Rubens Garcia Ricco

Factors associated with iron deficiency anemia in Brazilian preschool children

OBJECTIVE To examine the determining factors of anemia and iron deficiency in children attending two day care centers in the town of Pontal, southeast of Brazil. METHODS Cross-sectional study was conducted in 192 children aged 12 to 72 months. Personal data (age, sex, use of medicinal iron supplements, duration of breast-feeding, type of delivery, prenatal care, weight, and height), and socioeconomic data (number of co-inhabitants, parental schooling, and per capita family income) were obtained and evaluated together with hemoglobin, serum transferrin receptor, ferritin, and iron deficiency anemia. RESULTS Age was the variable that most affected iron nutritional status, with higher hemoglobin values, lower transferrin receptor concentrations, higher ferritin values and lower iron deficiency anemia being detected with increasing age. The other studied variables did not show any correlation with iron nutritional status. CONCLUSION The obtained data suggest that control strategies for this preschool population should be especially directed at younger children.

Colostrum Ingested during the First Day of Life by Exclusively Breastfed Healthy Newborn Infants

OBJECTIVE To determine the mass of colostrum ingested by exclusively breastfed newborn infants during the first 24 hours of extrauterine life. STUDY DESIGN Milk ingested during the first 24 hours of life by 90 healthy newborn infants was evaluated by use of a scale with high sensitivity. The masses were measured during 8-hour periods. Associations of the mass measured with prenatal and postnatal variables were tested. RESULTS The mass of colostrum ingested was evaluated in 307 feedings, with 3.4+/-1 feedings recorded per 8-hour period of observation. Mean gain per feeding was 1.5+/-1.1 g. The daily mass of milk ingested by newborn infants was estimated at 15+/-11 g. This volume did not show a tendency to increase during the first 24 postnatal hours, nor was it related to perinatal or postnatal factors or to breastfeeding time. CONCLUSIONS During the first 24 hours of life newborns ingested 15+/-11 g of milk.

Control of iron-deficiency anaemia in Brazilian preschool children using iron-fortified orange juice

Different fortified foods have been used for the control of iron-deficiency anaemia in children. In Brazil, a low cost, abundant and culturally accepted food but not yet used for fortification, is orange juice. To evaluate the usefulness of fortified orange juice, 50 preschool children enrolled in a day-care centre in the town of Pontal, Southeast Brazil, received two flasks of 200 ml orange juice fortified with 20 mg ferrous sulfate heptahydrate, providing 2 mg elemental/100 ml, from Monday to Friday for 4 months (a total of 84 days). Capillary haemoglobin and z scores of the anthropometric indicators weight-for-age, weight-for-height and height-for-age were determined at the beginning of the study and after 4 months. Mean haemoglobin increased from 10.48 ± 1.66 to 11.60 ± 1.09 mg/dl (p = 0.00003) and the prevalence of anaemia (Hb < 11 mg/dl) decreased from 60 to 20%. No significant alterations in the mean z scores of the anthropometric indicators were observed. The acceptance of fortified juice was excellent and no undesired effect was observed. We conclude that the consumption of iron-fortified orange juice is an adequate strategy to complement iron intake in preschool children and, therefore, to treat and prevent iron-deficiency anaemia.

Effect of fortification of drinking water with iron plus ascorbic acid or with ascorbic acid alone on hemoglobin values and anthropometric indicators in preschool children in day-care centers in Southeast Brazil.

Background Iron-deficiency anemia currently is the most frequently occurring nutritional disorder worldwide. Previous Brazilian studies have demonstrated that drinking water fortified with iron and ascorbic acid is an adequate vehicle for improving the iron supply for children frequenting day-care centers. Objective The objective of this study was to clarify the role of ascorbic acid as a vehicle for improving iron intake in children in day-care centers in Brazil. Methods A six-month study was conducted on 150 children frequenting six day-care centers divided into two groups of three day-care centers by drawing lots: the iron-C group (3 day-care centers, n = 74), which used water fortified with 10 mg elemental iron and 100 mg ascorbic acid per liter, and the comparison group (3 day-care centers, n = 76), which used water containing only 100 mg ascorbic acid per liter. Anthropometric measurements and determinations of capillary hemoglobin were performed at the beginning of the study and after six months of intervention. The food offered at the day-care centers was also analyzed. Results The food offered at the day-care center was found to be deficient in ascorbic acid, poor in heme iron, and adequate in non-heme iron. Supplementation with fortified drinking water resulted in a decrease in the prevalence of anemia and an increase in mean hemoglobin levels associated with height gain in both groups. Conclusions Fortification of drinking water with iron has previously demonstrated effectiveness in increasing iron supplies. This simple strategy was confirmed in the present study. The present study also demonstrated that for populations receiving an abundant supply of nonheme iron, it is possible to control anemia in a simple, safe, and inexpensive manner by adding ascorbic acid to drinking water.

O Programa de Saúde da Família e a Puericultura

This paper suggests a proposal of Child Health Care, to children and adolescents, to be developed in the Family Health Care Programs.

Determination of glycemia and insulinemia and the homeostasis model assessment (HOMA) in schoolchildren and adolescents with normal body mass index

OBJECTIVE To determine fasting glycemia and insulinemia levels and the HOMA index in a group of children and adolescents with normal body mass index (BMI). METHODS This was a cross-sectional study conducted at two public schools in Ribeirão Preto, SP, Brazil. A total of 447 children and adolescents of both sexes, with normal BMI, aged 7 to 17.9 years and of average maturity for their age, underwent anthropometric measurements and provided personal data and a sample of venous blood so that glycemia, insulinemia and HOMA index could be determined. The results obtained for boys and girls were compared for each age range using the Mann-Whitney test. The results within each age band were then compared for boys and girls using the Kruskal-Wallis test. RESULTS Glycemia results varied from 7 to 8.9 years (p = 0.0005). Fasting insulinemia varied significantly with age in both sexes (p < 0.001), with the highest values observed among children aged 13 to 14.9 years. HOMA indices varied significantly with age in both boys and girls (p < 0.001), with values that increased progressively up to the age band of 13 and 14.9 years. CONCLUSIONS These data demonstrate the necessity of establishing reference curves for these three indicators.

Acidentes de mordeduras de cães na infância

The incidence of dog bites injuries among children aged 0 to 15 years seen at CSE D. Pedro I health center in Ribeirão Preto, Brazil, in the period of 1993 to 1997, was studied. The results show that there is a need to develop and implement educational and preventive programs about the risks and severity of accidents occurred while in contact with dogs.Estudou-se a incidencia de casos de mordeduras caninas atendidas em uma unidade basica de saude da cidade de Ribeirao Preto, SP, no periodo de 1993 a 1997, entre criancas com idades de 0 a 15 anos. Os dados encontrados mostraram a importância de se promover programas educativos sobre os riscos dessas ocorrencias para evitar acidentes causados por contatos com caes.

Nível sérico de zinco e sua associação com deficiência de vitamina A em crianças pré-escolares

OBJECTIVES: To identify the prevalence of zinc deficiency in a population with high prevalence of vitamin A deficiency; to verify whether zinc deficiency is associated with vitamin A deficiency in the population studied; to verify risk factors for zinc deficiency (sex, age, diarrhea and fever). METHOD: Cross-sectional study of 182 healthy children aged > 24 months and 48 and 48 and < 60 months tended to have lower zinc serum levels than children of other ages. Zinc serum levels were not changed by previous diarrhea and/or fever.

Assessment of mid-upper arm circumference as a method for obesity screening in preschool children

OBJETIVOS: O presente estudo visou a avaliar se o perimetro braquial poderia ser utilizado para a triagem de criancas obesas na idade pre-escolar. METODOS: 1.090 criancas com idades entre 12 e 59,99 meses foram estudadas, obtendo-se informacoes pessoais, alem de peso, estatura e perimetro braquial. Foram obtidas as sensibilidades e especificidades de diferentes escores z de perimetro braquial para idade e perimetro braquial para estatura, para a deteccao de criancas obesas, definidas como aquelas que apresentaram escore z de peso para estatura acima de 2. RESULTADOS: Das 1.090 criancas avaliadas, 6,6% apresentaram escore z de peso para estatura acima de 2. O escore z de 0,7 do indicador perimetro braquial para idade determina a melhor associacao entre sensibilidade (76,5%) e especificidade (77,9%), para a deteccao das criancas obesas. O escore z de 0,6 do indicador perimetro braquial para estatura determina a melhor associacao entre sensibilidade (79,4%) e especificidade (77,6%) para a deteccao das criancas obesas. CONCLUSOES: Nao se observou vantagem do uso do perimetro braquial relacionado a estatura quando comparado a sua relacao com a idade. Dessa forma, propoem-se pontos de corte, utilizando-se apenas o indicador perimetro braquial para idade que, pela sua facilidade e rapidez de obtencao em populacoes, e um metodo alternativo viavel para triagem de criancas pre-escolares portadoras de obesidade.

Estudo comparativo de fatores de risco em crianças e adolescentes com diagnóstico antropométrico de sobrepeso ou obesidade

OBJECTIVE: Excess weight is a serious public health problem all over the world, affecting children and adolescents. The objective of the present study was to determine whether the condition of being overweight is associated to changes in health parameters. METHODS: 84 subjects aged 6-17 years old were studied (34 overweight and 50 obese patients), all of them assisted at the Pediatric Nutrology outpatient clinic of the University of Ribeirao Preto (Unaerp) from October/2004 to October/2005. Arterial pressure, abdominal circumference, fast glycemia, second hour glycemia, total cholesterol and its fractions (HDL-c and LDL-c) and triglycerides were determined. The two groups were compared by two statistical approaches: comparison of absolute values by Mann-Whitney test, and between frequencies of altered values by Fisher exact test. RESULTS: There was a statistical difference only for HDL-c, with higher concentrations in the overweight group when the subgroup of patients with 6-10 years old was considered. Regarding the second approach, there were statistical differences in the abdominal circumference by Freedman criteria, HDL-c and fast glycemia, with higher frequencies of altered values among obese subjects. CONCLUSIONS: Overweight patients presented alterations harmful to their health, similarly to obese individuals. It is necessary to enroll overweight children and adolescents in programs dedicated to the prevention and treatment of nutritional problems.