Ivan Savioli Ferraz

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.

Vitamin A deficiency in children aged 6 to 24 months in S~ao Paulo State, Brazil

Abstract Vitamin A deficiency (VAD), mainly the subclinical form, is endemic in several areas of the Brazilian Northeast. However, studies concerning its prevalence and etiology (risk factors) in urban areas of Sao Paulo State are lacking. The objective of the present study was to identify VAD and the risk factors among children attending a Child Care outpatient clinic in Ribeirao Preto city, Sao Paulo State, Brazil. A total of 103 children aged 6 to 24 months without any diarrhea or fever illness were selected from a pediatric outpatient clinic. A careful clinical history and physical examination provided information about breast-feeding, parental education, family income, family size, birth weight and anthropometric data. The children also underwent ophthalmologic examination to check for signs of xerophthalmia and were submitted to blood tests in order to determine hemoglobin and serum iron, zinc and retinol levels. Serum retinol levels £ 0.70 μmol/l are considered to be deficient by the World Health Organization. Retinol levels, determined by high performance liquid chromatography (HPLC), were £? 0.70 μ?mol/l in 22 children (21.4%). No child had xerophthalmia. The overall mean serum zinc level was 108.9 μg% (2SD ± 43.1 μg%) and the values for children with and without VAD were 105.1 μg% (2SD ± 44.1 μg%) and 110.0 μg% (2SD ± 43.2 μg%) respectively, with no child presenting serum zinc levels below the normal range. None of them showed a

Nível sérico de zinco e sua associação com deficiência de vitamina A em crianças pré-escolares

OBJECTIVES: To identify the prevalence of zinc deficiency in a population with high prevalence of vitamin A deficiency; to verify whether zinc deficiency is associated with vitamin A deficiency in the population studied; to verify risk factors for zinc deficiency (sex, age, diarrhea and fever). METHOD: Cross-sectional study of 182 healthy children aged > 24 months and 48 and 48 and < 60 months tended to have lower zinc serum levels than children of other ages. Zinc serum levels were not changed by previous diarrhea and/or fever.

Vitamin A deficiency among Brazilian school-aged children in a healthy child service

Background/Objectives:Vitamin A deficiency (VAD) is a world public health problem contributing to the increase in childhood morbidity and mortality in developing countries and severe deficiency of vitamin A may lead to xerophthalmia and blindness. The objective of this study was to determine the prevalence of VAD among Brazilian school-aged children attended at a primary health unit and to verify if some considered risk factor was associated with VAD in this group.Subjects/Methods:A descriptive prospective transverse study was conducted on 103 randomly selected children. A total of 54 boys and 49 girls aged 5.5–11 years had the relative dose–response (RDR) test performed on. Possible ocular alterations related to vitamin A and the status of anemia, serum zinc, some acute-phase proteins, and anthropometric situation were determinate by an analytic design.Results:No child presented xerophthalmia. Serum retinol values lower than 1.05 and 0.7 μmol l−1, respectively were found in 26.2 and 5.8% of the children. The prevalence of hypovitaminosis detected by RDR test was 20.4%. The following variables and their relationship with VAD were evaluated: sex (P=0.33; 95% confidence interval 0.61–4.34), weight and height (P⩾0.5), hemoglobin (P=0.15), C-reactive protein (P=0.56; 95% confidence interval 0.75–18.26), α-1-acid-glycoprotein (P=0.56; 95% confidence interval 0.15–15.42) and serum zinc (P=0.31). None of these variables was related to VAD.Conclusions:In this population, the prevalence of VAD detected could be considered a public health problem. School-aged children can be considered at risk for VAD mainly of a subclinical level, even without some associated risk factors.

Detection of vitamin A deficiency in Brazilian preschool children using the serum 30-day dose–response test

Background: Vitamin A deficiency (VAD) is endemic in Brazil and health professionals have difficulty in recognizing its subclinical form. In addition, serum retinol concentrations do not always represent vitamin A status in the organism.Objective: To identify VAD in preschool children by the serum 30-day dose–response test (+S30DR) and to examine its potential as a tool for the assessment of vitamin A status in the community.Design: A prospective transverse study in which blood samples were obtained from 188 preschool children for the determination of serum retinol concentrations and the children were submitted to ocular inspection and anthropometric measurements. Information about the presence of diarrhea and/or fever during the 15 days preceding the study was also obtained. The children received an oral dose of 200,000 IU vitamin A immediately after the first blood collection. A second blood sample was obtained 30–45 days after supplementation in order to determine the +S30DR.Results: In all, 74.5% (140/188; 95% confidence interval: 68.3–80.7%) of the children presented +S30DR values indicative of low hepatic reserves. The mean serum retinol concentration was significantly lower before supplementation (0.92 and 1.65 μmol/l, respectively; P<0.0001). No child presented xerophthalmia; 3.7% (7/188) of the children were malnourished. The presence of fever and/or diarrhea during the 15 days preceding the first blood collection did not affect the +S30DR value.Conclusions: The prevalence of VAD in the study group was elevated. +S30DR proved to be a good indicator of subclinical VAD in children from an underdeveloped country.Sponsorship: The study was supported by School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.

Zinc serum levels and their association with vitamin A deficiency in preschool children

OBJECTIVES To identify the prevalence of zinc deficiency in a population with high prevalence of vitamin A deficiency; to verify whether zinc deficiency is associated with vitamin A deficiency in the population studied; to verify risk factors for zinc deficiency (sex, age, diarrhea and fever). METHOD Cross-sectional study of 182 healthy children aged > or = 24 months and < 72 months. Peripheral blood samples were obtained from fasting children to determine zinc serum levels. Information about presence of diarrhea and/or fever during the 15 days preceding the study was also obtained. Vitamin A deficiency was identified by a serum 30-day dose-response test (+S30DR). RESULTS Of the children studied, 0.5% (1/182) presented zinc serum levels < 65 microg/dL; however, 74.7% (136/182) of them had vitamin A deficiency. Zinc serum levels were not correlated with retinol serum levels. Zinc serum levels were not changed by previous diarrhea and/or fever. There was no difference in zinc levels between boys and girls. Children aged between > or = 48 and < 60 months tended to have lower zinc serum levels than children of other ages. CONCLUSION Zinc deficiency prevalence was low and did not represent a risk factor for vitamin A deficiency. Children aged between > or = 48 and < 60 months tended to have lower zinc serum levels than children of other ages. Zinc serum levels were not changed by previous diarrhea and/or fever.

Tendência secular do aleitamento materno em uma unidade de atenção primária à saúde materno-infantil em Ribeirão Preto, São Paulo

OBJECTIVES: to determine the secular trend of breastfeeding and the average breastfeeding period among children in the Child and Mother Program of a primary health care clinic. METHODS: a retrospective survey of the medical files of children under one year old, enrolled in the Child Care Program of the Vila Lobato Community and Social Center in 1970, 1980, 1990 and 2000 followed up for at least one year. RESULTS: seven hundred and twenty eight children, 118 from 1970, 193 from 1980, 201 from 1990 and 216 from 2000 respectively. Breastfeeding, low in 1970, increased in the following years not only among the same age group in each one of the years as well as during the six first months of the year during the three years of the study. Reduction in breastfeeding frequencies during the first six months of age was higher in the first two months of age in 1970, in the first four months in 2000 and of five months in 1980 and 1990. CONCLUSIONS: Child Care Programs as in the Vila Lobato Community are an important tool to consolidade and promote breastfeeding practices.

Impact of maternal vitamin A supplementation on the mother–infant pair in Brazil

Background/Objectives:Vitamin A deficiency (VAD) is a major public health problem. The supplementation of lactating women could be an effective strategy to combat it. The objective of this study was to assess the impact of maternal vitamin A supplementation on the mother–infant pair.Subjects/Methods:This was a double blind, placebo-controlled randomized clinical assay in which 33 women received 200 000 IU of vitamin A and 33 women received soy oil between 20th and 30th postpartum days. Maternal blood and milk samples were collected immediately before supplementation and 3 months after delivery, when blood was also collected from the babies. Retinol concentrations ⩽0.70 μmol/l in serum and 1.05 μmol/l in milk were considered to indicate VAD.Results:Increase in serum retinol level was observed in the supplemented group compared with the pre-supplementation levels (1.05 and 1.17 μmol/l, respectively; P=0.026) and to the post-supplementation levels of the control group (1.02 μmol/l; P=0.032). Reduction in breast milk retinol was observed in the control group compared with the pre-supplementation levels (1.93 and 1.34 μmol/l, respectively; P<0.0001) and to the post-supplementation levels of the supplemented group (1.56 μmol/l; P=0.0003). There was significant difference in the prevalence of VAD in breast milk after supplementation, 55.6% (15/27) in the control group and 16.1% (5/31) in the supplemented group (P=0.002). VAD was present in 66.1% (39/59) of infants, with mean serum retinol levels of 0.64±0.30 μmol/l in the control group and of 0.69±0.26 μmol/l in the supplemented group.Conclusions:Supplementation had a positive impact on maternal vitamin A status. No effect on infant status was detectable 2 months after supplementation with a single dose.

Prevalência de tabagismo e consumo de bebida alcoólica em mães de lactentes menores de seis meses de idade

OBJETIVO: Conhecer a prevalencia de tabagismo e consumo de bebida alcoolica em maes de lactentes menores de seis meses de idade. METODOS: Estudo transversal e descritivo com maes de criancas com idade entre zero e seis meses completos, matriculadas em programas de puericultura das Unidades Basicas de Saude da cidade de Ribeirao Preto (SP), ligadas aos seis Centros de Saude Escola da Faculdade de Medicina de Ribeirao Preto da Universidade de Sao Paulo. Foi aplicado um questionario em que constavam informacoes como idade materna, grau de escolaridade, paridade, ocupacao, tempo de aleitamento materno exclusivo e complementado, consumo de bebidas alcoolicas e cigarros e existencia de algum tabagista no domicilio. RESULTADOS: Foram entrevistadas 504 mulheres; 324 (64,3%) tinham algum contato com cigarro sendo 97 (19,2%) tabagistas ativas, 142 (28,2%) tabagistas passivas e 85 (16,8%) tabagistas ativas e passivas. Dentre as 97 tabagistas ativas, 78 (80,4%) estavam amamentando. Tambem estavam amamentando 118 (83,1%) das 142 maes tabagistas passivas. Quanto as bebidas alcoolicas, 56 (11,1%) maes responderam que as consumiam e, destas, 45 (80,3%) estavam amamentando. Quinze (26,8%) maes que consumiam bebidas alcoolicas tambem eram tabagistas. CONCLUSOES: O estudo encontrou alta prevalencia de maes com algum tipo de contato com tabagismo e que consumiam bebidas alcoolicas, sendo imprescindivel investir na prevencao dessas praticas nos programas de assistencia pre-natal e de puericultura.

Can the insulin sensitivity index (ISI) in association with insulin-like growth factor binding protein-1 identify insulin resistance early in overweight children?

UNLABELLED Association between insulin resistance (IR) and non-alcoholic fatty liver disease (NAFLD) has been reported. This prompted us to evaluate the power of the insulin sensitivity index (ISI) in association with IGFBP-1 to identify IR early in obese children/adolescents. OGTT was performed in 34 obese/overweight children/adolescents. Glucose, insulin and IGFBP-1 were measured in serum samples and ISI was calculated. Considering the presence of three or more risk factors for IR as a criterion for IR, ISI < 4.6 showed 87.5% sensitivity and 94.5% specificity in diagnosing IR. IGFBP-1 was lower in the group with ISI < 4.6 (p < 0.01). In this group, three patients had higher than expected IGFBP-1, suggesting hepatic IR, while three patients with ISI > 4.6 showed very low IGFBP-1 levels. CONCLUSION ISI < 4.6 is a good indicator of early peripheral IR and, associated with IGFBP-1, can identify increased risk of hepatic IR. Low IGFBP-1 levels among non-IR children may indicate increased portal insulin levels.