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Objective: To evaluate the prevalence of vitamin D deficiency in obese children and adolescents when compared to eutrophic controls., Methods: Systematic review with meta-analysis covering studies with patients aged 0-18 years old diagnosed with obesity and vitamin D deficiency and control group of eutrophic patients. The studies were retrieved in the PubMed, Embase, and LILACS databases in December 2019. The search used the terms "obesity" in combination with "pediatric population" and "vitamin D"., Results: Through the search 3155 articles were retrieved; and after analysis, 20 studies were selected according to the study objectives. A total of 24,600 children and adolescents were included. Through meta-analysis, the relative risk for the association between obesity and vitamin D deficiency in the pediatric population was 1.41 (95% CI: 1.26-1.59) (I² = 89%, p < 0.01)., Conclusion: Children and adolescents with obesity have higher risk of vitamin D deficiency., (Copyright © 2020 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.)

Objectives: To measure the prevalence of vitamin D deficiency (through the 25-hydroxyvitamin D metabolite) in pediatric patients using antiepileptic drugs., Source of Data: Meta-analysis of studies identified through search in the PubMed, Embase, LILACS, and Cochrane Library databases, on February 19, 2019., Summary of Data: A total of 748 articles were identified, 29 of which were relevant to the objectives of this study. The prevalence of vitamin D deficiency found was 0.32 (95% CI=0.25-0.41; I 2 =92%, p<0.01). In the subgroup analyses, the most significant results were observed in the group of patients using cytochrome P450-inducing antiepileptic drugs, with a prevalence of 0.33 (95% CI=0.21-0.47; I 2 =86%, p<0.01) and, considering the study design, in the subgroup of cohort studies, with a prevalence of 0.52 (95% CI=0.40-0.64; I 2 =76%, p<0.01)., Conclusions: Taking into account the deleterious effects of vitamin D deficiency on the bone health of individuals using antiepileptic drugs, it is suggested to include in their care 25-hydroxyvitamin D monitoring, cholecalciferol supplementation, and treatment of the deficiency, when present., (Copyright © 2020 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.)

Background: The presence of dyslipidemia and behavioral aspects are determinants of cardiovascular risk, especially in childhood and adolescence., Objective: To verify possible relationships between dyslipidemia, cultural factors, and cardiorespiratory fitness (CRF) in schoolchildren., Methods: This cross-sectional study evaluated a sample of 1,254 children and adolescents between the ages of 7 and 17 from the South of Brazil, 686 of whom were female. Dyslipidemia was defined as increased levels of at least one of the following lipid profile parameters: triglycerides (TG), total cholesterol (TC) and fractions of high (HDL-c) and low-density lipoprotein (LDL-c). Cultural aspects were evaluated by a self-reported questionnaire. Data were analyzed by logistic regression, considering the odds ratios (OR) and confidence intervals (CI) at 95%., Results: The results revealed a high prevalence of dyslipidemia (41.9%), which was associated with female sex (OR: 1.56; IC: 1.24-1.96) and overweight/obese status (OR: 1.55; IC: 1.20-2.00). When lipid profile parameters were evaluated separately, high levels of LDL-c were observed to be associated with sedentary school transport (OR: 1.59; IC: 1.20-2.09). Schoolchildren who were overweight/obese had higher chances of elevated levels of TC (OR: 1.40; IC: 1.07-1.84) and TG (OR: 3.21; IC: 1.96-5.26). HDL-c was shown to be related to high television time (OR: 1.59; IC: 1.00-2.54)., Conclusion: Alterations in lipid parameters are associated with cultural factors, especially those related to sedentary lifestyle and low levels of CRF.

Introduction: Introduction: during hematopoietic stem cell transplantation (HSCT) some factors may impact on the patient's nutritional status (NS). Conditioning regimen, as well as signs and symptoms of the gastrointestinal tract, can negatively infl uence on oral food intake. Patients may require the use of complementary nutritional therapies aiming at an adequate caloric intake with the objective of avoiding decreasing in NS. Objective: the study aims to describe the nutritional aspects relevant to the maintenance of NS during hospitalization of children and adolescents undergoing HSCT at a tertiary hospital. Method: a retrospective study with a review of medical records of patients undergoing HSCT, aged between 0 and 19 years of age (incomplete) between January 2009 and December 2014. Data were collected regarding food intake, nutritional therapies used, and clinical signs and symptoms in six times: hospitalization, D0 (day of cell infusion), D+7, D+14, D+21 and D+28. Results: sixty-three patients were evaluated, being 56% males, with a median age of ten years. At the time of hospitalization, 100% of patients had their energy needs met by mouth, decreasing from D0 (about 30%), with more prevalent use of parental nutritional and enteral nutrition from D+7. Loss of appetite, mucositis and nausea were the most frequent signs and symptoms. From D+21 it was possible to observe an increase in caloric intake by mouth. Conclusion: patients showed decreased food intake throughout hospitalization. However, it has been shown that the prescription of complementary nutritional therapies has reduced the impact of weight loss.

Objective: To evaluate the prevalence of abnormalities in plasma lipid and glucose profiles among overweight and obese children and adolescents, and to assess the presence of a correlation between body mass index Z-scores and indicators of comorbidities related to both profiles., Methods: This was a multicenter cross-sectional study conducted at two outpatient clinics. The study included all 417 comers for the first visit from 2008 to 2012, aged between 7 and 18 years, with BMI above the Z-score +1. Anthropometry and blood sampling were obtained. The prevalence of dyslipidemias, hyperglycemia, and insulin resistance were evaluated, together with the correlations of these variables with the increase of Z-BMI., Results: Dyslipidemia was observed in 43.4% of the boys and 66.1% of the girls, with no difference between genders. High glucose levels were detected in 6.2% of the individuals. Insulin resistance was present in 32.3% and 41.7% of the cases, with no statistical significance between boys and girls. Correlations between the Z-BMI were noted for triglycerides in the entire group and among girls; for HDL-c, only among girls; for glucose, a correlation was observed for the entire group, but not when stratified by gender. The indicators of insulin resistance were all correlated with Z-BMI, even when corrected for age., Conclusions: Overweight and obesity give origin to a high prevalence of dyslipidemia and insulin resistance. BMI Z-scores showed a weak positive correlation with glucose and triglyceride, and negative with HDL-c. In turn, the strongest positive correlation was found with insulin resistance indicators., (Copyright © 2017 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.)

Background: Little has been studied on heart rate and its relationship with metabolic disorders., Objective: To identify possible association between heart rate (HR) and metabolic disorders in children and adolescents., Methods: This cross-sectional study evaluated 2.098 subjects, aged between 7 and 17 years. The variables evaluated were: HR, systolic (SBP) and diastolic blood pressure (DBP), pulse pressure (PP), double-product (DP), myocardial oxygen consumption (mVO2), lipids, glucose and uric acid levels, body mass index (BMI) and waist circumference (WC). The values of HR at rest and effort were divided into quartiles. The association between continuous values of HR and cardiometabolic indicators was tested by linear regression., Results: LDL cholesterol presented a significantly higher mean (p = 0.003) in schoolchildren with resting HR greater or equal to 91 bpm, compared to students with less than 75 bpm. Compared with the quartiles of effort HR, SBP, DBP, glucose and uric acid presented high values when HR was greater or equal than 185 bpm. SBP, glucose and HDL cholesterol demonstrated a significant association with resting HR. Uric acid was observed as a predictor of increased effort HR., Conclusion: Schoolchildren with a higher resting HR have higher mean of LDL cholesterol. For effort HR, there was an increase in blood pressure, glucose and uric acid levels. Uric acid has been shown to be a predictor of elevated effort HR.

Objective: Verify the association between metabolic risk profile in students with different levels of cardiorespiratory fitness and body mass index, as well as the nutritional status of their parents., Methods: A cross-sectional study comprising 1.254 schoolchildren aged between seven and 17 years. The metabolic risk profile was calculated by summing the standardized values of high density lipoproteins and low density lipoproteins, triglycerides, glucose and systolic blood pressure. The parents' nutritional status was evaluated by self-reported weight and height data, for body mass index calculating. The body mass index of schoolchildren was classified as underweight/normal weight and overweight/obesity. The cardiorespiratory fitness was assessed by 9-minute running/walk test, being categorized as fit (good levels) and unfit (low levels). Data were analyzed using prevalence ratio values (PR)., Results: The data indicates a higher occurrence of developing metabolic risk in schoolchildren whose mother is obese (PR: 1.50; 95% CI: 1.01, 2.23), and even higher for those whose father and mother are obese (PR: 2, 79, 95% CI: 1.41; 5.51). Students who have low levels of cardiorespiratory fitness and overweight/obesity have higher occurrence of presenting metabolic risk profile (PR: 5.25; 95% CI: 3.31; 8.16)., Conclusion: the occurrence of developing metabolic risk in schoolchildren increase when they have low levels of cardiorespiratory fitness and overweight/obesity, and the presence of parental obesity., (Copyright © 2016 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.)

Objective: To compare the volume, total calories, and protein received by critically ill patients between open and closed enteral nutrition (EN) systems and identify the main reasons for EN discontinuation., Methods: A cohort study in which adult patients admitted to the intensive care unit (ICU) were followed-up in two periods: throughout November 2009 with all patients (n = 85) receiving EN using the open system (OS group); and from October 2010 to April 2011 with patients (n = 170) receiving EN using the closed system (CS group). Parametric and nonparametric tests were used to compare the variables, taking into account their distribution., Results: Demographic and clinical characteristics were similar in both groups. There were minor differences with no statistical significance between groups: more calories/kg were prescribed to the OS group (p < 0.001), and a higher volume (mL/kg, p = 0.002) and protein (g/kg, p = 0.001) were prescribed to the CS group. Fasting, enteral feeding or gastrointestinal problems, and performance of procedures and ICU routines in different frequencies between groups (p = 0.001) led to the discontinuation of EN., Conclusion: There was no clinically relevant difference between the volume, energy, and protein intake of EN prescribed and administered in OS and CS groups. Clinical instability, procedures, and ICU routines led to EN discontinuation in both groups.

Objectives: Different conditions require that critically ill patients to receive lower than prescribed enteral nutrition volumes, energy and protein. This study objective was to evaluate the prescribed versus administered enteral nutrition difference in adults admitted to an intensive care unit., Methods: In 2009, patients were followed for 30 days from the start of enteral nutrition to its discontinuation, or discharge from the intensive care unit. Parametric and nonparametric tests were used to evaluate prescribed versus administered differences., Results: Eighty five patients were enrolled; mean age was 58.6±18.0 years and 40% were male. The patients remained in hospital for 29.5 days (IQ: 15.2 - 48.7) and were under enteral nutrition for 10 (IQ: 4.2 - 27.5) days. Lower than enteral nutrition prescribed volume (-428±243ml/day), energy (-665±412 Kcal/day) and protein (-30±19 g protein/day) was received. Individual patients' evaluation demonstrated that about 40% of the prescribed volume was not actually given. The main reasons for enteral nutrition interruptions were nausea and vomiting, abdominal distension, constipation and clinical complications (52%); diagnostic procedures (41.6%); and transition to oral feeding (5.6%)., Conclusion: Patients admitted to intensive care unit receive less than the prescribed enteral nutrition. The routine care and gastrointestinal tract complications lead to enteral nutrition interruptions, contributing to less than prescribed calories administration.

Objective: To investigate hematologic variables related to iron deficiency and food intake in attention-deficit/hyperactivity disorder., Method: The sample comprised 62 children and adolescents (6-15 years old) divided into three groups: Group 1: 19 (30.6%) patients with attention-deficit/hyperactivity disorder using methylphenidate for 3 months; Group 2: 22 (35.5%) patients with attention-deficit/hyperactivity disorder who were methylphenidate naive and Group 3: 21 (33.9%) patients without attention-deficit/hyperactivity disorder. Serum iron, ferritin, transferrin, hemoglobin, mean corpuscular volume, red cell distribution width, mean corpuscular hemoglobin concentration, nutritional diagnostic parameters - Body Mass Index Coefficient, food surveys were evaluated among the groups., Results: The attention-deficit/hyperactivity disorder group drug naive for methylphenidate presented the highest red cell distribution width among the three groups (p = 0.03). For all other hematologic and food survey variables, no significant differences were found among the groups. No significant correlation between dimensional measures of attention-deficit/hyperactivity disorder symptoms and ferritin levels was found in any of the three groups., Conclusion: Peripheral markers of iron status and food intake of iron do not seem to be modified in children with attention-deficit/hyperactivity disorder, but further studies assessing brain iron levels are needed to fully understand the role of iron in attention-deficit/hyperactivity disorder pathophysiology.

Objective: To assess the nutritional status of children and adolescents with bronchiolitis obliterans and to analyze associations with clinical and nutritional factors., Methods: The study included 57 patients. Nutritional status was assessed using z scores for weight/age, stature/age, weight/stature in children, and stature/age and body mass index percentiles in adolescents. Body composition was assessed via tricipital skin folds, subscapular skin folds, and the sum of both plus the muscular circumference of the arm; pulmonary function was also investigated in subjects over 8 years old., Results: The high percentages of malnutrition and risk for malnutrition are noteworthy: 21.7 and 17.5%, respectively. Among children, weight/age and stature/age detected higher percentages of malnutrition (21.6 and 16.2%), while weight/stature underestimated this diagnosis. Among adolescents, body mass index detected a high percentage of malnutrition (25%) and of risk for malnutrition (20%). Body composition analysis detected 51% of patients with low muscle reserves, and the majority of patients had normal fat reserves. Compromised pulmonary function was associated with poor performance at exercise (r = 0.434; p = 0.024). Malnutrition and/or nutritional risk and low muscle reserves were significantly associated with the 6-minute walk test (p = 0.032; p = 0.030). There was no association between spirometry and the nutritional variables (p > 0.05)., Conclusion: These results emphasize the need for nutritional intervention, and suggest that, in addition to using weight and height indices for nutritional assessment, it is necessary to combine these with an analysis of body composition, so that a larger number of patients with malnutrition and/or at an increased risk for developing malnutrition may be identified and correctly managed.

Background: Body weight (BW) is widely used to evaluate and manage clinical situations therefore assessment errors can influence the ichosen therapies., Objective: To assess the variability in values of BW obtained by using different equipment (weight scales)., Methods: A cross sectional study was performed to assess BW of 360 adult patients in eight units including clinical and surgical specialties Three types of scales were used: a portable domestic model and a fixed platform model, both from the units and a portable digital model previously calibrated and used as standard reference equipment. Self-reported weight (SRW) was also compared to weight assessed with the reference equipment. The values were compared trough paired-samples t-test using SPSS software., Results: The difference between weights assessed by the reference equipment and SRW was 445+/-3.359 g (P=0.015), it was -182+/-2.323 g (P=0.140) for portable domestic scales and 137+/-2.412 g (P=0.218) for platform fixed scales. Values obtained from SRW, portable domestic scales and fixed platform scales were strongly correlated to the mean value of weight assessed by the reference equipment (r=0.973, r=0.987 and r=0.986, respectively). Nevertheless, considering analyses of each patient, errors of magnitude greater than 500 g occurred in 78.8% of SRW, 80.6% of the portable domestic scales and 40% of the fixed platform scales., Conclusion: In general, the scales tested were neither accurate nor precise for measuring BW, considering the percentage of error in the evaluation of each patient and the variability observed.