Márcia Cristina Sales

Deficiência de micronutrientes e crescimento linear: revisão sistemática de estudos observacionais

O objetivo do artigo e avaliar a associacao das deficiencias de ferro, vitamina A e zinco com o deficit de crescimento linear. Revisao sistematica nas bases de dados eletronicas PubMed, LILACS e SciELO. Foram selecionados artigos publicados entre janeiro de 1995 e marco de 2010, considerando os descritores: (growth OR nutritional status) AND (child, preschool OR infant) AND (zinc AND iron AND vitamin A) OR (zinc AND iron) OR (zinc AND vitamin A) OR (iron AND vitamin A). Foram revisados 14 estudos de delineamento observacional. Dos estudos tipo coorte (dois), um indicou associacao estatistica entre o estado nutricional de ferro e o deficit de estatura; o outro apontou associacao estatistica entre as concentracoes de ferritina serica e o ganho de estatura. Dez estudos transversais investigaram a associacao estatistica entre as deficiencias de micronutrientes e o deficit de estatura, resultando tres deles na associacao para o ferro, dois para a vitamina A e nenhum para o zinco. O esclarecimento sobre a associacao entre o deficit de estatura e as deficiencias de ferro, vitamina A e zinco dificulta-se por fatores de carater biologico e relacionados a magnitude das deficiencias, o que sugere a importância da padronizacao metodologica dos estudos.Este estudo objetivou analisar a associacao dos fatores sociodemograficos, ocupacionais, comportamentos de risco e de saude com o comprometimento da qualidade de vida dos Agentes Comunitarios de Saude do municipio de Jequie, Bahia. Trata-se de um estudo transversal com 316 individuos, no qual foi utilizado o WHOQOL-Bref para avaliar a qualidade de vida. Aplicou-se o modelo de regressao de Poisson, adotando o intervalo de confianca de 95%. As variaveis associadas ao maior comprometimento do dominio Fisico foram sexo, idade, dor e satisfacao com a saude; ao dominio Psicologico foram escolaridade, aspectos psicossociais, tabagismo, dor e satisfacao com a saude; ao dominio Relacoes Sociais foram sexo, situacao conjugal, escolaridade, aspectos psicossociais e satisfacao com a saude; ao dominio Meio Ambiente foram sexo, renda familiar, local de trabalho, aspectos psicossociais e satisfacao com a saude. Espera-se que esse estudo possa subsidiar o desenvolvimento de politicas publicas destinadas a melhoria das condicoes de vida e trabalho desse grupo de trabalhadores.

Doencas infecciosas em criancas pre-escolares brasileiras assistidas em creches

The scope of this article is to analyze the prevalence and factors associated with the development of infectious diseases that affect children in daycare centers, namely respiratory infections, diarrheal disease and parasitic infections. Bibliographic research was conducted in the MEDLINE, LILACS and SciELO databases, and observational studies were included. 129 studies were identified, of which 21 were considered relevant to this study, namely two longitudinal and 19 cross-sectional studies. The systematization of the reviewed studies highlighted: i) the presence of intestinal parasites was the main outcome analyzed, followed by respiratory infections; ii) only one study investigated the occurrence of diarrheal disease; iii) the Giardia lamblia was the most prevalent parasitosis; iv) the variables that were most often associated with the development of intestinal parasitosis were child age, family income and maternal education; v) the attendance at daycare centers was a risk factor for intestinal parasites and respiratory infections. Respiratory and parasitic infections are major problems in institutionalized children in daycare centers. The reduction of such diseases involves a complex web of socio-economic, sanitation and daycare center infrastructure aspects.O objetivo deste artigo e analisar as prevalencias e os fatores associados ao desenvolvimento de doencas infecto-contagiosas que acometem criancas em creches: infeccoes respiratorias, doenca diarreica e infeccoes por parasitas. Realizou-se uma pesquisa bibliografica nas bases de dados Medline, Lilacs e SciELO, sendo incluidos estudos observacionais. Foram identificados 129 estudos, dos quais 21 foram considerados relevantes para o presente trabalho: 19 transversais e dois longitudinais. A sistematizacao dos estudos revisados destaca: i) a presenca de enteroparasitoses foi o principal desfecho analisado, seguido das infeccoes respiratorias; ii) um unico estudo investigou a ocorrencia de doenca diarreica; iii) a Giardia lamblia foi a parasitose mais prevalente; iv) as variaveis que mais vezes mostraram-se associadas ao desenvolvimento de enteroparasitoses foram a idade da crianca, a renda familiar e a escolaridade materna; v) o atendimento em creche foi um fator de risco de enteroparasitoses e de infeccoes respiratorias. As infeccoes respiratorias e parasitarias constituem problematicas importantes nas criancas institucionalizadas em creches cuja reducao perpassa uma complexa rede de fatores socioeconomicos, do saneamento basico e da infraestrutura das creches.

Nutritional status of iron in children from 6 to 59 months of age and its relation to vitamin A deficiency

OBJECTIVE To evaluate the iron nutritional status of children from 6 to 59 months of age and its relation to vitamin A deficiency. METHOD Cross-sectional study involving 100 children, living in nine cities in the state of Paraíba, which were selected for convenience to form two study groups: children with vitamin A deficiency (serum retinol < 0.70 μmol/L; n = 50) and children without vitamin A deficiency (serum retinol ≥ 0.70 μmol/L; n = 50). The iron nutritional status was evaluated by biochemical, haematological and hematimetric indices. The cases of subclinical infection (C-Reactive Protein ≥ 6 mg/L) were excluded. RESULTS Children with vitamin A deficiency had serum iron values statistically lower than the corresponding values in children without deficiency. The other iron nutritional status indices showed no statistical difference according to presence/absence of vitamin A deficiency. CONCLUSION The interaction between iron and vitamin A deficiencies was evidenced in the case of circulating iron deficiency (serum iron), suggesting failure in the transport mechanisms of the mineral in children with vitamin A deficiency.

Isolated and combined prevalence of anemia, vitamin A deficiency and zinc deficiency in preschool children 12-72 months for the government of Paraíba

OBJECTIVE:To estimate the isolated and combined prevalence of anemia, vitamin A deficiency and zinc deficiency in pre-school children, as well as the distribution of isolated deficiencies according to gender, age and prior supplementation with vitamin A.METHODS:Cross-sectional study with pre-school children in the state of Paraiba, Brazil. Analysis of the average concentrations of hemoglobin, serum retinol and serum zinc, according to gender, age and previous vitamin A supplementation of children were carried out as well as the risk of simultaneous occurrence of micronutrient deficiencies in the presence of these deficiencies.RESULTS:The prevalence of anemia, vitamin A deficiency and zinc deficiency were 15.4%, 23.3% and 13.8%, respectively. The anemia was significantly associated with age (p<0.01). Children previously supplemented by vitamin A had higher serum retinol concentrations than children without supplements, an effect that was not observed for concentrations of hemoglobin or serum zinc. The prevalence of anemia associated with vitamin A deficiency was 5.8%, with the chance of vitamin A deficiency and anemia coexist 2.21 times (95%CI=1.03-4.84) higher in the case of vitamin A deficiency or anemia rather than in the absence of these conditions.CONCLUSION:The high prevalence of micronutrient deficiencies which are important in child growth, as well as the coexistence of nutritional deficiencies, point out the need to strengthen nutrition intervention strategies that consider this issue.

Avaliação de desempenho das concentrações capilares de zinco como método diagnóstico da deficiência de zinco: um estudo comparativo com as concentrações séricas de zinco

OBJETIVO: Examinar o poder diagnostico de deficiencia de zinco das concentracoes capilares desse mineral por meio da comparacao com as concentracoes sericas. METODOS: Estudo transversal desenvolvido com 170 criancas na faixa etaria dos 12 aos 72 meses. A analise da Curva Caracteristica de Operacao do Receptor foi utilizada para identificar a sensibilidade e a especificidade do melhor ponto de corte para o diagnostico da deficiencia de zinco no cabelo. Verificou-se ainda a significância estatistica da area sob a curva. RESULTADOS:O ponto de corte apontado como otimo para o zinco no cabelo foi de 292,52ppm (sensibilidade de 55,6% e especificidade de 60,8%), com uma area sob a curva de 0,549, sem significância estatistica. CONCLUSAO: O diagnostico da deficiencia de zinco pelas concentracoes capilares desse elemento, em comparacao as concentracoes sericas de zinco, mostra baixa sensibilidade e ponto de corte ideal superior ao sugerido. Permanece, ainda, a necessidade de novos estudos que possibilitem a obtencao de indicadores bioquimicos mais sensiveis e especificos para o diagnostico da deficiencia de zinco na populacao, sob tudo sem importantes limitacoes tecnicas.

Deficiência de zinco: diagnóstico, estimativas do Brasil e prevenção

Objectives: To highlight the main aspects related to the population diagnosis of zinc nutritional status, describe the estimates of zinc deficiency magnitude in Brazil and emphasize the main interventions for improving zinc nutritional status. Data source: Publications were selected in SciELO, LILACS and MEDLINE/PUBMED databases, using the search terms “zinc deficiency e Brazil ” and “diet supplementation and zinc and Brazil”. Data synthesis: The use of a set of three indicators has been recommended to obtain the best estimate of zinc deficiency risk: i) biochemical indicator (serum zinc deficiency), ii) dietary indicator (inadequate zinc intake), iii) functional indicator (height-for-age deficit in children). According to these indicators, Brazil is a country with moderate zinc deficiency risk. The main strategies that can be implemented to improve zinc nutritional state in populations or population subgroups in risk are diet supplementation, fortification and modification/diversification. Conclusions: It is estimated that zinc deficiency is a public health problem in Brazil. The planning of new research becomes important for a better understanding of the risk factors, the identification of population groups with more vulnerability and the selection of appropriate intervention strategies.

Plasma zinc in institutionalized elderly individuals: Relation with immune and cardiometabolic biomarkers

Changes in zinc metabolism caused by aging and the institutionalization process may contribute to zinc deficiency in elderly individuals. Hypozincemia results in changes in glycemic, lipid, and inflammatory profiles. The aim of this study was to evaluate plasma zinc concentrations and their relationships with sociodemographic, dietary, inflammatory, and cardiometabolic biomarkers in institutionalized elderly individuals. A cross-sectional study was carried out including 255 elderly adults living in nursing homes. The associations between plasma zinc and dietary zinc intake, sociodemographic indicators, and glycemic, lipid, and inflammatory biomarkers were evaluated. Independent variables were analyzed according to quartiles of plasma zinc concentrations (Q1: <71.1 μg/dL; Q2: 71.1-83.3 μg/dL; Q3: <83.3-93.7 μg/dL; Q4: >93.7 μg/dL). The relationship between plasma zinc concentrations and predictor variables was also tested. In Q1, higher concentrations of the following variables were observed, compared with those in other quartiles: total cholesterol and low-density lipoprotein cholesterol (LDL-c; Q1 > Q2, Q3, Q4; all p <0.001); triglycerides (Q1 > Q3, Q4; all p < 0.001); interleukin (IL)-6 (Q1 > Q3, Q4; p = 0.024 and p = 0.010, respectively); tumor necrosis factor (TNF)-α (Q1 > Q3, p = 0.003). A significant reduction in plasma zinc concentrations was observed with increasing age-adjusted institutionalization time (Δ = - 0.10; 95% confidence interval [CI]: -0.18 to -0.01). The concentrations of total cholesterol (Δ = - 0.19; 95% CI: -0.23 to -0.15), LDL-c (Δ = - 0.19; 95% CI: -0.23 to -0.15), triglycerides (Δ = - 0.11; 95% CI: -0.16 to -0.06), IL-6 (Δ = - 1.41; 95% CI: -2.64 to -0.18), and TNF-α (Δ = - 1.04; 95% CI: -1.71 to -0.36) were also significantly increased. In conclusion, decreased plasma zinc concentrations were associated with longer institutionalization time and worse lipid and inflammatory profiles in elderly institutionalized individuals.

Fatores associados ao crescimento linear de crianças socialmente vulneráveis do Estado da Paraíba, Brasil

This study set out to examine the associated factors, including zinc deficiency, of stunting in children attended in daycare centers in the State of Paraíba. It is a cross-sectional study, involving 353 children aged 6-72 months old. Data on biological characteristics, health situation and socioeconomic conditions of children were obtained by a questionnaire. Children with height for age indices two z scores below the median value of the reference population were considered to be stunted. The level of zinc in hair was determined by atomic absorption spectrophotometry. The prevalence of stunting was 7.36%. Low birth weight, age range 6-36 months, incomplete immunization, low maternal weight, per capita income of less than 0.5 minimum wages and living in a given/donated or invaded house were significantly associated with height for age index deficit. Stunted children were more prone to zinc deficiency, however, without statistical difference with normal growth children. Thus, there is a clear differential in linear growth that favors the children of higher socioeconomic status and favorable maternal history and health.This study set out to examine the associated factors, including zinc deficiency, of stunting in children attended in daycare centers in the State of Paraiba. It is a cross-sectional study, involving 353 children aged 6-72 months old. Data on biological characteristics, health situation and socioeconomic conditions of children were obtained by a questionnaire. Children with height for age indices two z scores below the median value of the reference population were considered to be stunted. The level of zinc in hair was determined by atomic absorption spectrophotometry. The prevalence of stunting was 7.36%. Low birth weight, age range 6-36 months, incomplete immunization, low maternal weight, per capita income of less than 0.5 minimum wages and living in a given/donated or invaded house were significantly associated with height for age index deficit. Stunted children were more prone to zinc deficiency, however, without statistical difference with normal growth children. Thus, there is a clear differential in linear growth that favors the children of higher socioeconomic status and favorable maternal history and health.

Características sociodemográficas e fatores importantes para a manutenção da saúde em mulheres

Objective: To investigate important factors for health maintenance and the socioeconomic and demographic characteristics of women users of Basic Health Units. Methods: Observational, cross-sectional, and analytical study, carried out in 2011, involving 204 women seen in 26 units of the city of Queimadas, Paraiba. Information regarding demographic (housing location, skin colour, age, and marital status) and socioeconomic characteristics (educational level and assistance by the ‘Bolsa Familia’ conditional cash transfer program), and life habits (diet, smoking, medical consultation, sedentarism, alcohol intake, and weight and stress control) was obtained by questionnaire, and then applied descriptive statistics and prevalence ratio. Results: The participants had mean age of 28.22 years (SD=6.49). The majority lived in rural areas (n=126; 61.76%), declared being able to read or write (n=184; 90.2%) and receiving the Bolsa Familia grant (n=153; 75.0%). The most frequently cited features for health maintenance were healthy diet (n=126; 61.8%), not smoking (n=21; 10.3%), and regular medical consultation (n=19; 9.3%). The socioeconomic and demographic variables showed no significant statistical associations with the important features for health maintenance. Conclusion: The studied population recognizes the healthy diet, not smoking, and regular medical consultation as the most important features for healthmaintenance. doi: 10.5020/18061230.2014.p503

Food and nutrition (in)security: development of an indicator of the problem and experimentation in families of Paraíba, Brazil

Apesar dos esforcos, ainda nao se conta com metodos que possam avaliar a (in)seguranca alimentar em toda a sua extensao. Assim, a finalidade desse artigo e propor e aplicar uma medida complementar dos niveis de (in)seguranca alimentar familiar medidos com a aplicacao da Escala Brasileira de Inseguranca Alimentar. A medicao da severidade de inseguranca alimentar possibilita identificar, entre os individuos com inseguranca alimentar, aqueles que apresentam maior vulnerabilidade.