Carlos Alberto Nogueira de Almeida

Factors associated with iron deficiency anemia in Brazilian preschool children

OBJECTIVEnTo examine the determining factors of anemia and iron deficiency in children attending two day care centers in the town of Pontal, southeast of Brazil.nnnMETHODSnCross-sectional study was conducted in 192 children aged 12 to 72 months. Personal data (age, sex, use of medicinal iron supplements, duration of breast-feeding, type of delivery, prenatal care, weight, and height), and socioeconomic data (number of co-inhabitants, parental schooling, and per capita family income) were obtained and evaluated together with hemoglobin, serum transferrin receptor, ferritin, and iron deficiency anemia.nnnRESULTSnAge was the variable that most affected iron nutritional status, with higher hemoglobin values, lower transferrin receptor concentrations, higher ferritin values and lower iron deficiency anemia being detected with increasing age. The other studied variables did not show any correlation with iron nutritional status.nnnCONCLUSIONnThe obtained data suggest that control strategies for this preschool population should be especially directed at younger children.

Abdominal circumference as an indicator of clinical and laboratory parameters associated with obesity in children and adolescents: comparison between two reference tables

OBJECTIVEnTo evaluate the sensitivity and specificity of two pediatric abdominal circumference reference tables to detect abnormally high body mass index, total cholesterol, fasting blood insulin and leptin levels, and homeostasis model assessment values.nnnMETHODSnA total of 624 male and female subjects, with ages ranging from 7 to 18 years, were evaluated. All children were recruited from two public schools. Venous blood samples were collected for determination of fasting plasma insulin, glucose, leptin, and total cholesterol levels. Weight, height and abdominal circumference were assessed according to internationally accepted guidelines. Contingency tables were constructed, comparing the presence or absence of increased abdominal circumference, according to cutoff points established by Taylor et al. and Freedman et al., with the presence or absence of abnormal values in the laboratory tests.nnnRESULTSnSensitivity values were consistently higher for the table by Taylor et al., whereas the table by Freedman et al. showed greater specificity. Positive predictive values were quite low in general, and were only relevant for body mass index.nnnCONCLUSIONSnResults indicate that the table by Taylor et al. is best for screening purposes, as it identifies individuals at higher risk of presenting abnormal test results. On the other hand, the reference table by Freedman et al. is more suitable for clinical practice, as it could be used to replace laboratory measurements, such as blood insulin or leptin levels, which may not be available at all sites.

Circunferência abdominal como indicador de parâmetros clínicos e laboratoriais ligados à obesidade infanto-juvenil: comparação entre duas referências.

OBJECTIVE: To evaluate the sensitivity and specificity of two pediatric abdominal circumference reference tables to detect abnormally high body mass index, total cholesterol, fasting blood insulin and leptin levels, and homeostasis model assessment values. METHODS: A total of 624 male and female subjects, with ages ranging from 7 to 18 years, were evaluated. All children were recruited from two public schools. Venous blood samples were collected for determination of fasting plasma insulin, glucose, leptin, and total cholesterol levels. Weight, height and abdominal circumference were assessed according to internationally accepted guidelines. Contingency tables were constructed, comparing the presence or absence of increased abdominal circumference, according to cutoff points established by Taylor et al. and Freedman et al., with the presence or absence of abnormal values in the laboratory tests. RESULTS: Sensitivity values were consistently higher for the table by Taylor et al., whereas the table by Freedman et al. showed greater specificity. Positive predictive values were quite low in general, and were only relevant for body mass index. CONCLUSIONS: Results indicate that the table by Taylor et al. is best for screening purposes, as it identifies individuals at higher risk of presenting abnormal test results. On the other hand, the reference table by Freedman et al. is more suitable for clinical practice, as it could be used to replace laboratory measurements, such as blood insulin or leptin levels, which may not be available at all sites.

O Programa de Saúde da Família e a Puericultura

This paper suggests a proposal of Child Health Care, to children and adolescents, to be developed in the Family Health Care Programs.

Determination of glycemia and insulinemia and the homeostasis model assessment (HOMA) in schoolchildren and adolescents with normal body mass index

OBJECTIVEnTo determine fasting glycemia and insulinemia levels and the HOMA index in a group of children and adolescents with normal body mass index (BMI).nnnMETHODSnThis was a cross-sectional study conducted at two public schools in Ribeirão Preto, SP, Brazil. A total of 447 children and adolescents of both sexes, with normal BMI, aged 7 to 17.9 years and of average maturity for their age, underwent anthropometric measurements and provided personal data and a sample of venous blood so that glycemia, insulinemia and HOMA index could be determined. The results obtained for boys and girls were compared for each age range using the Mann-Whitney test. The results within each age band were then compared for boys and girls using the Kruskal-Wallis test.nnnRESULTSnGlycemia results varied from 7 to 8.9 years (p = 0.0005). Fasting insulinemia varied significantly with age in both sexes (p < 0.001), with the highest values observed among children aged 13 to 14.9 years. HOMA indices varied significantly with age in both boys and girls (p < 0.001), with values that increased progressively up to the age band of 13 and 14.9 years.nnnCONCLUSIONSnThese data demonstrate the necessity of establishing reference curves for these three indicators.

Acidentes de mordeduras de cães na infância

The incidence of dog bites injuries among children aged 0 to 15 years seen at CSE D. Pedro I health center in Ribeirão Preto, Brazil, in the period of 1993 to 1997, was studied. The results show that there is a need to develop and implement educational and preventive programs about the risks and severity of accidents occurred while in contact with dogs.Estudou-se a incidencia de casos de mordeduras caninas atendidas em uma unidade basica de saude da cidade de Ribeirao Preto, SP, no periodo de 1993 a 1997, entre criancas com idades de 0 a 15 anos. Os dados encontrados mostraram a importância de se promover programas educativos sobre os riscos dessas ocorrencias para evitar acidentes causados por contatos com caes.

Determinação dos valores de glicemia, insulinemia e índice (HOMA) em escolares e adolescentes eutróficos

OBJECTIVE: To determine fasting glycemia and insulinemia levels and the HOMA index in a group of children and adolescents with normal body mass index (BMI). METHODS: This was a cross-sectional study conducted at two public schools in Ribeirao Preto, SP, Brazil. A total of 447 children and adolescents of both sexes, with normal BMI, aged 7 to 17.9 years and of average maturity for their age, underwent anthropometric measurements and provided personal data and a sample of venous blood so that glycemia, insulinemia and HOMA index could be determined. The results obtained for boys and girls were compared for each age range using the Mann-Whitney test. The results within each age band were then compared for boys and girls using the Kruskal-Wallis test. RESULTS: Glycemia results varied from 7 to 8.9 years (p = 0.0005). Fasting insulinemia varied significantly with age in both sexes (p < 0.001), with the highest values observed among children aged 13 to 14.9 years. HOMA indices varied significantly with age in both boys and girls (p < 0.001), with values that increased progressively up to the age band of 13 and 14.9 years. CONCLUSIONS: These data demonstrate the necessity of establishing reference curves for these three indicators.

Leptinemia de jejum em crianças e adolescentes eutróficos

OBJECTIVE: To determine, in a group of eutrophic children and adolescents, the values of fasting leptinemia and its correlation with age and body mass index. METHODS: A cross-sectional study conducted in two public schoolsin Ribeirao Preto, Brazil. Anthropometric measurements and venous blood samples were obtained for determination of fasting leptinemia of 448 eutrophic and medium maturers children and adolescents, of both genders, aged between 7 and 17.9 years. Using the Mann-Whitney test, comparisons were made between the concentrations obtained for boys and girls in each age group. Subsequently, using the Kruskal-Wallis test, values were compared in each age group and, using the Spearman correlation test, the correlations between fasting leptinemia and age and between fasting leptinemia and the z-scores of body mass index were assessed. RESULTS: Fastingleptinemia values differed between boys and girls in all age groups and it was higher for girls. Among boys, the values of leptinemia did not show statistically significant variation; among girls, there was variability, with gradual increase according to age group. The correlation study showed positive correlation between leptinemia and z-scores of body mass index in both genders and between leptinemia and age only for girls. CONCLUSION: The data show the necessity of establishing reference curves for fasting leptinemia taking into account gender age and body mass index.

Dog bites and accidents in children

The incidence of dog bites injuries among children aged 0 to 15 years seen at CSE D. Pedro I health center in Ribeirão Preto, Brazil, in the period of 1993 to 1997, was studied. The results show that there is a need to develop and implement educational and preventive programs about the risks and severity of accidents occurred while in contact with dogs.Estudou-se a incidencia de casos de mordeduras caninas atendidas em uma unidade basica de saude da cidade de Ribeirao Preto, SP, no periodo de 1993 a 1997, entre criancas com idades de 0 a 15 anos. Os dados encontrados mostraram a importância de se promover programas educativos sobre os riscos dessas ocorrencias para evitar acidentes causados por contatos com caes.

Variation of the brachial artery diameter in obese children: present and future

Objective: Literature review on the use of the variation measure of the brachial artery diameter by highresolution ultrasound (flow-mediated dilation) as a predictor of cardiovascular disease risk in children and adolescents. Data source: Survey of studies indexed in Medline/Pubmed, which were published between 2002 and 2011 using the following keywords in various combinations:“endothelium,” “child”, “ultrasonography” and “obesity”, as well as classic texts on the subject. We found 54 publications and 32 were included in this review. Synthesis of data: The study of endothelial dysfunction has been used as a predictor of risk for cardiovascular diseases such as atherosclerosis and coronary heart disease, since endothelial injury is an important event in the physiopathology of these diseases. Conclusions: The flow-mediated dilation of the brachial artery seems to be important as a diagnostic and prognostic tool to assess endothelial function in children and adolescents who are overweight, because it is a noninvasive method with good profile regarding cost, safety, and benefits.