Abstract INTRODUCTION: Hypoalbuminemia may predict progression of disease and mortality in patients with human immunodeficiency virus (HIV) infection/acquired immune deficiency syndrome (AIDS). This study was conducted to investigate the risk factors associated with hypoalbuminemia in outpatients with HIV/AIDS. METHODS: A cross-sectional study was performed in 196 outpatients with HIV/AIDS. RESULTS: The prevalence of hypoalbuminemia was 11.7%. The only risk factor associated with hypoalbuminemia was current antiretroviral therapy (no exposure: odds ratio=3.46, 95% confidence interval=1.20-10.02). CONCLUSIONS: The monitoring of plasma albumin is key to determine when antiretroviral therapy should be initiated in individuals not exposed to antiretroviral medicines.

ABSTRACT Introduction: Assessment of the quantity and distribution of body fat in people living with HIV/AIDS is of great importance in clinical practice, due to the association of body fat changes with clinical conditions. The aim of this systematic review was to answer the central question: Can anthropometry accurately measure the body fat in people living with HIV/AIDS? Material and Methods: Systematic review carried out using four databases: Medline, LILACS, Scopus and BDTD. Results: Of the 581 studies found, 11 met the eligibility criteria. To assess the validate of anthropometry, only two studies employed regress analysis to development of predictive body fat equations in people living with HIV/AIDS and nine studies employed correlation analysis. This coefficient only measures the strength of the relation between two variables, and there is not concordance between them and therefore, these studies did not accurately evaluate whether or not the anthropometric information showed good concordance with the gold standard. The other two studies developed five equations to evaluate the total fat and limbs (arm, leg and trunk) in people living with HIV/AIDS using antiretrovirals and showed R2 between 0.50 and 0.83. Conclusions: Further research needs to be conducted to answer the central question of this review, as the small number of articles that applied the correct statistical test and the absence of research on people living with HIV/AIDS without the use of antiretrovirals.

RESUMEN Introducción: La evaluación de la cantidad y distribución de la grasa corporal en personas que viven con el VIH/SIDA es de gran importancia en la práctica clínica, debido a la asociación de los cambios de grasa corporal con condiciones clínicas. El objetivo de esta revisión es responder a la pregunta central: ¿Puede la antropometría medir con precisión la grasa corporal en las personas que viven con el VIH/SIDA? Material y Métodos: Revisión sistemática llevada a cabo por medio de cuatro bases de datos: Medline, LILACS, Scopus y BDTD. Resultados: De los 581 estudios encontrados, 11 cumplieron con los criterios de elegibilidad. Para evaluar la validación de la antropometría, sólo dos estudios emplearon análisis de regresión para el desarrollo de las ecuaciones de predicción de grasa corporal en las personas que viven con el VIH/SIDA y nueve estudios emplearon análisis de correlación. Este coeficiente sólo mide la fuerza de la relación entre dos variables, y no hay concordancia entre ellos y, por lo tanto, estos estudios no evaluaron con precisión si la información antropométrica mostró buena concordancia con el estándar de oro. Los otros dos estudios desarrollaron cinco ecuaciones para evaluar la grasa total y en las extremidades (brazos, piernas y tronco) en personas que viven con el VIH/SIDA y usan antirretrovirales y mostraron R2 entre 0,50 y 0,83. Conclusiones: Más investigación debe llevarse a cabo para responder a la pregunta central de esta revisión, dado el pequeño número de artículos en que se aplicó la prueba estadística correcta y la ausencia de investigaciones sobre personas que viven con el VIH/SIDA que no usan antirretrovirales.

ABSTRACT OBJECTIVE The objective of this study is to estimate the attrition rates and evaluate factors associated with loss to follow-up between 1994 and 2011 in an open cohort of HIV-negative men who have sex with men. METHODS The Project Horizonte is an open cohort study that aimed to assess the incidence of HIV infection, evaluate the impact of educational interventions, and identify potential volunteers for HIV vaccine trials. The rates of losses to follow-up were estimated for three periods (1994–1999, 2000–2005, and 2006–2011). The variables analyzed were collected in a psychosocial questionnaire. Volunteers who dropped out were compared with the ones who remained in the study using a Cox regression model. RESULTS A total of 1,197 volunteers were recruited. The median follow-up time in the study (n = 626) was 4.2 years. The median follow-up time for the volunteers who dropped out of the study (n = 571) was 1.46 years. The overall rate of loss to follow-up was 11.6/100 person-years. Attrition rates by period were: 12.60 (1994–1999), 11.80 (2000–2005), and 9.00 (2006–2011) per 100 person-years. Factors associated with losses to follow-up were: age group of 21–30 years old, monthly per capita income of more than six or less than one Brazilian minimum wage, having more than two dependents, report of bisexual practice, and inconsistent use of condoms for receptive anal sex. CONCLUSIONS A slight decrease of the loss to follow-up was observed over time. Higher attrition rates happened in the first three years of follow-up. It is possible that the link of the volunteers were not yet well established. Those who reported inconsistent condom use in receptive anal sex were more likely to leave the study, suggesting an underestimation of the incidence of HIV infection in a cohort population. For greater effectiveness, retention strategies must be reassessed considering the connection between the characteristics of homosexual and bisexual behavior and the motivations to engage in health research.

ABSTRACT OBJECTIVE The objective of this study is to estimate the attrition rates and evaluate factors associated with loss to follow-up between 1994 and 2011 in an open cohort of HIV-negative men who have sex with men. METHODS The Project Horizonte is an open cohort study that aimed to assess the incidence of HIV infection, evaluate the impact of educational interventions, and identify potential volunteers for HIV vaccine trials. The rates of losses to follow-up were estimated for three periods (1994–1999, 2000–2005, and 2006–2011). The variables analyzed were collected in a psychosocial questionnaire. Volunteers who dropped out were compared with the ones who remained in the study using a Cox regression model. RESULTS A total of 1,197 volunteers were recruited. The median follow-up time in the study (n = 626) was 4.2 years. The median follow-up time for the volunteers who dropped out of the study (n = 571) was 1.46 years. The overall rate of loss to follow-up was 11.6/100 person-years. Attrition rates by period were: 12.60 (1994–1999), 11.80 (2000–2005), and 9.00 (2006–2011) per 100 person-years. Factors associated with losses to follow-up were: age group of 21–30 years old, monthly per capita income of more than six or less than one Brazilian minimum wage, having more than two dependents, report of bisexual practice, and inconsistent use of condoms for receptive anal sex. CONCLUSIONS A slight decrease of the loss to follow-up was observed over time. Higher attrition rates happened in the first three years of follow-up. It is possible that the link of the volunteers were not yet well established. Those who reported inconsistent condom use in receptive anal sex were more likely to leave the study, suggesting an underestimation of the incidence of HIV infection in a cohort population. For greater effectiveness, retention strategies must be reassessed considering the connection between the characteristics of homosexual and bisexual behavior and the motivations to engage in health research.

OBJETIVO: A síndrome metabólica afeta a população em geral em proporções epidêmicas e está associada a um conjunto de fatores de risco de doenças cardiovasculares. Os objetivos deste estudo transversal foram determinar a prevalência e investigar os fatores de risco associados à síndrome metabólica em pacientes ambulatoriais afetados por HIV/AIDS usando avaliações antropométricas e clínicas. MÉTODO: O estudo foi realizado em 253 pacientes ambulatoriais infectados pelo HIV. A síndrome metabólica foi classificada de acordo com o National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATPIII) e os critérios da International Diabetes Federation (IDF). A regressão logística foi utilizada para identificar os fatores associados à síndrome metabólica. RESULTADOS: A prevalência de síndrome metabólica variou entre 19,4% e 26,4%, de acordo com o critério utilizado. Os fatores associados nas duas classificações utilizadas, quando ajustados por sexo e IMC, foram: idade (≥ 40 anos) e subescapular (> 12 mm). No modelo final, utilizando o critério do NCEP/ATPIII os fatores de risco associados à síndrome metabólica foram idade ≥ 40 anos (OR = 3,18; IC95% = 1,42; 7,14) e dobra cutânea subescapular > 12 mm (OR = 2,85, IC95% = 1,13; 7,17). No modelo final, utilizando o critério IDF os fatores de risco associados à síndrome metabólica foram idade (OR = 3,38, IC95% = 1,61; 7,10) e dobra cutânea subescapular > 12 mm (OR = 4,37, IC95% = 1,84; 10,39). CONCLUSÃO: Na prática clínica, o acompanhamento regular da dobra cutânea subescapular pode ajudar na identificação de indivíduos infectados pelo HIV em risco de MS.

OBJECTIVE: Metabolic syndrome, which affects the general population in epidemic proportions, is associated with a set of cardiovascular disease risk factors. The aims of this cross-sectional study were to determine the prevalence and investigate the risk factors associated with metabolic syndrome in outpatients living with HIV/AIDS using anthropometric and clinical evaluations. METHOD: The study was carried out on 253 HIV infected outpatients. Metabolic syndrome was classified according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATPIII) and the International Diabetes Federation (IDF) criteria. Logistic regression was used to identify factors associated with the metabolic syndrome. RESULTS: The prevalence of metabolic syndrome varied from 19.4% to 26.4%, according to the criterion used. The factors associated with it in the two classifications used, when adjusted by sex and BMI, were age (≥ 40years) and subscapular skinfold (> 12 mm). In the final model, using the NCEP/ATPIII criterion the risk factors associated with metabolic syndrome were age ≥ 40 years (OR = 3.18; CI95% = 1.42; 7.14) and subscapular skinfold > 12 mm (OR = 2.85, CI95% = 1.13; 7.17). In the final model, using the IDF criterion the risk factors associated with metabolic syndrome were age (OR = 3.38, CI95% = 1.61; 7.10) and subscapular skinfold > 12 mm (OR = 4.37, CI95% = 1.84; 10.39). CONCLUSION: In clinical practice, the regular monitoring of subscapular skinfold can help in the identification of HIV infected individuals in risk of MS.

Resumo As informações fornecidas sobre prevalência e os motivos da recusa de voluntários a participar em pesquisa científica são escassas. Este artigo objetiva descrever esses dados em coorte voltada a avaliar morbimortalidade de pessoas vivendo com HIV/aids (PVHA) a partir de estudo transversal realizado no Centro de Treinamento e Referência em Doenças Infecciosas e Parasitárias. Foram obtidas as informações: origem, data de nascimento, idade, sexo e motivo do não consentimento, quando aplicável. Falta de tempo para se dedicar a pesquisa foi o principal motivo alegado para o não consentimento (63%), seguido por medo de falta de sigilo (17%). Não houve diferença estatística entre os que aceitaram ou não participar por sexo, idade ou origem do serviço. Consideraram-se elevados os percentuais de recusa de PVHA (40,7%), bem como de falta de tempo disponível para participação (63%).

Abstract The information provided regarding the prevalence and reasons why volunteers refuse to participate in scientific research is sparse. This article aims to describe the prevalence and reasons for refusing to voluntarily participate in the cohort study whose objective is to evaluate morbidity and mortality amongst people living with HIV/AIDS (PLWHA), through a cross-sectional study conducted at the Centro de Treinamento e Referência em Doenças Infecciosas e Parasitárias (Training and Referral Center for Infectious and Parasitic Diseases). The following information was obtained: origin, date of birth, age, gender, and reason for not consenting, when applicable. The lack of time to devote to the research was the main reason given (63%), followed by fear of lack of confidentiality (17%). There was no statistical difference among those who accepted or not to participate in terms of gender, age or origin of the service. The percentage of PLWHA who refused to participate in the study (40.7%) and lack of time available for their participation (63%) were considered high.

Resumen Las informaciones disponibles respecto a la prevalencia y a los motivos de la negación de voluntarios para participar de investigaciones científicas son escasas. Este artículo tiene como objetivo describir la prevalencia y los motivos de la negación a participar voluntariamente en una cohorte dedicada a evaluar la morbilidad y la mortalidad de personas que viven con VIH/SIDA, a partir de un estudio transversal realizado en el Centro de Capacitación y Referencia en Enfermedades Infecciosas y Parasitarias. Se obtuvieron las siguientes informaciones: origen, fecha de nacimiento, edad, sexo y motivo del no consentimiento, cuando correspondiera. La falta de tiempo para dedicarse a la investigación fue el principal motivo alegado para el no consentimiento (63%), seguido por el temor a la no confidencialidad (17%). No hubo diferencias estadísticas entre los que aceptaron participar o no de acuerdo a sexo, edad u origen del servicio. Se consideraron elevados los porcentajes en la negación de las personas que viven con VIH/SIDA a participar de la investigación (40,7%), así como la falta de tiempo disponible para esta participación (63%).

RESUMO OBJETIVOS: A doença hepática gordurosa não alcoólica éa principal causa de patologia hepática. Essencial para seu manejo éa perda de peso. Nosso objetivo foi avaliar as respostas a aconselhamento nutricional em pacientes crônicos com esta condição. METODOS: Estudo prospectivo de coorte com inclusão consecutiva de 105 indivíduos com doenca hepática gordurosa não alcoólica que receberam dieta individualizada de baixa caloria (1400-1600kcal/dia, de acordo com o sexo) e aconselhamento a cada 3 meses, durante 24 meses. A perda de peso de 5% ou mais foi considerada como resposta terapêutica adequada. RESULTADOS: Dos 105 pacientes, 45 (42,9%) não voltaram para uma segunda avaliação. A média de idade foi de 55 ± 9 anos, 81,6% eram mulheres e o índice de massa corporal foi de 31,9 (23,8-44,9) kg/m2. O tempo de seguimento foi de 6,5 (3,2-26,9) meses e número médio de entrevistas foi de 3 (2-11). A síndrome metabólica e a hipercolesterolemia foram mais comuns em mulheres. O número de indivíduos que perderam mais de 5% em peso foi: 5/20 (25%) em 6 meses; 3/15 (33%) aos 12 meses; 3/18 (17%) e aos 18 meses 4/13 (31%) no final do seguimento. A perda de peso corporal média aos 6, 12, 18 e 24 meses diminuiu significativamente. CONCLUSÕES: A adesão ao aconselhamento nutricional épobre em pacientes com doenca hepática gordurosa não alcoólica. Apenas uma pequena proporcão de pacientes que atingiu a perda de peso corporal programada a longo prazo.

BACKGROUND: Nonalcoholic fatty liver disease is the leading cause of liver pathology. The mainstay of management is weight loss. Our aim was to evaluate responses to nutritional counseling in long-term patients with this condition. METHODS: A prospective cohort study with consecutive inclusion of 105 subjects with nonalcoholic fatty liver disease who received individualized low-calories diet counseling (1400 to 1600 kcal/day according to gender) every three months for 24 months. Weight loss of 5% or more was considered as a therapeutic response. RESULTS: Out of 105 patients, 45 (42.9%) did not return for a second evaluation. Mean age was 55 ± 9 years, 81.6% were women and mean body mass index was 31.9 (23.8-44.9) kg/m2. Follow-up time was 6.5 (3.2-26.9) months and median appointment number was 3 (2-11). Metabolic syndrome and hypercholesterolemia were more common in women. The number of subjects who lost more than 5% weight was: 5/20 (25%) at 6-months; 3/15 (33%) at 12 months; 3/18 (17%) at 18 months and 4/13 (31%) at the end of follow up. The median body weight loss at 6, 12, 18 and 24 months decreased significantly. CONCLUSIONS: Adherence to nutritional counseling is poor in patients with nonalcoholic fatty liver disease. Only a very small proportion of patients reached the targeted body loss of weight on long term.

OBJECTIVE: Recent evidence suggests that non-alcoholic fatty liver disease is associated with diet. Our aim was to investigate the dietary patterns of a Brazilian population with this condition and compare them with the recommended diet. METHODS: A cross-sectional study was conducted on 96 non-alcoholic fatty liver disease patients before any dietetic counseling. All patients underwent abdominal ultrasound, biochemical tests, dietary evaluations, and anthropometric evaluations. Their food intake was assessed by a semi-quantitative food-frequency questionnaire and 24-hour food recall. RESULTS: The median patient age was 53 years, and 77% of the individuals were women. Most (67.7%) participants were obese, and a large waist circumference was observed in 80.2% subjects. Almost 70% of the participants had metabolic syndrome, and 62.3% presented evidence of either insulin resistance or overt diabetes. Most patients (51.5, 58.5, and 61.7%, respectively) exceeded the recommendations for energy intake, as well as total and saturated fat. All patients consumed less than the amount of recommended monounsaturated fatty acids, and 52.1 and 76.6% of them consumed less polyunsaturated fatty acids and fiber, respectively, than recommended. In most patients, the calcium, sodium, potassium, pyridoxine, and vitamin C intake did not meet the recommendations, and in 10.5-15.5% of individuals, the tolerable upper limit intake for sodium was exceeded. The patients presented a significantly high intake of meats, fats, sugars, legumes (beans), and vegetables and a low consumption of cereals, fruits, and dairy products compared with the recommendations. CONCLUSIONS: Although patients with non-alcoholic fatty liver disease exhibited high energy and lipid consumption, most of them had inadequate intake of some micronutrients. The possible role of nutrient-deficient intake in the development of non-alcoholic fatty liver disease warrants investigation.

CONTEXTO: Bebidas alcoólicas estão amplamente disponíveis no ambiente universitário, principalmente nas festas. Há poucos estudos abordando a relação entre o consumo de bebidas alcoólicas e o desempenho acadêmico entre estudantes universitários. OBJETIVO: Este trabalho avaliou o comportamento de estudantes universitários quanto ao padrão de consumo de bebidas alcoólicas e sua consequência acadêmica. MÉTODOS: Os voluntários (343 estudantes) responderam a um questionário sobre o padrão de consumo de álcool e possível comportamento relacionado a esse consumo, especialmente sobre o desempenho acadêmico. Os participantes foram classificados como não bebedores (ND), bebedores não em binge (nBD), bebedores em binge (BD) e bebedores pesados (HD). RESULTADOS: 88,1% dos estudantes relataram ingerir bebidas alcoólicas, sendo 44% bebedores em binge. A maioria dos bebedores (75,5% - nBD, BD ou HD) ficou embriagada pelo menos uma vez por mês. O padrão predominante de consumo foi em binge (66,2% dos que relataram beber). Estudantes HD apresentaram risco 9,2 vezes maior de não estarem no período ideal do curso. CONCLUSÃO: Os universitários avaliados apresentaram maiores taxas de abuso de álcool. O beber em binge pode ter interferido no seu desempenho acadêmico. Consequências orgânicas, sociais e comportamentais foram também relatadas.

BACKGROUND: Alcoholic beverages are widely available in the university environment, particularly at the parties. There are few studies addressing the relationship between alcohol consumption and academic performance among college students. OBJECTIVE: This study evaluated the behavior of college students regarding the profile of alcohol consumption and its academic consequences. METHODS: The volunteers (343 students) answered a questionnaire about their pattern of alcohol consumption and possible related behaviors, especially academic performance. Participants were classified as "non-drinkers" (ND), "non-binge drinkers" (nBD), "binge drinkers" (BD) and "heavy drinkers" (HD). RESULTS: 88.1% of the students reported ingesting alcoholic beverages, 44% as BD. Most of the drinker students (75.5% - nBD, BD or HD) stated getting intoxicated at least once a month. Binge drinking was the predominant pattern (66.2% of those who drank). HD students presented a risk 9.2 times higher of not being in the ideal period of the course. DISCUSSION: The college students evaluated presented high rates of alcohol abuse. Binge drinking might have interfered in their academic performance. Organic, social and behavioral consequences were also reported.

The levels of inorganic contaminants (As, Cd, Cu, Ni and Pb) were measured in 18 Brazilian spirit beverages, before and after 4 contact cycles of 24h each with in natura soapstone (steatite) cups. Results were compared to Brazilian regulation levels. Spirits contained As, Cd, Ni and Pb within permitted levels. For Cu, 5.6% of the brands were above the limit. The contact with soapstone cups decreased Cu levels in the spirits, while the other elements remained unchanged. The use of in natura soapstone cups was considered safe because this kind of vessel did not transfer inorganic contaminants to the spirits.

RESUMO OBJETIVO: Investigar alterações no consumo dietético, bem como a influência das características gerais, dos fatores sociodemográficos, clínicos e nutricionais, e do tratamento antineoplásico sobre as mudanças do consumo energético, em mulheres do sul do Brasil, antes e após a realização de terapia adjuvante para o câncer de mama. MÉTODOS: Ensaio clínico não randomizado, conduzido em hospital da rede pública de saúde, com 53 pacientes. Informações dietéticas foram coletadas com questionário de frequência alimentar. Para avaliar os fatores que influenciaram alterações longitudinais da ingestão energética, usou-se modelo de regressão linear de efeitos mistos. RESULTADOS: Houve aumento significativo no consumo diário de energia, de gorduras, cálcio, ferro, cobre, ácidos graxos poli-insaturados, ômega 6 e ômega 3, e uma diminuição significativa da vitamina B2. O modelo final de regressão mostrou aumento médio de 19,2 kcal/mês. As maiores associações com ingestão energética foram frutas e leguminosas, sendo que cada 100 g de consumo destas, resultou um acréscimo médio de 68,4 e 370,5 kcal, respectivamente. Mulheres com idade compreendida entre 51 e 60 anos consumiram 403,5 kcal menos do que aquelas com idade de 31 a 50 anos. CONCLUSÃO: Observou-se que houve aumento na ingestão energética durante o tratamento e que o aumento na ingestão de frutas e leguminosas foi associado com aumentos significativos na ingestão de energia.

PURPOSE: To investigate changes in the dietary consumption as well as the influence of the general characteristics, of the sociodemographic, clinical and nutritional factors, and of the antineoplastic therapy on the changes in the energy intake of women from southern Brazil, before and after adjuvant therapy for breast cancer. METHODS: A non-randomized clinical study was conducted on 53 patients at a hospital of the public health network. Dietary information was collected with a food frequency questionnaire. A mixed-effects linear regression model was used to evaluate the factors that influenced longitudinal alterations of energy intake. RESULTS: A significant increase was observed in daily energy intake of fats, calcium, iron, copper, polyunsaturated fatty acids, omega 6 and omega 3, and a significant decrease in vitamin B2 intake. The final regression model for the change in energy intake showed an average increase of 19.2 kcal/month. Fruit and legume consumption showed the highest association with energy intake, with each 100 g consumed resulting in an average increase of 68.4 and 370.5 kcal, respectively. Women in the 51 to 60 year age range consumed 403.5 kcal less than those in the 31 to 50 year age range. CONCLUSION: There was an increase in energy intake during treatment and the increase in the ingestion of fruits and legumes was associated with significant increases in energy intake.

OBJETIVO: Avaliar os parâmetros de crescimento em lactentes nascidos de mães infectadas com o HIV-1. MÉTODOS: Avaliação longitudinal dos z-escores peso-idade (PI), estatura-idade (EI), peso-estatura (PE) foi realizada em uma coorte. Foram estudados 97 lactentes não-infectados e 33 lactentes infectados nascidos de mães infectadas com o HIV-1 em Belo Horizonte, MG, de 1995 a 2003. O tempo mediano de seguimento para os lactentes infectados e não-infectados foi de 15,8 meses (variação: 6,8 a 18,0 meses) e 14,3 meses (variação: 6,3 a 18,6 meses), respectivamente. Utilizou-se o modelo de regressão linear de efeitos mistos ajustado por máxima verossimilhança restrita para construir as curvas de crescimento. RESULTADOS: Os z-escores PI, EI e PE dos lactentes infectados com o HIV-1 apresentaram decréscimo. Aos seis meses, a diferença média nos z-escores PI, EI e PE entre lactentes infectados e não-infectados com o HIV era, respectivamente, 1,02, 0,59 e 0,63 desvios-padrão. Aos 12 meses, a diferença média nos z-escores PI, EI e PE entre lactentes infectados e não-infectados era, respectivamente, 1,15, 1,01 e 0,87 desvios-padrão. CONCLUSÕES: O comprometimento precoce e crescente dos indicadores antropométricos de crianças infectadas com o HIV-1 mostra a importância de identificar precocemente crianças infectadas com o HIV que estão em risco nutricional e a necessidade de se avaliarem continuamente as intervenções nutricionais adotadas.

OBJECTIVE: To evaluate the growth parameters in infants who were born to HIV-1-infected mothers. METHODS: The study was a longitudinal evaluation of the z-scores for the weight-for-age (WAZ), weight-for-length (WLZ) and length-for-age (LAZ) data collected from a cohort. A total of 97 non-infected and 33 HIV-infected infants born to HIV-1-infected mothers in Belo Horizonte, Southeastern Brazil, between 1995 and 2003 was studied. The average follow-up period for the infected and non-infected children was 15.8 months (variation: 6.8 to 18.0 months) and 14.3 months (variation: 6.3 to 18.6 months), respectively. A mixed-effects linear regression model was used and was fitted using a restricted maximum likelihood. RESULTS: There was an observed decrease over time in the WAZ, LAZ and WLZ among the infected infants. At six months of age, the mean differences in the WAZ, LAZ and WLZ between the HIV-infected and non-infected infants were 1.02, 0.59, and 0.63 standard deviations, respectively. At 12 months, the mean differences in the WAZ, LAZ and WLZ between the HIV-infected and non-infected infants were 1.15, 1.01, and 0.87 standard deviations, respectively. CONCLUSIONS: The precocious and increasing deterioration of the HIV-infected infants' anthropometric indicators demonstrates the importance of the early identification of HIV-infected infants who are at nutritional risk and the importance of the continuous assessment of nutritional interventions for these infants.

OBJETIVO: Evaluar los parámetros de crecimiento en lactantes nacidos de madres infectadas con el VIH-1. MÉTODOS: Evaluación longitudinal de los z-escores peso-edad (PI), estatura-edad (EI), peso-estatura (PE) fue realizada en una cohorte. Fueran estudiados 97 lactantes no infectados y 33 lactantes infectados nacidos de madres infectadas con el VIH-1 en Belo Horizonte, Sureste de Brasil, de 1995 a 2003. El tiempo medio de seguimiento para los lactantes infectados y no infectados fue de 15,8 meses (variación: 6,8 a 18,0 meses) y 14,3 meses (variación: 6,3 a 18,6 meses), respectivamente. Se utilizó el modelo de regresión linear de efectos mixtos ajustado por máxima verosimilitud restringida para construir las curvas de crecimiento. RESULTADOS: Los z-escores PI, EI y PE de los lactantes infectados con el VIH-1 presentaron decrecimiento. A los seis meses, la diferencia promedio en los z-escores PI, EI y PE entre lactantes infectados y no infectados con el VIH era, respectivamente, 1,02, 0,59 y 0,63 desviaciones-estándares. A los 12 meses, la diferencia promedio en los z-escores PI, EI y PE entre lactantes infectados y no infectados era, respectivamente, 1,15, 1,01 y 0,87 desviaciones-estándares. CONCLUSIONES: El comprometimiento precoz y creciente de los indicadores antropométricos de niños infectados con el VIH-1 muestra la importancia de identificar precozmente niños infectados con el VIH que están en riesgo nutricional y la necesidad de evaluarse continuamente las intervenciones nutricionales adoptadas.

OBJETIVO: Avaliar os parâmetros de crescimento em lactentes nascidos de mães infectadas com o HIV-1. MÉTODOS: Avaliação longitudinal dos z-escores peso-idade (PI), estatura-idade (EI), peso-estatura (PE) foi realizada em uma coorte. Foram estudados 97 lactentes não-infectados e 33 lactentes infectados nascidos de mães infectadas com o HIV-1 em Belo Horizonte, MG, de 1995 a 2003. O tempo mediano de seguimento para os lactentes infectados e não-infectados foi de 15,8 meses (variação: 6,8 a 18,0 meses) e 14,3 meses (variação: 6,3 a 18,6 meses), respectivamente. Utilizou-se o modelo de regressão linear de efeitos mistos ajustado por máxima verossimilhança restrita para construir as curvas de crescimento. RESULTADOS: Os z-escores PI, EI e PE dos lactentes infectados com o HIV-1 apresentaram decréscimo. Aos seis meses, a diferença média nos z-escores PI, EI e PE entre lactentes infectados e não-infectados com o HIV era, respectivamente, 1,02, 0,59 e 0,63 desvios-padrão. Aos 12 meses, a diferença média nos z-escores PI, EI e PE entre lactentes infectados e não-infectados era, respectivamente, 1,15, 1,01 e 0,87 desvios-padrão. CONCLUSÕES: O comprometimento precoce e crescente dos indicadores antropométricos de crianças infectadas com o HIV-1 mostra a importância de identificar precocemente crianças infectadas com o HIV que estão em risco nutricional e a necessidade de se avaliarem continuamente as intervenções nutricionais adotadas.

OBJECTIVE: To evaluate the growth parameters in infants who were born to HIV-1-infected mothers. METHODS: The study was a longitudinal evaluation of the z-scores for the weight-for-age (WAZ), weight-for-length (WLZ) and length-for-age (LAZ) data collected from a cohort. A total of 97 non-infected and 33 HIV-infected infants born to HIV-1-infected mothers in Belo Horizonte, Southeastern Brazil, between 1995 and 2003 was studied. The average follow-up period for the infected and non-infected children was 15.8 months (variation: 6.8 to 18.0 months) and 14.3 months (variation: 6.3 to 18.6 months), respectively. A mixed-effects linear regression model was used and was fitted using a restricted maximum likelihood. RESULTS: There was an observed decrease over time in the WAZ, LAZ and WLZ among the infected infants. At six months of age, the mean differences in the WAZ, LAZ and WLZ between the HIV-infected and non-infected infants were 1.02, 0.59, and 0.63 standard deviations, respectively. At 12 months, the mean differences in the WAZ, LAZ and WLZ between the HIV-infected and non-infected infants were 1.15, 1.01, and 0.87 standard deviations, respectively. CONCLUSIONS: The precocious and increasing deterioration of the HIV-infected infants' anthropometric indicators demonstrates the importance of the early identification of HIV-infected infants who are at nutritional risk and the importance of the continuous assessment of nutritional interventions for these infants.

OBJETIVO: Evaluar los parámetros de crecimiento en lactantes nacidos de madres infectadas con el VIH-1. MÉTODOS: Evaluación longitudinal de los z-escores peso-edad (PI), estatura-edad (EI), peso-estatura (PE) fue realizada en una cohorte. Fueran estudiados 97 lactantes no infectados y 33 lactantes infectados nacidos de madres infectadas con el VIH-1 en Belo Horizonte, Sureste de Brasil, de 1995 a 2003. El tiempo medio de seguimiento para los lactantes infectados y no infectados fue de 15,8 meses (variación: 6,8 a 18,0 meses) y 14,3 meses (variación: 6,3 a 18,6 meses), respectivamente. Se utilizó el modelo de regresión linear de efectos mixtos ajustado por máxima verosimilitud restringida para construir las curvas de crecimiento. RESULTADOS: Los z-escores PI, EI y PE de los lactantes infectados con el VIH-1 presentaron decrecimiento. A los seis meses, la diferencia promedio en los z-escores PI, EI y PE entre lactantes infectados y no infectados con el VIH era, respectivamente, 1,02, 0,59 y 0,63 desviaciones-estándares. A los 12 meses, la diferencia promedio en los z-escores PI, EI y PE entre lactantes infectados y no infectados era, respectivamente, 1,15, 1,01 y 0,87 desviaciones-estándares. CONCLUSIONES: El comprometimiento precoz y creciente de los indicadores antropométricos de niños infectados con el VIH-1 muestra la importancia de identificar precozmente niños infectados con el VIH que están en riesgo nutricional y la necesidad de evaluarse continuamente las intervenciones nutricionales adoptadas.

Os dados provenientes de estudos longitudinais se caracterizam pela seqüência de duas ou mais observações em cada indivíduo. Nos estudos de coorte, esses dados geralmente apresentam estrutura desbalanceada. Uma casuística que envolve a avaliação longitudinal de crescimento de lactentes nascidos de mães infectadas pelo HIV foi acompanhada no ambulatório de AIDS pediátrica do Hospital das Clínicas da Universidade Federal de Minas Gerais, Minas Gerais, Brasil. O objetivo deste estudo é demonstrar a aplicação do modelo linear misto na análise de dados longitudinais desbalanceados provenientes dessa coorte. Os resultados mostram que, aos seis meses de idade, os meninos eram, em média, 1,8cm maiores que as meninas e as crianças sororrevertoras eram, em média, 2,9cm maiores que as infectadas. Aos 12 meses, a diferença na altura entre meninos e meninas passou a ser, em média, de 2,4cm enquanto a diferença entre infectados e sororrevertores passou a ser, em média, de 3,5cm. Além de descrever o comportamento longitudinal do crescimento, o modelo também permite estimar a velocidade de crescimento das crianças por sexo e grupo.

A longitudinal data set is characterized by a time sequence of two or more observations from each individual. In cohort studies, these data are usually not balanced. A data set related to longitudinal height measurements in children of HIV-infected mothers was recorded at the university hospital of the Federal University in Minas Gerais, Brazil. The objective was to assess the application of the mixed effect model to this unbalanced data set. At six months of age, on average boys were 1.8cm taller than girls, and seroreverter infants were 2.9cm taller than their HIV+ peers. At 12 months of age, on average boys were 2.4cm taller than girls and seroreverter children were 3.5cm taller than HIV+ ones. In addition to describing longitudinal height behavior, this model also includes the growth rate estimation for this infant population by gender and group.

Os dados provenientes de estudos longitudinais se caracterizam pela seqüência de duas ou mais observações em cada indivíduo. Nos estudos de coorte, esses dados geralmente apresentam estrutura desbalanceada. Uma casuística que envolve a avaliação longitudinal de crescimento de lactentes nascidos de mães infectadas pelo HIV foi acompanhada no ambulatório de AIDS pediátrica do Hospital das Clínicas da Universidade Federal de Minas Gerais, Minas Gerais, Brasil. O objetivo deste estudo é demonstrar a aplicação do modelo linear misto na análise de dados longitudinais desbalanceados provenientes dessa coorte. Os resultados mostram que, aos seis meses de idade, os meninos eram, em média, 1,8cm maiores que as meninas e as crianças sororrevertoras eram, em média, 2,9cm maiores que as infectadas. Aos 12 meses, a diferença na altura entre meninos e meninas passou a ser, em média, de 2,4cm enquanto a diferença entre infectados e sororrevertores passou a ser, em média, de 3,5cm. Além de descrever o comportamento longitudinal do crescimento, o modelo também permite estimar a velocidade de crescimento das crianças por sexo e grupo.

A longitudinal data set is characterized by a time sequence of two or more observations from each individual. In cohort studies, these data are usually not balanced. A data set related to longitudinal height measurements in children of HIV-infected mothers was recorded at the university hospital of the Federal University in Minas Gerais, Brazil. The objective was to assess the application of the mixed effect model to this unbalanced data set. At six months of age, on average boys were 1.8cm taller than girls, and seroreverter infants were 2.9cm taller than their HIV+ peers. At 12 months of age, on average boys were 2.4cm taller than girls and seroreverter children were 3.5cm taller than HIV+ ones. In addition to describing longitudinal height behavior, this model also includes the growth rate estimation for this infant population by gender and group.