Margarida Maria de Freitas Lola

Magnitude, geographic distribution and trends of anemia in preschoolers, Brazil

OBJECTIVEnTo assess the magnitude, geographical distribution and trends of the prevalence of nutritional anemia among preschoolers and to identify risk groups in the state of Paraiba, Brazil.nnnMETHODSnA cross-sectional survey with multistage random sampling procedure was conducted in 8 urban municipalities of three mid-regions (Zona da Mata, Agreste and Sertão) in the state of Paraíba in 1992. A total of 1,287 preschoolers of both sexes were selected. Hemoglobin was determined by the cyanometahemoglobin method in venous blood, employing <11 g/dl as the cut-off for anemia. Statistical analysis of proportions employed the chi Square test, whereas for means Mann-Whitney and Kruskal-Wallis were the choice, all with confidence interval of 95%.nnnRESULTSnThe prevalence of anemia was 36.4% (CI 33.7 - 39.1) in the state of Paraiba, greater (p=0.00) than that observed (19.3%, CI 17.3 - 21.5) in 1982. Only 1.0% (CI 0.61 - 1.8) and 6.8% (CI 5.5 - 8.3) of anemia cases were classified as severe and moderate, respectively. Boys presented lower mean hemoglobin concentration (p=0.00), and children under age 3 comprised the biological group of highest susceptibility for deficiency status (p= 0.00). It was found that the second year of life is the most critical for developing nutritional deficiency (p= 0.00). The Agreste mid-region revealed to be the geographical area of highest risk (p= 0.00), outlining a new epidemiological dynamics when compared to the year 1982, when the drought-ridden Sertão region were the geographical area at greatest risk of deficiency.nnnCONCLUSIONSnAccording to international epidemiological criteria, anemia in the studied regions represents a public health problem of moderate degree Assuming the analytical comparability of the 1982 and 1992 cross-sectional surveys, it suggests an increasingly prevalence of nutritional anemia (+88.5%) in all 3 mid-regions in a 10-year-period (1982-92).

Hipovitaminose A em pré-escolares de creches públicas do Recife: indicadores bioquímico e dietético

OBJECTIVE: To evaluate the extent of vitamin A deficiency among preschool children attending public day care centres in Recife, State of Pernambuco, Brazil. METHODS: A cross-sectional survey involving 311 under 5-year-old children of both sexes, randomly selected, and assessed by biochemical (serum retinol), dietetic (vitamin A rich-food consumption) and anthropometric indicators (weight-for-height, weight-for-age and height-for-age). RESULTS: The prevalence of hyporetinolemia (serum retinol 0.05). Vitamin A rich-food intake showed low sensitivity (43.0%) and a very low positive predictive value (6.8%) as a screening diagnostic test for vitamin A deficiency. CONCLUSION: The identification of vulnerable population groups, and the selection of reliable indicators for the assessment of vitamin A status, are both essential for the diagnosis and planning aimed at preventing and controlling vitamin A deficiency.

Nutritional assessment of iron status and anemia in children under 5 years old at public daycare centers.

OBJECTIVESnTo assess nutritional iron status and anemia prevalence in children less than 5 years old at public daycare centers in the city of Recife, PE, Brazil.nnnMETHODSnA cross-sectional study, with a systematic random sampling of 162 children aged 6 to 59 months. Nutritional iron status was assessed in terms of body iron reserves (serum ferritin), transferrinemia (serum iron, total iron binding capacity, and transferrin saturation %), erythropoiesis (free erythrocyte protoporphyrin) and hemoglobin production (hemoglobin).nnnRESULTSnThe prevalence of anemia (hemoglobin < 11.0 g/dL) was 55.6% (95%CI 47.3-63.5), evidence was found of depleted iron stocks (serum ferritin < 12.0 ng/mL) in 30.8% (95%CI 22.9-39.3), low transferrinemia levels (transferrin saturation % < 16) in 60.1% (95%CI 51.7-68.0) and deficient erythropoiesis (free erythrocyte protoporphyrin > 40 micromol/mol heme) in 69.6% (95%CI 61.0-77.1) of the children. Iron parameters were not correlated with sex (p > 0.05). However, children < 24 months exhibited lower hemoglobin concentrations (p < 0.00) and higher levels of free erythrocyte protoporphyrin (p < 0.000) and total iron binding capacity (p < 0.001) when compared with children > 24 months. The significant correlation observed between reserves, transferrinemia and erythropoiesis is a finding that is compatible with the expected lifecycle of iron in the body.nnnCONCLUSIONSnIron deficiency and anemia appear to be an important public health problem among children less than 5 years old at public daycare centers in Recife. Therefore, effective actions aimed at the prevention and control of this deficiency are strongly recommended in this ecological context.

Avaliação do estado nutricional de ferro e anemia em crianças menores de 5 anos de creches públicas

OBJECTIVE: To assess nutritional iron status and anemia prevalence in children less than 5 years old at public daycare centers in the city of Recife, PE, Brazil. METHODS: A cross-sectional study, with a systematic random sampling of 162 children aged 6 to 59 months. Nutritional iron status was assessed in terms of body iron reserves (serum ferritin), transferrinemia (serum iron, total iron binding capacity, and transferrin saturation %), erythropoiesis (free erythrocyte protoporphyrin) and hemoglobin production (hemoglobin). RESULTS: The prevalence of anemia (hemoglobin 40 µmol/mol heme) in 69.6% (95%CI 61.0-77.1) of the children. Iron parameters were not correlated with sex (p > 0.05). However, children 24 months. The significant correlation observed between reserves, transferrinemia and erythropoiesis is a finding that is compatible with the expected lifecycle of iron in the body. CONCLUSIONS: Iron deficiency and anemia appear to be an important public health problem among children less than 5 years old at public daycare centers in Recife. Therefore, effective actions aimed at the prevention and control of this deficiency are strongly recommended in this ecological context.

Parameters of evaluation of zinc nutritional status: comparison between zinc hair rates and serum alkaline phosphatase in pre-scholars of the Municipality of João Pessoa, Paraíba

OBJETIVOS: avaliar o estado nutricional de zinco em criancas de dois a cinco de idade, institucionalizadas em creches do municipio de Joao Pessoa, Paraiba. METODOS: Utilizou-se uma amostra aleatoria sistematica, constituida de 377 criancas. O status nutricional de zinco foi avaliado pelos seguintes parâmetros: concentracoes do mineral no cabelo e niveis de atividade enzimatica da fosfatase alcalina serica. RESULTADOS: a prevalencia das concentracoes inadequadas de zinco no cabelo foi de 61,9% predominando a deficiencia na sua forma grave, 38,5%. A prevalencia das concentracoes inadequadas de niveis de atividade enzimatica da fosfatase alcalina serica foi de 40,1%. As concentracoes de zinco no cabelo nao mostraram correlacao com a fosfatase alcalina serica (r = 0,01; p = 0,882). A distribuicao do zinco no cabelo segundo sexo e idade foi homogenea; comportamento identico foi observado com a fosfatase alcalina. CONCLUSOES: a deficiencia de zinco mostrou-se extremamente elevada no municipio de Joao Pessoa.

Serum Retinol Concentrations in Hospitalized Severe Protein-energy Malnourished Children

BACKGROUNDnVitamin A deficiency (VAD) is a major nutritional problem in many developing countries. Vitamin A status has been reported to be adversely affected in protein-energy malnutrition (PEM).nnnOBJECTIVEnTo assess and compare serum retinol concentrations in hospitalized children with severe PEM and normal ones.nnnMETHODSnA prospective series of 34 malnourished and 29 normal control children, <60 months old, hospitalized at IMIP, Recife-PE were recruited for the study between August 2004 and May 2005. Serum retinol level was assayed by high performance liquid chromatography and concentrations adjusted for presence of inflammation as evidenced by levels of C-reactive protein. Blood retinol level was compared according to nutritional status (severe PEM versus normal), gender, age, maternal schooling, family income, breastfeeding practice, residence and perceived morbidity.nnnRESULTSnThe prevalence of low serum retinol (<0.70 micromol l(-1)) was 41.2% in children with severe PEM and 24.1% in normal children. Serum retinol concentrations were lower in children whose mothers had low schooling (p = 0.025) and families with low per capita income (p = 0.049), regardless of their nutritional status. Serum retinol concentrations had similar distribution between children with severe PEM and normal, when adjusted for gender (p > 0.05), age (p > 0.05), maternal schooling (p > 0.05), family income (p > 0.05), breastfeeding practice (p > 0.05) and residence (p > 0.05). However, malnourished children with diarrhoea showed lower serum retinol concentrations (p = 0.021) compared to those without diarrhoea.nnnCONCLUSIONnVAD was prevalent in hospitalized children with severe PEM and also among normal ones although in lesser magnitude. Intervention for prevention and control of deficiency of vitamin A are recommended in settings where diarrhea is endemic and there are unfavorable socio-economical conditions.

Citologia de impressão conjuntival em crianças desnutridas graves hospitalizadas

OBJECTIVES: to evaluate conjunctival impression cytology (CIC) findings in children hospitalized with severe energy protein malnutrition at the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP). METHODS: a descriptive case series study was carried out between august 2005 and may 2006 with 41 children aged between 1 and 60 months with severe malnutrition (weight/height < -3DP and/or edema -NCHS standard). The CIC technique used followed the standard norms established by the validation study. The slides were examined by two independent observers. RESULTS: the age of cases varied from one to 47 months, with a median of nine months. An abnormal CIC pattern was observed in 46.3% of children. Forty percent of cases of abnormal CIC (marginal (-) and deficient), also presented edema. CONCLUSIONS: the high prevalence of abnormal CIC results found here justifies the standard treatment of high doses of vitamin A for cases of severely malnourished children admitted to hospital.