Joel Alves Lamounier

Determinants of Iron Deficiency Anemia in a Cohort of Children Aged 6-71 Months Living in the Northeast of Minas Gerais, Brazil

Iron deficiency anemia is one of the most common nutritional disorders worldwide. The aim was to identify the prevalence and incidence of anemia in children and to identify predictors of this condition, including intestinal parasites, social, nutritional and environmental factors, and comorbidities. A population-based cohort study was conducted in a sample of 414 children aged 6–71 months living in Novo Cruzeiro in the Minas Gerais State. Data were collected in 2008 and 2009 by interview and included socio-economic and demographic information about the children and their families. Blood samples were collected for testing of hemoglobin, ferritin and C-reactive protein. Anthropometric measurements and parasitological analyses of fecal samples were performed. To identify risk factors associated with anemia multivariate analyses were performed using the generalized estimating equations (GEE). In 2008 and 2009, respectively, the prevalence rates of anemia were 35.9% (95%CI 31.2–40.8) and 9.8% (95%CI 7.2–12.9), the prevalence rates of iron deficiency were 18.4% (95%CI 14.7–22.6) and 21.8% (95%CI 17.8–26.2), and the incidence rates of anemia and iron deficiency were 3.2% and 21.8%. The following risk factors associated with anemia were: iron deficiency (OR = 3.2; 95%CI 2.0-.5.3), parasitic infections (OR = 1.9; 95%CI 1.2–2.8), being of risk of or being a low length/height-for-age (OR = 2.1; 95%CI 1.4–3.2), and lower retinol intake (OR = 1.7; 95%CI 1.1–2.7), adjusted over time. Nutritional factors, parasitic infections and chronic malnutrition were identified as risk factors for anemia. These factors can be verified in a chronic process and have been classically described as risk factors for these conditions.

Prevalence of iron-deficiency anemia in children aged less than 60 months: A population-based study from the state of Minas Gerais, Brazil

OBJECTIVE: To identify the prevalence of iron-deficiency anemia in children aged less than 60 months and the conditioning factors in Minas Gerais, Brazil. METHODS: This cross-sectional study conducted from February 2007 to July 2008 in Minas Gerais included a random sample of 725 male and female children aged less than 60 months. A household survey was administered to the childrens parents or guardians to collect socioeconomic, demographic, food security, and the childs anthropometric data. The hemoglobin level was determined by a portable hemoglobinometer. Anemia was considered present when hemoglobin levels were below 11.0 g/dL. Statistical analyses estimated the prevalence of anemia and its association with socioeconomic, demographic, and food security-related variables. The model was adjusted by multivariate logistic regression. The significance level was set at 5% (p<0.05). RESULTS: The prevalence of anemia was 37.4%. The greatest prevalence occurred in the age group 6 to 24 months (43.0%). The associated variables were being female (PR=1.43; p<0.026); age (PR=1.53; p<0.024); and not frequenting a daycare center (PR=2.41; p<0.001). In the multivariate regression model, the variables being female and not frequenting a daycare center remained in the model. CONCLUSION: The present population-based study found that in Minas Gerais, one-third (37.5%) of the children aged less than 60 months have iron-deficiency anemia. The results show that not frequenting a daycare center and being female are risk factors for anemia.

Deficiência de iodo e fatores associados em lactentes e pré-escolares de um município do semiárido de Minas Gerais, Brasil, 2008

The aim of this study was to evaluate the prevalence of iodine deficiency in children aged 6 to 71 months in Novo Cruzeiro, Minas Gerais State, Brazil. A total of 475 children, allocated by stratified probability sampling, were analyzed with respect to the iodine concentrations in the salt consumed by the family and urinary iodine. Iodine deficiency was verified in 34.4% of the children, of which 23.5% showed slight deficiency, 5.9% moderate and 5% serious deficiency. A difference in the distribution of iodine deficiency was observed between the urban and the rural environments (p < 0.001) where average urinary iodine concentrations of 150.8 and 114.3µg/L respectively were found. A greater proportion of iodine deficiency was observed among children where the proportion of iodine in the salt consumed was below the recommended level. Although expressive, iodine deficiency in Novo Cruzeiro is not a public health problem according to World Health Organization (WHO), The limitrophe distribution of the urinary iodine associated with low iodine levels in salt suggests that efforts to control this deficiency are not yet complete.

Aleitamento materno em prematuros: política pública na atenção primária.

The importance and benefits of human milk have been well established for full-term and also preterm children.1,2 However, breastfeeding rates are lower in preterm infants.3,4 The initial survival of premature infants depends on hospital care and adequate nutritional support. Human milk provides nutrients and protection elements against infection. After hospital discharge, the patient should be treated at specialized reference centers and breastfeeding should be maintained.5--7 It is important to identify mothers at risk of not breastfeeding and who delivered babies with very low and extremely low birth weight to schedule home visits and consultations at the basic health units (UBS), especially in the first weeks after hospital discharge.8--10 An observational study with preterm infants after discharge from the Neonatal Intensive Care Unit showed that support from the health teams at the UBS is required to maintain breastfeeding.11 In 2002, in the state of Minas Gerais, the Secondary Reference Viva Vida Centers (CVV) were established as a public policy aimed at reducing maternal and infant mortality. The CVV are public healthcare units, offering health care exclusively through the Brazilian Public Health Service (SUS), characterized as micro-regional average-complexity health care facilities, which must work in an integrated manner with primary and tertiary care, seeking to ensure full attention to sexual and reproductive health and provide care to at-risk children, including preterm ones. In the

Associação de índice de massa corporal e aptidão física aeróbica com fatores de risco cardiovascular em crianças

Resumo Objetivo Identificar a associacao do indice de massa corporal e aptidao fisica aerobica com fatores de risco de doencas cardiovasculares em criancas. Metodos Estudo transversal realizado na cidade de Itauna-MG no ano de 2010 com 290 escolares de 6 a 10 anos de ambos os sexos, aleatoriamente selecionados. Criancas de escolas da zona rural e aquelas com limitacoes medicas para pratica de atividade fisica nao foram incluidas. Coletou-se o sangue apos jejum de 12 horas. A pressao arterial, a estatura e o peso foram avaliados segundo padroes internacionais. Foram considerados fatores de risco cardiovascular: hipertensao arterial, colesterol total, LDL, triacilglicerois e insulinemia elevados e HDL baixo. A analise estatistica incluiu a Correlacao de Spearman e a Regressao Logistica, com os fatores de risco cardiovascular como variaveis dependentes. Resultados Correlacoes significativas foram encontradas, nos dois sexos, entre indice de massa corporal e aptidao fisica aerobica com a maioria dos fatores de risco cardiovascular. Criancas dos dois sexos com indice de massa corporal acima do percentil 75 apresentaram chances aumentadas para insulinemia alterada e agrupamento de fatores de risco cardiovascular. Meninas com aptidao fisica aerobica no primeiro quartil apresentaram chances aumentadas para insulinemia alterada e agrupamento de fatores de risco cardiovascular. Conclusao As associacoes significativas e as chances aumentadas para presenca de fatores de risco cardiovascular em criancas com menor aptidao fisica aerobica e maior indice de massa corporal justificam o uso dessas variaveis no monitoramento da saude em pediatria.Objective: To identify the association between both, body mass index and aerobic fitness, with cardiovascular disease risk factors in children. Methods: Cross-sectional study, carried out in Itaúna-MG, in 2010, with 290 school children ranging from 6 to 10 years-old of both sexes, randomly selected. Children from schools located in the countryside and those with medical restrctions for physical activity were not included. Blood sample was collected after a 12-hour fasting period. Blood pressure, stature and weight were evaluated in accordance with international standards. The following were considered as cardiovascular risk factors: high blood pressure, high total cholesterol, LDL, triglycerides and insulin levels, and low HDL. The statistical analysis included the Spearmans coefficient and the logistic regression, with cardiovascular risk factors as dependent variables. Results: Significant correlations were found, in both sexes, among body mass index and aerobic fitness with most of the cardiovascular risk factors. Children of both sexes with body mass index in the fourth quartile demonstrated increased chances of having high blood insulin and clustering cardiovascular risk factors. Moreover, girls with aerobic fitness in the first quartile also demonstrated increased chances of having high blood insulin and clustering cardiovascular risk factors. Conclusion: The significant associations and the increased chances of having cardiovascular risk factors in children with less aerobic fitness and higher levels of body mass index justify the use of these variables for health monitoring in Pediatrics.

Aplicabilidade do indice adiposidade corporal na estimativa do percentual de gordura de jovens mulheres brasileiras

INTRODUCCION: La estimativa de la composicion corporal es un campo de estudio importante en el pronostico y diagnostico de enfermedades degenerativas. OBJETIVO: Analizar la aplicabilidad del Indice de Adiposidad Corporal (IAC) y el metodo de pliegues cutaneos. METODOS: La muestra fue constituida por 19 adultas jovenes con promedio de edad de 24,53 ± 2,65 anos, sometidas a evaluacion antropometrica (circunferencias y pliegues cutaneos) y absorciometria por doble emision de rayo X (DXA). Los valores estimados fueron comparados al valor de referencia por medio del test t pareado y por el analisis del nivel de asociacion entre los metodos por la correlacion de Pearson; el nivel de significancia fue de p 0,05) con nivel de asociacion fuerte (r = 0,879). CONCLUSION: Aunque el IAC no presente diferencia para los valores estimados, queda evidente la necesidad de mas estudios sobre la aplicabilidad del metodo en la poblacion brasilena.

Applicability of body adiposity index in estimating body fat of young brazilian women

INTRODUCCION: La estimativa de la composicion corporal es un campo de estudio importante en el pronostico y diagnostico de enfermedades degenerativas. OBJETIVO: Analizar la aplicabilidad del Indice de Adiposidad Corporal (IAC) y el metodo de pliegues cutaneos. METODOS: La muestra fue constituida por 19 adultas jovenes con promedio de edad de 24,53 ± 2,65 anos, sometidas a evaluacion antropometrica (circunferencias y pliegues cutaneos) y absorciometria por doble emision de rayo X (DXA). Los valores estimados fueron comparados al valor de referencia por medio del test t pareado y por el analisis del nivel de asociacion entre los metodos por la correlacion de Pearson; el nivel de significancia fue de p 0,05) con nivel de asociacion fuerte (r = 0,879). CONCLUSION: Aunque el IAC no presente diferencia para los valores estimados, queda evidente la necesidad de mas estudios sobre la aplicabilidad del metodo en la poblacion brasilena.

Consumo de bebidas açucaradas, leite e sua associação com o índice de massa corporal na adolescência: uma revisão sistemática

Objective To systematize literature references addressing the association of sugar-sweetened beverage (SSB) and milk intake with body mass index (BMI) in adolescents. Data source A search was carried out in PubMed (US National Library of Medicine National Institutes of Health) and BVS (Virtual Library in Health). The descriptors used were: adolescents, young adult, beverages, drinking, obesity, overweight, BMI, and nutritional status. The following filters were applied: age ranging from 10 to 19 years, studies published in Portuguese or English language between 2011-2015. Data synthesis Thirty studies were selected (22 cross-sectional studies, 4 cohort studies, 1 randomized clinical trial, 1 case-control study, and 1 quasi-experimental study). There was association between the intake of these beverages and increase in BMI in 55% of all 20 studies that dealt with sugary drinks. When it came to soft drinks, 100% of studies reported association with increase in BMI. As to milk intake, only one article showed association with increased BMI. Three articles reported milk as a protection factor against increase in BMI; three studies found no association between this intake and BMI. Nineteen studies had representative samples and 20 surveys reported random samples. Among papers using questionnaires, 84% had been validated. Conclusions There is no consensus in the literature about the association between SSB or milk intake and BMI in adolescents.ABSTRACT Objective: To systematize literature references addressing the association of sugar-sweetened beverage (SSB) and milk intake with body mass index (BMI) in adolescents. Data source: A search was carried out in PubMed (US National Library of Medicine National Institutes of Health) and BVS (Virtual Library in Health). The descriptors used were: adolescents, young adult, beverages, drinking, obesity, overweight, BMI, and nutritional status. The following filters were applied: age ranging from 10 to 19 years, studies published in Portuguese or English language between 2011-2015. Data synthesis: Thirty studies were selected (22 cross-sectional studies, 4 cohort studies, 1 randomized clinical trial, 1 case-control study, and 1 quasi-experimental study). There was association between the intake of these beverages and increase in BMI in 55% of all 20 studies that dealt with sugary drinks. When it came to soft drinks, 100% of studies reported association with increase in BMI. As to milk intake, only one article showed association with increased BMI. Three articles reported milk as a protection factor against increase in BMI; three studies found no association between this intake and BMI. Nineteen studies had representative samples and 20 surveys reported random samples. Among papers using questionnaires, 84% had been validated. Conclusions: There is no consensus in the literature about the association between SSB or milk intake and BMI in adolescents.

ANÁLISE HIERARQUIZADA DOS FATORES ASSOCIADOS À ANEMIA EM LACTENTES

ABSTRACT Objective: To evaluate the prevalence of anemia and the associated factors in infants assisted in health units of Vitória da Conquista, Bahia, Northeast Brazil. Methods: Cross-sectional study with a representative sample of 366 children aged 6 to 23 months. A questionnaire was applied to the caregiver, and the children’s anthropometric measurements and hemoglobin levels were collected. The associations were identified by Poisson regression with robust variances based on a hierarchical analysis model. Results: The prevalence of anemia was 26.8%, and the associated factors were: family income equal to or lower than one minimum wage (PR: 1.50; 95%CI 1.03-2.18), number of household members higher than five (PR: 1.50; 95%CI 1.07-2.11), use of unfiltered water (PR: 1.68; 95%CI 1.11-2.56), number of offspring higher than three (PR: 1.64; 95%CI 1.01-2.68), consumption of meat and/or viscera less than once/week (PR: 1.78; 95%CI 1.24-2.58) and age 6-11 months (PR: 1.75; 95%CI 1.20-2.55). Conclusions: Anemia in the infants assessed is a moderate public health problem, which is associated with socioeconomic, demographic, and dietary factors; thus, measures are necessary for its prevention.

Intra-abdominal fat measurement by ultrasonography: association with anthropometry and metabolic syndrome in adolescents

OBJECTIVE To associate intra-abdominal fat thickness measured by ultrasonography to the factors related to metabolic syndrome and to determine cutoff points of intra-abdominal fat measurement associated with a greater chance of metabolic syndrome in adolescents. METHODS This was a cross-sectional study, with 423 adolescents from public schools. Intra-abdominal fat was measured by ultrasonography. Anthropometric data were collected, and biochemical analyses were performed. RESULTS Intra-abdominal fat was measured by ultrasonography, showing a statistically significant association with the diagnosis of metabolic syndrome (p=0.037), body mass index (p<0.001), elevated triglyceride levels (p=0.012), decreased plasma HDL levels (p=0.034), and increased systemic blood pressure values (p=0.023). Cutoff values of intra-abdominal fat thickness measurements were calculated by ultrasound to estimate the individuals most likely to develop metabolic syndrome. In the logistic regression models, the cutoff values that showed the highest association with metabolic syndrome in males were 4.50, 5.35, 5.46, 6.24, and 6.50cm for the ages of 14, 15, 16, 17, and 18/19 years, respectively. In the female gender, the cutoff values defined for the same age groups were 4.46, 4.55, 4.45, 4.90, and 6.46cm. In an overall analysis using the ROC curve, without gender and age stratification, the cut-off of 3.67cm showed good sensitivity, but low specificity. CONCLUSION Ultrasonography is a useful method to estimate intra-abdominal adipose tissue in adolescents, which is associated with the main factors related to obesity and metabolic syndrome.