ABSTRACT Objective: Intrauterine environment can induce fetal metabolic programming that predisposes to adiposity-related chronic diseases in its lifespan. We examined the associations of parental nutritional status and gestational weight gain with offspring body composition in early adulthood. Materials and methods: This is cross-sectional analysis of female participants of the NutriHS who were submitted to questionnaires, clinical examinations and body composition assessed by DXA. Association of pre-conception parental BMI and maternal gestational weight gain (exposures) with body composition measurements (outcomes) were analyzed using multiple linear models adjusted for Directed Acyclic Graphs-based covariables (maternal and paternal educational level, maternal age, and tobacco, alcohol and/or drugs use). The sample included 124 women (median 28 (24-31) years) with a mean BMI of 25.4 ± 4.7 kg/m2. Results: No association between previous paternal BMI and offspring’s body composition was detected. In the fully adjusted linear regression model, maternal BMI was associated with offspring’s total lean mass (β = 0.66, p = 0.001), appendicular skeletal muscle mass index (ASMI) (β = 0.11, p = 0.003) and fat mass index (FMI) (β = 0.03, p = 0.039). Gestational weight gain was associated with increased offspring’s BMI (OR 1.12 [95% CI 1.02-1.20], p = 0.01). The linear regression model adjusted for maternal age and maternal and paternal education levels showed associations of gestational weight gain with offspring’s ASMI (β = 0.42, p = 0.046), FMI (β = 0.22, p = 0.005) and android-to-gynoid fat ratio (β = 0.09, p = 0.035). Conclusion: Our findings suggest that preconception maternal BMI could influence lean mass and general adiposity of young adult female offspring and that gestational weight gain could be useful for predicting centrally distributed adiposity. Objective adiposityrelated related lifespan adulthood methods crosssectional cross sectional questionnaires DXA pre conception exposures (exposures outcomes (outcomes Graphsbased Graphs based level tobacco andor or use. use . use) 12 median 2 2431 24 31 (24-31 years 254 25 4 25. 47 7 4. kgm2 kgm kg m2 m kg/m2 Results offsprings s detected β 066 0 66 0.66 0.001, 0001 0.001 , 001 0.001) (ASMI 011 11 0.11 0.003 0003 003 (FMI 03 0.03 0.039. 0039 0.039 039 0.039) OR 112 1 1.1 95% 95 [95 1.021.20, 102120 1.02 1.20 02 20 1.02-1.20] 0.01. 0.01 01 0.01) 042 42 0.42 0.046, 0046 0.046 046 0.046) 022 22 0.22 0.005 0005 005 androidtogynoid android gynoid 009 09 0.09 0.035. 0035 0.035 035 0.035) Conclusion 243 3 (24-3 kg/m 06 6 0.6 000 0.00 00 0.1 0.0 1. 9 [9 021 1.021.20 10212 102 1.0 120 1.2 1.02-1.20 04 0.4 004 0.04 0.2 (24- 0. [ 1.021.2 1021 10 1.02-1.2 (24 1.021. 1.02-1. (2 1.021 1.02-1 ( 1.02-

RESUMO CONTEXTO: A deficiência de vitamina D está sendo reconhecida como uma pandemia devido ao volume de pessoas afetadas pela deficiência e o número de doenças geradas ou estimuladas por tal deficiência. Há falta de consenso na literatura sobre o que é considerado deficiência de vitamina D [25(OH)D]. OBJETIVO: Esta revisão reúne os níveis mais comuns de 25(OH)D encontrados em escolares saudáveis e o que é considerado deficiência. MÉTODOS: Esta revisão sistemática foi baseada na literatura acessada a partir das bases de dados eletrônicas: MEDLINE, EMBASE, LILACS, SCOPUS e WEB OF SCIENCE. Foram utilizados os seguintes descritores em inglês, português e espanhol: “Vitamina D”; “Deficiência de vitamina D”; “Suplementos Nutricionais”, bem como todos os seus sinônimos. A meta-análise foi realizada considerando o modelo aleatório. Critérios de inclusão: crianças saudáveis na faixa etária de 6 a 12 anos, estudos que tinham níveis de vitamina D, deficiência de vitamina D definida. RESULTADOS: Dos 191 artigos potencialmente elegíveis, apenas seis artigos foram incluídos, com 2618 escolares no total. O valor médio de 25(OH)D foi estimado em 18,11 ng/mL com 95% de intervalo de confiança. Dentre os artigos encontrados três consideraram deficiência níveis abaixo de 20 ng/mL, um considerou abaixo de 18 ng/mL, outro abaixo de 15 ng/mL, e o último abaixo de 11 ng/mL. A prevalência da deficiência de vitamina D entre os artigos foi de 48,6%, 7%, 98%, 64,63%, 19,5%, 28,4%, de acordo com cada classificação utilizada por eles. CONCLUSÃO: A definição mais comum na literatura de deficiência de 25(OH)D em escolares foi em níveis inferiores a 20 ng/mL. Nenhum efeito colateral foi relatado em estudos que usaram fortificação e/ou suplementação de vitamina D. A suplementação diária é mais eficaz do que a suplementação sazonal. No entanto, mais estudos são necessários para definir o que pode ser considerado como níveis ótimos de 25(OH)D em crianças.

ABSTRACT BACKGROUND: Vitamin D deficiency is being recognized as a pandemic due to the volume of people affected by the deficiency and the number of illnesses generated or stimulated by the deficiency. There is a lack of consensus in the literature on what is considered vitamin D deficiency [25(OH)D]. OBJECTIVE: This review brings together the most common levels of 25(OH)D found in healthy schoolchildren and what is considered deficient. METHODS: This systematic review was based on the literature accessed from the electronic databases: MEDLINE, EMBASE, LILACS, SCOPUS and WEB OF SCIENCE. The following descriptors were used in English, Portuguese and Spanish: “Vitamin D”; “Vitamin D deficiency”; “Nutritional Supplements” as well as all their synonyms. The meta-analysis was performed considering the random model. Inclusion criteria: healthy children aged 6 to 12 years, studies that had vitamin D levels, defined vitamin D deficiency. RESULTS: Of the 191 potentially eligible articles, only six articles were included, with 2618 students in total. The mean value of 25(OH)D was estimated at 18.11 ng/mL with 95% confidence interval. Among the articles found, three were considered deficiency levels below 20 ng/mL, one considered below 18 ng/mL, another below 15 ng/mL, and the latter below 11 ng/ mL. The prevalence of vitamin D deficiency among the articles was 48.6%, 7%, 98%, 64.63%, 19.5%, 28.4%, according to each classification used by the same. CONCLUSION: The most common definition in the literature of 25(OH)D deficiency in schoolchildren was at levels below 20 ng/mL. No side effects have been reported in studies that used fortification and/or vitamin D supplementation. Daily supplementation is more effective than seasonal supplementation. However, more studies are needed to define what can be considered as optimal levels of 25(OH)D in children.

Resumo Objetivo: Analisar o estado nutricional relativo ao selênio e verificar o efeito da suplementação desse mineral em pacientes pediátricos durante 14 dias de nutrição parenteral (NP). Método: Trata-se de estudo prospectivo de uma série de casos de pacientes acompanhados durante duas semanas de uso de NP. A coleta de dados foi realizada no início (T0), no 7º (T1) e no 14º dia de NP (T2). Após randomização, o grupo suplementado recebeu 2 µg/kg/dia de ácido selenioso. Peso e altura foram aferidos para avaliação do estado nutricional. Exames coletados: selênio plasmático, albumina, pré-albumina, proteína C-reativa (PCR), colesterol total e HDL-colesterol. Resultados: Foram avaliados 14 pacientes com processo inflamatório em curso e com baixo ou muito baixo peso para a idade. Os pacientes (grupo suplementado e não suplementado) tinham baixas concentrações de selênio. A mediana dos valores de selênio plasmático foi de 17,4 µg/L (T0), 23,0 µg/L (T1) e 20,7 µg/L (T2). Aumento e redução de selênio ocorreram tanto nos pacientes com PCR elevada quanto naqueles que apresentaram normalização desse parâmetro. Conclusão: Os níveis de selênio detectados foram muito baixos e a suplementação (2 µg/kg/dia de ácido selenioso) não foi suficiente para normalização dos níveis plasmáticos.

Summary Objective: To analyze the nutritional status of selenium and verify the effect of its supplementation in pediatric patients during 14 days of parenteral nutrition (PN). Method: This is a series of cases with patients followed for two weeks while using PN. Data collection was performed at the beginning (T0), in the 7th (T1) and 14th days of PN (T2). The supplemented group received 2 µg/kg/day of selenous acid. Weight and height were measured for nutritional status assessment. Tests requested: plasma selenium, albumin, pre-albumin, C-reactive protein (CRP), total cholesterol and HDL-cholesterol. Results: Fourteen (14) patients with inflammatory process and with low or very low weight for their ages were evaluated. In both groups (with and without supplementation), all patients had low selenium levels. Median plasma selenium concentrations were 17.4 µg/L (T0), 23.0 µg/L (T1) and 20.7 µg/L (T2). Increase and reduction of selenium occurred both in patients with high CRP and in those presenting normalization of this parameter. Conclusion: Lower plasma selenium levels have been detected since the start of the research and supplementation (2 µg/kg/day of selenous acid) was not to enough to approach the reference values.

Background: assess whether the current protein intake recommendations may improve the biochemical parameters of critical patients receiving parenteral nutrition. Methods: longitudinal study with three evaluations made (during the first 72 hours, on the 7th and the 14th days of PN). The following tests were applied: albumin, C-reactive protein, prealbumin, total cholesterol, HDL, triglycerides, lymphocytes, and glutathione peroxidase. The severity was determined by SOFA. The statistical analysis included the Spearman and Mann-Whitney tests, as well as ANOVA (analysis of variance). Results: among the 53 patients evaluated, 20 (37.74%) died. The mean calorie was 24.68 ± 9.78 kcal/kg (beginning of PN), 26.49 ± 8.89 kcal/kg (3rd to 7th days of PN), and 30.9 ± 12.19 kcal/kg (7th to 14th days of PN). The mean protein was 1.19 ± 0.44 g/kcal/kg (first 72 hours of PN), 1.29 ± 0.44 g/kcal/kg (3rd to 7th days of PN) and 1.49 ± 0.69 g/kcal/kg (7th to 14th days of PN). Prealbumin, albumin, total cholesterol and HDL were below the reference values, while the CRP levels were high. Throughout the three evaluation times, there was no a significant improvement on the levels of laboratory examinations. A strong and negative correlation was found between SOFA and prealbumin (r = -0.64, p = 0.05). Conclusions: the protein offer, according to the traditional recommendations, was not enough to improve the biochemical parameters of critical patients undergoing parenteral nutrition.

Introducción: evaluar si las recomendaciones de ingesta de proteínas actuales pueden mejorar los parámetros bioquímicos de los pacientes críticos que reciben nutrición parenteral. Métodos: estudio longitudinal con tres evaluaciones realizadas (durante las primeras 72 horas, en el séptimo y los días decimocuarto de nutrición parenteral). Se aplicaron las siguientes pruebas: albúmina, proteína C reac ti va, prealbúmina, colesterol total, HDL, triglicéridos, linfocitos y glutatión peroxidasa. La gravedad se determinó por SOFA. El análisis estadístico incluyó las pruebas de Spearman y Mann-Whitney, así como ANOVA (análisis de varianza). Resultados: de los 53 pacientes evaluados, 20 (37,74%) fallecieron. La caloría media fue de 24,68 ± 9,78 kcal/kg (comienzo de PN), 26,49 ± 8,89 kcal/kg (tercero-séptimo días de PN), y 30,9 ± 12,19 kcal/kg (séptimo-décimo cuarto días de PN). La proteína media fue de 1,19 ± 0,44 g/ kcal/kg (primeras 72 horas de PN), 1,29 ± 0,44 g/kcal/kg (tercero-séptimo días de PN) y 1,49 ± 0,69 g/kcal/kg (séptimo- decimocuarto días de PN). La prealbúmina, la albúmina, el colesterol total y la HDL estaban por debajo de los valores de referencia, mientras que los niveles de PCR eran altos. A lo largo de los tres tiempos de evaluación, no hay una mejora significativa en los niveles de los exámenes de laboratorio. Una correlación fuerte y negativa entre SOFA y prealbúmina (r = -0,64, p = 0,05). Conclusiones: la oferta de proteínas, de acuerdo con las recomendaciones tradicionales, no fue suficiente para mejorar los parámetros bioquímicos de los pacientes críticos sometidos a nutrición parenteral.

INTRODUÇÃO: As formulações da nutrição parenteral (NP) são comumente individualizadas, visto que a padronização destas parece inadequada para a população pediátrica. O objetivo do estudo foi avaliar o estado nutricional e os motivos para individualização da NP dos pacientes pediátricos em uso de NP internados em um hospital terciário de Campinas-SP.MÉTODOS: Estudo longitudinal conduzido com pacientes acompanhados por até 67 dias de uso de NP. Para a classificação do estado nutricional, foram utilizados os critérios propostos pela World Health Organization (WHO) (2006) e WHO (2007). As dosagens sanguíneas analisadas foram: sódio, potássio, cálcio iônico, cloreto, magnésio, fósforo inorgânico e triglicerídeo (TGL). Foram considerados motivos indubitáveis para individualização da NP quando esses elementos apresentavam redução expressiva dos níveis sanguíneos (potássio <3 mEq/L; sódio <125 mEq/L; magnésio <1 mEq/L; fósforo <1,5 mEq/L; cálcio iônico <1 mmol/L; cloreto <90 mEq/L) ou qualquer valor superior aos de referência.RESULTADOS: Foram estudados 12 pacientes (49 individualizações) com idade de 1 mês a 15 anos. A maioria dos pacientes foi classificada como desnutrida. Observou-se que 74/254 (29,2%) dos exames demandaram NP individualizada por motivos indubitáveis.CONCLUSÃO: O estado nutricional dos pacientes foi considerado crítico, na maioria dos casos. Desta forma, a individualização realizada no início da NP para a adequação energética proteica foi essencial. Além disto, a NP individualizada foi indispensável em, no mínimo, 29,2% das NP, para correção das alterações encontradas nos exames bioquímicos.

INTRODUCTION: Parenteral nutrition (PN) formulations are commonly individualized, since their standardization appears inadequate for the pediatric population. This study aimed to evaluate the nutritional state and the reasons for PN individualization in pediatric patients using PN, hospitalized in a tertiary hospital in Campinas, São Paulo.METHODS: This longitudinal study comprised patients using PN followed by up to 67 days. Nutritional status was classified according to the criteria established by the World Health Organization (WHO) (2006) and WHO (2007). The levels of the following elements in blood were analyzed: sodium, potassium, ionized calcium, chloride, magnesium, inorganic phosphorus, and triglycerides (TGL). Among the criteria for individualization, the following were considered undeniable: significant reduction in blood levels of potassium (<3mEq/L), sodium (<125mEq/L), magnesium (<1mEq/L), phosphorus (<1.5mEq/L), ionic calcium (<1mmol), and chloride (<90mEq/L), or any value above the references.RESULTS: Twelve pediatric patients aged 1 month to 15 years were studied (49 individualizations). Most patients were classified as malnourished. It was observed that 74/254 (29.2%) of examinations demanded individualized PN for indubitable reasons.CONCLUSION: The nutritional state of patients was considered critical in most cases. Thus, the individualization performed in the beginning of PN for energy protein adequacy was indispensable. In addition, the individualized PN was indispensable in at least 29.2% of PN for correction of alterations found in biochemical parameters.