Letícia de Oliveira Cardoso

Consumo e comportamento alimentar entre adolescentes brasileiros: Pesquisa Nacional de Saúde do Escolar (PeNSE), 2009

The objective of this article is to describe the characteristics of food consumption and eating behavior of adolescents and its association with socio-demographic factors. In 2009, a random sample of students in 9th grade of elementary education at public and private schools from 26 Brazilian state capitals and Federal District was studied. It was applied a self-administered questionnaire with socio-demographic attributes, food consumption and eating behavior, among others. Estimates of the constructed indicators were presented for the total population and by sex. The association of each indicator with socio-demographic variables was examined by logistic regression. The results showed that over half of adolescents presented frequent consumption of beans (62.6%), milk (53.6%) and sweets (50.9%), and held at least lunch or dinner with the mother or responsible (62.6%) and watching television or studying (50.9%). In general, girls were more exposed to undesirable eating habits and higher socioeconomic status was associated with a higher prevalence of the indicators studied. The results revealed regular consumption of unhealthy diet markers and consumption of less than the recommended for a healthy diet, pointing the need for strengthening health promotion activities targeting young people.

Iniciativa STROBE: subsídios para a comunicação de estudos observacionais

Reporting of observational studies is often inadequate, hampering the assessment of their strengths and weaknesses and, consequently, the generalization of study results. The initiative named Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) developed a checklist of 22 items, the STROBE Statement, with recommendations about what should be included in a more accurate and complete description of observational studies. Between June and December 2008, a group of Brazilian researchers was dedicated to the translation and adaptation of the STROBE Statement into Portuguese. The present study aimed to show the translation into Portuguese, introduce the discussion on the context of use, the potential and limitations of the STROBE initiative.El objetivo del articulo fue estimar la prevalencia de extremos antropometricos indicativos del estado nutricional de ninos. Se realizo estudio transversal con muestra probabilistica de 1.386 ninos menores de cinco anos del estado de Alagoas. Las prevalencias de deficit (z< -2; patron de la Organizacion Mundial de Salud - 2006) para los indices peso-para-edad (bajo peso), peso-para-altura (flacura) y altura-para-edad (deficit estatural) fueron, respectivamente, 2,9% (n=40), 1,2% (n=17) y 10,3% (n=144). El exceso de peso-para-altura (sobrepeso) acometio 135 ninos (9,7%). Se concluyo que las prevalencias de bajo peso y flacura son epidemiologicamente irrelevantes y que el deficit estatural y el sobrepeso prevalecen con identica magnitud.

Vigilância de fatores de risco para doenças não transmissíveis entre adolescentes: a experiência da cidade do Rio de Janeiro, Brasil

This paper presents the methodology and results of the implementation of a Surveillance System for Non-Communicable Disease Risk Factors in Adolescents. A random sample of 8th-grade students (n = 1,684) enrolled in municipal schools in Rio de Janeiro, Brazil, was studied. Students were asked to complete a confidential questionnaire on food consumption, physical activity, sedentary leisure-time activities, and tobacco consumption. Prevalence estimates of risk factors were calculated for the entire sample and by gender. Non-response rates ranged from 1.1 to 8.9%. The findings included low consumption of fruits (45.8%) and vegetables (20.0% and 16.5% for salads and cooked vegetables, respectively), regular consumption of soft drinks (36.7%) and candies (46.7%), extensive time on TV, computer, and videogames (71.7% spend at least 4h/day at these activities), low frequency of regular physical activity (40%), and 6.4% prevalence of smoking. Girls showed less physical activity and more smoking. The system appeared to be feasible and indicated high prevalence of risk factors for non-communicable diseases.

Reprodutibilidade e validade relativa do Questionário de Frequência Alimentar do ELSA-Brasil

Avaliou-se a reprodutibilidade e a validade do Questionario de Frequencia Alimentar (QFA) utilizado no Estudo Longitudinal de Saude do Adulto (ELSA-Brasil). Foram aplicados tres registros alimentares e um QFA em dois momentos no periodo de um ano (n = 281). Valores de energia e nutrientes dos registros alimentares foram deatenuados e Log transformados. Para avaliacao da reprodutibilidade e validade foi aplicado o teste de correlacao intraclasse (CCI) e calculados percentuais de concordância do consumo de nutrientes apos categorizacao por tercis. Na avaliacao da reprodutibilidade, coeficientes de CCI variaram de 0,55-0,83 para proteina e vitamina E, respectivamente; na avaliacao da validade, variaram de 0,20-0,72 para selenio e calcio, respectivamente. Concordâncias exata e adjacente entre metodos variaram de 82,9% para vitamina E a 89% para lipidio e calcio (media = 86%). Foi encontrada uma discordância media de 13,6%. Conclui-se que o QFA ELSA-Brasil apresenta confiabilidade satisfatoria para todos nutrientes e validade relativa razoavel para energia, macronutrientes, calcio, potassio e vitaminas E e C.

The impact of implementation of the Breastfeeding Friendly Primary Care Initiative on the prevalence rates of breastfeeding and causes of consultations at a basic healthcare center

OBJECTIVE To compare the prevalence rates of breastfeeding and the principal causes of consultations at the infant and neonatal clinic of a basic healthcare center in the city of Rio de Janeiro, before and after its being accredited by the Breastfeeding Friendly Primary Care Initiative. METHODS Information was analyzed from 121 and 200 children followed-up at the healthcare center before and after certification, respectively. Type of feeding was classified as exclusive breastfeeding, predominant breastfeeding or breastfeeding, and the 10th International Classification of Diseases was used to classify the complaints causing consultations. RESULTS A statistically significant increase was observed in the prevalence of exclusive breastfeeding, both among those less than 4 months old (68 vs. 88%; p < 0.0001) and among children aged from 4 to 6 months (41 vs. 82%; p < 0.0001). Furthermore, an impressive increase was observed in the prevalence of breastfeeding in children more than 6 months old, especially those aged 9 to 12 months (24 vs. 82%; p < 0.0001). After certification, there was also a reduction in the number of consultations motivated by some type of disease among infants more than 4 months old. CONCLUSION Implementation of the Breastfeeding Friendly Primary Care Initiative proved to be an important strategy for increasing the rate of breastfeeding and reducing consultations due to disease among infants less than one year old cared for at this health center.

Imagem corporal, estado nutricional e comportamento com relação ao peso entre adolescentes brasileiros

The objective of this work is to describe the agreement between body image (BI) and nutritional status (NS) as well as to verify the association of BI and NS with behaviors regarding body weight (BRBW) among Brazilian adolescents. In 2009, a random sample of students in 9th year at public and private schools from 26 Brazilian state capitals and Federal District was studied. It was used a self-administered questionnaire with information about BI, BRBW and socioeconomic factors. Weight and height were measured. Logistic regression analyses were performed to evaluate associations between variables and weighted kappa test was used to verify the agreement between NS and BI. Twenty-four percent of the adolescents had excessive weight (EW) and 17.7% considered themselves fat. Almost 2/3 performed some action to weight control and 7% showed extreme behavior for weight control (EBWC). Low agreement between the NS and BI was observed. Nearly half and 27% of those with EW considered themselves as having normal weight and being thin, respectively. Greater proportion of EW adolescents had EBWC when compared with those with normal weight and underweight. The same was observed in relation to BI. Low agreement between EN and BI was observed. Practices for weight control were observed even among individuals with adequate NS.

Reproducibility and relative validity of the Food Frequency Questionnaire used in the ELSA-Brasil

This study evaluated the reproducibility and relative validity of the Food Frequency Questionnaire (FFQ) used in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Participants (n = 281) completed the FFQ and three food records on two occasions during a 12-month period. Energy and nutrient values from food records were disattenuated and log-transformed. Reproducibility and validity were assessed by the intra-class correlation coefficient (ICC). Agreement between the two methods was evaluated by classification in tertiles. In the evaluation of reproducibility, ICC estimated ranged from 0.55 to 0.83 for protein and vitamin E, respectively. On relative validity, ICC ranged from 0.20 to 0.72 for selenium and calcium, respectively. Exact and adjacent agreement between methods varied from 82.9% for vitamin E to 89% for lipids and calcium (mean 86%). Average disagreement was 13.6%. In conclusion, this FFQ showed satisfactory reliability for all nutrients and reasonable validity, especially for energy, macronutrients, calcium, potassium, and vitamins E and C.

Tendência temporal da amamentação na cidade do Rio de Janeiro: 1996-2006

OBJETIVO: Analisar a tendencia temporal da pratica de aleitamento materno (AM) e de aleitamento materno exclusivo (AME). METODOS: Foram analisados dados de sistema de monitoramento baseado em inqueritos realizados nos anos de 1996, 1998, 2000, 2003 e 2006 durante a Campanha Nacional de Imunizacao na cidade do Rio de Janeiro, RJ. A populacao de estudo foi constituida de 19.044 criancas menores de um ano de idade que compareceram aos postos de vacinacao. Para cada ano foi estudada uma amostra probabilistica por conglomerado (postos de vacinacao), auto-ponderada representativa da populacao de criancas menores de 12 meses ( 6 e em AME<6 foram observadas em todas as categorias de todas as variaveis sociodemograficas maternas. Para AME<6, a desvantagem observada em 1996 entre mulheres de menor escolaridade e em 1998 entre mulheres que trabalhavam nao foi completamente superada ate 2006. CONCLUSOES: O AM e o AME aumentaram no periodo estudado independentemente da faixa etaria da crianca e das caracteristicas sociodemograficas maternas. Nao foram totalmente superadas diferencas observadas entre mulheres em diferentes situacoes sociodemograficas.OBJECTIVE To analyze time trend in breast-feeding (BF) and exclusive breast-feeding (EBF). METHODS Data from a monitoring system, based on surveys conducted during the National Immunization Campaign in the city of Rio de Janeiro, Southeastern Brazil, in 1996, 1998, 2000, 2003 and 2006, were analyzed. Study population was comprised of 19,044 children younger than one year of age, who were present in vaccination stations. A probability cluster sample (vaccination stations), self-weighted and representative of the population of children younger than 12 months of age (<12), was studied for each year. A structured questionnaire with closed questions about the childs diet at the moment of the study and maternal sociodemographic characteristics was applied. The BF and EBF indicators proposed by the World Health Organization were adopted. RESULTS BF<12 increased from 61.3% to 73.4% between 1996 and 2006. Similar trend was observed in all age groups analyzed. EBF in children <4 and <6 months of age (EBF<6) increased from 18.8% to 42.4% and from 13.8% to 33.3%, respectively. Improvements in BF>6 and EBF<6 were found in all categories of all maternal sociodemographic variables. For EBF<6, the disadvantage observed in women with a lower level of education in 1996 and in women who worked in 1998 was not completely overcome by 2006. CONCLUSIONS BF and EBF increased in the period studied, independently from child age group and maternal socio-demographic characteristics. The differences found among women in distinct sociodemographic situations were not completely overcome.

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.OBJECTIVE To evaluate the effectiveness of universal prophylactic targeting with iron sulfate on daily or weekly basis in the prevention of anemia in infants. METHODS Randomized 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. OUTCOME mean 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). RESULTS Groups 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. CONCLUSIONS Universal 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.OBJECTIVE To evaluate the effectiveness of universal prophylactic targeting with iron sulfate on daily or weekly basis in the prevention of anemia in infants. METHODS Randomized 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. OUTCOME mean 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). RESULTS Groups 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. CONCLUSIONS Universal 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.