Eduardo Freitas da Silva

Prevalência do aleitamento materno nas capitais brasileiras

OBJECTIVE: To estimate the prevalence of breastfeeding and of exclusive breastfeeding in Brazilian capital cities, in the 5 major geographical areas of Brazil and in the whole country, at the ages of 30, 120 and 180 days, as agreed among specialists. METHODS: Restudy of data from the population inquiry about breastfeeding in 25 capital cities and in the Federal District during a mass immunization campaign, on October 16th, 1999, National Day of Vaccination, supervised by one of the authors. The random sample of this study refers to 10,778 children, according to the ages mentioned above. The point and interval estimates (95% CI) were given for the capital cities and then extrapolated to the major geographical areas and to Brazil. The regression analysis was used on the SAS statistical program. RESULTS: The estimated prevalence of breastfeeding in Brazil was 87.3% (CI 95%: 86.8 87.7) at the age of 30 days, 77.5% (77.1 78.0) at the age of 120 days and 68.6% (68.2 69.1) at the age of 180 days. The exclusive breastfeeding prevalence was 47.5% (46.4 48.5), 17.7% (17.2 18.3) and 7.7% (7.2 8.2) at the ages mentioned. At the age of 30 days, variation of the frequency of exclusive breastfeeding was wide, from 73.4% (Fortaleza) to 25.2% (Cuiaba). At the age of 180 days, the prevalence ranged from 16.9% in Belem to 2.8% in Cuiaba. CONCLUSION: There was a moderate reduction of the prevalence of breastfeeding and a steep decline of the prevalence of exclusive breastfeeding from birth to the age of 180 days. Important differences were noted in the frequency of exclusive breastfeeding among the capital cities surveyed.

Avaliação das estruturas de concordância e discordância nos estudos de confiabilidade

OBJECTIVE: To complement the data of a previous research concerning the evaluation of the lifetime risk of radiation-induced cancer due to the ingestion of 226Ra, 228Ra and 222Rn in mineral spring waters from a natural highly radioactive region of Brazil. The study was performed to evaluate the lifetime risk of radiation-induced cancer due to the ingestion of 238U and 234 U in the same spring waters. METHOD: It is assumed that the risk coefficient for natural U isotopes is the same as for the 226Ra-induced bone sarcomas and that the equilibrium for skeletal content is 25 times the daily ingestion of 226Ra, but 11 times the daily ingestion of long-lived uranium isotopes. Waters samples were collected seasonally over a period of one year at all the spring sites used by the local population of Aguas da Prata, S. Paulo State (Brazil). RESULTS: Concentrations ranging from 2.0 to 28.4 mBq/L and from 4.7 to 143 mBq/L were observed for 238U and 234U, respectively. Based upon the measured concentrations the lifetime risk due to the ingestion of uranium isotopes was estimated. A total of 0.3 uranium-induced cancers per 106 exposed persons was predicted, suggesting that chronic ingestion of uranium at the levels observed at these springs will result in an incremental increase of fatal cancers of 0.1 %. CONCLUSIONS: By taking into account the uncertainties in evaluating the carcinogenic effects, it can be concluded that virtually no cancer would be expected from the ingestion of uranium in the mineral spring waters analyzed.

Iron status and oxidative stress biomarkers in adults: a preliminary study.

OBJECTIVE Although essential to many vital processes, iron catalyzes reactions that produce reactive oxygen species, which are associated with the increased risk of non-communicable chronic diseases and precocious aging. This study investigated whether ferritin, hemoglobin concentration, and dietary iron consumption are related to oxidative stress biomarkers in adults. METHODS Data were collected from 134 allegedly healthy subjects >18 y of age who were randomly selected to participate in a cross-sectional study as part of the pilot project Prevalence of Risk Factors for Non-communicable Chronic Diseases in the Federal District, Brazil (VIVA Saúde-DF). Serum ferritin, malondialdehyde (MDA) and protein carbonyl concentrations, hemoglobin, and dietary iron consumption were analyzed. RESULTS A weak positive correlation (r = 0.189, P = 0.032) and association (P = 0.046) was observed for serum ferritin and MDA. Hemoglobin concentrations were positively associated with serum MDA (P = 0.040). Dietary iron intake and serum protein carbonyl concentrations showed a weak positive correlation (r = 0.173, P = 0.046) for all subjects. Iron intake by women was positively associated with serum protein carbonyl (P = 0.03). A lower serum MDA concentration was found in ferritin-deficient subjects (P = 0.015) and men with anemia (P = 0.011). CONCLUSION These results suggest that low levels of iron may reduce oxidative stress.

Fatores associados à atividade física em adultos, Brasília, DF

OBJECTIVE To describe physical activity practice in adults and to identify associated factors. METHODS A cross-sectional study was performed with cluster sampling from the four areas of the city of Brasília, Central-West Brazil, in 2006-2007. A sample comprised of 469 adults was obtained from 250 randomly selected households. Sociodemographic data, weight and height were obtained during a household interview. The short version of the International Physical Activity Questionnaire (IPAQ) was used to measure physical activity. A multivariate linear regression analysis was made to assess the effect of sex, body mass index (BMI), socioeconomic classification and marital status on physical activity scores. RESULTS The majority of the sample was comprised of women (57%). The percentage of individuals who achieved 150 minutes of weekly physical activity practice was 52% (95% CI: 47; 56), while that of inactive individuals was 21.5% (95% CI: 17.8; 25.3). An inverse association between physical activity and BMI was only found in men. Types of physical activity reported differed between sexes: walking and doing household chores among women; cycling, running, swimming and weight-lifting among men. There was a strong interaction between male sex and BMI in terms of the association with physical activity scores: the higher the BMI, the lower the physical activity score. CONCLUSIONS The portion of inactive individuals in Brasília can be considered low, when compared to estimates from other Brazilian cities. Differences in BMI and physical activity score found between sexes are associated with the type of physical activity practiced.OBJETIVO: Descrever a pratica de atividade fisica por adultos e identificar fatores associados. METODOS: Estudo transversal com amostragem por conglomerados das quatro regioes de Brasilia, DF, em 20062007. A amostra de 469 adultos foi obtida em 250 domicilios selecionados aleatoriamente. Dados sociodemograficos, peso e altura foram obtidos durante uma entrevista no domicilio. O questionario internacional de atividade fisica (Ipaq), versao curta, foi utilizado para a mensuracao da atividade fisica. Para se avaliar o efeito do sexo, indice de massa corporal (IMC), classificacao socioeconomica e estado civil sobre o escore de atividade fisica, foi realizada uma analise de regressao linear multivariavel. RESULTADOS: A maioria da amostra era composta por mulheres (57%). O percentual de individuos que atingiu 150 minutos semanais de pratica de atividade fisica foi de 52% (IC 95%: 47; 56) e de inativos de 21,5% (IC 95%: 17,8;25,3). Somente nos homens foi observada uma associacao inversa entre atividade fisica e IMC. Os tipos de atividades fisicas relatados diferiram entre os sexos: entre mulheres, caminhar e fazer servicos domesticos; entre os homens, pedalar, correr, nadar e fazer exercicios com pesos. Houve uma forte interacao entre sexo masculino e IMC para a associacao com o escore de atividade fisica: quanto maior o IMC, menor o escore de atividade fisica. CONCLUSOES: A parcela de individuos inativos em Brasilia pode ser considerada baixa, em contraste com estimativas de outras cidades brasileiras. Diferencas entre sexos em relacao a IMC e escore de atividade fisica estao associadas ao tipo de atividade fisica praticada.

Tendência do aleitamento materno no Brasil no último quarto do século XX

OBJETIVO: analisar a evolucao do aleitamento materno no Brasil de 1974-1975 a 1999. METODO: foram comparados tres inqueritos populacionais realizados em 1974-1975, 1989, 1999. Os tres estudos variaram quanto aos objetivos, plano amostral e coleta de dados, mas foi constante a definicao de aleitamento materno. Os resultados das duas primeiras pesquisas foram retirados de trabalho que analisou a evolucao do aleitamento materno no periodo correspondente. Os do terceiro foram gerados por nova analise do banco de dados do estudo original. A fim de permitir a comparacao direta dos resultados desta analise com os demais, utilizou-se o modelo probito. A evolucao do aleitamento materno nos tres pontos no tempo aqui considerados foi verificada pelo metodo grafico e por numeros-indice. RESULTADOS: o aumento da frequencia da amamentacao, no periodo de 25 anos decorridos entre a primeira e a terceira pesquisa, correspondeu a 40% no grupo de criancas com um mes de vida, a 150%, no quarto mes, a 200%, no sexto mes, e a 240% aos 12 meses. CONCLUSAO: persistiu nos anos de 1990 a tendencia de aumento da pratica da amamentacao verificada no pais no periodo de 1974-1975 a 1989.

Prevalência do aleitamento materno no Distrito Federal, Brasil

O artigo relata os resultados de um inquerito transversal, de base populacional, realizado em Dia Nacional de Vacinacao. Um grupo de 3.305 maes, com filhos na faixa etaria de 0 a 180 dias, selecionado por amostragem sistematica, foi entrevistado com questionario pre-testado. A prevalencia do aleitamento materno exclusivo, na faixa etaria de 0-15 dias, foi de 62% (intervalo de confianca de 95%: 58,5-65,3) e de 12,8% (11,0-14,7), na faixa etaria de 151-180 dias. A duracao mediana do aleitamento materno exclusivo correspondeu a 39,4 dias. O aleitamento predominante manteve-se constante ao longo dos intervalos etarios, com uma prevalencia media de 33,1% (31,4-34,7), enquanto o parcial variou de 4,5% (3,1-6,4) a 28,4% (25,8-31,0), nas idades mencionadas. Para o aleitamento materno (todas as modalidades), a prevalencia foi de 96,8% (95,8-97,7) e 70,9% (67,7-73,9), respectivamente. Em conclusao, a prevalencia do aleitamento materno no Distrito Federal e elevada, mas e curto o periodo em que as criancas sao amamentadas exclusivamente ao seio.

Validade de peso, altura e indice de massa corporal autorreferidos na populacao adulta de Brasilia

OBJECTIVE: To assess the validity of self-reported weight, height and body mass index (BMI) estimates from adults in Brasilia and to identify factors associated to differences between measured and self-reported values. METHODS: In a cluster sampling 250 household´s were selected and weight and height were measured in all adults after an interview. Bland & Altman (B&A) was used to determined agreement between measured and self-reported parameters. The multiple analysis of variance was used to determine the associated factors. Sensitivity and specificity were used for excess weight (BMI ≥ 25 kg/m2). RESULTS: Interviews and measurements were done in 469 individuals. B&A showed bias (difference between measured and self-reported values) was not significant for weight (- 0.17 kg, p = 0.1) and significant for height (- 1 cm, p < 0.001). The limits of agreement (LA) were wide: from ± 4 kg for weight and - 6 cm to 4 cm for height. BMI presented a non significant bias of - 0.06 kg/m2 (p = 0.08) and LA of - 1.5 to + 1.4 kg/m2. Men with a BMI < 25 kg/m2 overestimated weight, while overweight or obese men underestimated it (p < 0.01). Men older than 60y of age (p = 0.037) and women with less than 12y of study (p < 0.01) overestimated height. The sensitivity and specificity to detect excess weight were for men and women, respectively: 94%, 88% and 90%, 98%. Sensitivity to detect excess weight was 77% for 60 or over years old women and 75% for women between 9 to 11 years of study, while. specificity was 78% for men between 30 e 39 years old. CONCLUSION: In Brasilia, self-reported height can be used for subgroups of women with more than 12y of study and men under 60y of age. Men with adequate BMI over estimate their weight when compared to overweight and obese men. Self-reported measures can be used for excess weight population follow-up.

Aleitamento materno exclusivo e fatores associados a sua interrupção precoce: estudo comparativo entre 1999 e 2008

Objective: To analyze the indicators of exclusive breastfeed- ing (EB) in Brasilias University Hospital (BUH) during a 10- year interval and to verify associated factors to early weaning. Methods: A retrospective cross-sectional study was con- ducted by chart review of children attending the Pediatric Clinic during 1999 and 2008. The duration of exclusive breastfeeding was categorized at four months and four months or more. Prevalence ratios for early weaning (EB<4 months) were estimated with a model of Poisson regression and robust variance. Non-parametric Mann-Whitney test was used to compare the exclusive breastfeeding duration in the studied years. Results: Among 2,173 patients, 1,443 in 1999 and 730 in 2008. There was an increase from 110.7 to 123.6 days in the duration of EB. A significant association between maternal education and early weaning was shown, with a 12.6% higher prevalence in mothers with less than eight years of schooling compared to those with 11 or more years. No other associa- tions were found in the study. Conclusions: Similarly to what was found in Brazilian capitals and Brasilia, there was an increase in the length of exclusive breastfeeding related to mother educational level. Nevertheless, the duration exclusive breastfeeding is still below the threshold of 180 days recommended by the World Health Organization.Objective: To analyze the indicators of exclusive breastfeeding (EB) in Brasilia’s University Hospital (BUH) during a 10-year interval and to verify associated factors to early weaning. Methods: A retrospective cross-sectional study was conducted by chart review of children attending the Pediatric Clinic during 1999 and 2008. The duration of exclusive breastfeeding was categorized at four months and four months or more. Prevalence ratios for early weaning (EB<4 months) were estimated with a model of Poisson regression and robust variance. Non-parametric Mann-Whitney test was used to compare the exclusive breastfeeding duration in the studied years. Results: Among 2,173 patients, 1,443 in 1999 and 730 in 2008. There was an increase from 110.7 to 123.6 days in the duration of EB. A significant association between maternal education and early weaning was shown, with a 12.6% higher prevalence in mothers with less than eight years of schooling compared to those with 11 or more years. No other associations were found in the study.

Prevalence of breast-feeding in Brasilia, Brazil

This article presents the findings of a population-based cross-sectional survey carried out during a mass immunization campaign. A group of 3,305 mothers whose babies were 0 to 180 days old was selected by systematic sampling and interviewed with a pretested questionnaire. The prevalence of exclusive breast-feeding among 0-15 day-old children was 62% (IC 95%: 58.5-65.3) and 12.8% (11.0-14.7), among 151-180 day-old children. The average duration of exclusive breast-feeding was 39.4 days. The prevalence of predominant breast-feeding was invariable along the age intervals showing a mean of 33.1% (31.4-34.7). The prevalence of partial breast-feeding among 0-15 day-old children was 4.5% (3.1-6.4) and 28.4% (25.8-31.0) for the mentioned age groups. For maternal breast-feeding, the overall prevalence varied from 96.8% (95.8-97.7) to 70.9% (67.7-73.9). In conclusion, although the overall prevalence of breast-feeding in Brasilia is relatively high, the period that children are exclusively breast-fed is short.

Association of Moderate Coffee Intake with Self-Reported Diabetes among Urban Brazilians

Coffee has been associated with reductions in the risk of non-communicable chronic diseases (NCCD), including diabetes mellitus. Because differences in food habits are recognizable modifying factors in the epidemiology of diabetes, we studied the association of coffee consumption with type-2 diabetes in a sample of the adult population of the Federal District, Brazil. This cross-sectional study was conducted by telephone interview (n = 1,440). A multivariate analysis was run controlling for socio-behavioural variables, obesity and family antecedents of NCCD. A hierarchical linear regression model and a Poisson regression were used to verify association of type-2 diabetes and coffee intake. The independent variables which remained in the final model, following the hierarchical inclusion levels, were: first level—age and marital status; second level—diabetes and dyslipidaemias in antecedents; third level—cigarette smoking, supplement intake, body mass index; and fourth level—coffee intake (≤100 mL/d, 101 to 400 mL/day, and >400 mL/day). After adjusting hierarchically for the confounding variables, consumers of 100 to 400 mL of coffee/day had a 2.7% higher (p = 0.04) prevalence of not having diabetes than those who drank less than 100 mL of coffee/day. Compared to coffee intake of ≤100 mL/day, adults consuming >400 mL of coffee/day showed no statistically significant difference in the prevalence of diabetes. Thus, moderate coffee intake is favourably associated with self-reported type-2 diabetes in the studied population. This is the first study to show a relationship between coffee drinking and diabetes in a Brazilian population.