Lenise Mondini

Tendência secular da anemia na infância na cidade de São Paulo (1984-1996)

OBJETIVO: Estimar a prevalencia e a distribuicao social da anemia na infância, estabelecer a tendencia secular dessa enfermidade e analisar sua determinacao, com base em dados coletados por dois inqueritos domiciliares realizados na cidade de Sao Paulo, SP, em 1984/85 e em 1995/96. METODOS: Os inqueritos estudaram amostras probabilisticas da populacao residente na cidade com idade entre zero e 59 meses (1.016 em 1984/85 e 1.280 em 1995/96). Amostras de sangue capilar obtidas por punctura digital foram coletadas nos dois inqueritos e analisadas com relacao a concentracao de hemoglobina. O diagnostico da anemia correspondeu a concentracoes inferiores a 11 g/dL. O estudo da distribuicao social da anemia levou em conta tercis da renda familiar per capita em cada um dos inqueritos. A estrategia analitica para estudar os determinantes da evolucao da prevalencia da anemia na populacao empregou modelos hierarquicos de causalidade, analises multivariadas de regressao e procedimentos analogos aos utilizados para calcular riscos atribuiveis populacionais. RESULTADOS/CONCLUSOES: Houve entre os inqueritos reducao significativa na concentracao media de hemoglobina (de 11,6 g/dL para 11,0 g/dL) e aumento significativo na prevalencia de anemia (de 35,6% para 46,9%). Essa evolucao desfavoravel foi observada em ambos os sexos, em todas as faixas etarias e em todos os estratos economicos da populacao. A evolucao tendeu a ser ainda mais desfavoravel para o terco mais pobre das criancas da cidade, o que determinou o agravamento das desvantagens desse estrato frente aos demais. Determinantes distais (renda familiar e escolaridade materna) e proximais (tipo de aleitamento) da anemia evoluiram favoravelmente entre os inqueritos e, assim, nao puderam explicar o aumento da enfermidade. A estabilidade apurada quanto a densidade de ferro na dieta, em valores inferiores as necessidades, justifica a elevada prevalencia da enfermidade, mas nao explica seu aumento.

Changing diet patterns in Brazil (1962-1988)

Contemporary changes in food consumption patterns in urban areas of Brazil are described. The main data sources are two national food expenditure surveys undertaken in the early 60s and late 80s (1961-62 and 1987-88) and one national food intake survey undertaken in the mid-70s (1974-75). The analysis is restricted to the seven metropolitan areas represented in the three surveys. Food patterns are described on the basis of the relative consumption of different food groups, proportion of energy from carbohydrates, protein and lipids, proportion of animal and vegetable protein and fats, proportion of complex and simple carbohydrates, ratio between polyunsaturated and saturated fatty acids and relative consumption of cholesterol. Main food changes were similar in the Northeastern and Southeastern cities and involved: 1) reduction in the relative consumption of cereals, beans, roots and tubercles; 2) replacement of lard, bacon and butter by vegetable oils and margarine: and 3) increase in the relative consumption of eggs, milk and dairy products. As a net result of these changes there was, simultaneously, a decrease in the carbohydrate content of the Brazilian diet and an increase in its fat content. Total protein content of the diet remained at around 12% in the three surveys but animal protein increased. Changes in the fat content of the diet involved an increased proportion of vegetable fat, an increased ratio of poly-unsaturated/saturated fatty acids and a reduction in cholesterol intake. Health implications of dietary changes are discussed based on the World Health Organizations dietary guidelines.Objetivou-se avaliar o comportamento do padrao alimentar da populacao urbana brasileira ao longo das tres ultimas decadas. As fontes de dados foram duas pesquisas nacionais de orcamentos familiares realizadas no inicio da decada de 60 (1961-63) e no final da decada de 80 (1987-88) e um inquerito nacional sobre consumo alimentar realizado em meados da decada de 70 (1974-75), restringindo-se a analise a sete areas metropolitanas estudadas em comum pelas tres pesquisas. O padrao alimentar foi caracterizado a partir da participacao relativa de diferentes alimentos na dieta e do consumo relativo de nutrientes especificos. As mudancas principais mostraram-se semelhantes nas regioes Nordeste e Sudeste e envolveram: 1) reducao no consumo relativo de cereais, feijao, raizes e tuberculos; 2) substituicao de banha, toucinho e manteiga por oleos e margarinas; e 3) aumento no consumo relativo de leite e derivados e ovos. Essas mudancas deterninaram diminuicao na participacao relativa de carboidratos na dieta e aumento na participacao de lipidios. A proporcao total de proteinas manteve-se estavel entre as pesquisas (ao redor de 12%), crescendo, entretanto, a participacao especifica de proteinas de origem animal na dieta. Situacao inversa foi observada com os lipidios, registrando-se aumento da fracao correspondente aos lipidios de origem vegetal, o que levou ao predominio dos acidos graxos poli-insaturados sobre os saturados e a reducao do consumo relativo de colesterol. As implicacoes das mudancas no padrao alimentar da populacao urbana do pais sao discutidas a luz de recomendacoes dieteticas enunciadas pela Organizacao Mundial de Saude.

Distribuição regional e socioeconômica da disponibilidade domiciliar de alimentos no Brasil em 2008-2009

OBJETIVO: Descrever a distribuicao regional e socioeconomica da disponibilidade domiciliar de alimentos no Brasil. METODOS: Estudo com dados secundarios da Pesquisa de Orcamentos Familiares 2008-2009, realizada pelo Instituto Brasileiro de Geografia e Estatistica sobre aquisicoes de alimentos e bebidas para consumo domiciliar. As quantidades de alimentos, registradas durante sete dias consecutivos nos 55.970 domicilios brasileiros amostrados, foram transformadas em calorias e nutrientes. Indicadores de qualidade da dieta foram construidos e analisados segundo estratos socioeconomicos e regionais da populacao brasileira. RESULTADOS: O teor proteico da disponibilidade alimentar mostrou-se adequado em todos os estratos regionais e economicos. Em contrapartida, observou-se excesso de acucares livres e de gorduras em todas as regioes, especialmente nas regioes Sul e Sudeste. A proporcao de gorduras saturadas foi elevada no meio urbano e consistente com a maior participacao de produtos de origem animal. A presenca insuficiente de frutas, legumes e verduras foi comum em todas as regioes. Intensificacao do teor de gorduras e diminuicao do teor de carboidratos da dieta foram observadas com o aumento da renda. CONCLUSOES: As caracteristicas negativas da qualidade da dieta da populacao brasileira observadas ao final da primeira decada do seculo XXI conferem alta prioridade para politicas publicas de promocao da alimentacao saudavel.OBJECTIVE To describe the regional and socioeconomic distribution of household food availability in Brazil. METHODS Data from the 2008-2009 Household Budget Survey on food and beverage acquisition for household consumption, conducted by the Instituto Brasileiro de Geografia e Estatística (Brazilian Institute of Geography and Statistics), were analyzed. The amounts of foods, recorded during seven consecutive days in the 55,970 sample households, were converted into calories and nutrients. Food quality indicators were constructed and analyzed according to the regional and socioeconomic strata of the Brazilian population. RESULTS The amount of energy from protein was adequate in all regional and socioeconomic strata. On the other hand, an excess of free sugars and fats was observed in all regions of the country, especially in the Southern and Southeastern regions. The proportion of saturated fats was high in urban areas and consistent with the greater contribution of animal-derived products. Limited availability of fruits and vegetables was found in all regions. An increase in the fat content and reduction in carbohydrate content of the diet were observed with the increase in income. CONCLUSIONS The negative characteristics of the Brazilian diet observed at the end of the first decade of the 21st century indicate the need to prioritize public policies for the promotion of healthy eating.

Relevância epidemiológica da desnutrição e da obesidade em distintas classes sociais: métodos de estudo e aplicação à população brasileira

The search for criteria of the same specificity in the diagnosis of both undernutrition and obesity is the main objective of this study. The selected criteria are applied to data collected by a nation-wide cross-sectional anthropometric survey undertaken in Brazil in 1989 as to produce comparable estimates for the prevalence of undernutrition and obesity in different socioeconomic strata. The study included 20-64 year-old male adults (n=14,235), 18-64 year-old female adults (n=15,669), and 6-35 month-old children (n=3.641). Body Mass Index (kg/m2) was employed to assess nutritional status of adults and weight-for-age and weight-for-height indices were used for children. The 5th and 95th centiles of the distribution of these indices in a reference population were used as limits for the diagnosis of undernutrition and obesity, respectively. These results challenge the common belief that undernutrition is a relevant problem for the poor population, and that obesity only affects affluent strata. The need for an urgent revision of national public health nutrition priorities and interventions is stressed.

Regional and socioeconomic distribution of household food availability in Brazil, in 2008-2009

OBJETIVO: Descrever a distribuicao regional e socioeconomica da disponibilidade domiciliar de alimentos no Brasil. METODOS: Estudo com dados secundarios da Pesquisa de Orcamentos Familiares 2008-2009, realizada pelo Instituto Brasileiro de Geografia e Estatistica sobre aquisicoes de alimentos e bebidas para consumo domiciliar. As quantidades de alimentos, registradas durante sete dias consecutivos nos 55.970 domicilios brasileiros amostrados, foram transformadas em calorias e nutrientes. Indicadores de qualidade da dieta foram construidos e analisados segundo estratos socioeconomicos e regionais da populacao brasileira. RESULTADOS: O teor proteico da disponibilidade alimentar mostrou-se adequado em todos os estratos regionais e economicos. Em contrapartida, observou-se excesso de acucares livres e de gorduras em todas as regioes, especialmente nas regioes Sul e Sudeste. A proporcao de gorduras saturadas foi elevada no meio urbano e consistente com a maior participacao de produtos de origem animal. A presenca insuficiente de frutas, legumes e verduras foi comum em todas as regioes. Intensificacao do teor de gorduras e diminuicao do teor de carboidratos da dieta foram observadas com o aumento da renda. CONCLUSOES: As caracteristicas negativas da qualidade da dieta da populacao brasileira observadas ao final da primeira decada do seculo XXI conferem alta prioridade para politicas publicas de promocao da alimentacao saudavel.OBJECTIVE To describe the regional and socioeconomic distribution of household food availability in Brazil. METHODS Data from the 2008-2009 Household Budget Survey on food and beverage acquisition for household consumption, conducted by the Instituto Brasileiro de Geografia e Estatística (Brazilian Institute of Geography and Statistics), were analyzed. The amounts of foods, recorded during seven consecutive days in the 55,970 sample households, were converted into calories and nutrients. Food quality indicators were constructed and analyzed according to the regional and socioeconomic strata of the Brazilian population. RESULTS The amount of energy from protein was adequate in all regional and socioeconomic strata. On the other hand, an excess of free sugars and fats was observed in all regions of the country, especially in the Southern and Southeastern regions. The proportion of saturated fats was high in urban areas and consistent with the greater contribution of animal-derived products. Limited availability of fruits and vegetables was found in all regions. An increase in the fat content and reduction in carbohydrate content of the diet were observed with the increase in income. CONCLUSIONS The negative characteristics of the Brazilian diet observed at the end of the first decade of the 21st century indicate the need to prioritize public policies for the promotion of healthy eating.

Prevalência de sobrepeso e obesidade e fatores associados em escolares de área urbana de Chilpancingo, Guerrero, México, 2004

This study aimed to investigate the prevalence rates for overweight and obesity among Mexican schoolchildren, identifying factors associated with the outcomes. A cross-sectional study was conducted in a sample consisting of 700 schoolchildren. Prevalence rates were calculated according to age and gender, and odds ratios were estimated by point and intervals, using multivariate logistic regression. Overweight and obesity prevalence were 28.1% and 13.7%, respectively. Risk factors for overweight were: mothers schooling (in years); eating while studying or watching TV; scores for risk food items > or = 12 points; sedentary activities > or = 1.6 hours/day, and birth weight > or = 2,890 grams. Obesity risk factors were similar to those related to overweight. Higher frequency of sport activities was detected as a protective factor in both outcomes. The associated factors for overweight and obesity highlighted the focus for health programs to prevent chronic diseases in this population, for which risk factors can already be identified in childhood.

Prevalência de diabetes mellitus e identificação de fatores associados em adultos residentes em área urbana de Ribeirão Preto, São Paulo, Brasil, 2006: Projeto OBEDIARP

To identify diabetes mellitus prevalence and associated factors, a cross-sectional epidemiological study was developed including participants aged 30 years and older living in Ribeirão Preto, São Paulo State, Brazil. Using three-stage cluster sampling, probability weights were applied, resulting in a weighted sample of 2,197 participants. Diabetes mellitus diagnosis was based on previous medical history or World Health Organization (WHO) cut-offs after oral glucose tolerance test. To investigate associated factors, crude and adjusted prevalence ratios were estimated by points and confidence intervals, using Poisson regression. Diabetes mellitus prevalence was 15.02%. After adjusting for potential confounding, factors associated with diabetes mellitus in the final model were: age; family history of diabetes mellitus; waist hip ratio; waist height ratio; number of medicines taken; and use of outpatient services. The results showed high diabetes mellitus prevalence and identified associated factors amenable to intervention.

Per capita versus adult-equivalent estimates of calorie availability in household budget surveys

This study aims to estimate an adult-equivalent scale for calorie requirements and to determine the differences between adult-equivalent and per capita measurements of calorie availability in the Brazilian population. The study used data from the 2002-2003 Brazilian Household Budget Survey. The calorie requirement for a reference adult individual was based on the mean requirements for adult males and females (2,550kcal/day). The conversion factors were defined as the ratios between the calorie requirements for each age group and gender and that of the reference adult. The adult-equivalent calorie availability levels were higher than the per capita levels, with the largest differences in rural and low-income households. Differences in household calorie availability varied from 22kcal/day (households with adults and an adolescent) to 428kcal/day (households with elderly individuals), thus showing that per capital measurements can underestimate the real calorie availability, since they overlook differences in household composition.

Variabilidade na aferição de medidas antropométricas: comparação de dois métodos estatísticos para avaliar a calibração de entrevistadores

Estudos que incluem medidas antropometricas exigem, alem da padronizacao de tecnicas de afericao, o emprego de metodos estatisticos para a avaliacao de erros de mensuracao. OBJETIVO: Comparar duas tecnicas estatisticas para avaliar a calibracao de entrevistadores, em treinamento para a afericao de medidas antropometricas. METODOLOGIA: Treze entrevistadores participaram da fase de treinamento, que foi programado de modo que, em cada sessao, sub-grupos de entrevistadores realizassem duas afericoes de medidas de peso e duas de altura em voluntarios (em media, 10 voluntarios/sessao). Ao todo, foram realizadas seis sessoes para a afericao das medidas de peso e onze para a afericao das medidas de altura. Para as medidas de peso foram utilizadas balancas eletronicas e, para as de altura, estadiometros de parede. Para avaliar a calibracao, dois metodos estatisticos foram comparados: a) o coeficiente de correlacao intraclasse (CCI) e b) a precisao e a exatidao das afericoes, segundo Habicht. RESULTADOS: Os entrevistadores foram submetidos, em media, a duas sessoes para a calibracao das medidas de peso e a tres sessoes para a calibracao das medidas de altura, sendo a precisao atingida antes da exatidao. Os valores dos respectivos CCIs indicaram medicoes fortemente concordantes desde a primeira sessao. CONCLUSAO: O metodo de Habicht apresentou melhor desempenho que o CCI, pois, alem do calculo da precisao, indicou a magnitude da divergencia das afericoes realizadas pelos entrevistadores, em relacao as do supervisor (exatidao).

Availability of added sugars in Brazil: distribution, food sources and time trends

OBJECTIVE To describe the regional and socio-economic distribution of consumption of added sugar in Brazil in 2002/03, particularly products, sources of sugar and trends in the past 15 years. METHODS The study used data from Household Budget Surveys since the 1980s about the type and quantity of food and beverages bought by Brazilian families. Different indicators were analyzed: % of sugar calories over the total diet energy and caloric % of table sugar fractions and sugar added to processed food/ sugar calories of diet. RESULTS In 2002/03, of the total energy available for consumption, 16.7% came from added sugar in all regional and socio-economic strata. The table sugar/ sugar added to processed food ratio was inversely proportional to increase in income. Although this proportion fell in the past 15 years, sugar added to processed food doubled, especially in terms of consumption of soft drinks and cookies. CONCLUSIONS Brazilians consume more sugar than the recommended levels determined by the WHO and the sources of consumption of sugar have changed significantly.