Estado nutricional e teste do hidrogênio no ar expirado com lactose e lactulose em crianças indígenas terenas

Abstract

Objective: to evaluate the nutritional status, absorption and tolerance of lactose and the occurrence of small-bowel bacterial overgrowth.Methods: a cross-sectional study including all 264 Terena Indian children younger than 10 years from two tribes (Limão Verde and Córrego Seco) in Mato Grosso do Sul. The nutritional status was assessed based upon weight and height, using NCHS data as reference. The breath hydrogen test after an oral lactose (18g) administration was used for evaluation of lactose absorption and tolerance. The occurrence of bacterial overgrowth was evaluated using the breath hydrogen test after the administration of lactulose (5g).Results: the median z scores of weight-for-age, weight-forheight and height-for-age were, respectively, in infants under 1 year (n=34): -0.66, +0.60 and -0.85. Between 1 and 5 years (n=111), the values were: -0.50, +0.28 and -1.17. Between 5 and 10 years (n=119), these anthropometric values were, respectively: -0.09, +0.50 and -0.60. Deficient lactose absorption or malabsorption was verified only after the fourth year of age in 89.3% of the 197 evaluated children. Lactose intolerance was found in 37.1% of them. Small-bowel overgrowth was detected in 11.5% of the Terena Indian children (n=252).Conclusions: the prevalence of recent malnutrition was low, but the median height-for-age was lower than the NCHS reference. The prevalence of ontogenetic lactase deficiency was high. Bacterial overgrowth may be considered as evidence of the occurrence of nonsymptomatic environmental enteropathy in Terena Indian children.J Pediatr (Rio J) 2002; 78 (2): 113-9: nutritional status, lactose, lactulose, breath test, South American Indians, small intestine bacterial overgrowth. ResumoObjetivo: avaliar o estado nutricional, a absorção e a tolerância à lactose e a ocorrência de sobrecrescimento bacteriano no intestino delgado.Métodos: estudo transversal envolvendo todas as 264 crianças índias terenas, menores de 10 anos, das aldeias Limão Verde e Córrego Seco, em Aquidauana (MS). O estado nutricional foi avaliado pelo peso e pela estatura, relacionados com a referência do NCHS. Após a ingestão de 18 gramas de lactose, foi avaliada sua absorção, pelo teste do hidrogênio no ar expirado, e a tolerância de acordo com o aparecimento de manifestações clínicas. Sobrecrescimento bacteriano no intestino delgado foi avaliado com o teste do hidrogênio no ar expirado após a administração de lactulose (5g).Resultados: a mediana dos escores Z do peso-idade, pesoestatura e estatura-idade para as crianças com idade inferior a 12 meses (n=34) foram, respectivamente: -0,66, +0,60 e -0,85. Entre 1 e 5 anos (n=111) foram, respectivamente: -0,50, +0,28 e -1,17. Entre os 5 e 10 anos (n=119), estes valores foram, respectivamente: -0,09, +0,50 e -0,60. Após os 4 anos (n=197), absorção deficiente e má absorção de lactose foi observada em 89,3% das 197 crianças avaliadas. Intolerância à lactose foi observada em 37,1% destas 197 crianças. Sobrecrescimento bacteriano no intestino delgado foi caracterizado em...

Estado nutricional de crianças índias terenas: evolução do peso e estatura e prevalência atual de anemia

“…The weight and stature measurements of the indigenous Terenas children obtained in 2002 confirm the nutritional profile observed in 1995, 3 i.e. a predominance of stature for age deficit over weight for stature deficit.…”

“…Tests for parasites performed in the nineties found Giardia lamblia in 30.3%, Hymenolepsis nana in 10.6%, Necator americanus in 3.3%, Strongyloides stercoralis in 3.3% and Ascaris lumbricoides in 1.6% of the children in the villages evaluated. 3 The occurrence of ancylostomiasis in 3.3% of the children, cannot therefore explain the high levels of anemia found among the Terenas children. Furthermore, it is unlikely that giardiasis, unassociated with chronic diarrhea, can cause poor intestinal iron intake.…”

“…Based on fieldwork undertaken in 1995, the number of inhabitants of the villages was estimated at 1,500. 3 The dwellings in the Limão Verde and Córrego Seco villages have walls made from tree trunks and clay and roofs made from leaves of the aguaje palm (Mauritia flexuosa). They do not have electricity or running water.…”

“…In an earlier study, 3 it was found that the children of Terenas Indians, from the villages of Limão Verde and Córrego Seco, located in the district of Aquidauana, exhibited a pattern of weight and stature comparable with other groups indigenous to Brazil, characterized by a deficit in height for age and appropriate weight for height. [4][5][6][7][8][9][10] A study undertaken of the children of Alto Xingu Indians found that from 1980 to 1992, a statistically significant reduction in median height for age z-score had occurred, 10 emphasizing the importance of periodic assessments of the nutritional status of indigenous groups since cultural changes over the long term could be associated with alterations to the anthropometric pattern of the child population.…”

O que significa a avaliação do estado nutricional

“…Este grupo já vem há algum tempo estudando esta população, como em outro trabalho publicado por esse Jornal, sobre o estado nutricional e o teste de hidrogênio no ar expirado 4 . O atual estudo diferencia-se por avaliar mais atentamente o estado nutricional, comparando métodos antropométricos com a impedância bioelétrica .…”