Denise de Oliveira Schoeps

Risco de sobrepeso e excesso de peso em crianças de pré-escolas privadas e filantrópicas

OBJECTIVE: To assess the risk prevalence of overweight and obesity in children enrolled in private and philanthropic preschools in the State of Sao Paulo. METHODS: Comparison of two cross sectional studies with children enrolled in private preschools (PPS) or philanthropic (PHP) of the Sao Paulo Metropolitan Region. Both surveys evaluated the childrens environment. To determine the risk of overweight, excess weight and obesity, body mass index (BMI) values were transformed into z scores (according to the World Health Organization - 2006 and 2007). RESULTS: The risk prevalence of overweight (≥ 1 BMIz < 2) in PPS was 21.9% and 24.6% in PHP, with PR = 1.12 (95% CI: 0.96-1.32), without statistical difference. Considering the children with overweight or obesity, (BMIz ≥ 2) the prevalence in PPS was 14.3% and in PHP was 9.0%, with PR = 1.54 (95% CI: 1.23-1.93), p = 0.0002. Overweight and obesity prevalence in males in PPS was 16.4% (n = 409) and in PHP, 11.1% (n = 829), PR = 1.48 (95% CI: 1.10-1.98) and in females it was 12.5% (n = 400) in the PPS and 6.6% (n = 698) in PHP, corresponding to PR = 1.90 (95% CI: 1.30-2.78), both significant differences. CONCLUSION: Both groups showed a similar and very high prevalence of weight excess. However, overweight and obesity showed a higher prevalence in children from private preschools. This indicates that even though a better socioeconomic level is still a risk factor for overweight and obesity in preschoolers, the same does not seem to occur when analyzing the risk of overweight.

Impact of Vitamin A Megadose Supplementation on the Anthropometry of Children and Adolescents with Non-Hormonal Statural Deficit: a Double-blind and Randomized Clinical Study

OBJECTIVE To evaluate the intake of retinol and carotenoids, and their serum levels, as well as the impact of vitamin A supplementation on the anthropometry and body composition of children and adolescents with non-hormonal-related statural deficit. METHOD Double-blind, randomized trial of 46 pre-pubertal patients, between 4 and 14 years of age, with normal growth rates. The subjects were divided into two groups, each with 23 individuals (Group I: Placebo; Group II: Vitamin A in a single megadose), and were evaluated at moments A and B with a six month interval. RESULTS There were no statistically significant differences in serum retinol levels, anthropometry, growth velocity, or body composition, between moments A and B, in Group II. Carotenoids were significantly lower in Group I at moment B. The semi-quantitative food intake questionnaire showed that approximately 60.9% of the children and adolescents ingested less than half of the amounts of retinol and carotenoids recommended by the Food Guide Pyramid. Inadequate intake was more prevalent regarding vegetable and fruit carotenoid sources, with 75 and 70% of inadequacy, respectively. CONCLUSION If one considers the inadequate food intake observed in the dietary evaluation in this study, it is possible that multiple micronutrient deficiencies could be involved in statural deficits. This could explain why vitamin A supplementation does not seem to influence growth in children and adolescents with statural deficit, as indicated by the present study. Thus in populations such as the one studied here, the supplementation with vitamin A should be integrated into comprehensive nutritional interventions, so as to possibly promote greater positive impact on linear growth.

Vitamina A: nível sérico e ingestão dietética em crianças e adolecentes com déficit estatural de causa não hormonal

OBJETIVOS: Determinar a ingestao dietetica de vitamina A e os niveis sericos de carotenoides e retinol em criancas e adolescentes com deficit estatural sem causa hormonal, atendidos no Ambulatorio de Endocrinopediatria do Nucleo de Nutricao (NUNADI) da Secretaria de Estado da Saude de Sao Paulo. METODOS: Foram avaliados de maneira prospectiva 47 pacientes pre-puberes, entre 4 e 14 anos, com relacao a: antropometria, idade ossea, inquerito alimentar, bioimpedanciometria e nivel serico de retinol e carotenoides. RESULTADOS: A media do escore Z da estatura foi de -2,4; 20% dos pacientes eram desnutridos, 25,5% tinham inadequacao da massa gorda e maior atraso da idade ossea. Os niveis sericos de retinol e carotenoides foram inadequados em 21% dos pacientes, sendo que foi maior o percentual de inadequacao dos carotenoides nos pacientes que apresentavam deficit estatural mais acentuado. Nao houve relacao dos niveis sericos de retinol e carotenoides com a velocidade de crescimento. Em 82,9% dos inqueritos alimentares realizados, houve ingestao de vitamina A inferior a 50% do estabelecido na Pirâmide de Alimentos. CONCLUSAO: Baseados nestes resultados, concluimos que ha uma elevada prevalencia de desnutricao, comprometimento da idade ossea, inadequacao no nivel serico de carotenoides e ingestao de vitamina A em criancas com comprometimento estatural.

Peso insuficiente ao nascer e crescimento alcançado na idade pré-escolar, por crianças atendidas em creches filantrópicas do município de Santo André, São Paulo, Brasil

OBJECTIVES: to compare rate of growth and prevalence of low stature at preschool age in children who were underweight at birth and in children born with a normal weight. METHODS: the study covered 323 children born underweight and 886 born with a normal weight from low-income families in fifteen charitably funded creches in the municipality of Santo Andre, in the State of Sao Paulo, Brazil, in 2001 and 2002. The variables used were the z score for weight and height for age, using the Center for Disease Control (CDC) and National Center for Health Statistics (NCHS) 2000 benchmark, comparing the means for the two groups. The prevalence ratio was calculated for low stature in preschool age children resulting from insufficient weight at birth. RESULTS: the z score for weight was -0.09 and 0.39 and the average z score for height was -0.06 and 0.24 for underweight and normal weight at birth, respectively. The prevalence of low stature was 2.78% for children born underweight and 0.79% for normal weight. The PR for low stature at preschool age for children born underweight was 3.5 (CI95% 1.3-9.4). CONCLUSIONS: children born underweight had a lower rate of growth and greater risk of developing a growth disorder up to preschool age, suggesting a negative effect of insufficient birth weight on child growth.

Risk of overweight and obesity in preschoolers attending private and philanthropic schools

OBJECTIVE To assess the risk prevalence of overweight and obesity in children enrolled in private and philanthropic preschools in the State of São Paulo. METHODS Comparison of two cross sectional studies with children enrolled in private preschools (PPS) or philanthropic (PHP) of the São Paulo Metropolitan Region. Both surveys evaluated the childrens environment. To determine the risk of overweight, excess weight and obesity, body mass index (BMI) values were transformed into z scores (according to the World Health Organization - 2006 and 2007). RESULTS The risk prevalence of overweight (≥ 1 BMIz < 2) in PPS was 21.9% and 24.6% in PHP, with PR = 1.12 (95% CI: 0.96-1.32), without statistical difference. Considering the children with overweight or obesity, (BMIz ≥ 2) the prevalence in PPS was 14.3% and in PHP was 9.0%, with PR = 1.54 (95% CI: 1.23-1.93), p = 0.0002. Overweight and obesity prevalence in males in PPS was 16.4% (n = 409) and in PHP, 11.1% (n = 829), PR = 1.48 (95% CI: 1.10-1.98) and in females it was 12.5% (n = 400) in the PPS and 6.6% (n = 698) in PHP, corresponding to PR = 1.90 (95% CI: 1.30-2.78), both significant differences. CONCLUSION Both groups showed a similar and very high prevalence of weight excess. However, overweight and obesity showed a higher prevalence in children from private preschools. This indicates that even though a better socioeconomic level is still a risk factor for overweight and obesity in preschoolers, the same does not seem to occur when analyzing the risk of overweight.