Mirian Ribeiro Baião

Anemia em crianças menores de cinco anos que freqüentam creches públicas do município do Rio de Janeiro, Brasil

OBJETIVOS: estimar a prevalencia de anemia em criancas matriculadas em creches municipais do Rio de Janeiro e identificar os subgrupos de maior risco. METODOS: foram avaliadas 865 criancas. A hemoglobina (Hb) foi dosada em fotometro portatil (HemoCue) e a anemia foi definida quando Hb <11g/dL e <9,5g/dL para maiores e menores de seis meses, respectivamente. Foram obtidas informacoes biologicas e socioeconomicas atraves de questionarios aplicados as maes. RESULTADOS: A prevalencia de anemia foi de 47,3%. As criancas anemicas apresentaram medias de z escore de peso para a idade (-0,239) e a altura para a idade (-0,548) mais baixas do que as nao-anemicas. O risco de anemia foi maior para as criancas com idade abaixo de dois anos (razao de prevalencia [RP]=1,73; intervalo de confianca [IC95%: 1,52-1,97), para as que tinham pais com menos de quatro anos de estudo (RP=1,57; IC95%:1,24-1,99) e moravam em domicilios com mais de oito moradores (RP=1,45; IC95%:,1,07-1,95). . CONCLUSOES: a prevalencia de anemia foi elevada. As criancas com mais baixo peso e estatura para a idade, menores de dois anos, que moravam em residencias com numero elevado de pessoas e que tinham pais com baixa escolaridade foram as mais vulneraveis a anemia, devendo ser alvo de politicas de controle e prevencao.

Effect of weekly rice fortification with iron on anemia prevalence and hemoglobin concentration among children attending public daycare centers in Rio de Janeiro, Brazil

This was a double-blind, placebo-controlled, community-based trial. For 16 weeks, children in the intervention group (n = 180) received iron-fortified rice, while children in the control group (n = 174) received rice with placebo. Anemia was defined as hemoglobin < 11.0g/dL. Students t-test was used to compare mean variation in hemoglobin between the groups. Hemoglobin concentration improved in both groups, with a mean increase of 0.42g/ dL in the intervention group (11.28+/-1.23g/dL to 11.75+/-1.16g/dL, p < 0.001), and 0.49g/dL in controls (11.06+/-1.13g/dL to 11.51+/-1.16g/dL, p < 0.001). Anemia decreased (p < 0.01) in both groups (37.8% to 23.3% in the intervention group and 45.4% to 33.3% in controls), with no significant difference between the two. Hemoglobin increase was significantly higher in children that received total iron = 53.76mg from fortified rice, compared to those who received less than this cut-off value (0.94g/dl vs. 0.39g/dl, p = 0.03). The findings suggest that this type of intervention can be useful in anemia control as long as fortified food intake is adequate.

Alimentação na gestação e puerpério

The scientific precepts for healthy eating have been widely divulged and are recognized as essential to the nutritional demands of pregnancy and its related events, such as postpartum and breastfeeding, aiming mainly at the health of the mother-child binomial. On the other hand, the eating habits of women during the pregnancy-postpartum cycle may be influenced by other logic. This article is a theoretical essay that aims to reflect on the dynamics of the socio-cultural dimension and on social relationships with respect to the eating habits of pregnant and postpartum women. It also aims to enhance the understanding of feeding beyond a strict nutritional and biological observation, in greater part interpreted from the bio-statistical perspective. It highlights the importance of approaching questions related to feeding from an interdisciplinary point of view, which allows for the conjugation of knowledge based on the Social Sciences and Biomedicine, in order to review public policies and improve the practice of assistance offered specifically to this group.

Estado nutricional pré-gestacional, ganho de peso materno, condições da assistência pré-natal e desfechos perinatais adversos entre puérperas adolescentes

OBJETIVO: Identificar associacao entre estado nutricional pre-gestacional, ganho ponderal materno e condicoes do pre-natal com os desfechos prematuridade e baixo peso ao nascer (BPN) em filhos de maes adolescentes. METODOS: Estudo transversal com 542 pares de puerperas adolescentes e conceptos atendidos em uma maternidade publica do municipio do Rio de Janeiro (RJ). Os dados foram coletados em prontuarios. Para verificar a associacao entre as variaveis independentes e os desfechos estudados, foram estimados a odds ratio (OR) e o intervalo de confianca (IC) de 95%. RESULTADOS: Quanto ao estado nutricional pre-gestacional das adolescentes, 87% apresentavam eutrofia, 1% baixo peso, 10% sobrepeso e 2% obesidade. A inadequacao do ganho de peso gestacional total (72%) superou a adequacao (28%). O peso ao nascer foi favorecido com maior ganho de peso gestacional e reduzido com inicio tardio do pre-natal (PN). A comparacao entre os grupos de conceptos com baixo peso e com peso adequado ao nascer revelou diferencas significativas entre as medias das variaveis: intervalo entre a ultima gestacao e a atual (p = 0,022); peso pre-gestacional (p = 0,018); indice de massa corporal pre-gestacional (p < 0,001) e ganho de peso gestacional total (p = 0,047). As chances de BPN (OR 2,70; IC 95% 1,45 - 5,06) e de prematuridade (OR 5,82; IC 95% 3,10 - 10,92) reduziram quando a adolescente recebeu 6 ou mais consultas de PN. CONCLUSAO: O peso ao nascer foi relacionado ao intervalo intergestacional, ao peso pre-gestacional e ao indice de massa corporal pre-gestacional. A frequencia minima de 6 consultas de assistencia pre-natal constituiu-se em fator de protecao contra o BPN e a prematuridade.OBJECTIVE To identify the association between pre-gestational nutritional status, maternal weight gain, and prenatal care with low birth weight (LBW) and prematurity outcomes in infants of adolescent mothers. METHODS Cross-sectional study with 542 pairs of adolescent mothers and their children attending a public maternity hospital in Rio de Janeiro. Data were collected from medical records. To determine the association between independent variables and the outcomes studied, odds ratio (OR) and a 95% confidence interval (CI) were estimated RESULTS With respect to pre-pregnancy nutritional status of adolescents, 87% had normal weight, 1% were underweight, 10% were overweight, and 2% obese. Inadequate total gestational weight gain (72%) exceeded adequacy (28%). Birth weight was favored with greater gestational weight gain, and reduced with late onset of prenatal care. The comparison between the low birth weight and normal birth weight groups revealed significant differences between variable means: interval between the past pregnancy and current pregnancy (p = 0.022), pre-gestational weight (p = 0.018); pre-gestational body mass index (p < 0.001), and total gestational weight gain (p = 0.047). The odds of LBW (OR 2.70, 95% CI 1.45 to 5.06) and prematurity (OR 5.82, 95% CI 3.10 to 10.92) fell when the adolescent received six or more prenatal visits. CONCLUSION Birth weight was associated with inter-gestational interval, pre-pregnancy weight and body mass index before pregnancy. The minimum frequency of six prenatal care visits was a protective factor against LBW and prematurity.

Avaliação da assistência pré-natal na perspectiva de puérperas e profissionais de saúde

The aim of this study was to evaluate the prenatal assistance in a public maternity hospital in the point of view of puerperas and health care professionals. Nineteen puerperas and six health professionals took part in the study. The puerperas answered a semi-structured interview and the health professionals took part in a focus group. The discourse analysis was based on in-depth hermeneutics. The main results pointed out that users showed a deep appreciation for the health professionals. Concerning the professionals view, pregnant women had a wrong knowledge of health during pregnancy. As regards the nutrition appointments, puerperas pointed out they had room for dialogue, support and encouragement. In conclusion, prenatal health education should consider that each woman is a unique individual with her own background. Bonding is of paramount importance for pregnant women to get involved with health-related issues.

A relação interpessoal entre profissionais de saúde e adolescente gestante: distanciamentos e aproximações de uma prática integral e humanizada

This study presents an analysis of relations between health professionals and pregnant adolescents in the installations of the prenatal care program of a public hospital in Rio de Janeiro. It involves qualitative research based on an interpretive approach, with comprehensiveness and humanization of care in relationship dimensions as a theoretical benchmark. Based on two predefined themes - the interaction between subjects and educational dimension of health practices - 22 individual and group care sessions were observed, with the participation of 31 pregnant adolescents, 5 professionals and 2 nutrition interns. The interpretation of the data using content analysis created five categories. The results show the negative effect of the predominance of the biomedical dimension in the perception of health professionals about psychosocial and cultural aspects of teenage pregnancy. There was a failure to utilize the care session as a privileged space for the construction of collective and individual significance about pregnancy and teenage motherhood, albeit in the context studied there are professionals who are aware of the need for a broader view regarding the needs of pregnant adolescent.

Gravidez e comportamento alimentar em gestantes de uma comunidade urbana de baixa renda no Município do Rio de Janeiro, Brasil

The aim of this study was to understand the meanings of acceptance attributed to pregnancy and their influence on the eating behavior of pregnant women attending a health unit located in a low-income neighborhood in the city of Rio de Janeiro, Brazil. The methodology involved a qualitative approach with social representations as the analytical category. Data were collected through semi-structured interviews with adolescent and adult pregnant women (primiparous or multiparous) in different stages of pregnancy. Discourse analysis drew on in-depth hermeneutics, using thematic analysis as the main technical resource. Two representational categories emerged from the set of discourses, namely accepting versus not accepting the pregnancy, which involved different eating behaviors. In the former, women tended to either eat adequately or overeat. For the latter, not accepting the pregnancy was associated with denial of eating, temporarily or throughout the pregnancy.

Iron deficiency anaemia in infants attended at municipal primary health care centres in Rio de Janeiro – Brazil

This study evaluated the prevalence of anaemia and its association with various risk factors in 500 infants attended at two municipal primary health care centres in Rio de Janeiro. Anaemia was assessed using a portable haemoglobinometer (HemoCue). Nutritional status was assessed via weight/age, weight/height and height/age indices. The cut off value –2 z score was used to define underweight, wasted and stunted children according to the National Centre for Health and Statistics – NCHS – curves. Socio‐economic and biological data were obtained from the child’s mother through the use of questionnaires. No association was corroborated between the prevalence of anaemia and the studied risk factors. Development of primary health care intervention is important as a means of reducing the incidence of anaemia in infants, especially in boys and children in the second semester of life, who demonstrated a higher risk.

Breast‐feeding, weaning diet and iron deficiency anaemia in infants

This study describes the breast‐feeding profile as well as the consumption of iron source foods and vitamin C source foods for both anaemic and non‐anaemic children. A total of 500 infants attending two Municipal Primary Health‐Care Centres in Rio de Janeiro were assessed. The prevalence of anaemia was 57.6 per cent. A low probability of consumption of exclusive breast‐feeding at four months was found (9 per cent for anaemic and 12 per cent for non‐anaemic). Further findings showed that the early consumption of cow’s milk, as well as the low probability of consumption and late introduction of beans, liver and green vegetables in the child’s diet, were considered risk dietary factors for iron deficiency anaemia among the evaluated children.

The symbolic dimension of prenatal nutrition care in diabetes Mellitus

1 Universidade Federal do Rio de Janeiro, Maternidade Escola. Rio de Janeiro, RJ, Brasil. 2 Universidade Federal do Rio de Janeiro, Instituto de Nutrição Josué de Castro, Programa de Pós-Graduação em Nutrição. Av. Carlos Chagas Filho, 373, Edifício do Centro de Ciências da Saúde, Bloco J, Cidade Universitária, 21941-902, Rio de Janeiro, RJ, Brasil. Correspondência para/Correspondence to: MMAS SANTOS. E-mail: <marta@nutrição.ufrj.br>. 3 Nutricionista. Rio de Janeiro, RJ, Brasil.