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Dyslipidemia, Diet and Physical Exercise in Children on Treatment With Antiretroviral Medication in El Salvador: A Cross-sectional Study. Pediatr Infect Dis J 2016; 35:1111-6. [PMID: 27254031 PMCID: PMC5130060 DOI: 10.1097/inf.0000000000001244] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Dyslipidemias are common in HIV-infected children, especially if treated with protease inhibitors, but there are few data on how to treat dyslipidemias in this population. We estimated the dyslipidemia prevalence and its association with treatment, diet and physical exercise in children on antiretroviral treatment at the El Salvador reference center for pediatric HIV care (CENID). METHODS Information was gathered regarding socio-demographic characteristics, treatment, diet and physical activity of 173 children aged 5-18 years and receiving antiretroviral therapy. Triglycerides, total cholesterol, low-density lipoprotein (LDL-C), high-density lipoprotein (HDL-C), viral load and CD4 T-lymphocytes were measured. Abnormal concentrations were defined as triglycerides ≥130 mg/dL in 10- to 18-year olds and ≥100 mg/dL in <10-year olds; total cholesterol ≥200 mg/dL; LDL-C ≥130 mg/dL and HDL-C ≤35 mg/dL. We adjusted 4 different multivariate models to assess the independent association of each type of dyslipidemia with protease inhibitors, diet and physical exercise. RESULTS Of the 173 children, 83 (48%) had hypertriglyceridemia and 25 (14.5%) hypercholesterolemia. High LDL-C concentrations were observed in 17 children (9.8%) and low HDL-C in 38 (22%). Treatment with protease inhibitors was significantly associated with hypertriglyceridemia [prevalence ratio (PR) 2.8; 95% confidence interval (CI): 2.0-3.8] and hypercholesterolemia (PR 9.0; 95% CI: 3.6-22.2). Higher adherence to a "high fat/sugar diet" was associated with hypercholesterolemia (PR 1.6; 95% CI: 1.1-2.3) and high LDL-C (PR 1.7; 95% CI: 1.0-2.9). Compared with those exercising <3 times/week, children exercising ≥7 times were less likely to have low HDL-C (PR = 0.4; 95% CI: 0.2-0.7). CONCLUSIONS These results suggest that a healthy diet and exercise habits can contribute to controlling some aspects of the lipid profile in this population.
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Benzecry SG, Alexandre MA, Vítor-Silva S, Salinas JL, de Melo GC, Marinho HA, Paes ÂT, de Siqueira AM, Monteiro WM, Lacerda MVG, Leite HP. Micronutrient Deficiencies and Plasmodium vivax Malaria among Children in the Brazilian Amazon. PLoS One 2016; 11:e0151019. [PMID: 26963624 PMCID: PMC4786135 DOI: 10.1371/journal.pone.0151019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 02/23/2016] [Indexed: 02/07/2023] Open
Abstract
Background There is a growing body of evidence linking micronutrient deficiencies and malaria incidence arising mostly from P. falciparum endemic areas. We assessed the impact of micronutrient deficiencies on malaria incidence and vice versa in the Brazilian state of Amazonas. Methodology/Principal Findings We evaluated children <10 years old living in rural communities in the state of Amazonas, Brazil, from May 2010 to May 2011. All children were assessed for sociodemographic, anthropometric and laboratory parameters, including vitamin A, beta-carotene, zinc and iron serum levels at the beginning of the study (May 2010) and one year later (May 2011). Children were followed in between using passive surveillance for detection of symptomatic malaria. Those living in the study area at the completion of the observation period were reassessed for micronutrient levels. Univariate Cox-proportional Hazards models were used to assess whether micronutrient deficiencies had an impact on time to first P. vivax malaria episode. We included 95 children median age 4.8 years (interquartile range [IQR]: 2.3–6.6), mostly males (60.0%) and with high maternal illiteracy (72.6%). Vitamin A deficiencies were found in 36% of children, beta-carotene deficiency in 63%, zinc deficiency in 61% and iron deficiency in 51%. Most children (80%) had at least one intestinal parasite. During follow-up, 16 cases of vivax malaria were diagnosed amongst 13 individuals. Micronutrient deficiencies were not associated with increased malaria incidence: vitamin A deficiency [Hazard ratio (HR): 1.51; P-value: 0.45]; beta-carotene [HR: 0.47; P-value: 0.19]; zinc [HR: 1.41; P-value: 0.57] and iron [HR: 2.31; P-value: 0.16]). Upon reevaluation, children with al least one episode of malaria did not present significant changes in micronutrient levels. Conclusion Micronutrient serum levels were not associated with a higher malaria incidence nor the malaria episode influenced micronutrient levels. Future studies targeting larger populations to assess micronutrients levels in P. vivax endemic areas are warranted in order to validate these results.
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Affiliation(s)
- Silvana Gomes Benzecry
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Márcia Almeida Alexandre
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Gerência de Malária, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Sheila Vítor-Silva
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Gerência de Malária, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Jorge Luis Salinas
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, United States of America
| | - Gisely Cardoso de Melo
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Gerência de Malária, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | | | | | - André Machado de Siqueira
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Gerência de Malária, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil
| | - Wuelton Marcelo Monteiro
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Gerência de Malária, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Marcus Vinícius Guimarães Lacerda
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Gerência de Malária, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Instituto de Pesquisas Leônidas & Maria Deane, Fundação Oswaldo Cruz, Manaus, Brazil
- * E-mail: (ML); (HPL)
| | - Heitor Pons Leite
- Department of Pediatrics, Discipline of Nutrition and Metabolism, Federal University of São Paulo, São Paulo, Brazil
- * E-mail: (ML); (HPL)
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da Silva R, dos Santos-Valente EC, Burim Scomparini F, Saccardo Sarni RO, Costa-Carvalho BT. The relationship between nutritional status, vitamin A and zinc levels and oxidative stress in patients with ataxia-telangiectasia. Allergol Immunopathol (Madr) 2014; 42:329-35. [PMID: 23769738 DOI: 10.1016/j.aller.2013.02.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 01/25/2013] [Accepted: 02/02/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND Ataxia-telangiectasia (A-T) is a rare and degenerative disease that leads to varying degrees of immunodeficiency, oxidative stress, and malnutrition. Vitamin A and zinc are essential for immune function and antioxidant defence. OBJECTIVE To compare levels of retinol, beta carotene, and zinc in patients with ataxia-telangiectasia and healthy controls. METHODS We performed a cross-sectional study with 14 AT patients and 14 healthy controls matched for age and gender. All participants underwent a nutritional and laboratory evaluation comprising concentrations of retinol, beta carotene, serum and erythrocyte zinc, malondialdehyde (MDA), T lymphocyte numbers (CD4(+) and CD8(+)) and immunoglobulin (IgA). RESULTS The AT patients showed high rates of malnutrition with reduced lean body mass when compared to the control group. However, the concentrations of MDA, retinol, beta carotene, and serum and erythrocyte zinc in AT patients were similar to those of the control group. The retinol levels presented a negative correlation with MDA and positive correlation with IgA serum level. CONCLUSIONS The AT patients assessed showed no change in nutritional status for vitamin A and zinc; however, they presented severe impairment in overall nutritional status observed and correlation between retinol with MDA and IgA.
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Affiliation(s)
- R da Silva
- Federal University of Sao Paulo, Sao Paulo, SP, Brazil; Federal University of Alfenas, Alfenas, MG, Brazil
| | | | | | - R O Saccardo Sarni
- Federal University of Sao Paulo, Sao Paulo, SP, Brazil; ABC University, Santo Andre, SP, Brazil
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Nutritional status and metabolic disorders in HIV-exposed uninfected prepubertal children. Nutrition 2014; 29:1020-3. [PMID: 23759262 DOI: 10.1016/j.nut.2013.01.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 01/19/2013] [Accepted: 01/30/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The objective of the study was to assess the nutritional status and metabolic alterations in HIV-exposed uninfected (HIVe) children compared with HIV-unexposed (HIVn) children. METHODS A cross-sectional study was carried out with 76 children distributed into two groups: HIVe (n = 31) and HIVn (n = 45). Biochemical data (hematologic test, lipid profile, insulin resistance, hepatic profile, and C-reactive protein) were evaluated. Anthropometric parameters and body composition analyses were performed. RESULTS The groups were similar regarding body mass index-for-age z-scores (P = 0.297) and height-for-age z-scores (P = 0.666). HIVe had a higher dyslipidemia prevalence (38.7% versus 11.1%; P = 0.010), altered total cholesterol (TC) values (19.4% versus 2.2%; P = 0.016) higher LDL-C mean levels (97.8 mg/dl versus 86 mg/dl; P = 0.028), borderline low-density lipoprotein cholesterol (LDL-C) (40% versus 14%; P = 0.011) and TC (41.9% versus 20%; P = 0.038) compared with HIVn. CONCLUSION Despite the similar nutritional status between groups, our data clearly demonstrated a higher prevalence of dyslipidemia, altered TC, higher LDL-C levels and also LDL-C and TC borderline values in HIVe children.
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Souza SJ, Luzia LA, Santos SS, Rondó PHC. Lipid profile of HIV-infected patients in relation to antiretroviral therapy: a review. Rev Assoc Med Bras (1992) 2013; 59:186-98. [PMID: 23582562 DOI: 10.1016/j.ramb.2012.11.003] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 10/10/2012] [Accepted: 11/04/2012] [Indexed: 10/27/2022] Open
Abstract
This study reviewed the lipid profile of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients in relation to use of antiretroviral therapy (ART), and its different classes of drugs. A total of 190 articles published in peer-reviewed journals were retrieved from PubMed and LILACS databases; 88 of them met the selection criteria and were included in the review. Patients with HIV/AIDS without ART presented an increase of triglycerides and decreases of total cholesterol, low density lipoprotein (LDL-c), and high density lipoprotein (HDL-c) levels. Distinct ART regimens appear to promote different alterations in lipid metabolism. Protease inhibitors, particularly indinavir and lopinavir, were commonly associated with hypercholesterolemia, high LDL-c, low HDL-c, and hypertriglyceridemia. The protease inhibitor atazanavir is apparently associated with a more advantageous lipid profile. Some nucleoside reverse-transcriptase inhibitors (didanosine, stavudine, and zidovudine) induced lipoatrophy and hypertriglyceridemia, whereas abacavir increased the risk of cardiovascular diseases even in the absence of apparent lipid disorders, and tenofovir resulted in lower levels of cholesterol and triglycerides. Although non-nucleoside reverse-transcriptase inhibitors predisposed to hypertriglyceridemia and hypercholesterolemia, nevirapine was particularly associated with high HDL-c levels, a protective factor against cardiovascular diseases. Therefore, the infection itself, different classes of drugs, and some drugs from the same class of ART appear to exert distinct alterations in lipid metabolism.
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Affiliation(s)
- Suelen Jorge Souza
- Nutrition Department, School of Public Health, Universidade de São Paulo USP, Sao Paulo, SP, Brazil
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Tremeschin MH, Sartorelli DS, Cervi MC, Negrini BVDM, Salomão RG, Monteiro JP. Nutritional assessment and lipid profile in HIV-infected children and adolescents treated with highly active antiretroviral therapy. Rev Soc Bras Med Trop 2011; 44:274-81. [PMID: 21739071 DOI: 10.1590/s0037-86822011005000039] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Accepted: 02/17/2011] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION HIV-infected children and adolescents treated with highly active antiretroviral therapy (HAART) regimens that include a protease inhibitor (PI) can show significant improvements in clinical outcomes, nutritional status and quality of life. The study aimed to report nutritional and metabolic alterations for pediatric patients continuously exposed to HAART and for healthy controls for up to 1 year. METHODS Clinical, anthropometric, lipid profile and food intake data were collected prospectively over approximately 12-months for each patient. RESULTS Fifty-one individuals were studied, of these, 16 were healthy. After 12 months follow-up, HIV-positive individuals remained below the healthy control group parameters. No change was observed concerning food intake. Triglyceride serum levels were higher in patients using protease inhibitor at the onset of the study [PI groups: 114 (43 - 336), and 136 (63 - 271) versus control group: 54.5 (20 - 162); p = 0.003], but after twelve months follow-up, only the group using protease inhibitor for up to two months presented higher values [140 (73 - 273) versus 67.5 (33 - 117); p = 0.004]. HDL-cholesterol was lower in HIV-positive individuals [HIV-positive groups: 36 (27 - 58) and 36 (23 - 43); control 49.5 (34 - 69); p = 0.004]. CONCLUSIONS HIV-infected children and adolescents treated with highly active antiretroviral therapy showed compromised nutritional parameters compared to a paired healthy control group. Individuals using protease inhibitor presented worse triglyceride serum levels compared to their healthy counterparts.
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Affiliation(s)
- Marina Hjertquist Tremeschin
- Departamento de Puericultura e Pediatria, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP
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Sarni RS. Re: Lipodystrophy, lipid profile changes, and low serum retinol and carotenoid concentrations in children and adolescent with acquired immunodeficiency syndrome. Nutrition 2011. [DOI: 10.1016/j.nut.2010.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Contri PV, Berchielli EM, Tremeschin MH, Negrini BVDM, Salomão RG, Monteiro JP. Nutritional status and lipid profile of HIV-positive children and adolescents using antiretroviral therapy. Clinics (Sao Paulo) 2011; 66:997-1002. [PMID: 21808865 PMCID: PMC3129963 DOI: 10.1590/s1807-59322011000600013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Revised: 12/14/2010] [Accepted: 03/03/2011] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To describe nutritional status, body composition and lipid profile in children and adolescents receiving protease inhibitors. METHODS Fifty-nine patients, 23 treated with protease inhibitors (group 1) and 36 not using protease inhibitors (group 2). Their dietary intake, anthropometry, bioimpedance analysis and lipid profile variables were measured. RESULTS There was no difference in nutritional status or body composition between groups at the beginning of the study. After 6 months of follow-up, there was an increase in weight and height in both groups, as well as in waist circumference and subscapular skinfold thickness. In group 2, body mass index and triceps skinfold thickness adequacy were significantly higher after 6 months of follow-up. The groups had similar energy and macronutrient intake at any time point. After 6 months, group 1 had a higher cholesterol intake and group 2 had a higher fiber intake. Triglyceride serum levels were significantly different between the groups, with higher values in G1, at any time point [G1: 153 mg/dl (30-344); 138 (58-378) versus G2: 76 mg/dl (29-378); 76 (29-378)]. After 6 months of follow-up, G1 had higher LDL-cholesterol than G2 [104 mg/dl (40-142) versus 82 (42-145)]. CONCLUSION The use of protease inhibitors, per se, does not seem to significantly interfere with anthropometric measures, body composition and food intake of HIV-infected children and adolescents. However, this antiretroviral therapy was associated with a significant increase in triglyceride and LDL-cholesterol in our subjects.
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Affiliation(s)
- Patricia Viganó Contri
- Nutrition and Metabolism, Medical School of Ribeirão Preto, University of São Paulo Department of Pediatrics, Ribeirão Preto, São Paulo, Brazil.
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Paim BS, Ikeda ML, Pedro FL, Wolff FH, Barcellos NT. Low serum retinol and carotenoid levels in children and adolescents with AIDS: Does it really not matter? Nutrition 2010; 27:122. [PMID: 20800451 DOI: 10.1016/j.nut.2010.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Revised: 06/24/2010] [Accepted: 06/28/2010] [Indexed: 10/19/2022]
Affiliation(s)
- Betina Soldateli Paim
- Department of Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Maria Letícia Ikeda
- Department of Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Fabio L Pedro
- Department of Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Fernando H Wolff
- Department of Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Nemora T Barcellos
- Department of Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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