Luciana Ferreira da Rocha Sant'Ana

A influência da rede social da nutriz no aleitamento materno: o papel estratégico dos familiares e dos profissionais de saúde

The objective was to raise and classify scientific works on the influence of the social net of lactating mothers in the context of the breastfeeding. A bibliographical review was done in the main databases (MEDLINE, LILACS, SciELO), using as keywords: breastfeeding, weaning and family (and their versions in English and Spanish). Books, thesis, dissertations, and publications in international and national institutions were consulted (WHO, UNICEF, Ministry of Health). It could be observed that the actors that compose the social net of the lactating mothers can interfere in the decision of breastfeeding, through different extents, such as the encouragement/support to the initiative; reviewing the knowledge and cultural values; family tradition; and the cultivation of the indifference/discourage and the pressure exercised on the lactating mothers in relation to the form of feeding the child. In this way, it can infer on the need of the implementation of new health practices regarding to the care of this group. It is worth to highlight, the importance of the professionals to be qualified for the sensitive listening on the meaning of the nursing under the glance of the lactating mothers . Finally, it stands out the importance role of the social net of the lactating mothers, especially the family, for a successful breastfeeding.

Social and biological determinants of iron deficiency anemia

This cross-sectional study aimed to identify the social and biological determinants of anemia in children enrolled in the Brazilian Income Transfer Program (PBF). The study evaluated 446 children (69.1% of the total enrolled) ranging from 6 to 84 months of age, of whom 262 were receiving the income transfer (60.2% of the beneficiaries) and 184 were not (87.6% of the non-beneficiaries). Testing for anemia was performed with the Hemocue portable hemoglobinometer, and the cutoff points were set at 11.0 and 11.5 g/dL, according to age bracket. The data were analyzed using Poisson hierarchical regression with robust variance for multivariate analysis. There was no difference in the anemia prevalence rates between the beneficiary and non-beneficiary groups. Risk factors for anemia were low paternal schooling, cesarean birth, consumption of untreated water, stunting, and age less than 24 months. Prevalence of anemia in the group of non-beneficiary children under two years of age was significantly higher than in the beneficiary group in the same age bracket, suggesting the importance of the PBF income transfer for preventing anemia in children.

Programa Bolsa Família e estado nutricional infantil: desafios estratégicos

The main nutritional deficiencies during childhood, namely anemia and malnutrition, are predominantly related to socio-economic factors. Thus, as the Bolsa Familia Program (BFP) is the main policy to combat poverty, it is expected that it will have an impact on child nutrition. The aim was to analyze the differences in the nutritional situation of children registered with the BFP of a municipality located in Zona da Mata of Minas Gerais state. 446 children aged between 6 and 84 months were evaluated, of which 262 were non-beneficiaries and 184 were beneficiaries. Nutritional evaluation included analysis of weight and height parameters through weight/age, weight/height, height/age and Body Mass Index/age indexes and hemoglobin levels, using the Hemocue. The prevalence of anemia, short stature and obesity were 22.6, 6.3 and 5.2%, respectively, and there were no statistical differences between beneficiaries and non-beneficiaries. The beneficiary group initially had worse socio-economic conditions, but with the BFP it managed to financially match the non-beneficiary group. It is possible that the similarity between the two groups, also in the nutritional status, can be attributed to the program benefits, due to the financial funding as well as to the nutritional monitoring required as a condition of the program.

Efetividade superior do esquema diário de suplementação de ferro em lactentes

OBJETIVO: Avaliar a efetividade de esquemas, diario e semanal, de suplementacao profilatica de ferro medicamentoso na prevencao da anemia ferropriva em lactentes nao anemicos. METODOS: Estudo populacional, prospectivo, de abordagem quantitativa com intervencao profilatica, realizado no municipio de Vicosa, MG, em 2007/8. Foram selecionadas 103 criancas nao anemicas, entre seis e 18 meses de idade, correspondendo a 20,2% das criancas cadastradas e atendidas pelas Equipes de Saude da Familia. As criancas foram divididas em dois grupos de suplementacao: dosagem diaria recomendada pela Sociedade Brasileira de Pediatria (grupo 1, n=34) e dosagem semanal preconizada pelo Ministerio da Saude (grupo 2, n=69). As avaliacoes ocorreram no inicio do estudo e apos seis meses, sendo realizadas dosagem de hemoglobina (s-hemoglobinometro portatil), avaliacao antropometrica e dietetica, e aplicacao de questionario socioeconomico. Os indicadores de impacto utilizados foram a prevalencia de anemia, variacao de hemoglobina, adesao e efeitos adversos aos suplementos. RESULTADOS: Os grupos se mostraram homogeneos quanto as variaveis socioeconomicas, biologicas e de saude anteriores a intervencao. Apos seis meses de suplementacao, observaram-se maiores medias de hemoglobina no grupo 1 em relacao ao grupo 2, (11,66; DP=1,25 e 10,95; DP=1,41, respectivamente, p=0,015); alem de menores prevalencias de anemia (20,6% e 43,5%, respectivamente, p=0,04). Apenas o tempo de suplementacao influenciou na anemia grave (p=0,009). Nao foram encontradas diferencas estatisticamente significantes para as variaveis adesao ao suplemento e efeitos adversos. CONCLUSOES: A dosagem diaria recomendada pela Sociedade Brasileira de Pediatria mostrou-se mais efetiva na prevencao da anemia em lactentes, quando comparada a dosagem utilizada pelo Ministerio da Saude. A dosagem semanal recomendada pelo programa do governo brasileiro precisa ser reavaliada para aumentar sua efetividade na prevencao de anemia em criancas atendidas em servicos publicos de saude.

Body fat assessment by bioelectrical impedance and its correlation with different anatomical sites used in the measurement of waist circumference in children

OBJECTIVE: To compare the different anatomical sites used in the measurement of waist circumference, as well as the effectiveness of these landmarks to predict the percentage of body fat by tetrapolar bioelectrical impedance analysis. METHODS: We evaluated 205 children from 6 to 9 years of age of both sexes. Data on weight, height and waist circumference were collected at three different sites: at the lower abdominal curvature, above the navel and at the midpoint between the last rib and the iliac crest. Nutritional status was assessed through the body mass index (BMI)/age as recommended by the World Health Organization. RESULTS: The sample was considered homogeneous in terms of sex, and the mean age was 7.2±1.2 years. Regarding nutritional status, 6.3% of the children had low weight, 75.1% were eutrophic, 7.3% were overweight, and 11.2% were obese. Among males, there was no statistical difference between the different sites of measurement; in females, the measurement above the navel was statistically higher. In the correlation analysis, the midpoint measurement showed the best correlation with percentage of body fat, with values of 0.50 in boys and 0.62 in girls. CONCLUSION: Waist circumference measured at the midpoint between the last rib and the iliac crest presented the best correlation with percentage of body fat.

Greater effectiveness of daily iron supplementation scheme in infants

OBJETIVO: Avaliar a efetividade de esquemas, diario e semanal, de suplementacao profilatica de ferro medicamentoso na prevencao da anemia ferropriva em lactentes nao anemicos. METODOS: Estudo populacional, prospectivo, de abordagem quantitativa com intervencao profilatica, realizado no municipio de Vicosa, MG, em 2007/8. Foram selecionadas 103 criancas nao anemicas, entre seis e 18 meses de idade, correspondendo a 20,2% das criancas cadastradas e atendidas pelas Equipes de Saude da Familia. As criancas foram divididas em dois grupos de suplementacao: dosagem diaria recomendada pela Sociedade Brasileira de Pediatria (grupo 1, n=34) e dosagem semanal preconizada pelo Ministerio da Saude (grupo 2, n=69). As avaliacoes ocorreram no inicio do estudo e apos seis meses, sendo realizadas dosagem de hemoglobina (s-hemoglobinometro portatil), avaliacao antropometrica e dietetica, e aplicacao de questionario socioeconomico. Os indicadores de impacto utilizados foram a prevalencia de anemia, variacao de hemoglobina, adesao e efeitos adversos aos suplementos. RESULTADOS: Os grupos se mostraram homogeneos quanto as variaveis socioeconomicas, biologicas e de saude anteriores a intervencao. Apos seis meses de suplementacao, observaram-se maiores medias de hemoglobina no grupo 1 em relacao ao grupo 2, (11,66; DP=1,25 e 10,95; DP=1,41, respectivamente, p=0,015); alem de menores prevalencias de anemia (20,6% e 43,5%, respectivamente, p=0,04). Apenas o tempo de suplementacao influenciou na anemia grave (p=0,009). Nao foram encontradas diferencas estatisticamente significantes para as variaveis adesao ao suplemento e efeitos adversos. CONCLUSOES: A dosagem diaria recomendada pela Sociedade Brasileira de Pediatria mostrou-se mais efetiva na prevencao da anemia em lactentes, quando comparada a dosagem utilizada pelo Ministerio da Saude. A dosagem semanal recomendada pelo programa do governo brasileiro precisa ser reavaliada para aumentar sua efetividade na prevencao de anemia em criancas atendidas em servicos publicos de saude.

A problemática da adesão na prevenção da anemia ferropriva e suplementação com sais de ferro no município de Viçosa (MG)

The scope of this article is to analyze the understanding of mothers and persons responsible for infants taking ferrous sulfate supplement about anemia and its consequences, assessed by the level of adherence to supplementation. A prospective, qualitative and quantitative population study was conducted with non-anemic children not taking supplements to receive prophylactic supplementation with ferrous sulfate for six months. After six months, there was adherence to supplementation. Among the 133 children initially eligible for the study, 97 returned for the second evaluation. Of these, 4 had anemia during the follow-up and began treatment and 3 others were brought in by individuals who were unable to provide information on use of the supplement. High adherence was showed by 56.7% of children and low adherence by 43.3%, while 23.3% had interrupted supplementation due to the lack of guidance and support of the health service. Mothers and persons responsible of the two groups (high and low adherence) manifested little knowledge about anemia, its prevention and health consequences for the child. More information regarding iron deficiency anemia, routine follow-up by professionals and evaluation of the perception of individuals involved with iron supplementation is necessary.

Correlação entre variáveis de composição corporal e metabólica em adolescentes do sexo feminino

BACKGROUND Analysis of metabolic alterations and body composition in adolescents. OBJECTIVES To study the correlation of serum levels of lipids, glycemia, insulin, homocysteine, HOMA-IR and blood pressure among themselves and with body variables. METHODS Data concerning glycemia, total cholesterol and fractions (LDL, HDL and VLDL), triacylglycerols, insulin, homocysteine and blood pressure were measured in 100 adolescents at the age range of 14 to 17 years, who had already had menarche and attended the public schools in Vicosa, state of Minas Gerais, Brazil. The percentage of body fat (%BF) was evaluated by horizontal bioimpedance. RESULTS In relation to nutritional status, 83%, 11% and 6%, respectively were eutrophic (EU), presented overweight/overweight risk (OW/OR) or low weight (LW) (CDC/NCHS, 2000) and 61% presented high percentage of BF. Total cholesterol presented the highest percentage of inadequacy (57%), followed by HDL (50%), LDL (47%) and triacylglycerols (22%). Inadequacy in 11%, 9%, 5% and 4% were observed in relation to insulin resistance, insulin, blood pressure and glycemia, respectively. For total cholesterol, insulin, HOMA-IR and nutritional state, OW/OR>LW (p<0.05). For body composition and nutritional status, OW/OR>EU>LW (p <0.001). Some positive and strong correlations were found between BMI and the anthropometrical measures estimating the % of total BF, as well as central distribution, except for the waist/hip ratio. The %BF was correlated with insulin levels (r=0.303; p <0.001) and HOMA-IR (r=0.281; p<0.001). CONCLUSIONS Some metabolic alterations, most often related with excess weight and body fat as well as insulin resistance were found, reinforcing the importance of specific programs directed at the adolescent health.FUNDAMENTO: Analise das alteracoes metabolicas e de composicao corporal em adolescentes. OBJETIVO: Estudar a correlacao entre niveis sericos de lipidios, glicemia, insulina, homocisteina, HOMA-IR e pressao arterial, entre si e com variaveis corporais. METODOS: Coletaram-se dados referentes a glicemia, colesterol total e fracoes (LDL, HDL e VLDL), triacilglicerois, insulina, homocisteina e pressao arterial em 100 adolescentes de 14 a 17 anos de escolas publicas de Vicosa (MG) que ja haviam apresentado a menarca. A porcentagem de gordura corporal (%GC) foi avaliada pela bioimpedância horizontal. RESULTADOS: Em relacao ao estado nutricional, 83%, 11% e 6%, respectivamente, apresentaram eutrofia (EU), risco de sobrepeso/sobrepeso (RS/SP) e baixo peso (BP) (CDC/NCHS, 2000), e 61% apresentaram alta %GC. O colesterol total foi o que apresentou maior porcentagem de inadequacao (57%), seguido do HDL (50%), LDL (47%) e triacilglicerois (22%). Observou-se inadequacao em 11%, 9%, 5% e 4%, respectivamente, em relacao a resistencia a insulina, insulina, pressao arterial e glicemia. Para colesterol total, insulina, HOMA-IR e estado nutricional, RS/SP>BP (p EU>BP (p<0,001). Encontraram-se correlacoes positivas e fortes entre o IMC e as medidas antropometricas que estimam a %GC total, bem como distribuicao central, exceto para relacao cintura/quadril. A %GC correlacionou-se com niveis de insulina (r=0,303; p<0,001) e HOMA-IR (r=0,281; p<0,001). CONCLUSAO: Encontraram-se alteracoes metabolicas ligadas na maioria das vezes ao excesso de peso e de gordura corporal e a resistencia a insulina, reforcando a importância de programas especificos de atencao a saude do adolescente.

Influência do excesso de peso corporal e da adiposidade central na glicemia e no perfil lipídico de pacientes portadores de diabetes mellitus tipo 2

Influence of Body Weight Excess and Central Adiposity in Glycemic and Lipid Profile in Patients with Type 2 Diabetes Mellitus. The purpose of the present study was to evaluate, in diabetic type 2 patients, the influence of body weight excess assessed by BMI and the central adiposity assessed by the waist circumference in the lipid and glycemic profile. One hundred and forty five individuals assisted in a unit of health, aged ≥ 20 years old, were appraised. The female frequency was 61.4%. Among men, the weight excess was correlated with HDL (r = -0.34, p < 0.05), with the total cholesterol (r = 0.35, p < 0.01), and with the triglycerides (r = 49, p < 0.0001), and among women there was correlation just with the triglycerides (r = 0.24, p < 0,05). Waist circumference was correlated with the fast glycemia women’s group (r = 0.3, p < 0.01), with the total cholesterol among men (r = 0.33, p < 0.05) and with triglycerides in both genders (F: r = 0.22, p < 0.05; M: r = 0.49, p < 0.001). Highest glycemic and triglycerides levels were present in patients with excess body weight and central adiposity and lower HDL levels were present in patients with body weight excess. In conclusion, there is association between inadequate metabolic profile and the excess of body weight and/or central obesity, evidencing the need for a nutritional and clinical intervention in the diabetic type 2 patients, in order to reduce the risk of future chronic complications. (Arq Bras Endocrinol Metab 2007;51/9:1516-1521)

Exclusive Breastfeeding and Other Foods in the First Six Months of Life: Effects on Nutritional Status and Body Composition of Brazilian Children

Objective. To evaluate the effect of exclusive breastfeeding and consumption of other foods in the first six months of life in the nutritional status and body composition of children. Methods. A retrospective cohort study with 185 children aged from 4 to 7 years was monitored during the first months of life in a program of support to breastfeeding. We evaluated weight, height, waist circumference, and body composition by using DEXA. The nutritional status was assessed by the BMI/age index. The parameters of adiposity were classified by using as the cutoff point, the 85th percentile of the sample itself, according to gender and age. Confounding factors considered were variables related to maternal, pregnancy, birth, sociodemographic, health, lifestyle, and diet. Bivariate and multivariate analyses were performed, the latter by means of multiple logistic regression. Results. The median exclusive breastfeeding was 3 months. Of the children, 42.7% received cows milk and 35.7% received infant formula. Regarding nutritional status, 21.1% of the children showed changes. The variables of infant feeding were not independently associated with nutritional status and body composition of the children and there were no differences between the groups studied. Conclusion. Breastfeeding was not a protective factor to overweight and body fat in children.