Inês Rugani Ribeiro de Castro

Increasing consumption of ultra-processed foods and likely impact on human health: evidence from Brazil.

OBJECTIVEnTo assess time trends in the contribution of processed foods to food purchases made by Brazilian households and to explore the potential impact on the overall quality of the diet.nnnDESIGNnApplication of a new classification of foodstuffs based on extent and purpose of food processing to data collected by comparable probabilistic household budget surveys. The classification assigns foodstuffs to the following groups: unprocessed/minimally processed foods (Group 1); processed culinary ingredients (Group 2); or ultra-processed ready-to-eat or ready-to-heat food products (Group 3).nnnSETTINGnEleven metropolitan areas of Brazil.nnnSUBJECTSnHouseholds; n 13,611 in 1987-8, n 16,014 in 1995-5 and n 13,848 in 2002-3.nnnRESULTSnOver the last three decades, the household consumption of Group 1 and Group 2 foods has been steadily replaced by consumption of Group 3 ultra-processed food products, both overall and in lower- and upper-income groups. In the 2002-3 survey, Group 3 items represented more than one-quarter of total energy (more than one-third for higher-income households). The overall nutrient profile of Group 3 items, compared with that of Group 1 and Group 2 items, revealed more added sugar, more saturated fat, more sodium, less fibre and much higher energy density.nnnCONCLUSIONSnThe high energy density and the unfavourable nutrition profiling of Group 3 food products, and also their potential harmful effects on eating and drinking behaviours, indicate that governments and health authorities should use all possible methods, including legislation and statutory regulation, to halt and reverse the replacement of minimally processed foods and processed culinary ingredients by ultra-processed food products.

A tendência cambiante da relação entre escolaridade e risco de obesidade no Brasil (1975-1997)

Based on three comparable surveys conducted in the last quarter of the 20th century in the most heavily populated areas of Brazil, a substantial change was observed in the secular trend towards obesity based on levels of schooling in the population. While during the first period (1975-1989) there was an increasing risk of obesity for all levels of schooling, with the greatest upward trend for men and women with more schooling, during the second period (1989-1997) the increase in obesity was the greatest for individuals with no schooling, along with a stabilization or even decrease in this condition among groups of females with medium or higher education. As a result of the upward trend, the positive relationship decreased between schooling and risk of obesity in men, and the inverse relationship already observed in the female population was further increased. The main potential implications of these findings are for public health.

Efetividade da suplementação diária ou semanal com ferro na prevenção da anemia em lactentes

OBJETIVO: Evaluar la efectividad del suplemento universal profilactico con sulfato ferroso, en administracion diaria o semanal, en la prevencion de la anemia en lactantes. METODOS: Se realizo un ensayo de campo aleatorio con ninos de seis a 12 meses de edad, atendidos en unidades basicas de salud del municipio de Rio de Janeiro (Sureste de Brasil), en 2004-2005. Se formaron tres cohortes coincidentes con suplemento universal con sulfato ferroso con grupos: diario (n=150; 12,5mgFe/dia), semanal (n=147; 25mgFe/semana) y control (n=94). La intervencion duro 24 semanas y fue acompanada por acciones educativas promotoras de adhesion. La concentracion de hemoglobina serica fue analizada de acuerdo a su distribucion, promedio y prevalencia de anemia (Hb<110,0g/L) a los 12 meses de edad. La evaluacion de la efectividad fue realizada con base a la intencion de tratar y adhesion al protocolo, utilizandose analisis de regresion multiple (lineal y de Poisson). RESULTADOS: Los grupos se mostraron homogeneos con relacion a las variables de caracterizacion. La intervencion fue operacionalizada con exito, con elevada adhesion al protocolo en ambos grupos expuestos, sin diferencia estadistica entre ellos. Luego de un ajuste, solamente el esquema diario presento efecto protector. En el analisis por adhesion, el esquema diario presento evidente efecto dosis-respuesta para el promedio de hemoglobina serica y prevalencia de anemia, sin observarse efecto protector del esquema semanal. CONCLUSIONES: Solo el esquema diario de suplemento universal con sulfato ferroso de los seis a los 12 meses de edad fue efectivo para aumentar la concentracion de hemoglobina serica y reducir el riesgo de anemia.OBJECTIVEnTo evaluate the effectiveness of universal prophylactic targeting with iron sulfate on daily or weekly basis in the prevention of anemia in infants.nnnMETHODSnRandomized clinical field trial with children between ages six and 12 months seen at primary health care units in the municipality of Rio de Janeiro, Brazil, between 2004 and 2005. Three concurrent cohorts were compared: daily group (n=150; 12.5mg Fe/day); weekly group (n=147; 25mg Fe/week) and control group. The intervention consisted of universal supplementation with iron sulfate for 24 weeks, combined with educational adherence-promoting measures.nnnOUTCOMEnmean serum hemoglobin concentration, distribution and prevalence of anemia (Hb<110.0 g/l) at age 12 months. Effectiveness was evaluated considering both intent to treat and adherence to protocol, using multiple regression analysis (linear and Poisson).nnnRESULTSnGroups were homogeneous in terms of descriptive variables. The intervention was implemented successfully, with high adhesion to protocol in both groups, and no statistical difference between them. After adjustment, only the daily regimen showed a protective effect. Adherence analysis demonstrated an evident dose-response effect on mean Hb and prevalence of anemia only for the daily regimen. No protective effect was detected for the weekly regimen.nnnCONCLUSIONSnUniversal supplementation with iron sulfate from six to 12 months of age was effective in increasing serum Hb and decreasing risk of anemia only when administered on a daily basis.

Effectiveness of daily and weekly iron supplementation in the prevention of anemia in infants

OBJETIVO: Evaluar la efectividad del suplemento universal profilactico con sulfato ferroso, en administracion diaria o semanal, en la prevencion de la anemia en lactantes. METODOS: Se realizo un ensayo de campo aleatorio con ninos de seis a 12 meses de edad, atendidos en unidades basicas de salud del municipio de Rio de Janeiro (Sureste de Brasil), en 2004-2005. Se formaron tres cohortes coincidentes con suplemento universal con sulfato ferroso con grupos: diario (n=150; 12,5mgFe/dia), semanal (n=147; 25mgFe/semana) y control (n=94). La intervencion duro 24 semanas y fue acompanada por acciones educativas promotoras de adhesion. La concentracion de hemoglobina serica fue analizada de acuerdo a su distribucion, promedio y prevalencia de anemia (Hb<110,0g/L) a los 12 meses de edad. La evaluacion de la efectividad fue realizada con base a la intencion de tratar y adhesion al protocolo, utilizandose analisis de regresion multiple (lineal y de Poisson). RESULTADOS: Los grupos se mostraron homogeneos con relacion a las variables de caracterizacion. La intervencion fue operacionalizada con exito, con elevada adhesion al protocolo en ambos grupos expuestos, sin diferencia estadistica entre ellos. Luego de un ajuste, solamente el esquema diario presento efecto protector. En el analisis por adhesion, el esquema diario presento evidente efecto dosis-respuesta para el promedio de hemoglobina serica y prevalencia de anemia, sin observarse efecto protector del esquema semanal. CONCLUSIONES: Solo el esquema diario de suplemento universal con sulfato ferroso de los seis a los 12 meses de edad fue efectivo para aumentar la concentracion de hemoglobina serica y reducir el riesgo de anemia.OBJECTIVEnTo evaluate the effectiveness of universal prophylactic targeting with iron sulfate on daily or weekly basis in the prevention of anemia in infants.nnnMETHODSnRandomized clinical field trial with children between ages six and 12 months seen at primary health care units in the municipality of Rio de Janeiro, Brazil, between 2004 and 2005. Three concurrent cohorts were compared: daily group (n=150; 12.5mg Fe/day); weekly group (n=147; 25mg Fe/week) and control group. The intervention consisted of universal supplementation with iron sulfate for 24 weeks, combined with educational adherence-promoting measures.nnnOUTCOMEnmean serum hemoglobin concentration, distribution and prevalence of anemia (Hb<110.0 g/l) at age 12 months. Effectiveness was evaluated considering both intent to treat and adherence to protocol, using multiple regression analysis (linear and Poisson).nnnRESULTSnGroups were homogeneous in terms of descriptive variables. The intervention was implemented successfully, with high adhesion to protocol in both groups, and no statistical difference between them. After adjustment, only the daily regimen showed a protective effect. Adherence analysis demonstrated an evident dose-response effect on mean Hb and prevalence of anemia only for the daily regimen. No protective effect was detected for the weekly regimen.nnnCONCLUSIONSnUniversal supplementation with iron sulfate from six to 12 months of age was effective in increasing serum Hb and decreasing risk of anemia only when administered on a daily basis.

Considerações sobre o plano de combate à fome e à miséria

Neste trabalho discute-se a proposta do Plano de Combate a Fome e a Miseria para o Ministerio da Saude. O programa Leite e Saude constitui a linha central de atuacao do Plano, sendo subsidiado pelo Sistema de Vigilância Nutricional (Sisvan) e dirigido a criancas desnutridas, seus contatos familiares e gestantes sob risco nutricional atendidos na rede de saude. Sao levantados questionamentos relativos aos papeis previstos para o setor saude e para o Sisvan, a acao especifica de distribuicao de alimentos, aos indicadores empregados e populacao-alvo e aos criterios de avaliacao do programa Leite e Saude. Os autores argumentam que o Plano deve valorizar a execucao de medidas estruturais, sem as quais nao sera possivel superar o quadro de miseria e fome que acomete segmentos da populacao brasileira.

Vigilância nutricional e morbidade de crianças menores de 5 anos numa unidade básica de saúde: análise da série histórica 1987-91

This paper presents preliminary analysis of the nutritional status assessment (NS) and morbidity of low-income children under 5 years of age seen by the Food and Nutritional Surveillance System of a primary health care unit in Rio de Janeiro between 1987 and 1991. The distribution of lengh/stature for age (LSA) was skewed to the left as early as the first semester of life. Approximately 20% of the children had values of body mass for age (BMA) below the 10th percentile of the reference growth curve (NCHS). The prevalence of stunting (Z LSA < - 2) decreased yearly during the period. The eight most frequent causes of visit to the unit were the same but the frequencies varied from year to year. In the last three years upper respiratory (URD) and digestive diseases (DD) and undernutrition prevailed. NS did not correlate with UPD but the prevalence of DD was inversely associated with BMA percentile. These data indicate relevant growth deficits in the children which justifies the implementation of nutritional surveillance in health units. It is also clear that morbidity and NS must be correlated in future studies, so that, the role of nutritional surveillance is enhanced in the Health Sector.

PROMOCIÓN DE FRUTAS Y HORTALIZAS EN BRASIL: LA CONTRIBUCIÓN DEL PROGRAMA «5 AL DÍA»

Un desafio importante a escala global en la actualidad es la reversion del aumento acelerado de enfermedades cronicas no transmisibles. Una de las prioridades de la Estrategia Global de Alimentacion, Actividad Fisica y Salud es el incentivo para aumentar el consumo de frutas, legumbres y verduras. En este contexto, la Iniciativa «5 al Dia», ya adoptada en mas de 40 paises, viene siendo reconocida ampliamente como una importante estrategia de promocion de frutas y verduras. En Brasil, el «5 al Dia» es coordinado por el IBRA, una organizacion sin fines de lucro que tiene como objetivo difundir el programa en conjunto con otras instituciones y sectores de la sociedad. Las acciones que estan siendo desarrolladas son la inclusion de actividades de promocion del consumo de frutas y verduras en los proyectos educativos de instituciones asociadas; divulgacion del tema para profesionales de la salud y comunidad; desarrollo de pesquisas en las areas de promocion y consumo de frutas y verduras y construccion de convenios estrategicos para la difusion del tema en las escuelas, ambientes de trabajo de redes de comercio minorista y mayorista de alimentos

Efectividad en el suplemento diario o semanal de hierro en la prevención de anemia en lactantes

OBJETIVO: Evaluar la efectividad del suplemento universal profilactico con sulfato ferroso, en administracion diaria o semanal, en la prevencion de la anemia en lactantes. METODOS: Se realizo un ensayo de campo aleatorio con ninos de seis a 12 meses de edad, atendidos en unidades basicas de salud del municipio de Rio de Janeiro (Sureste de Brasil), en 2004-2005. Se formaron tres cohortes coincidentes con suplemento universal con sulfato ferroso con grupos: diario (n=150; 12,5mgFe/dia), semanal (n=147; 25mgFe/semana) y control (n=94). La intervencion duro 24 semanas y fue acompanada por acciones educativas promotoras de adhesion. La concentracion de hemoglobina serica fue analizada de acuerdo a su distribucion, promedio y prevalencia de anemia (Hb<110,0g/L) a los 12 meses de edad. La evaluacion de la efectividad fue realizada con base a la intencion de tratar y adhesion al protocolo, utilizandose analisis de regresion multiple (lineal y de Poisson). RESULTADOS: Los grupos se mostraron homogeneos con relacion a las variables de caracterizacion. La intervencion fue operacionalizada con exito, con elevada adhesion al protocolo en ambos grupos expuestos, sin diferencia estadistica entre ellos. Luego de un ajuste, solamente el esquema diario presento efecto protector. En el analisis por adhesion, el esquema diario presento evidente efecto dosis-respuesta para el promedio de hemoglobina serica y prevalencia de anemia, sin observarse efecto protector del esquema semanal. CONCLUSIONES: Solo el esquema diario de suplemento universal con sulfato ferroso de los seis a los 12 meses de edad fue efectivo para aumentar la concentracion de hemoglobina serica y reducir el riesgo de anemia.OBJECTIVEnTo evaluate the effectiveness of universal prophylactic targeting with iron sulfate on daily or weekly basis in the prevention of anemia in infants.nnnMETHODSnRandomized clinical field trial with children between ages six and 12 months seen at primary health care units in the municipality of Rio de Janeiro, Brazil, between 2004 and 2005. Three concurrent cohorts were compared: daily group (n=150; 12.5mg Fe/day); weekly group (n=147; 25mg Fe/week) and control group. The intervention consisted of universal supplementation with iron sulfate for 24 weeks, combined with educational adherence-promoting measures.nnnOUTCOMEnmean serum hemoglobin concentration, distribution and prevalence of anemia (Hb<110.0 g/l) at age 12 months. Effectiveness was evaluated considering both intent to treat and adherence to protocol, using multiple regression analysis (linear and Poisson).nnnRESULTSnGroups were homogeneous in terms of descriptive variables. The intervention was implemented successfully, with high adhesion to protocol in both groups, and no statistical difference between them. After adjustment, only the daily regimen showed a protective effect. Adherence analysis demonstrated an evident dose-response effect on mean Hb and prevalence of anemia only for the daily regimen. No protective effect was detected for the weekly regimen.nnnCONCLUSIONSnUniversal supplementation with iron sulfate from six to 12 months of age was effective in increasing serum Hb and decreasing risk of anemia only when administered on a daily basis.