Rita de Cássia Lanes Ribeiro

Childhood anemia prevalence and associated factors in Salvador, Bahia, Brazil

A cross-sectional study was conducted in 1996 to estimate the prevalence of anemia in a stratified sample of 603 preschool children and identify factors associated with the disease. Hemoglobin assays were conducted in finger-prick blood samples using a Hemocue hemoglobinometer. Anemia was defined as hemoglobin below 11.0 g/dl. Logistic regression analysis was used to evaluate the potential associations. Observed anemia prevalence was 46.3%. Associated factors were: the 6-12-month and 12-24-month age brackets, the lowest tertiles for iron density and protein content dietary intake, and any degree of deficit in the height-for-age anthropometric parameter. Inadequate physical, sanitary, and environmental conditions in the home were associated with a significantly increased risk of anemia. Anemia constitutes an important health problem in this studys child population. Improvements in living conditions and dietary quality could contribute to a reduction in anemia prevalence.

Níveis de hemoglobina, aleitamento materno e regime alimentar no primeiro ano de vida

OBJETIVO: Identificar a relacao entre os niveis de hemoglobina e o consumo de leite materno, alimentos complementares e liquidos nao nutritivos no primeiro ano de vida. METODOS: Estudo transversal envolvendo 553 criancas menores de 12 meses de vida, que frequentavam os servicos publicos de saude. A concentracao de hemoglobina foi avaliada pelo metodo cianometahemoglobina, usando-se o sistema HemoCue. Utilizou-se a tecnica da regressao linear multipla para avaliar as associacoes de interesse. RESULTADOS: Niveis de hemoglobina compativeis com a anemia foram identificados em 62,8% das criancas investigadas, com maior ocorrencia naquelas de seis a 12 meses de idade (72,6%). O aleitamento materno exclusivo nos primeiros seis meses de vida assegurou os mais elevados niveis de hemoglobina. Os demais regimes alimentares declinaram de maneira diferenciada os niveis de hemoglobina, que se tornaram compativeis com a anemia quando o regime de aleitamento artificial foi adotado (p=0,009). O consumo de cha e/ou agua declinou em 0,76 g/dl (p<0,001) os niveis de hemoglobina dos menores de seis meses de idade. Para as criancas de seis a 12 meses, os niveis de hemoglobina variaram significante e positivamente com o consumo de acucar (p=0,017) e feijao (p=0,018) e negativamente com o consumo de fruta (p<0,001). CONCLUSOES: O aleitamento materno exclusivo ate os seis meses de idade e a manutencao do leite materno a partir dessa idade, associado aos alimentos complementares quali e quantitativamente adequados, podem contribuir para o aumento dos niveis da hemoglobina no primeiro ano de vida.

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.

Habilidade de indicadores antropométricos e de composição corporal em identificar a resistência à insulina

OBJECTIVE To assess the ability of anthropometric and body composition indicators in identifying insulin resistance (IR), determining cut-off points for those showing the best efficacy. METHOD 138 men were evaluated. Waist perimeter (WP), sagittal abdominal diameter (SAD), conicity index, body mass index (BMI), body fat percent, sagittal index, and the waist-to-height, waist-to-hip and waist-to-thigh ratios were determined. IR was assessed by the HOMA-IR index. Statistical analysis consisted of Spearman correlation coefficient and ROC (receiver operating characteristic) curves, calculating the area under the curve (AUC). RESULTS SAD (r=0.482, AUC=0.746) and WP (r=0.464, AUC=0.739) showed stronger correlations with the HOMA-IR and greater ability to identify IR (p<0.001), being 89.3 cm and 20.0 cm the best cut-offs, respectively. CONCLUSION The anthropometric indicators of central obesity, WP and SAD, have shown greater ability to identify IR in men. We encourage studies in women and elderly people in search of the best cut-off points for the entire population.

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.

Predictive ability of the anthropometric and body composition indicators for detecting changes in inflammatory biomarkers

INTRODUCTION Obesity has been considered a chronic subclinical inflammation. High sensitivity C-reactive protein (hs-CRP) and fibrinogen are increasingly associated with cardiovascular risk. OBJECTIVES To evaluate the ability of anthropometric and body composition indicators in discriminating higher levels of hs-CRP and fibrinogen. METHODS 130 men (20-59 years) were assessed, having measurement of weight, height, waist circumference (WC), hip and thigh circumferences, sagittal abdominal diameter (SAD), coronal diameter (CD) and body composition. Conicity index, waist/height ratio, body mass index, waist/hip ratio, waist/thigh ratio and sagittal index were calculated. It was considered as the cutoff point for hs-CRP values ≥ 0.12 mg/dL and for fibrinogen the 50th percentile of the evaluated sample. RESULTS Sagittal index (r = 0.280), waist/thigh ratio (r = 0.233) and waist/height ratio (r = 0.233) showed the best correlation with hs-CRP (p < 0.01). Conicity index (r = 0.305) and waist/height ratio (r = 0.279) showed the best correlation with fibrinogen (p < 0.01). In ROC analysis, the SAD (0.698 ± 0.049) and the conicity index (0.658 ± 0.048) had greater ability to discriminate cardiovascular risk through higher levels of hs-CRP and fibrinogen, respectively (p < 0.01). The cutoff points of 30 cm, 89.9 cm and 20.5 cm were the ones that reached largest sum between sensitivity and specificity values for the CD, WC and SAD, respectively. CONCLUSIONS The SAD and the conicity index demonstrated a greater ability to detect higher levels of hs-CRP and fibrinogen, respectively, in apparently healthy adult men.

Risk factors for Toxocara spp. seroprevalence and its association with atopy and asthma phenotypes in school-age children in a small town and semi-rural areas of Northeast Brazil.

Toxocara canis, Toxocara cati, are roundworms that live in the intestines of dogs and cats, respectively, and are predominantly agents of human toxocariasis. Studies have suggested that Toxocara spp. seroprevalence increases levels of total and aeroallergen-specific IgE (sIgE), asthma prevalence and asthma morbidity. Nevertheless, other work reported a negative association between Toxocara spp. seropositivity with skin hypersensititity and a positive association with sIgE. The objective of the present study was to evaluate risk factors for acquiring Toxocara spp. infection and to investigate possible significant association between its seroprevalence with atopy and asthma. Students from elementary schools, residents in a small town and its surroundings of Northeast Brazil, underwent blood sampling to measure levels of anti-Toxocara spp. IgG, peripheral blood eosinophils, and specific IgE to aeroallergens. We used univariable and multivariable logistic regression analyses to assess possible risk factors for Toxocara spp. seropositivity and its association with atopy, wheeze/asthma with asthma phenotypes, in a sample of 791 elementary school children aged 6-13 years. Toxocara spp. seroprevalence reached 63.6%; 49.9% had sIgE; 7.2% and 3.3% had atopic wheeze/asthma and non-atopic wheeze/asthma respectively. Risk factors associated with Toxocara spp. seropositivity were: contact with dogs (adj. OR 2.33; 95% CI=1.70-3.19) and cats (adj. OR 3.09; 95% CI=2.10-4.55), and male sex (adj. OR 2.21; 95% CI=1.62-3.02). The presence of anti-Toxocara IgG was statistically associated with blood eosinophils >4% and >10% (adj. OR 1.84; 95% CI=1.33-2.55 and adj. OR 2.07; 95% CI=1.45-2.97, respectively), and atopy (adj. OR 2.00; 95% CI=1.49-2.68), but it was not associated with wheeze/asthma. Concluding, the results obtained in this study showing the association of Toxocara spp. seroprevalence with sIgE may suggest a possible immunological cross-reactivity between IgE epitopes from Toxocara spp. and aeroallergens.

Patient-generated subjective global assessment and classic anthropometry: comparison between the methods in detection of malnutrition among elderly with cancer.

INTRODUCTION A comparative study of the various methods of nutritional assessment currently available in oncology are necessary to identify the most appropriate one, as well as the relationships that exist among the different instruments. OBJECTIVE To compare the nutritional diagnosis obtained by the Patient-Generated Subjective Global Assessment (PG-SGA) with the objective anthropometric measurements in the elderly undergoing oncology treatment and to assess the concordance between the methods used in detecting malnutrition. METHODS A cross-sectional study of the elderly, older than or equal to 60 years in age undergoing oncology treatment. The PG-SGA was performed and the anthropometric parameters including weight, height, Body Mass Index (BMI), arm circumference, arm muscle circumference, corrected arm muscle area, arm fat area, calf circumference, waist circumference, hip circumference, waist-hip ratio and triceps skinfold were evaluated. From a 24-hour recall the energy and macronutrient intakes were estimated. RESULTS A total of 96 elderly patients were evaluated. The PG-SGA identified 29.2% with moderate malnutrition or suspected malnutrition and 14.6% with severe malnutrition. From among the elderly evaluated, 47.9% required critical nutritional intervention. The anthropometric parameters and the consumption of energy and macronutrients revealed significant differences based on the subjective PG-SGA classification. The prevalence of malnutrition ranged from 43.8% to 61.4%, depending upon the instrument used. The method most consistent with the diagnosis of malnutrition provided by the PGSGA was the BMI (kappa = 0.54; CI: 0.347-0.648). CONCLUSIONS The PG-SGA showed a significant correlation with the anthropometric measurements and with food consumption for both the categorical classification, as well as for the scoring system. Diagnosis of malnutrition showed variable prevalence depending upon the method used, and none were found equivalent to the PG-SGA.

Classic Anthropometric and Body Composition Indicators Can Predict Risk of Metabolic Syndrome in Elderly

Background/Aims: Although a variety of classical body measurements have been used to assess adiposity, it is still uncertain which is the best indicator to predict effects arising from the accumulation of body fat (BF) in the elderly. The objective of this study was to analyze different classical anthropometric and body composition measurements and their potential for predicting metabolic syndrome (MS) in elderly women. Methods: There were 113 women (60–83 years old) participating in the study, all of whom had their anthropometric, biochemical, hemodynamic and health conditions evaluated. Statistical analysis consisted of correlation coefficient and receiver operating characteristic (ROC) curves, and calculation of the area under the curve. Results: The waist-hip ratio (WHR) and waist circumference correlated with three (hyperglycemia, hypertriglyceridemia and low concentrations of high density lipoprotein-cholesterol) of the seven cardiometabolic risk factors studied. Body mass index, BF, percentage of BF, and the sum of skinfolds were less related to metabolic risk factors. Among the indicators used to characterize central adiposity, WHR was the index that showed the greatest area under the ROC curve. Conclusions: It is suggested that the WHR, an indicator of abdominal adiposity, should be incorporated into the identification of risk of MS in elderly women.

Data on prevalence and risk factors associated with Toxocara spp infection, atopy and asthma development in Northeast Brazilian school children

In the present article, we provide shortly, data on risk factors for acquiring Toxocara spp. infection and investigate possible associations between this infection with atopy and asthma in school children of a small town and its semi-rural areas of Northeast Brazil. The data set are composed by demographic, social and home environment variables. The detection of anti-Toxocara spp. IgG and specific IgE to aeroallergens was determined by ELISA and ImmunocAP/Phadiatrope systems, respectively. The data presented in this article are related to the article entitled “Risk factors for Toxocara spp. seroprevalence and its association with atopy and asthma phenotypes in school-age children in a small town and semi-rural areas of Northeast Brazil” (M.B. Silva, A.L. Amor, L.N. Santos, A.A. Galvão, A.V. Oviedo Vera, E.S. Silva et al., 2016) [1].