Alcides da Silva Diniz

Prevalência e caracterização da anemia em idosos do Programa de Saúde da Família

Anemia is a serious public health problem worldwide that mainly affects children and women of childbearing age. However, data about anemia in elderly individuals are still scarce in developing countries. This study aimed at assessing the prevalence and characteristics of anemia among an elderly population attending the Health Family Program in Camaragibe, northeast Brazil. Following a systematic sampling procedure, a cross-sectional study was carried out in November and December 2003 involving 284 subjects of both genders with ages grater than or equal to 60 years old. Anemia was estimated by the measurement of hemoglobin, mean cell hemoglobin concentration, mean cell volume and red cell distribution width. The prevalence of anemia was around 11.0%. Red cell distribution width and mean cell volume were not correlated to hemoglobin count. The major characteristics of anemia were normochromia with normocytosis without anisocytosis suggesting anemia due to chronic diseases. The very low prevalence of microcytosis, macrocytosis and anisocytosis seems to be more likely due to causes other than iron, vitamin B12 or folic acid deficiencies. The use of indicators that reflect the degree of anisocytosis, as well as parameters to assess iron status should be strongly recommended in the screening of anemia in the elderly population.

Effect on Infant Illness of Maternal Supplementation With 400 000 IU Vs 200 000 IU of Vitamin A

BACKGROUND AND OBJECTIVE: Postpartum vitamin A supplementation is a strategy used to combat vitamin A deficiency and seems to reduce maternal/infant morbidity and mortality. However, studies have shown that a dose of 200u2009000 IU (World Health Organization [WHO] protocol) does not seem to provide adequate retinol levels in maternal breast milk, infant serum, and infant tissue. The objective of this study was to compare the effect of postpartum maternal supplementation with 400u2009000 IU (International Vitamin A Consultative Group protocol) compared with 200u2009000 IU of vitamin A on infant morbidity. METHODS: This was a randomized controlled, triple-blinded clinical trial conducted at 2 public maternity hospitals in Recife in northeastern Brazil. There were 276 mother–child pairs that were allocated to 2 treatment groups: 400u2009000 IU or 200u2009000 IU of vitamin A. They were followed up for >6 months to evaluate infant morbidity. RESULTS: Fever (rate ratio [RR]: 0.92 [95% confidence interval (CI): 0.75–1.14]), diarrhea (RR: 0.96 [95% CI: 0.72–1.28]), otitis (RR: 0.94 [95% CI: 0.48–1.85]), acute respiratory infection (RR: 1.03 [95% CI: 0.88–1.21]), the need for intravenous rehydration (RR: 2.08 [95% CI: 0.64–2.07]), and the use of antibiotic treatment (RR: 0.80 [95% CI: 0.43–1.47]) did not differ significantly between the 2 treatment groups. CONCLUSIONS: Our findings suggest that postpartum maternal supplementation with 400u2009000 IU of vitamin A does not provide any additional benefits in the reduction of illness in children aged <6 months; therefore, we do not support the proposal to increase the standard vitamin A dose in the existing WHO protocol.

Serum Retinol Concentrations in Hospitalized Severe Protein-energy Malnourished Children

BACKGROUNDnVitamin A deficiency (VAD) is a major nutritional problem in many developing countries. Vitamin A status has been reported to be adversely affected in protein-energy malnutrition (PEM).nnnOBJECTIVEnTo assess and compare serum retinol concentrations in hospitalized children with severe PEM and normal ones.nnnMETHODSnA prospective series of 34 malnourished and 29 normal control children, <60 months old, hospitalized at IMIP, Recife-PE were recruited for the study between August 2004 and May 2005. Serum retinol level was assayed by high performance liquid chromatography and concentrations adjusted for presence of inflammation as evidenced by levels of C-reactive protein. Blood retinol level was compared according to nutritional status (severe PEM versus normal), gender, age, maternal schooling, family income, breastfeeding practice, residence and perceived morbidity.nnnRESULTSnThe prevalence of low serum retinol (<0.70 micromol l(-1)) was 41.2% in children with severe PEM and 24.1% in normal children. Serum retinol concentrations were lower in children whose mothers had low schooling (p = 0.025) and families with low per capita income (p = 0.049), regardless of their nutritional status. Serum retinol concentrations had similar distribution between children with severe PEM and normal, when adjusted for gender (p > 0.05), age (p > 0.05), maternal schooling (p > 0.05), family income (p > 0.05), breastfeeding practice (p > 0.05) and residence (p > 0.05). However, malnourished children with diarrhoea showed lower serum retinol concentrations (p = 0.021) compared to those without diarrhoea.nnnCONCLUSIONnVAD was prevalent in hospitalized children with severe PEM and also among normal ones although in lesser magnitude. Intervention for prevention and control of deficiency of vitamin A are recommended in settings where diarrhea is endemic and there are unfavorable socio-economical conditions.

The Effect of a Maternal Double Megadose of Vitamin A Supplement on Serum Levels of Retinol in Children Aged under Six Months

Objective. To measure concentrations of serum retinol in children after the use of maternal vitamin A double megadose supplements. Design. Randomized controlled clinical trial. Setting. The study was conducted at two maternity hospitals in the city of Recife, in the northeast region of Brazil between August 2007 and June 2009. Subjects and Methods. 276 children/mothers were recruited after birth and the women received a 200,000u2009IU capsule of vitamin A. After ten days they were randomly assigned to two treatment groups. One group received a second 200.000u2009IU capsule, while the other received a placebo. The concentrations of retinol in the serum of the children from each group were measured at 2, 4, and 6u2009months. Results. 173 children completed the study. There was no difference between the two treatment groups (P = 0.514). The mean base retinol level was lower than that at four and six months (P < 0.001). Conclusions. The maternal double megadose supplement had no additional effect on the serum retinol levels of the children, although concentrations of retinol in the children rose in the first six months of life. This trial is registered with NCT00742937.

The Effects of Two Maternal Vitamin A Supplementation Regimens on Serum Retinol in Postpartum Mothers: A Randomised Controlled Trial in Brazil

Objective. To test whether the serum retinol level in mothers supplemented with 400,000u2009IU of vitamin A is higher than in those supplemented with 200,000u2009IU and to estimate duration of the protective effect of vitamin A supplementation in the serum retinol level. Methods. Double-blind, randomised controlled trial performed in two hospitals in the state of Pernambuco in northeast Brazil. Three hundred twelve mothers were recruited immediately postpartum. All women received a capsule containing 200,000u2009IU of vitamin A, and 10 days after delivery, they were randomly assigned to one of two treatment groups. One group received a second capsule containing vitamin A and the other group received a placebo. Each group was invited back after 2, 4, and 6 months for serum retinol analyses. Results. No difference was found between the two groups in serum maternal retinol concentration at 2 months (2.13 versus 2.03u2009μmol/L), 4 months (2.20 versus 2.24u2009μmol/L) or 6 months (2.29 versus 2.31u2009μmol/L). Because there was no further effect and because this population has a level of vitamin A deficiency considered mild, our results do not support a proposal to increase the dosing schedule for vitamin A in postpartum women as recommended by the IVACG.

Characterization of eating behavior disorders in school-aged children and adolescents: a population-based study.

Abstract Objective: Cross-sectional study to assess the characteristics of the risk behaviors for eating disorders (EDs) in school children between 10 and 14 years of age in the city of Recife, Pernambuco, Brazil. Methods: 1405 school-aged children were assessed, using the Eating Behaviours and Body Image Test (EBBIT) to screen for EDs. The normality of the continuing variables was tested using the Kolmogorov-Smirnov test with Lilliefors correction. They were described as medians and interquartile intervals (25 and 75th percentiles). Results: The criteria that represented a condition of anorexia and/or bulimia nervosa were considered as strong indicators of risk for EDs in school-aged children who indicated the following behaviors with scores superior to the 75th percentile on the scales: “compulsive eating” 3.0% (CI95% 2.2–4.0); “dissatisfaction with body image/restrictive eating” 1.3% (CI95% 0.8–2.0); children scoring superior to the 30th percentile, “compulsive eating” + “dissatisfaction with body image/restrictive eating”, 0.6% (CI95% 0.3–1.2); and superior to the 50th percentile; “compensatory behavior for hyperphagia” 6.7% (CI95% 5.4–8.1). In addition, greater vulnerability of the female gender was perceived, as well as an increase in the preliminary risk factors of EDs, such as advanced age, dissatisfaction with the body image linked to restrictive behaviors and the compulsive establishment of an eating pattern. Conclusion: This study shows the dimension of the problem in this ecological context and the urgent need for intervention programs, developed among different sectors, from the perspective of the adolescents’ empowerment to prevent and minimize the vulnerability factors of the eating disorders.

Prevalence and factors associated with fat-soluble vitamin deficiency in adolescents

BACKGROUNDnfat-soluble vitamin deficiency may be a health problem not recognized in children and adolescents.nnnOBJECTIVEnto estimate the prevalence and factors associated with the deficiency of vitamins A, D and E among adolescent students fromxa0Northeastern Brazil.nnnMETHODSntransversal study with adolescents aged 12 to 19 of both genders. A questionnaire to collect socioeconomic and lifestyle data and foodxa0intake was applied to adolescents. Then, an anthropometric evaluation and a blood sampling were performed to analyze serum concentrationsxa0of retinol, β-carotene, α-tocopherol and 25-hydroxy vitamin D (25[OH]D).nnnRESULTSnthe intake of vitamins A (50.3%), E (94.0%) and D (99.8%), as well as α-tocopherol (88.1%), β-carotene (74.1%), 25(OH)D (50.9%)xa0and retinol (46.6%) serum levels were mostly deficient/insufficient. An increased risk of α-tocopherol deficiency was observed in girls (PR = 1.11)xa0and an increased risk of 25(OH)D deficiency was observed in boys (PR = 1.41). An increased likelihood of β-carotene (PR = 1.14) and 25(OH)xa0D (PR = 1.38) insufficiency was observed in overweight individuals.nnnCONCLUSIONSnthe adolescents had a deficit in the intake and in serum levels of fat-soluble vitamins. The greatest risk of inadequacy was associatedxa0with gender and weight excess. However, the behavior of fat-soluble vitamins in adolescents needs further research.

Predictive models for estimating visceral fat: The contribution from anthropometric parameters

Background Excessive adipose visceral tissue (AVT) represents an independent risk factor for cardiometabolic alterations. The search continues for a highly valid marker for estimating visceral adiposity that is a simple and low cost tool able to screen individuals who are highly at risk of being viscerally obese. The aim of this study was to develop a predictive model for estimating AVT volume using anthropometric parameters. Objective Excessive adipose visceral tissue (AVT) represents an independent risk factor for cardiometabolic alterations. The search continues for a highly valid marker for estimating visceral adiposity that is a simple and low cost tool able to screen individuals who are highly at risk of being viscerally obese. The aim of this study was to develop a predictive model for estimating AVT volume using anthropometric parameters. Methods A cross-sectional study involving overweight individuals whose AVT was evaluated (using computed tomography–CT), along with the following anthropometric parameters: body mass index (BMI), abdominal circumference (AC), waist-to-hip ratio (WHpR), waist-to-height ratio (WHtR), sagittal diameter (SD), conicity index (CI), neck circumference (NC), neck-to-thigh ratio (NTR), waist-to-thigh ratio (WTR), and body adiposity index (BAI). Results 109 individuals with an average age of 50.3±12.2 were evaluated. The predictive equation developed to estimate AVT in men was AVT = -1647.75 +2.43(AC) +594.74(WHpR) +883.40(CI) (R2 adjusted: 64.1%). For women, the model chosen was: AVT = -634.73 +1.49(Age) +8.34(SD) + 291.51(CI) + 6.92(NC) (R2 adjusted: 40.4%). The predictive ability of the equations developed in relation to AVT volume determined by CT was 66.9% and 46.2% for males and females, respectively (p<0.001). Conclusions A quick and precise AVT estimate, especially for men, can be obtained using only AC, WHpR, and CI for men, and age, SD, CI, and NC for women. These equations can be used as a clinical and epidemiological tool for overweight individuals.