Lílian Ramos Sampaio

Avaliação nutricional e envelhecimento

A avaliacao do estado nutricional do idoso e considerada complexa em razao da influencia de uma serie de fatores, os quais necessitam ser investigados, detalhadamente, visando diagnostico nutricional acurado, que possibilite intervencao nutricional adequada. Alteracoes fisiologicas, processos patologicos cronicos e situacoes individuais que ocorrem com o envelhecimento, geralmente interferem no estado nutricional do individuo. Portanto impoe-se uma associacao de indicadores nutricionais e a utilizacao de padroes de referencia os mais especificos possiveis para realizar-se tal avaliacao. Com o objetivo de contribuir ao estudo nutricional do individuo idoso, este trabalho discute os principais aspectos relacionados a avaliacao do estado nutricional, com enfase nos indicadores e criterios de avaliacao mais apropriados para esse grupo etario, considerando-se as modificacoes inerentes ao processo de envelhecimento.

Validity and reliability of the sagittal abdominal diameter as a predictor of visceral abdominal fat

OBJECTIVES To evaluate the reliability of the sagittal abdominal diameter and its validity as a predictor of visceral abdominal fat, as well as to identify the most appropriate cut-off points to identify the area of visceral fat that is known to represent a risk factor for cardiovascular disease. DESIGN Validation study. SUBJECTS 92 healthy volunteers (57 women, 35 men), age: 20-83 y, body mass index: 19.3 to 35.9 kg/m2. MEASUREMENTS Sagittal abdominal diameter (SAD), weight, height, circumferences (waist, hip, and thigh), sub-scapular skinfold thickness, abdominal diameter index, and waist-hip ratio (WHR). METHOD OF CHOICE: Computed tomography (CT). STATISTIC Receiver operating characteristic (ROC) curve. RESULTS The reliability for SAD measurement was very high (Inter-class coefficient = 0.99). Visceral fat as measured by VAF through CT was highly correlated with SAD (women r = 0.80; men r = 0.64, p < 0.001), waist circumference (women r = 0.77; men r = 0.73, p < 0.001), and WHR (women r = 0.72; men r = 0.58, p < 0.001). The ROC curve indicated 19.3 cm and 20.5 cm as the threshold values for abdominal sagittal diameter in women and men (sensitivity 85% and 83%, specificity 77% and 82%, respectively). CONCLUSIONS There was a high correlation between SAD and VAF. The cut-off values identified for SAD presented a sensitivity and specificity that were considered adequate.

Childhood anemia prevalence and associated factors in Salvador, Bahia, Brazil

A cross-sectional study was conducted in 1996 to estimate the prevalence of anemia in a stratified sample of 603 preschool children and identify factors associated with the disease. Hemoglobin assays were conducted in finger-prick blood samples using a Hemocue hemoglobinometer. Anemia was defined as hemoglobin below 11.0 g/dl. Logistic regression analysis was used to evaluate the potential associations. Observed anemia prevalence was 46.3%. Associated factors were: the 6-12-month and 12-24-month age brackets, the lowest tertiles for iron density and protein content dietary intake, and any degree of deficit in the height-for-age anthropometric parameter. Inadequate physical, sanitary, and environmental conditions in the home were associated with a significantly increased risk of anemia. Anemia constitutes an important health problem in this studys child population. Improvements in living conditions and dietary quality could contribute to a reduction in anemia prevalence.

Evaluation of the accuracy of anthropometric clinical indicators of visceral fat in adults and elderly.

Background Visceral obesity is associated with higher occurrence of cardiovascular events. There are few studies about the accuracy of anthropometric clinical indicators, using Computed Tomography (CT) as the gold standard. We aimed to determine the accuracy of anthropometric clinical indicators for discrimination of visceral obesity. Methods Cross-sectional study with 191 adults and elderly of both sexes. Variables: area of visceral adipose tissue (VAT) identified by CT, Waist-to-Height Ratio (WHtR), Conicity index (C index), Lipid Accumulation Product (LAP) and Visceral Adiposity Index (VAI). ROC analyzes. Results There were a strong correlation between adiposity indicators and VAT area. Higher accuracy of C index and WHtR (AUC≥0.81) than the LAP and the VAI was observed. The higher AUC of LAP and VAI were observed among elderly with areas of 0.88 (CI: 0.766–0.944) and 0.83 (CI: 0.705–0.955) in men and 0.80 (CI: 0.672–0.930) and 0.71 (CI: 0.566–0.856) in women, respectively. The cutoffs of C index were 1.30 in elderly, in both sexes, with sensitivity ≥92%, the LAP ranged from 26.4 to 37.4 in men and from 40.6 to 44.0 in women and the VAI was 1.24 to 1.45 (sens≥76.9%) in men and 1.46 to 1.84 in women. Conclusion Both the anthropometric indicators, C Index and WHtR, as well as LAP and VAI had high accuracy in visceral obesity discrimination. So, they are effective in cardiovascular risk assessment and in the follow-up for individual and collective clinical practice.

Correlação entre o índice de massa corporal e os indicadores antropométricos de distribuição de gordura corporal em adultos e idosos

Trata-se de um estudo transversal, constituido por 634 individuos (316 adultos e 318 idosos) de ambos ossexos, atendidos nos ambulatorios do Hospital das Clinicas da Universidade Federal da Bahia (Salvador, BA).Mediram-se em cada individuo: peso, altura, pregas cutâneas triciptal e subescapular, circunferencias dequadril e cintura, segundo tecnicas propostas por Lohman, em 1988. Utilizou-se o teste de correlacao dePearson para avaliar a correlacao entre o indice de massa corporal e os indicadores antropometricos dedistribuicao de gordura.OBJECTIVE: This cross-sectional study investigates the correlation between the body mass index and the fat distribution anthropometric indices in adults and the elderly. METHODS: Upon ambulatory visits to the Medical School Hospital of the Federal University of Bahia (Salvador, Bahia, Brazil), 634 male and female patients (316 adults and 318 elderly subjects) were measured individually, to determine weight, height, triceps and subscapular skinfold thicknesses, and waist and hip circumferences, according to Lohmans guidelines, 1988. Pearsons correlation test was used to get the correlation, in this sample, between body mass index and fat distribution anthropometric indices. RESULTS: The correlations between body mass index and waist in both age groups for male were: adults (r = 0.93; p<0.001) and elderly (r = 0.89; p<0.001). For the female groups, these correlations were: adults (r = 0.93; p<0.001) and elderly (r = 0.86; p<0.001). The correlation between body mass index and waist-to-hip ratio was smaller, but statistically significant, between these groups: thus, for male adults (r = 0.64; p<0.001) and elderly (r = 0.63; p<0.001); and for female adults (r = 0.66; p<0.001) and elderly (r = 0.34; p<0.001). CONCLUSION: Body mass index was found to correlate strongly and positively with waist circumference in both age groups, for both genders. Though statistically significant, Body mass index showed a weaker correlation with waist-to-hip ratio, primarily in the elderly womens group.

Bioimpedância elétrica e sua aplicação em avaliação nutricional

A busca por metodos de estimativa da composicao corporal e uma preocupacao constante da comunidadecientifica, com vistas a obtencao de um acurado diagnostico do estado nutricional de individuos e populacoes.A bioimpedância eletrica tem sido uma alternativa atraente na avaliacao da composicao corporal, pelapossibilidade de se trabalhar com equipamento nao invasivo, portatil, de facil manuseio, boa reprodutibilidadee, portanto, viavel para a pratica clinica e para estudos epidemiologicos. Sua utilizacao, que tem como finalidadedeterminar o fracionamento da composicao corporal, tem sido apontada como uma tecnica capaz de superaralguns desafios encontrados em outros metodos para avaliar o estado nutricional. Entre os componentes dabioimpedância eletrica, o ângulo de fase consiste em uma ferramenta cada vez mais utilizada na praticaclinica, sendo estudado como indicador prognostico e de estado nutricional. Esse ângulo indica alteracoes nacomposicao corporal e na funcao da membrana celular, portanto, no estado de saude de individuos. Dada acarencia de estudos brasileiros sobre determinadas aplicacoes da bioimpedância eletrica, a proposta desteestudo, buscando contribuir com a literatura, e tracar um panorama sobre o emprego dessa tecnica e, ainda,apresentar trabalhos que a comparam com outros metodos de avaliacao nutricional e composicao corporal.

Condições socioeconômicas e padrões alimentares de crianças de 4 a 11 anos: estudo SCAALA - Salvador/ Bahia

OBJECTIVE: to identify the patterns of food intake in children and the association between these and the socio-economic conditions of their families. METHODS: a cross-sectional study was carried out with 1260 children aged between 4 and 11 years, resident in the city of Salvador, in the Brazilian State of Bahia, including application of a semi-quantitative Food Intake Frequency questionnaire. The pattern of food intake of the children was assessed using factorial analysis by principal components. socio-economic level was assessed using a compound socio-economic indicator. Multivariate logistic regression was employed. RESULTS: four food groups were identified that explained 45.9% of the variability in food intake frequency data. Children from a more privileged socio-economic background were found to be 1.6 times more likely (p<0.001) to have a higher frequency of intake of food from group 1 (fruit, vegetables, pulses, cereals and sea food) and 3.09 times more likely (p<0.001) to have a higher frequency of consumption of food from group 2 (milk and dairy products, ketchup/mustard/mayonnaise and chicken), compared with children from a less privileged background. The opposite was found for group 4 (processed meat products, eggs, and red meat); with the children from more privileged backgrounds less likely to consume food from this group. A similar tendency was found for food from group 3 (fried food, sweets, snacks, soda/artificial fruit juice). CONCLUSION: patterns of food intake in children depend on the socio-economic conditions of their families and the choice of healthier food is associated with a more privileged socio-economic background.

Perfil do nutricionista do programa nacional de alimentação escolar na região Nordeste do Brasil

OBJECTIVE: This study analyzed the profile of dieticians who work for the National School Food Program and participated in training courses offered by the Schoolchildrens Food and Nutrition Collaborator Center of the Northeastern states in 2007. METHODS: This descriptive, exploratory study used nonprobability sampling to recruit 434 dieticians. Education, work experience, work, activities performed at National School Food Program and sociodemographic variables were analyzed. Pearsons chi square test was used to investigate possible associations between time working for National School Food Program and performed activities. RESULTS: Most participants were females (97.2%) aged 20 to 30 years (42.7%) and graduated more than ten years ago (40.2%). Most were also working only part time in the program (53.3%). The income of most dieticians ranged from 2-5 minimum salaries (64.1%). Most dieticians who frequently performed the analyzed activities had been in National School Food Program for 2-5 years (p<0.05). CONCLUSION: National School Food Program dieticians take on responsibilities that overlap with other areas of knowledge, especially education and administration. In parallel, despite the professional satisfaction, the participants were not very satisfied with their work conditions.

Determinants of mild-to-moderate malnutrition in preschoolers in an urban area of Northeastern Brazil: a hierarchical approach

OBJECTIVE To investigate the determinants of mild-to-moderate malnutrition in preschoolers. DESIGN Cross-sectional study conducted in October and November 1996, with a representative sample of 1740 children less than 5 years old from the city of Salvador, situated in the Brazilian Northeastern region. Socio-economic and dietary data were collected through a structured questionnaire. Anthropometric measures were performed in duplicate and data analysis was based upon the hierarchical model approach. Logistic regression analysis was used to estimate the prevalence ratio and to identify the determinants of mild-to-moderate deficits in weight-for-age and height-for-age Z-scores. RESULTS Family monthly income under US

Discriminatory power of indicators predictors of visceral adiposity evaluated by computed tomography in adults and elderly individuals

67.00 per capita and family headed by a woman were the main basic determinants of mild-to-moderate weight-for-age and height-for-age deficits in the studied children. Household agglomeration, an underlying determinant, was associated with weight-for-age and height-for-age deficits. Among the immediate determinants, age above 6 months and dietary caloric availability in the lowest tertile (<930 kcal day-1) were also associated with weight-for-age deficits. In addition to these, hospitalisation in the 12 months preceding the interview was shown to be a predictor of mild-to-moderate weight-for-age and height-for-age deficits. CONCLUSION Adverse social and economic factors interact with family environmental factors to define food consumption and morbidity patterns that culminate in a high prevalence of mild-to-moderate malnutrition. The strengthening and restructuring of nutrition and healthcare actions, the definition of public policies that improve family income, and the adequate insertion of women in the labour market are possible strategies to reduce mild-to-moderate malnutrition and to sustain the decline already observed in severe malnutrition.