Prevalência da deficiência de vitamina A e características nutricionais de pacientes escolares e adolescentes com fibrose cística / Prevalence of vitamin A deficiency and nutritional characteristics of school-aged and adolescent patients with cystic fibrosis
DOI:
https://doi.org/10.34117/bjdv8n3-116Keywords:
fibrose cística, vitamina a, nutrição em saúde pública.Abstract
Objetivo: Avaliar características nutricionais, prevalência da deficiência de vitamina A (DVA) segundo o indicador funcional e sua associação com: consumo alimentar de vitamina A, estado nutricional, funções pancreática e pulmonar em pacientes com fibrose cística (FC). Métodos: Estudo transversal, com escolares e adolescentes com FC, acompanhados por um centro de referência. Os dados foram coletados durante as consultas de Nutrição e nos prontuários médicos. A DVA foi avaliada pelo indicador funcional da cegueira noturna e o consumo alimentar pelo registro alimentar de três dias. Foram avaliados indicadores antropométricos, de função pulmonar e pancreática. A análise estatística ocorreu por meio do teste Qui-quadrado, no SPSS, versão 17.0. Resultados: 55,6% apresentou risco nutricional, o consumo médio de lipídeos correspondeu a 30,7% em relação ao valor energético total da dieta e 61% apresentou consumo energético inadequado. A prevalência de DVA foi de 6,5% e sem associação com estado nutricional ou insuficiência pancreática. Houve tendência de associação da DVA com o menor consumo alimentar de vitamina A (p = 0,19) e com a deterioração pulmonar (p = 0,11). Os suplementos calóricos-proteicos, contribuíram, em média, com 39% da ingestão alimentar de vitamina A e o suplemento medicamentoso contribuiu, em média, com 74% na ingestão total diária de vitamina A. Conclusão: A maioria da população estudada apresentou risco nutricional, baixo consumo de energia, lipídeos e a elevada prevalência da DVA. A função pulmonar gravemente comprometida e o baixo consumo alimentar de vitamina A tenderam a se associar com a DVA.
References
Pencharz PB, Durie PR. Pathogenesis of malnutrition in cystic fibrosis, and its treatment. Clin Nutr. 2000; 19(6):387-94.
Underwood BA, Denning CR. Correlations between plasma and liver concentrations of vitamins a and e in children with cystic fibrosis. Bull N Y Acad Med. 1971; 43(1):34-39.
Palín D, Underwood BA, Denning CR. The effect of zinc supplementation on plasma levels of vitamin A and retionol-binding protein in cystic fibrosis. Am J Clin Nutr. 1979; 32(6):1253-1259.
Borowitz D, Baker RD, Stallings V. Consensus report on nutrition for pediatric patients with cystic fibrosis. J Pediatr Gastroenterol Nutr. 2002; 35(3):246-259.
Hakim F, Kerem E, Rivilin J, Bentur L, Stankilwicz H, Bdolach-Abram T, et al. Vitamins A and E and Pulmonary Exacerbations in patients with Cystic Fibrosis. J Pediatr Gastroenterol Nutr. 2007; 45(3):347-53.
Turk D, Braegger CP, Colombo C, Declerq D, Morton A, Pancheva R et al. ESPEN-ESPGHAN-ECF guideline on nutrition care for infants, children and adults with cystic fibrosis. Clinical Nutrition. 2016, http://dx.doi.org/10.1016/j.clnu.2016.03.004
Lancellotti L, D’Orazio C, Mastella G, Mazzi G, Lipp U. Deficiency of vitamins E and A in cystic fibrosis is independent of pancreatic function and current enzyme and vitamin supplementation. Eur J Pediatr. 1996; 155(4):281–285.
Penteado VC. Vitaminas – Aspectos Nutricionais bioquímicos, clínicos e analíticos. Rio de Janeiro: Manole; 2003.
Taren D. Historical and practical uses of assessing night blindness as an indicator for vitamin A deficiency. In: World Health Organization. Report: Priorities in the assessment of vitamin A and iron status in populations, Panama City, Panama, 15–17 September 2010. Geneva, World Health Organization, 2012.
Sommer A; Hussaini G, Muhilal, Tarwotjo I, Susanto D, Saroso S. History of nightblindness: a simple tool for xerophthalmia screening. Am J Clin Nutr.1980; 33(4): 887-891.
Saunders C, Ramalho RA., Lima APT, Gomes MM, Campos LF, Silva BAS, Soares AG, Leal MC. Association between gestational night blindness and serum retinol in mother/newborn pairs in the city of Rio de Janeiro, Brazil. Nutrition, 2005; 21(4): 456-461.
World Health Organization (WHO). Indicators for assessing vitamin A deficiency and their application in monitoring and evaluating intervention programs. Geneva: WHO, 1996.
Mclaren DS, FRIGG M. Manual de Ver y Vivir sobre los transtornos por deficiência de vitamina A (VADD). Washington: OPS, 1999.
Pinheiro ABV, Lacerda EMA, Benzecry EH, Gonçalves MC, Costa VM. Tabela para Avaliação de Consumo Alimentar em Medidas Caseiras. 5ª ed. Rio de Janeiro. Atheneu; 2005.
Food Agriculture Organization (FAO) /Organização Mundial de Saúde (OMS). Human energy requirements. Food and Nutrition Technical reports series. Roma; 2001.
Institute of Medicine (IOM). Dietary Reference Intakes (DRIs): Vitamins - Food and Nutrition Board, Institute of Medicine, National Academies. IOM, 2005.
Pellegrino R, Viegi G, Brusasco V, Crapo RO, Burgos F, Casaburi R, et al. Interpretative strategies for lung function tests. Eur Respir J. 2005; 26(5):948-968.
Sommer A. Vitamin A deficiency and its consequences: A field guide to detection and control. 3 ed. Geneva: WHO; 1995.
World Health Organization (WHO). Global prevalence of vitamin A deficiency in populations at risk 1995–2005. WHO Global Database on Vitamin A Deficiency. Geneva: WHO; 2009.
Vuralli D, Tumer L, Hasanoglu A, Biberoglu G, Pasaoglu H. Vitamin A status and factors associated in healthy school-age children. Clin Nutr. 2013; 33(3):509-12.
Aird FA, Greene AS, Ogston AS, Macdonald TM, Mukhopadhyay S. Vitamin A and lung function in Cystic Fibrosis. J Cyst Fibros. 2006; 5(2):129-131.
Rivas - Crespo MF, Jiménez DG, Quirós MDA, Aguirre AS, González SH, Martín JJD, et al. Hight Serum Retinol and Lung Function in Young Pacients with Cystic Fibrosis. J Pediatr Gastroenterol Nutr. 2013; 56(6):657-662.
Huet F, Semama D, Maingueneau C, Charavel A, Nivelon JL. Vitamin A deficiency and nocturnal vision in teenagers with cystic fibrosis. Eur J Pediatr. 1997; 156(12):949-951.
Mrugacz M, Tobolczyk EJ; Minarowska A. Retinol binding protein status in relation to ocular surface changes in patients with cystic fibrosis treated with daily vitamin A supplements. Eur J Pediatr. 2005; 164(4):202–206.
Yadav K, Singh M, Angurana SK, Attri SA, Sharma G, Tageja M and Bhalla, KA. Evaluation of micronutrient profile of north indian children with cystic fibrosis: a case–control study. Pediatr Res. 2014; 75 (6):762-766.
Graham-Maar RC, Schall JI, Stettler N, Zemel BS, Stallings VA. Elevated vitamin A intake and serum retinol in preadolescent children with cystic fibrosis. Am J Clin Nutr. 2006; 84(1):174–82.
Woestenenk JW, Broos N, Stellato RK, Arets HGM, Van der Ent CK, Houwen RHJ. Vitamin A intake and serum retinol levels in children and adolescents with cystic fibrosis. Clin Nutr. 2016; 35(3)654-659.
Maqbool A, Graham-Maar RC, Schall JI, Zemel BS, Stallings VA. Vitamin A intake and elevated serum retinol levels in children and Young adults with Cystic Fibrosis. J Cyst Fibros. 2008; 7(2):137-41.
Bertolaso C, Groleau V, Schall JI, Maqbool A, Mascarenhas M, Latham N, et al. Fat Soluble Vitamins in Cystic Fibrosis and Pancreatic Insufficiency: Efficacy of a Nutrition Intervention. J Pediatr Gastroenterol Nutr. 2014; 58(4):443-8.
Cruz AF, Alves MRA, Fernandes RSV, Guimarães, EV. Ingestão de vitamina A por pacientes com fibrose cística diagnosticados precocemente. Rev Bras Nutr Clin. 2012; 27(3):176-80.
Woestenenk JW, Broos N, Stellato RK, Arets HG, Van der Ent CK, Houwen RH. Vitamin A intake and serum retinol levels in children and adolescents with cystic fibrosis. Clin Nutr. 2015 Apr 23. pii: S0261-5614(15)00120-X. doi: 10.1016/j.clnu.2015.04.010.
Forte GC, Pereira JS, Drehmer M, Simon MISS. Indicadores antropométricos e de ingestão alimentar como preditores da função pulmonar em pacientes com fibrose cística. J Bras Pneumol. 2012;38(4):470-476.
Stark LJ, Quittner AL, Powers SW, Opipari L, Bean J, Duggan C, Stallings VA. A Randomized Clinical Trial of Behavioral Intervention and Nutrition Education to Improve Caloric Intake and Weight in Children with Cystic Fibrosis. Arch Pediatr Adolesc Med. 2009; 163(10): 915–921.
Simon MISS, Drehmer M, Menna-Barreto SS. Association between nutritional status and dietary intake in patients with cystic fibrosis. J Bras Pneumol. 2009; 35(10):966-972.
Shoff SM, Tluczek A, Laxova A, Farrell MP, Lai HJ. Nutritional status is associated with health-related quality of life in children with cystic fibrosis aged 9–19 years. J Cyst Fibros. 2013; 12(6):746-753.
Oliveira G, Oliveira C, Acosta E, Espidora F, Garrido-Sanchez L, Garcia-Escobar E et al. Fatty acid supplementation improves respiratory, inflammatory and nutritional parameters in adults with cystic fibrosis. Arch Bronconeumol. 2010; 46(2): 70-77.
Chaves CRMM, Britto JAA, Oliveira CQ, Gomes MM, Cunha ALP. Associação entre medidas do estado nutricional e a função pulmonar de crianças e adolescentes com fibrose cística. J Bras Pneumol. 2009;35(5):409-414.
Smith C, Winn A, Seddon P, Ranganathan, S . A fat lot of good: Balance and trends in fat intake in children with cystic fibrosis. J Cyst Fibros. 2012; 11(2): 154–157.
Woestenenk JW, Castelijns SJAM, Van ser Ent CK, Houwen RHJ. Dietary intake in children and adolescents with cystic fibrosis. Clin Nutr. 2014;33(3):528-523.
Woestenenk JW, Castelijns SJAM, Van ser Ent CK, Houwen RHJ. Nutritional intervention in patients with Cystic Fibrosis: A systematic review. J Cyst Fibros. 2013, 12(2):102–11.
