studies including infants at risk for NPCE are scarce. The objective of this study was to prospectively follow growth in infants with risk factors for NPCE and with abnormal neurological examination (N=132). Children were seen from 6 to 24 months age, in a tertiary outpatient clinic. Anthropometric data, neurological condition and speechaudiology test were recorded at 6th and 24th months of life. Control group with the same socio-economic characteristics included healthy infants (N=125) followed in a primary care health center. Specific objectives were to record anthropometric indicators: weight, length, head circumference and respective Z scores and to compare them to the control group; to analyze case group values of arm circumference, triceps skin fold and respective Z scores; to describe socio-demographic aspects, habits and nutritional conditions, birth conditions, hospital admissions, co-morbidities, gastrointestinal symptoms and use of medications. Statistical analysis used chi-square, Fisher's exact, Mann-Whitney and Kruskal-Wallis tests. Analysis of variance for repeated measurements, followed by Tukey's multiple comparison test and the contrast profile test were used to compare longitudinal measurements between both groups. Most common risk factors were those occurred in perinatal period, observed in 121 children (92%), prematurity was seen in about half of cases and was associated with other risk factors. Only 7 children were breastfed after 6 months and feeding misinterpretation were seen in 50% of patients. Gastroesophageal reflux symptoms were referred in 44 infants (33%), constipation in 17 (13%) and both in 65 (49%). Adherence to therapies with speech-therapist or physiotherapist was irregular. Neurological severity was associated with dysphagia. Dysphagia severity was also associated with greater anthropometric impairment at 6th and 24th months. At birth, NPCE patient's weight, length and head circumference were significantly lower, but the statistical difference did not remain at 12th month, although with lower absolute values in the case group. The case group showed a positive increment in arm circumference and triceps skinfold Z scores throughout time, indicating accumulation of fat mass. The severity of dysphagia correlated with more severe anthropometric impairment. preterm newborns in case group showed significantly lower growth values when compared to term infants In conclusion, infants with NPCE presented significant anthropometric impairment at birth and at 6 months, and preterm infants were significantly smaller than term patients<br>Doutorado<br>Saude da Criança e do Adolescente<br>Doutor em Saude da Criança e do Adolescente

L'anorexie mentale est une pathologie psychiatrique grave et complexe, faisant partie des troubles du comportement alimentaire. L’un de ses symptômes est l’hyperactivité physique, généralement associée à un pronostic clinique et thérapeutique défavorable. La connaissance et la compréhension de l'activité physique, qui s’avère être problématique dans les troubles du comportement alimentaire, restent à élucider, en particulier dans l'anorexie mentale. Cette thèse a pour objectifs : 1) d'examiner exhaustivement la littérature publiée au cours des 40 dernières années (1975-2015). Cela permettra de mieux comprendre ce phénomène et de donner des recommandations générales, clinique et de recherche, pour les futures études. 2) D’étudier l'impact des différentes définitions de l'activité physique problématique, retrouvées dans la littérature, sur la prévalence de celle-ci au sein d’un large échantillon de patientes souffrants d’anorexie mentale aigue. Nous examinons aussi les associations entre ces différentes définitions et les principaux symptômes alimentaires, le profil émotionnel et la qualité de vie. 3) D’étudier l'impact de l'activité physique problématique sur le statut nutritionnel (indice de masse corporelle et composition corporelle) de ces patientes. Cela est réalisé en prenant en compte les manifestations cliniques de la maladie, incluant les types d’anorexie mentale (restrictif ou avec crises de boulimie/vomissements ou prise de purgatifs), l’âge à la découverte et la durée de la maladie, le diagnostic de l’anorexie mentale avant la ménarche et la présence d'aménorrhée. Finalement, nous proposons un modèle compréhensif du développement de l’activité physique problématique dans l'anorexie mentale. En outre, ce travail met en relief le fait que l'activité physique pourrait être positivement ciblée dans les programmes thérapeutiques. Sa prise en charge pourrait être intégrée dans la modalité thérapeutique conjointement aux différentes dimensions psychologiques, somatiques et sociales. L'activité physique problématique dans l'anorexie mentale doit urgemment solliciter l’attention des cliniciens et des chercheurs<br>Anorexia nervosa is a serious and complex psychiatric pathology included in eating disorders. Its symptoms include physical hyperactivity, which has been associated by many with a worse clinical and therapeutic outcome. Much remains to be known and understood about physical activity, which is problematic in eating disorders, especially in anorexia nervosa. The aims of this thesis are to: 1) critically and exhaustively examine the literature published during the past 40 years (1975-2015). This is done in order to clarify the landscape and give general clinical and research perspectives for future studies. 2) Investigate the impact of different definitions of problematic physical activity, found in the literature, on its prevalence in a large sample of patients suffering from acute anorexia nervosa. We will examine the associations between these different definitions and core eating disorders symptoms, emotional profile and quality of life. 3) Investigate the impact of problematic physical activity on nutritional status (body mass index and body composition) of patients. This is done by taking into account clinical features. These features include anorexia nervosa subtypes (restricting or binge-eating/purging type), age at onset, illness duration, premenarchal anorexia nervosa, and presence of amenorrhea. Finally, we propose a comprehensive model of the development of problematic physical activity in anorexia nervosa. We highlight the fact that physical activity could be positively taken into account in global treatment programs. It could be integrated in these programs, in addition to their psychological, somatic and social dimensions. Problematic physical activity in anorexia nervosa is in need of immediate attention from clinicians and researchers

Introdução: As Mucopolissacaridoses (MPS) são doenças lisossômicas causadas pela deficiência de enzimas envolvidas na degradação dos glicoaminoglicanos. O acúmulo anormal dessa molécula compromete a função celular e orgânica, levando a um espectro de manifestações clínicas, de caráter multissistêmico e progressivo. Manifestações gastrointestinais, tais como episódios frequentes de fezes amolecidas e diarréia, têm sido frequentemente evidenciadas e relatadas por pacientes com MPS. Ainda que os sintomas gastrointestinais sejam frequentemente ofuscados pelos fenótipos neurológicos graves, eles podem afetar a qualidade de vida dos pacientes e de seus familiares. Objetivo: Avaliar as manifestações gastrointestinais em pacientes com MPS que estavam ou não recebendo Terapia de Reposição Enzimática (TRE). Adicionalmente, para melhor compreender o assunto, avaliamos a histologia da mucosa intestinal em camundongos com MPS I. Métodos: Estudo transversal com amostragem de conveniência. Foram incluídos no estudo pacientes com diagnóstico de qualquer tipo de MPS que estavam ou não em TRE. Os sujeitos foram avaliados através de inquérito alimentar, questionamentos quanto ao aparecimento de sintomas gastrointestinais e realização de uma série de exames bioquímicos. Adicionalmente, foram realizados testes de bioimpedância elétrica (para avaliação da composição corporal) e teste molecular para hipolactasia primária a partir de amostras de DNA dos pacientes, assim como análise da histologia da mucosa intestinal em um modelo de camundongo com MPS I. Resultados: Foram incluídos 27 pacientes com diferentes tipos de MPS, sendo 15 (55,6%) do sexo feminino e 12 (44,4%) do sexo masculino, com mediana de idade de 12 (1-28) anos. Os sintomas gastrointestinais mais prevalentes foram flatulência, distensão abdominal, dor abdominal e fezes amolecidas. Houve diferença significativa na prevalência de flatulência entre os tipos de MPS (p=0,004). A prevalência de flatulência e de distensão abdominal foi significativamente maior no grupo dos que não recebiam TRE, em comparação ao grupo dos que recebia TRE (p = 0,04 e 0,03, respectivamente). A maioria dos exames bioquímicos realizados para investigação e/ou exclusão de alguma patologia específica apresentaram resultados normais, sugerindo que o aparecimento de sintomas gastrointestinais nesses pacientes possa ser decorrente da própria MPS através de mecanismo fisiopatológico independente. A análise da histologia do intestino delgado de camundongos MPS I identificou células aumentadas de volume, sugerindo algum tipo de acúmulo intracelular. Em relação ao Teste Molecular para Hipolactasia, 58,8% dos pacientes apresentaram genótipo CC, o qual é compatível com intolerância à lactose. Os exames de Bioimpedância Elétrica sugerem que, os pacientes em TRE apresentam menor proporção de massa gorda (MG) em relação aos pacientes que não estavam em TRE. Conclusão: Este foi o primeiro estudo sobre manifestações gastrointestinais de pacientes brasileiros com MPS realizado em nosso meio. Inúmeros sinais e sintomas foram observados, com maior prevalência relativa nas MPS I, II, III e IV do que na MPS VI. O sintoma mais frequentemente relatado foi flatulência. Embora não tenha sido estatisticamente significativo a diferença, a proporção de pacientes com sintomas gastrointestinais foi menor nos pacientes que estavam em TRE. A Intolerância à lactose observada em maior proporção nos pacientes com MPS com manifestações gastrointestinais, a avaliação da composição corporal e as alterações observadas na mucosa intestinal do camundongo com MPS I devem ser levadas em consideração na interpretação dos resultados. Acreditamos que mais estudos, dirigidos para as manifestações gastrointestinais, devam ser realizados para comprovar esses achados e melhor compreender os mecanismos fisiopatológicos dos sintomas relacionados nos pacientes aferidos.<br>Introduction: The mucopolysaccharidoses (MPS) are lysosomal storage disorders characterized by a deficiency in enzymes involved in glycosaminoglycan degradation. Abnormal accumulation of this molecule compromises cellular and organic function, leading to a spectrum of progressive, multisystem clinical manifestations. Gastrointestinal manifestations, such as frequent episodes of loose stools and diarrhea, are often reported by patients with MPS. Although these gastrointestinal symptoms are often overshadowed by severe neurological phenotypes, they can have a negative impact on the quality of life of patients and their family members. Objective: To assess gastrointestinal manifestations in patients with MPS who were or not receiving enzyme replacement therapy (ERT). Furthermore, we sought to assess bowel mucosa histology in a mouse model of MPS I. Methods: Cross-sectional study with a convenience sampling strategy. The sample comprised patients with a diagnosis of MPS of any type and regardless of ERT status. Patients were assessed by means of a dietary recordatory and an interview focused on gastrointestinal symptoms, as well as a battery of biochemical tests. Bioelectrical Impedance was performed for body composition assessment.Patient DNA samples were also tested by molecular tests for primary lactase hypolactasia, and bowel mucosa specimens from MPS I mice underwent histological examination. Results: A total of 27 MPS patients were included, 15 (55.6%) female and 12 (44.4%) male, with a median age of 12 (1-28) years. The most prevalent gastrointestinal symptoms were flatulence, abdominal distension, abdominal pain, and loose stools. A significant difference in the prevalence of flatulence was observed among different MPS types (p=0.004). The prevalence of flatulence and abdominal distension was significantly higher in the non-ERT group than in the ERT group (p = 0.04 and 0.03 respectively). Most biochemical tests performed to work up and/or rule out specific conditions were within normal limits, which suggests that the development of gastrointestinal systems in these patients may be due to MPS itself through an independent pathophysiological mechanism. Histological analysis of smallbowel tissue from MPS I mice found increased cell volume indicative of some form of intracellular accumulation. On molecular testing for lactase deficiency, 58.8% of patients had the CC genotype, which is consistent with lactose intolerance. Bioelectrical Impedance analysis suggest that patients with TRE have lower proportion of fat mass (FM) compared to patients who were not on ERT. Conclusion: This was the first study to assess gastrointestinal manifestations in Brazilian patients with different MPS subtypes.Several signs and symptoms were observed with higher relative prevalence in MPS I, II, III and IV to that in MPS VI. The most frequently reported symptom was flatulence. Although was no statistical difference the proportion of patients with gastrointestinal symptoms was lower in patients on ERT.The lactose intolerance observed in a higher proportion of MPS patients with gastrointestinal manifestations, body composition assessment and observed changes in the bowel mucosa of MPS I mice should be taken into account when interpreting the results. Further studies focusing on the gastrointestinal manifestations of MPS are warranted to corroborate our findings and provide a better understanding of the pathophysiological mechanisms associated with these symptoms in affected patients.

The incidence of autism continues to rise with no cure or understanding of the cause of the disorder. Approximately one in 150 children will be diagnosed with an (ASD) Autism Spectrum Disorder although recent prevalence data suggest one in 91. The objective of the study is to assess medicinal intake regarding prescription and nonprescription medications of children with Autism Spectrum Disorders and its affect on their nutritional status compared to age, and sex matched healthy children. The study included families of children with autism in which they completed questionnaires and 24‐hour recalls. There were 26 children used within the questionnaire and 13 were utilized in the 24‐hour recall, ranging in age from 2‐11. Results demonstrated that children with autism were not deficient in relation to vital nutrients needed for neurological function. Prescription and nonprescription medications also did not pose many side effects; however, there was slight weight gain in their utilization. Information from the assessments of the child’s nutritional needs and drug nutrient interaction will allow parents, paraprofessionals and healthcare professionals to provide education to families.