Andréa das Graças Ferreira Frazão

Anemia in Brazilian pregnant women before and after flour fortification with iron

OBJECTIVE To compare prevalence of anemia and hemoglobin (Hb) levels in Brazilian pregnant women before and after flour fortification with iron. METHODS A repeated cross-sectional panel study of public health care centers of municipalities in the five Brazilian regions was conducted. Retrospective data were obtained from 12,119 medical records of pregnant women distributed in two groups: before fortification (delivery prior to June 2004) and after fortification (date of last period after June 2005). Anemia was defined as Hb<11.0 g/dl. Hb levels according to gestational age were assessed using two references from the literature. Statistical analysis was carried out using chi-squared tests, Students t tests, and logistic regression, with a significance level of 5%. RESULTS In the total sample, prevalence of anemia fell from 25% to 20% after fortification (p<0.001). However, important regional differences were evident: while significant reductions were seen in the Northeast (37% to 29%) and North (32% to 25%) regions, where pre-fortification prevalence was high, smaller reductions were seen in the Southeast (18% to 15%) and South (7% to 6%) regions, where prevalence was low. Hb levels according to gestational age were slightly higher in the first months of pregnancy and lower after the third or fourth months, depending on the reference used. Logistic regression analysis showed that group, geographic region, marital status, trimester of pregnancy, initial nutritional status, and prior pregnancy were associated with anemia (p<0.05). CONCLUSIONS Prevalence of anemia decreased after fortification, but remains high in the North and Northeast regions. Although fortification may have played a role in this favorable outcome, the contribution of other public policies implemented during the studied period should also be considered.

Anemia em gestantes brasileiras antes e após a fortificação das farinhas com ferro

OBJECTIVE To compare prevalence of anemia and hemoglobin (Hb) levels in Brazilian pregnant women before and after flour fortification with iron. METHODS A repeated cross-sectional panel study of public health care centers of municipalities in the five Brazilian regions was conducted. Retrospective data were obtained from 12,119 medical records of pregnant women distributed in two groups: before fortification (delivery prior to June 2004) and after fortification (date of last period after June 2005). Anemia was defined as Hb<11.0 g/dl. Hb levels according to gestational age were assessed using two references from the literature. Statistical analysis was carried out using chi-squared tests, Students t tests, and logistic regression, with a significance level of 5%. RESULTS In the total sample, prevalence of anemia fell from 25% to 20% after fortification (p<0.001). However, important regional differences were evident: while significant reductions were seen in the Northeast (37% to 29%) and North (32% to 25%) regions, where pre-fortification prevalence was high, smaller reductions were seen in the Southeast (18% to 15%) and South (7% to 6%) regions, where prevalence was low. Hb levels according to gestational age were slightly higher in the first months of pregnancy and lower after the third or fourth months, depending on the reference used. Logistic regression analysis showed that group, geographic region, marital status, trimester of pregnancy, initial nutritional status, and prior pregnancy were associated with anemia (p<0.05). CONCLUSIONS Prevalence of anemia decreased after fortification, but remains high in the North and Northeast regions. Although fortification may have played a role in this favorable outcome, the contribution of other public policies implemented during the studied period should also be considered.

Nutritional analysis of the School Feeding Program menus offered in a municipality of Pará

The National School Feeding Program (PNAE) is a policy that aims to contribute to the improvement of school feeding. Therefore, the goal of this study was to analyze the menus offered in the year 2014 in public schools of the municipal and state educational network in the municipality of Abaetetuba, Pará, according to the recommendations of the PNAE. For nutritional adequacy, the average energy consumption (Kcal), carbohydrate (g), protein (g), lipid (g), fiber (g), calcium (mg), iron (mg), magnesium (mg), zinc (mg), vitamin A (μg) and vitamin C (mg) of all the menus by educational category, were compared with the values established in Resolution No.26/2013. Nutrient values above or below the recommendation by the PNAE were considered inadequate. The analyzed menus were nutritionally inadequate, which may contribute to the reduction of school performance and student growth, in addition to dietary uncertainty. The elaborate menus were not nutritionally adequate, demonstrating the need to readjust the recommendations and thus guarantee the Human Right to Adequate Food and consequently the improvement of the learning and school performance.

Anemia en gestantes brasileñas antes y después de la fortificación de harinas con hierro

OBJECTIVE To compare prevalence of anemia and hemoglobin (Hb) levels in Brazilian pregnant women before and after flour fortification with iron. METHODS A repeated cross-sectional panel study of public health care centers of municipalities in the five Brazilian regions was conducted. Retrospective data were obtained from 12,119 medical records of pregnant women distributed in two groups: before fortification (delivery prior to June 2004) and after fortification (date of last period after June 2005). Anemia was defined as Hb<11.0 g/dl. Hb levels according to gestational age were assessed using two references from the literature. Statistical analysis was carried out using chi-squared tests, Students t tests, and logistic regression, with a significance level of 5%. RESULTS In the total sample, prevalence of anemia fell from 25% to 20% after fortification (p<0.001). However, important regional differences were evident: while significant reductions were seen in the Northeast (37% to 29%) and North (32% to 25%) regions, where pre-fortification prevalence was high, smaller reductions were seen in the Southeast (18% to 15%) and South (7% to 6%) regions, where prevalence was low. Hb levels according to gestational age were slightly higher in the first months of pregnancy and lower after the third or fourth months, depending on the reference used. Logistic regression analysis showed that group, geographic region, marital status, trimester of pregnancy, initial nutritional status, and prior pregnancy were associated with anemia (p<0.05). CONCLUSIONS Prevalence of anemia decreased after fortification, but remains high in the North and Northeast regions. Although fortification may have played a role in this favorable outcome, the contribution of other public policies implemented during the studied period should also be considered.