Milena Baptista Bueno

Riscos associados ao processo de desmame entre crianças nascidas em hospital universitário de São Paulo, entre 1998 e 1999: estudo de coorte prospectivo do primeiro ano de vida

O objetivo do estudo foi descrever a pratica do aleitamento materno de criancas nascidas em um hospital universitario em Sao Paulo, e identificar fatores associados com a duracao do aleitamento materno e aleitamento materno exclusivo. Criou-se uma coorte potencial de 506 recem-nascidos, destas, foi possivel utilizar informacoes de 450 que tinham dados sobre alimentacao, pelo menos, ate o segundo mes de vida. A mae anotava diariamente, em um questionario de frequencia alimentar, os alimentos consumidos pela crianca. Tecnicas de analise de sobrevida (Kaplan-Meier e Cox) foram utilizadas para as analises. A mediana do aleitamento materno foi 205 dias e do aleitamento materno exclusivo 23 dias. Os fatores de importância na duracao do aleitamento materno exclusivo foram idade da mae (rh mais jovem/mais velha = 1,22; IC95% = 1,006-1,486) e escolaridade da mae (rh fundamental/superior = 2,13; IC95% = 1,381-3,307 e rh medio/superior = 1,78; IC95% = 1,145-2,792), podendo estar relacionadas com o conhecimento dos beneficios do aleitamento materno exclusivo.

Evolução nutricional de crianças atendidas em creches públicas no Município de São Paulo, Brasil

OBJECTIVE To assess changes in the anthropometric characteristics of children receiving care in public day care facilities in the municipality of São Paulo, Brazil. METHODS Using a sampling procedure, 21 day care centers and 849 children were selected for the study. The children in the study were to be weighed and measured at three points over a one-year period: in October of 1999, April of 2000, and October of 2000. Of the 849 children selected, 821 of them were weighed and measured in October of 1999, and 420 of them were weighed and measured at all three points. The data in this paper refer to those 420 children. McNemars chi-square test was used to analyze any changes at the end of the year in the proportions of children who were malnourished or overweight. Two-way analysis of variance was used to compare the mean height-for-age, weight-for-age, and weight-for-height z scores at the three observations. RESULTS At the first observation, the prevalences found were: low height-for-age, 7.1%; low weight-for-age, 2.8%; low weight-for-height, 0.2%; and overweight, 5.7%. By the end of the year, the prevalence of low height-for-age had decreased to 3.1% (P = 0.007), of low weight-for-age had decreased to 1.7% (P = 0.56), of low weight-for-height had increased to 0.5% (P = 0.99), and of overweight had increased to 6.9% (P = 0.33). Both malnutrition and overweight were more prevalent in children younger than 24 months than they were among older children studied, at both the beginning and the end of the study period. The changes in the mean indices of height-for-age, weight-for-height, and weight-for-age over the one-year period were significantly positive, except for weight-for-height in children younger than 24 months. CONCLUSIONS Our results indicate that receiving care in the public day care facilities had a positive impact on the nutritional status of the children over the one-year study period. However, the physical growth of the children in these day care centers should be monitored in order to prevent malnutrition from turning into another public health problem: excessive weight gain.

Prevalência e fatores associados à anemia entre crianças atendidas em creches públicas de São Paulo

Um dos grandes desafios na saude publica e o combate a anemia ferropriva em criancas. Considerando a importância da cidade de Sao Paulo em relacao ao tamanho da sua populacao e a escassez de estudos representativos de criancas que frequentam creches, este estudo teve como objetivo analisar a prevalencia de anemia em uma amostra probabilistica de criancas frequentadoras de creches da rede municipal de Sao Paulo e identificar os fatores associados. Este e um estudo transversal com 330 pre-escolares sorteados entre 20 creches publicas. Anemia foi definida como hemoglobina menor de 11g/dL. Utilizou-se regressao logistica hierarquizada para analise multipla. A prevalencia de anemia foi de 68,8% (IC95% = 63,8%; 73,8%). Entre as criancas com anemia, o percentual de anemia grave (< 9,5g/dL) foi de 26,9%. Estiveram associados a anemia idade menor de 24 meses (Odds ratio (OR) = 2,7; IC95% = 1,4; 5,2) e idade do responsavel pela crianca menor de 25 anos (OR = 1,8; IC95% = 1,0; 3,2). A prevalencia de anemia foi alta quando comparada a outros estudos. O acompanhamento de programas de combate a esta doenca deve ser realizado e modificado, quando necessario, especialmente entre criancas frequentadoras de creches publicas menores de dois anos que possuem responsaveis mais jovens.

Trans fatty acid intake among the population of the city of São Paulo, Brazil

OBJECTIVE To analyze the monounsaturated and polyunsaturated trans fatty acid intake among the general population. METHODS A cross-sectional study was conducted in São Paulo, Southeastern Brazil, in 2003, on a representative sample of 2,298 male and female subjects, including 803 adolescents (12 to 19 years), 713 adults (20 to 59 years) and 782 elderly people (60 years or over). Food intake was measured using 24-hour recall. Mean trans fatty acid intake was described according to gender and age group. RESULTS The mean trans fatty acid intake was 5.0 g/day (SE = 0.1), accounting for 2.4% (SE = 0.1) of total energy and 6.8% (SE = 0.1) of total lipids. The adolescents had the highest mean intake levels (7.4 g/day; 2.9% of energy) while the adults and the elderly had similar intake (2.2% of energy for both; 6.4% of lipids and 6.5% of lipids, respectively). The mean trans fatty acid intake among adult and elderly women (approximately 2.5% of energy and 7.0% of lipids) was higher than among men in the same age group. The food item with the highest contribution towards trans fatty acids was margarine, accounting for more than 30% of total intake, followed by filled cookies among adolescents and meat among adults and the elderly. CONCLUSIONS The trans fatty acid intake is above the level recommended by the World Health Organization. Replacement of the trans fatty acids in manufactured food items may be an effective measure for reducing trans fatty acid intake in Brazil.OBJETIVO: Analisar o consumo de acidos graxos monoinsaturados e poliinsaturados de configuracao trans na populacao geral. METODOS: Estudo transversal realizado em Sao Paulo, SP, 2003, com amostra representativa de 2.298 individuos, sendo 803 adolescentes (12 a 19 anos), 713 adultos (20 a 59 anos) e 782 idosos (60 anos ou mais), de ambos os sexos. O consumo alimentar foi medido por meio do recordatorio alimentar de 24 horas. Os valores medios de ingestao de acidos graxos trans foram descritos segundo sexo e faixa etaria. RESULTADOS: O consumo medio de acidos graxos trans foi de 5,0g/dia (EP=0,1), correspondendo a 2,4% (EP=0,1) do total calorico e 6,8% (EP=0,1) do total de lipidios. Os adolescentes apresentaram as maiores medias de ingestao (7,4g/dia e 2,9% energia), enquanto os adultos e idosos registraram ingestao semelhante (2,2% energia; 6,4% lipidios e 6,5% lipidios, respectivamente). As medias de consumo de acidos graxos trans entre mulheres adultas e idosas (aproximadamente 2,5% energia e 7,0% lipidios) foram maiores que as medias dos homens de mesma faixa etaria. O alimento de maior contribuicao para o consumo de acidos graxos trans foi a margarina, representando mais de 30% do total ingerido, seguido do biscoito recheado para os adolescentes e da carne bovina para os adultos e idosos. CONCLUSOES: O consumo de acidos graxos trans encontra-se acima do preconizado pela Organizacao Mundial da Saude. A substituicao dos acidos graxos trans dos alimentos industrializados pode ser uma medida eficaz para a reducao do consumo desse tipo de gordura no Brasil.

Comparação de três critérios de classificação de sobrepeso e obesidade entre pré-escolares

INTRODUCTION: There is not a consensus about the diagnostic of overweight and obesity in children. The recommendations by World Health Organization (WHO), Center of Disease Control (CDC) and International Obesity Task Force (IOTF) are more commons. There are differences among the index (BMI or score), population (american or others) and/or conception. OBJECTIVES: to compare three nutritional status classifications in a representative sample of preschoolers, whose attended regularly public day-care centers in Sao Paulo city. METHODS: Twenty-one day-care centers and 676 children, between 2 and 7 years old, were randomly assigned by a cluster sampling in two stages. Each child was classified about his nutritional status using three different criteria and the concordance among the indexes were analyzed by Kappa statistics. The prevalence of overweight was 18.6%, 13.2% and 12.2% according to the indexes WHO, CDC and IOTF, respectively. RESULTS: About the overweight, the range of prevalence difference was 2,7% until 12,4% and for obesity, the range was 3,7% until 5,4%. Highlighting the difference between indexes proposed by CDC and IOTF, mainly in males obesities, which the CDC was 2.6 higher. The concordance was low (k < 0,40) only between males overweight classified by CDC and IOTF. CONCLUSIONS: It is the possible to compare studies which use different criteria to classify nutritional status in children but they need to be done carefully.

Duração da amamentação após a introdução de outro leite: seguimento de coorte de crianças nascidas em um hospital universitário em São Paulo

O objetivo deste trabalho foi estudar a duracao do aleitamento materno apos a introducao de outro leite na alimentacao infantil. Foi analisada uma coorte de 450 criancas selecionadas no hospital universitario de Sao Paulo na ocasiao do parto, entre 1998 e 1999. Informacoes diarias sobre a alimentacao da crianca foram obtidas a partir de registro feito pela mae. Para analise dos dados foi utilizada a tecnica de analise de sobrevida, atuarial e Kaplan-Meier, e o modelo de Cox. Cinquenta e quatro criancas (12,0%) nao chegaram a receber leite nao materno durante o tempo de observacao, 193 (43,0%) tiveram a introducao de outro leite ate sessenta dias de idade (grupo 1), 151 (33,5%) receberam leite nao materno pela primeira vez entre sessenta e um e cento e oitenta dias (grupo 2) e 52 (11,5%) passaram a receber leite nao materno depois de cento e oitenta dias (grupo 3). Os tempos medianos de duracao da amamentacao para os tres grupos, apos a introducao do leite nao materno, foram, respectivamente, 76, 120 e 176 dias. Tomando como categoria basal o primeiro grupo, a razao de hazards do segundo grupo foi 0,73 (IC: 0,57-0,94) e a do terceiro foi 0,43 (IC: 0,26-0,72). Concluiu-se que quanto mais tarde e introduzido o outro leite, por mais tempo a mae tende a amamentar, e as maes que desejam prolongar a amamentacao retardam a introducao de outro leite e, apos a introducao, mantem pelo maior tempo possivel a concomitância do outro leite com o leite materno.

Dietary calcium intake and overweight: An epidemiologic view

OBJECTIVE We evaluated the relation between overweight and calcium intake in adults living in the municipality of São Paulo, Brazil. METHODS This was a cross-sectional population-based study on a sample of 1459 adults that was obtained by multistage cluster sampling. Dietary intake was measured by the 24-h recall method. Poissons and linear regression analyses were performed to evaluate the relation between overweight and quartiles of calcium intake adjusted for energy. RESULTS The prevalence of overweight was 43.1% and the average adjusted calcium intake was 448.6 mg. In the linear regression analyses, the regression coefficient for adjusted calcium was significant and negative (P = 0.019, beta(1) = -0.0001). Although evaluated by quartiles, the prevalence ratio for overweight in the first quartile of calcium intake was 1.24 (95% confidence interval 1.00-1.54) and that in the second quartile was 1.24 (95% confidence interval 1.03-1.49). CONCLUSION In the present study, calcium intake showed a significant negative association with body mass index.

Nutritional risk among Brazilian children 2 to 6 years old: A multicenter study

OBJECTIVE To estimate the nutritional risk in children 2 to 6 y old. METHODS The sample consisted of 3058 children enrolled in public and private schools in nine Brazilian cities. The assessment of nutrient intake was based on 1-d data combining direct individual weighing of foods and a food diary. A second evaluation of food consumption was conducted in a subsample to estimate the usual intake. RESULTS There was low prevalence of inadequate intake of vitamin B6 (<0.001%), riboflavin (<0.001%), niacin (<0.001%), thiamin (<0.001%), folate (<0.001%), phosphorus (<0.1%), magnesium (<0.1%), iron (<0.5%), copper (<0.001%), zinc (<0.5%), and selenium (<0.001%). However, 22% of children younger than 4 y and 5% of children older than 4 y consumed fiber quantities larger than the adequate intake. Approximately 30% of the sample consumed more saturated fat than recommended. The prevalence of inadequate vitamin E intake ranged from 15% to 29%. More than 90% of the children had an inadequate vitamin D intake. In children older than 4 y, the prevalence of inadequate calcium intake was approximately 45%. Sodium intake was higher than the upper intake level in 90% of children younger than 4 y and 73% of children older than 4 y. CONCLUSIONS The prevalence of inadequate dietary intake was low for most nutrients. However, fiber, calcium, and vitamin D and E intakes were lower than recommended. Moreover, children consumed large amounts of sodium and saturated fat.

Trans fatty acid intake among the population of the city of São Paulo, Southeasthern Brazil

OBJECTIVE To analyze the monounsaturated and polyunsaturated trans fatty acid intake among the general population. METHODS A cross-sectional study was conducted in São Paulo, Southeastern Brazil, in 2003, on a representative sample of 2,298 male and female subjects, including 803 adolescents (12 to 19 years), 713 adults (20 to 59 years) and 782 elderly people (60 years or over). Food intake was measured using 24-hour recall. Mean trans fatty acid intake was described according to gender and age group. RESULTS The mean trans fatty acid intake was 5.0 g/day (SE = 0.1), accounting for 2.4% (SE = 0.1) of total energy and 6.8% (SE = 0.1) of total lipids. The adolescents had the highest mean intake levels (7.4 g/day; 2.9% of energy) while the adults and the elderly had similar intake (2.2% of energy for both; 6.4% of lipids and 6.5% of lipids, respectively). The mean trans fatty acid intake among adult and elderly women (approximately 2.5% of energy and 7.0% of lipids) was higher than among men in the same age group. The food item with the highest contribution towards trans fatty acids was margarine, accounting for more than 30% of total intake, followed by filled cookies among adolescents and meat among adults and the elderly. CONCLUSIONS The trans fatty acid intake is above the level recommended by the World Health Organization. Replacement of the trans fatty acids in manufactured food items may be an effective measure for reducing trans fatty acid intake in Brazil.OBJETIVO: Analisar o consumo de acidos graxos monoinsaturados e poliinsaturados de configuracao trans na populacao geral. METODOS: Estudo transversal realizado em Sao Paulo, SP, 2003, com amostra representativa de 2.298 individuos, sendo 803 adolescentes (12 a 19 anos), 713 adultos (20 a 59 anos) e 782 idosos (60 anos ou mais), de ambos os sexos. O consumo alimentar foi medido por meio do recordatorio alimentar de 24 horas. Os valores medios de ingestao de acidos graxos trans foram descritos segundo sexo e faixa etaria. RESULTADOS: O consumo medio de acidos graxos trans foi de 5,0g/dia (EP=0,1), correspondendo a 2,4% (EP=0,1) do total calorico e 6,8% (EP=0,1) do total de lipidios. Os adolescentes apresentaram as maiores medias de ingestao (7,4g/dia e 2,9% energia), enquanto os adultos e idosos registraram ingestao semelhante (2,2% energia; 6,4% lipidios e 6,5% lipidios, respectivamente). As medias de consumo de acidos graxos trans entre mulheres adultas e idosas (aproximadamente 2,5% energia e 7,0% lipidios) foram maiores que as medias dos homens de mesma faixa etaria. O alimento de maior contribuicao para o consumo de acidos graxos trans foi a margarina, representando mais de 30% do total ingerido, seguido do biscoito recheado para os adolescentes e da carne bovina para os adultos e idosos. CONCLUSOES: O consumo de acidos graxos trans encontra-se acima do preconizado pela Organizacao Mundial da Saude. A substituicao dos acidos graxos trans dos alimentos industrializados pode ser uma medida eficaz para a reducao do consumo desse tipo de gordura no Brasil.

Porcionamento dos principais alimentos e preparações consumidos por adultos e idosos residentes no município de São Paulo

OBJETIVO: Identificar o tamanho das porcoes dos alimentos e das preparacoes mais consumidas ou que mais contribuem com o valor energetico total da dieta de adultos e idosos. METODOS: Realizou-se inquerito domiciliar de base populacional em 2003, com amostra representativa de 1 477 individuos acima de 20 anos residentes no municipio de Sao Paulo. O consumo alimentar foi verificado pelo recordatorio de 24 horas, digitado no programa Nutrition Data System. Os alimentos e as preparacoes selecionados para averiguacao da porcao foram os consumidos por, no minimo, 10% da populacao de estudo ou que contribuiram com ate 80% do valor energetico total. As porcoes medias, obtidas pelo percentil 50, foram comparadas segundo sexo e estado nutricional, por meio do teste de Kruskal Wallis. RESULTADOS: Arroz e feijao foram os alimentos mais consumidos e que mais contribuiram para o valor energetico da dieta. Os homens consumiram maior porcao destes alimentos, quando sao comparados as mulheres. Observou-se que a porcao de leite esta abaixo do estipulado pelo Guia Alimentar Brasileiro, porem a maior diferenca encontrada foi em relacao a alface e ao tomate. Verificou-se que individuos com excesso de peso consomem maiores porcoes de peito de frango. CONCLUSAO: O tamanho das porcoes de alguns alimentos e maior entre homens, porem, na pratica, nao ha como diferenciar, em medidas caseiras, valores tao proximos como os encontrados na maioria dos alimentos. As porcoes dos principais alimentos dos grupos de verduras e legumes e leite e derivados sao menores que o proposto pelo Guia Alimentar.