Flávio Diniz Capanema

Estado nutricional e prevalência de anemia em crianças que freqüentam creches em Belo Horizonte, Minas Gerais

ABstRAct Objective: Assess the prevalence of anemia and the nu-tritional status of children with 7-74 months old, enrolled in day care centers. Methods: This cross-sectional study enrolled children of 25 day care centers of the eastern district of Belo Horizonte city, Minas Gerais, Brazil. Anthropometric parameters were evalu-ated and hemoglobin count was done by a portable hemoglobi-nometer. The cutoff level for anemia was 11.0g/dL for children less than 60 months, and 11.5g/dL for those older than 5 years old. Nutritional status was assessed by anthropometric indexes: weight-for-age, height-for-age and weight-for-height and classi-fied in 3 groups: below -2 Z score (malnutrition/height deficit), -2 to -1 Z score (nutritional risk for malnutrition/height deficit) and above or equal to -1 Z score. Statistical analysis included: chi-square, chi-square with linear trend, analysis of variance (ANOVA) followed by Tukey test, being significant p <0.05. Results: 402 children, with a median age of 46.3 months, were assessed. The overall anemia prevalence was 28.8%. The

Anemia entre pré-escolares - um problema de saúde pública em Belo Horizonte, Brasil

O artigo tem por objetivo determinar a prevalencia de anemia em criancas matriculadas em creches da regional Centro-Sul de Belo Horizonte (MG), identificando fatores biologicos e socioeconomicos associados. Estudo transversal descritivo realizado em 18 creches. Foram avaliadas 373 criancas com base em amostragem estratificada por instituicao participante. A hemoglobina (Hb) serica foi determinada por puncao capilar e leitura em β-hemoglobinometro, adotando-se pontos de corte para anemia de Hb < 11,0g/dL para criancas de seis a 60 meses e Hb < 11,5g/dL para aquelas com idade superior, preconizados pela OMS. O estado nutricional foi definido por afericao do peso e altura e confeccao dos indices Peso/Idade (P/I), Estatura/Idade (E/I) e IMC/Idade (IMC/I). Entre os participantes 54% eram meninas. A media de idade foi de 38,1 ± 6,2 meses. A prevalencia global de anemia foi de 38,3%, sendo superior nas criancas com idade inferior ou igual a 24 meses (56,1%). Encontrou-se associacao significativa entre anemia e os fatores menor idade da crianca, menor idade materna e baixa renda familiar. O estudo mostrou que anemia em criancas de creches de Belo Horizonte constitui relevante problema de saude publica, sinalizando a necessidade de se implantar acoes especificas para mitigacao dos riscos por ele apontados.

Prevalência e fatores determinantes da anemia em crianças assistidas em creches de Belo Horizonte - MG

OBJETIVO: Avaliar a prevalencia e fatores determinantes da anemia em criancas assistidas em creches de Belo Horizonte. METODOS: Trata-se de estudo transversal com 312 criancas, entre 7 e 59 meses, assistidas em creches de um Distrito Sanitario de Belo Horizonte. O diagnostico de anemia foi realizado por puncao digital e leitura em b-hemoglobinometro portatil, considerando-se anemia niveis de hemoglobina inferiores a 11,0g/dL. Foram aferidos peso e altura das criancas, sendo o estado nutricional classificado segundo criterio OMS (2006). As variaveis foram coletadas por meio de questionario aplicado aos pais ou responsaveis pelas criancas, contendo informacoes socioeconomicas, maternas e relacionadas a saude das criancas. Foi realizada a regressao logistica multipla para avaliar a associacao entre as variaveis e a anemia, com o controle das variaveis de confusao. RESULTADOS: A prevalencia de anemia na populacao estudada foi de 30,8%, sendo esta superior nas criancas com idade ≤ 24 meses (71,1%). Os fatores determinantes da anemia na analise ajustada foram: idade menor ou igual a 24 meses (OR: 9,08; IC: 3,96 − 20,83) e altura/idade < − 1 z escore (OR: 2,1; IC: 1,20 - 3,62). CONCLUSOES: A elevada prevalencia de anemia em criancas atendidas em creches de Belo Horizonte, especialmente naquelas menores de 24 meses e nas criancas com altura/idade < − 1 z escore demonstra a importância do cuidado nutricional com os lactentes, e reforca a necessidade de comprometimento das instituicoes de atendimento infantil no combate a esta deficiencia.

Iron Fortification Strategies for the Control of Childhood Anemia in Brazil

This article presents data on the fortification of foods, necessary as an important public health approach for the success in reducing anemia. The use of food vehicles, iron salts and their costs, as well as recent work on iron fortification of foods in Brazil are reviewed. Recent research serves as a cornerstone for countries that attempt to implement permanent, long-lasting iron fortification programs aimed at the prevention of anemia considering cultural habits, type of iron salts and at-risk groups.

Indicators of surgical treatment of patent ductus arteriosus in preterm neonates in the first week of life

Objective To identify clinical and echocardiographic indicators of the necessity for early surgical closure of patent ductus arteriosus in preterm neonates. Methods The prospective study was conducted at the Neonatal Unit of Hospital Municipal Odilon Behrens between 2006 and 2010. The study population comprised 115 preterm neonates diagnosed with patent ductus arteriosus in the first week after birth, of whom 55 (group S) were submitted to clinical and or surgical closure and 60 (group NS) received non-surgical treatment. The parameters analyzed were birth weight, diameter of the ductus arteriosus (DAD), left atrial-to-aortic root diameter ratio (LA:Ao), the quotient of DAD2 and birth weight (mm2/kg), and ductal shunting. Results The study population comprised 58 males and 57 females. The average birth weight of group S (924 ± 224.3 g) was significantly (P=0.049) lower than that of group NS (1012.3 ± 242.8 g). The probability of the preterm neonates being submitted to surgical closure was 62.1% (P=0.006) when the DAD2/birth weight index was > 5 mm2/kg, 72.2% (P=0.001) when the LA:Ao ratio was > 1.5, and 61.2% when ductal shunting was high (P=0.025). Conclusion The parameters DAD2/birth weight index > 5 mm2/kg, LA:Ao ratio > 1.5 and high ductal shunting were statistically significant indicators (P<0.05) of the need for surgical closure of patent ductus arteriosus in low birth weight preterm neonates. Moreover, when an LA:Ao ratio > 1.5 was associated with the occurrence of shock, the probability of surgical closure increased to 78.4%.

Excess weight and factors associated in preschool of southwest of Bahia

Objetivos: avaliar a prevalencia e os fatores associados ao excesso de peso em pre-esco-lares do sudoeste da Bahia. Metodos: estudo transversal envolvendo 664 pre-escolares matriculados em periodo inte-gral em creches publicas de Vitoria da Conquista (BA). O excesso de peso foi definido considerando o indice IMC/idade maior que + 2 escore Z. As variaveis independentes foram agrupadas em caracteristicas maternas, socioeconomica, relacionadas a crianca e a creche. Realizou-se regressao logistica multipla para verificar a associacao entre excesso de peso e as variaveis estudadas. Resultados: a prevalencia de excesso de peso foi de 5,7%, sendo 3,9% de sobrepeso e 1,8% de obesidade. Os fatores associados ao excesso de peso infantil foram o parto cesareo (Odds Ratio - OR: 2,59; Intervalo de Confianca - IC95%: 1,11; 6,01), ser filho unico (OR: 3,32; IC95%: 1,44; 7,67) e aleitamento materno exclusivo inferior a 4 meses (OR: 2,59; IC95%: 1,12; 5,99). Conclusoes: os resultados mostram que intervencoes para reducao e/ou prevencao do excesso de peso devem comecar no pre-natal com incentivo ao aleitamento materno exclu-sivo e ao parto vaginal, alem de orientacoes nutricionais para maes com apenas um filho.

Prevalence and factors associated to vitamin A deficiency in children attending public day care centers in the Southwest of Bahia

Objectives: to determine the prevalence of vitamin A deficiency and factors associated to children attending public day care centers in the Southwest of Bahia. Methods: a cross-sectional study involving 303 children aged 24 to 60 months attending public day care centers in the city of Vitoria da Conquista, BA. A questionnaire was applied for the parents or legal guardians to answer and the childrens height and weight were measured. Blood samples were collected to analyze serum retinol taking in consideration the values below 0.70 imol/L as inadequate. The vaccination card was verified in relation to the adequacy of vitamin A supplementation. Food weighting was done to evaluate the consuming of lipids and vitamin A. The association between the variables and vitamin A deficiency was verified by logistic regression. Results: the prevalence of inadequate serum retinol levels was 13.1% (1.99 ± 1.17 imol/L); 4.3% were low height and 1.2% of thinness. Most children (91.7%) had their vitamin A doses outdated on their vaccination cards. The variables associated to vitamin A deficiency were children aged less or equal to 34 months (OR: 2.66, 95% CI: 1.23 - 5.74) and maternal age was less than 26 years (OR: 2.39; 95% CI: 1.11 - 5.17). Conclusions: vitamin A deficiency configures as a moderate public health problem in children attending public day care centers in the Southwest of Bahia.

Adiposity and metabolic profile of schoolchildren in the urban areas of Ouro Preto, Minas Gerais

Obesity, defined as an excess in body fat, is a multifactorial disease involving both genetic and environmental risk factors. Early diagnosis and interventions during critical periods of development of obesity – childhood and adolescence – have been recommended, aiming at preventing unfavorable outcomes at a later age. This cross-sectional study sought to characterize the lipid profile, glucose, adiponectin, leptin and ghrelin in schoolchildren between six and nine years of age with overweight and obesity in the city of Ouro Preto (MG). The data was analyzed with the Shapiro Wilk normality test, groups comparisons were made with either a parametric (T test) or a nonparametric (Mann Whitney) test, adopting confidence intervals of 95% and a significance level of ≤ 0.05. The average age of the school population was 7.8 ± 1.1 years, with a prevalence of 8.9% of overweight and 3% of obesity. Hypercholesterolemia was found in 5.5%, HDL was abnormal in 98.7%, LDL levels were borderline in 32.4% and altered glucose levels were present in 46.6% of the children. In stratified analysis by gender, higher values of leptin in girls (p = 0.032) and ghrelin in boys (p = 0.033) were found, with no difference for the other variables. The results show that overweight/obesity among schoolchildren should be considered a significant health problem in this population, highlighting the importance of implementing early intervention programs. Uncovering the precursors of childhood obesity could lead to interventions so as to prevent or mitigate its consequences in youth and adulthood.

Iron Fortification Strategies in Brazil

Iron deficiency anemia represents a serious nutritional problem worldwide, and it especially affects children and pregnant women in developing countries, like Brazil. According to World Health Organization, anemia can be considered a major public health problem in Brazil, which requires effective public policies [1] regarding the short- and long-term effects anemia can have on growth in at-risk groups [2].

Iron Food Fortification for the Control of Childhood Anemia in Brazil

Iron deficiency anemia represents a serious nutritional problem worldwide, and it especially affects children and pregnant women in developing countries. According to Global Health Burden Disease Report of World Health Organization, anemia is considered the most prevalent public health problem in the World (World Health Organization [WHO], 2008), which requires public policies to combat iron deficiency and anemia. In Brazil, the National Survey of Demography and Health of Children and Women PNDS showed 20.9% prevalence of anemia among children 6 to 59 months, with the highest prevalence in the northeast (Brazilian Institute of Geography and Statistics [IBGE], 2010). Studies conducted between 1996 and 2007, involving children less than 5 years in different regions of the country, showed very high rates of anemia. The prevalences were 47.8-63.7% in south, 10.477.8% in southern, 55.1-84% in north, 35.7-89.1% in northeast, and 31-63.1% in midwest of Brazil (Jordao et al., 2009).