Sonia Lúcia Lucena Sousa de Andrade

Excesso de peso em crianças e adolescentes no Estado de Pernambuco, Brasil: prevalência e determinantes

This study aimed to determine the prevalence of overweight and associated risk factors in children and adolescents in Pernambuco State, Brazil, in 2006. The cross-sectional, population-based study included 1,435 individuals from 5 to 19 years of age. Poisson regression was used to evaluate the association between selected variables and overweight. Prevalence was 13.3% for overweight (95%CI: 11.6-15.1) and 3.8% for obesity. Adjusted prevalence ratios showed that higher family income, maternal schooling, possession of household consumer goods, living in urban areas, and maternal overweight were associated with overweight in children and adolescents. The high prevalence of overweight in Pernambuco emphasizes the need for public health measures targeting all families regardless of socioeconomic status.

Insegurança Alimentar e estado nutricional de crianças de São João do Tigre, no semi-árido do Nordeste

OBJETIVO: Analisar o estado nutricional de menores de cinco anos e sua relacao com a situacao de (in)seguranca alimentar. METODOS: Estudo transversal de 458 familias, com 558 menores de 5 anos, realizado no municipio de Sao Joao do Tigre. A avaliacao da (in)seguranca alimentar foi realizada mediante aplicacao da Escala Brasileira de Inseguranca Alimentar (EBIA). A categorizacao do estado nutricional foi feita a partir dos indicadores estatura/idade, peso/idade e indice de massa corporal (IMC), utilizando-se as curvas da Organizacao Mundial da Saude. Tambem foram analisadas as associacoes com os indicadores socioeconomicos e biologicos da crianca sobre o indice estatura/idade. RESULTADOS: A seguranca alimentar foi caracterizada em torno de 13% das familias, prevalecendo nas demais a condicao de inseguranca alimentar, sendo a forma moderada a predominante (40,2%). Encontrou-se uma frequencia mais baixa do que o normalmente esperado de desnutricao pelo IMC (1,2% e 1,3%, respectivamente, para as areas rural e urbana), com resultados bem mais elevados ao se considerar o indice estatura/idade (16,8% e 12,9%). A analise de regressao linear multivariada revelou que apenas duas variaveis (renda familiar per capita e escolaridade materna) influenciaram significativamente o indice estatura/idade. CONCLUSAO: Em populacao de elevado grau de pobreza, baixo Indice de Desenvolvimento Humano e prevalencia quase generalizada de inseguranca alimentar, o uso exclusivo de indicadores antropometricos pode revelar uma situacao aparentemente bem mais favoravel. Portanto, os resultados nao podem ser interpretados apenas no campo da validade interna, mas no interior de um processo de rapidas mudancas que caracterizam a transicao nutricional em curso, atingindo inclusive as populacoes de condicoes de vida excepcionalmente desfavoraveis.

Prevalência e determinantes do excesso de peso em pré-escolares

OBJETIVO: Identificar a prevalencia do excesso de peso e sua associacao com as condicoes socioeconomicas, ambientais, bens de consumo, estado nutricional materno e assistencia a saude em pre-escolares. METODOS: Estudo transversal com 954 pre-escolares do estado de Pernambuco, no ano de 2006. Foi realizada regressao logistica multipla, utilizando-se o modelo hierarquizado. Razoes de chances de excesso de peso (bruta e ajustada para confundimento) foram calculadas para cada variavel de exposicao. RESULTADOS: A prevalencia de excesso de peso foi de 8,1% para o estado e 9% para a regiao metropolitana de Recife (PE). No interior urbano e rural, foram encontradas prevalencias de 9,7 e 6,8%, respectivamente. Maiores prevalencias de excesso de peso foram observadas entre criancas pertencentes a familias com melhores condicoes socioeconomicas: maior renda familiar per capita e nivel de escolaridade, acesso a bens de consumo, melhores condicoes de moradia e saneamento basico e de assistencia a saude. O modelo final de regressao logistica multipla indicou que a escolaridade materna, os bens de consumo e o indice de massa corporal da mae foram os fatores que melhor explicaram o excesso de peso das criancas. CONCLUSOES: As prevalencias do excesso de peso superam as de desnutricao entre pre-escolares no estado, e esse excesso acomete principalmente as criancas de familias com condicoes socioeconomicas mais favorecidas.

Prevalence and determinants of overweight in preschool children

OBJECTIVE To examine the prevalence of overweight and its association with socioeconomic and environmental factors, ownership of household goods, maternal nutritional status, and healthcare in preschoolers. METHODS Cross-sectional study with 954 preschoolers from the state of Pernambuco, Brazil, 2006. Multiple logistic regression with hierarchical modeling was conducted. Odds ratios for overweight (crude and adjusted for confounders) were calculated for each independent variable. RESULTS The prevalence of overweight was 8.1% for the state as a whole and 9% for the Recife Metropolitan Region. In urban and rural areas, the prevalence was 9.7 and 6.8%, respectively. A high prevalence of overweight was found among children whose families lived in better socioeconomic conditions (per capita family income, high educational achievement and access to household goods, better housing and sanitation, and healthcare). The logistic regression final model indicated that maternal educational achievement, ownership of household goods, and maternal body mass index were the determinants that best explained child overweight. CONCLUSIONS Overweight was more prevalent than malnutrition among preschoolers. The prevalence was highest among children living in more privileged socioeconomic conditions.

Fatores associados ao declínio do déficit estatural em crianças e adolescentes em Pernambuco

OBJETIVO: Analisar a evolucao do deficit estatural em criancas e adolescentes e identificar seus fatores associados. METODOS: Estudo transversal, com dados das Pesquisas Estaduais de Saude e Nutricao realizadas em Pernambuco nos anos de 1997 e 2006. A amostra do tipo probabilistica (aleatoria estratificada), com representatividade para os estratos urbanos e rurais do estado. Para a coleta de dados foram utilizados questionarios com perguntas pre-codificadas referentes a informacoes sobre as variaveis socioeconomicas, demograficas e antropometricas (das maes, criancas e adolescentes). A populacao estudada foi de, respectivamente, 1.853 e 1.484 criancas e adolescentes de cinco a 19 anos. A analise de regressao multipla com selecao hierarquizada foi utilizada para avaliar a associacao das variaveis explanatorias sobre o deficit estatural. RESULTADOS: A prevalencia do deficit de estatura apresentou reducao significante de 43% (de 16,9% em 1997 para 9,6% em 2006). As variaveis socioeconomicas e a estatura materna estiveram associadas a este declinio, com reducoes variando de 39% a 60% entre os estratos analisados. Na analise dos determinantes do deficit estatural, no ano de 2006, permaneceram como significantes: a renda familiar per capita (<0,25 salario minimo), a posse de bens domesticos (< tres), o maior numero de pessoas por domicilio, a menor escolaridade e menor estatura materna. CONCLUSOES: A reducao do deficit de estatura refletiu a melhoria nas condicoes sociais e economicas. Entretanto, permanecem necessarios a manutencao e incremento de politicas publicas, de modo a aumentar o poder aquisitivo dos mais pobres e universalizar o acesso da populacao a servicos de saude e educacao.OBJETIVO: Analizar la evolucion de la disminucion del deficit de estatura en ninos y adolescentes e identificar sus factores asociados. METODOS: Estudio transversal, con datos de las Investigaciones Estatales de Salud y Nutricion realizadas en Pernambuco (Noreste de Brasil) en los anos de 1997 y 2006. La muestra de tipo probabilistica (aleatoria estratificada), con representacion de los estratos urbanos y rurales del estado. Para la colecta de datos fueron utilizados cuestionarios con preguntas pre-codificadas referentes a informaciones sobre las variables socioeconomicas, demograficas y antropometricas (de las madres, ninos y adolescentes). La poblacion estudiada fue de, respectivamente, 1.853 y 1.484 ninos y adolescentes de cinco a 19 anos. El analisis de regresion multiple con seleccion jerarquizada fue utilizado para evaluar la asociacion de las variables explicativas sobre el deficit de estatura. RESULTADOS: La prevalencia del deficit de estatura presento reduccion significativa de 43% (de 16,9% en 1997 a 9,6% en 2006). Las variables socioeconomicas y la estatura materna estuvieron asociadas a esta disminucion, con reducciones variando de 39% a 60% entre los estratos analizados. En el analisis de los determinantes del deficit de estatura, en el ano 2006, permanecieron como significativos: la renta familiar per capita (<0,25 salario minimo), la posesion de bienes domesticos (< tres), el mayor numero de personas por domicilio, la menor escolaridad y menor estatura materna. CONCLUSIONES: La reduccion del deficit de estatura reflejo la mejoria en las condiciones sociales y economicas. Sin embargo, permanecen necesarios el mantenimiento e incremento de politicas publicas, de modo a aumentar el poder adquisitivo de los mas pobres y universalizar el acceso de la poblacion a servicios de salud y educacion.OBJECTIVE To analyze the evolution of stunting among children and adolescents and identify their associated factors. METHODS This was a cross-sectional study using data from the state health and nutrition surveys that were conducted in Pernambuco (Northeastern Brazil) in 1997 and 2006. The sample was probabilistic (random and stratified) and was representative of urban and rural strata of the state. Questionnaires containing precoded questions relating to information on socioeconomic, demographic and anthropometric variables (of the mothers, children and adolescents) were used for data gathering. The population studied comprised 1853 children and 1484 adolescents between the ages of five and 19 years. Multiple regression analysis with hierarchical selection was used to evaluate associations between explanatory variables relating to stunting. RESULTS The prevalence of stunting presented a significant reduction of 43% (from 16.9% in 1997 to 9.6% in 2006). Socioeconomic variables and maternal height were associated with this decline. The reductions ranged from 39% to 60% among the strata analyzed. Analysis on determinants of stunting showed that in 2006, the following remained significant: per capita family income (< 0.25 minimum salary), possession of domestic goods (< three), greater number of people per household, lower schooling level and lower maternal height. CONCLUSIONS The reduction in stunting reflected improvements in social and economic conditions. However, it remains necessary to maintain and improve public policies, in order to increase the purchasing power of the poorest people and to achieve universal access to health and education services for the population.

Estado nutricional e insegurança alimentar de adolescentes e adultos em duas localidades de baixo índice de desenvolvimento humano

OBJECTIVE: The objective of this study was to describe the food insecurity profile and its relationship with the nutritional status of adolescents and adults of two cities in Northeast Brazil: (Gameleira (PE), located in the sugarcane area of Pernambuco and Sao Joao do Tigre (PB), located in the semiarid area of Paraiba), both characterized by a low human development index. METHODS: This is a cross-sectional study with 501 families from Gameleira (PE) and 458 families from Sao Joao do Tigre (PB), totaling 1 528 adolescents and 1 163 adults. Food insecurity was determined by Cornells questionnaire (United States of America), localized for Brazil (Brazilian Food Insecurity Scale) while the nutritional status was determined by calculating the body mass index. RESULTS: Almost 90% of the families of both cities were on food insecurity. Moderate food insecurity was more common in Sao Joao do Tigre (PB) (40.2%) and severe food insecurity in Gameleira (PE) (36.9%). In the two cities, food insecurity prevailed in families with adolescents. There was a low prevalence of low weight-forheight (proxy for malnutrition) in all age groups, and a high prevalence (58.6%) of overweight and obesity in adults 40 years or older in Sao Joao do Tigre. There was no statistical association between moderate and severe food insecurity and malnutrition. CONCLUSION: The Brazilian scale to assess food insecurity is more of a psychosocial indicator of vulnerability. Under the anthropometric standpoint, the malnutrition rates found by this study among adolescents and adults were not consistent with their food insecurity statuses, even though poverty in these populations was widespread.

Desnutrição e excesso de peso em crianças e adolescentes: uma revisão de estudos brasileiros

OBJETIVO: Revisar la literatura brasilena de 2001 a 2010 sobre las prevalencias y los factores asociados al deficit de estatura y al exceso de peso en ninos y adolescentes de cinco a 19 anos. FUENTES DE DATOS: La investigacion fue realizada en las bases de datos Pubmed y Bireme, utilizandose los descriptores a continuacion: «desnutricion», «deficit estatural», «obesidad», «sobrepeso», «IMC», «nino», «escolar», «adolescente», «Brasil» y «determinantes». Se consideraron los siguientes criterios de seleccion: articulo original de base poblacional, evaluacion de los factores asociados, por medio de analisis estadistico de regresion, y articulos publicados entre 2000 y 2009. SINTESIS DE LOS DATOS: En lo que se refiere al deficit estatural, solamente dos estudios atendieron a los criterios establecidos, presentando variaciones de 3,5 a 16,7%, e indicacion de la condicion social y de la escolaridad de los jovenes como factores asociados. De los 12 estudios que investigaron el exceso de peso, 66,6% fueron realizados en la region Sur de Brasil y ninguno incluyo al Norte del pais. La mayoria presento delineacion transversal. Las prevalencias variaron de 13,9 a 38,9%, siendo los principales factores asociados: estandares socioeconomicos, influencia familiar y estilo de vida sedentario. CONCLUSIONES: Las asociaciones de las variables ingresos y nivel de escolaridad con el deficit de estatura y el sobrepeso, aunque con tendencias opuestas, llaman la atencion. Se sugiere la realizacion de mas estudios, en especial en las regiones Norte y Nordeste de Brasil.

Malnutrition and excess weight in children and adolescents: a review of Brazilian studies

OBJETIVO: Revisar la literatura brasilena de 2001 a 2010 sobre las prevalencias y los factores asociados al deficit de estatura y al exceso de peso en ninos y adolescentes de cinco a 19 anos. FUENTES DE DATOS: La investigacion fue realizada en las bases de datos Pubmed y Bireme, utilizandose los descriptores a continuacion: «desnutricion», «deficit estatural», «obesidad», «sobrepeso», «IMC», «nino», «escolar», «adolescente», «Brasil» y «determinantes». Se consideraron los siguientes criterios de seleccion: articulo original de base poblacional, evaluacion de los factores asociados, por medio de analisis estadistico de regresion, y articulos publicados entre 2000 y 2009. SINTESIS DE LOS DATOS: En lo que se refiere al deficit estatural, solamente dos estudios atendieron a los criterios establecidos, presentando variaciones de 3,5 a 16,7%, e indicacion de la condicion social y de la escolaridad de los jovenes como factores asociados. De los 12 estudios que investigaron el exceso de peso, 66,6% fueron realizados en la region Sur de Brasil y ninguno incluyo al Norte del pais. La mayoria presento delineacion transversal. Las prevalencias variaron de 13,9 a 38,9%, siendo los principales factores asociados: estandares socioeconomicos, influencia familiar y estilo de vida sedentario. CONCLUSIONES: Las asociaciones de las variables ingresos y nivel de escolaridad con el deficit de estatura y el sobrepeso, aunque con tendencias opuestas, llaman la atencion. Se sugiere la realizacion de mas estudios, en especial en las regiones Norte y Nordeste de Brasil.

Factors associated with the decline in stunting among children and adolescents in Pernambuco, Northeastern Brazil.

OBJETIVO: Analisar a evolucao do deficit estatural em criancas e adolescentes e identificar seus fatores associados. METODOS: Estudo transversal, com dados das Pesquisas Estaduais de Saude e Nutricao realizadas em Pernambuco nos anos de 1997 e 2006. A amostra do tipo probabilistica (aleatoria estratificada), com representatividade para os estratos urbanos e rurais do estado. Para a coleta de dados foram utilizados questionarios com perguntas pre-codificadas referentes a informacoes sobre as variaveis socioeconomicas, demograficas e antropometricas (das maes, criancas e adolescentes). A populacao estudada foi de, respectivamente, 1.853 e 1.484 criancas e adolescentes de cinco a 19 anos. A analise de regressao multipla com selecao hierarquizada foi utilizada para avaliar a associacao das variaveis explanatorias sobre o deficit estatural. RESULTADOS: A prevalencia do deficit de estatura apresentou reducao significante de 43% (de 16,9% em 1997 para 9,6% em 2006). As variaveis socioeconomicas e a estatura materna estiveram associadas a este declinio, com reducoes variando de 39% a 60% entre os estratos analisados. Na analise dos determinantes do deficit estatural, no ano de 2006, permaneceram como significantes: a renda familiar per capita (<0,25 salario minimo), a posse de bens domesticos (< tres), o maior numero de pessoas por domicilio, a menor escolaridade e menor estatura materna. CONCLUSOES: A reducao do deficit de estatura refletiu a melhoria nas condicoes sociais e economicas. Entretanto, permanecem necessarios a manutencao e incremento de politicas publicas, de modo a aumentar o poder aquisitivo dos mais pobres e universalizar o acesso da populacao a servicos de saude e educacao.OBJETIVO: Analizar la evolucion de la disminucion del deficit de estatura en ninos y adolescentes e identificar sus factores asociados. METODOS: Estudio transversal, con datos de las Investigaciones Estatales de Salud y Nutricion realizadas en Pernambuco (Noreste de Brasil) en los anos de 1997 y 2006. La muestra de tipo probabilistica (aleatoria estratificada), con representacion de los estratos urbanos y rurales del estado. Para la colecta de datos fueron utilizados cuestionarios con preguntas pre-codificadas referentes a informaciones sobre las variables socioeconomicas, demograficas y antropometricas (de las madres, ninos y adolescentes). La poblacion estudiada fue de, respectivamente, 1.853 y 1.484 ninos y adolescentes de cinco a 19 anos. El analisis de regresion multiple con seleccion jerarquizada fue utilizado para evaluar la asociacion de las variables explicativas sobre el deficit de estatura. RESULTADOS: La prevalencia del deficit de estatura presento reduccion significativa de 43% (de 16,9% en 1997 a 9,6% en 2006). Las variables socioeconomicas y la estatura materna estuvieron asociadas a esta disminucion, con reducciones variando de 39% a 60% entre los estratos analizados. En el analisis de los determinantes del deficit de estatura, en el ano 2006, permanecieron como significativos: la renta familiar per capita (<0,25 salario minimo), la posesion de bienes domesticos (< tres), el mayor numero de personas por domicilio, la menor escolaridad y menor estatura materna. CONCLUSIONES: La reduccion del deficit de estatura reflejo la mejoria en las condiciones sociales y economicas. Sin embargo, permanecen necesarios el mantenimiento e incremento de politicas publicas, de modo a aumentar el poder adquisitivo de los mas pobres y universalizar el acceso de la poblacion a servicios de salud y educacion.OBJECTIVE To analyze the evolution of stunting among children and adolescents and identify their associated factors. METHODS This was a cross-sectional study using data from the state health and nutrition surveys that were conducted in Pernambuco (Northeastern Brazil) in 1997 and 2006. The sample was probabilistic (random and stratified) and was representative of urban and rural strata of the state. Questionnaires containing precoded questions relating to information on socioeconomic, demographic and anthropometric variables (of the mothers, children and adolescents) were used for data gathering. The population studied comprised 1853 children and 1484 adolescents between the ages of five and 19 years. Multiple regression analysis with hierarchical selection was used to evaluate associations between explanatory variables relating to stunting. RESULTS The prevalence of stunting presented a significant reduction of 43% (from 16.9% in 1997 to 9.6% in 2006). Socioeconomic variables and maternal height were associated with this decline. The reductions ranged from 39% to 60% among the strata analyzed. Analysis on determinants of stunting showed that in 2006, the following remained significant: per capita family income (< 0.25 minimum salary), possession of domestic goods (< three), greater number of people per household, lower schooling level and lower maternal height. CONCLUSIONS The reduction in stunting reflected improvements in social and economic conditions. However, it remains necessary to maintain and improve public policies, in order to increase the purchasing power of the poorest people and to achieve universal access to health and education services for the population.

Epidemia de beribéri no Maranhão, Brasil

This Editorial addresses the scientific community to report on a beriberi outbreak affecting part of the population in the Tocantins Region in the State of Maranhao, Brazil, with 466 and 543 reported cases and 33 and zero deaths in 2006 and 2007, respectively, predominating among males from 15 to 50 years of age, mainly with the dry beriberi clinical form (data from the Non-Communicable Diseases Division of the Superintendency for Epidemiology and Disease Control, Maranhao State Health Secretariat). During the same period, 30 cases and three deaths were recorded in the neighboring State of Tocantins, according to information provided by its respective State Health Secretariat. Importantly, the last previously recorded beriberi epidemic in Brazil occurred from 1870 to 1910, during the rubber boom in the Amazon Region, as extensively documented by Josue de Castro in Geography of Hunger (1946; English translation, 1952). After numerous patients were hospitalized in Imperatriz, Maranhao, with edema, paresthesia of the lower and upper limbs, difficulty walking, and death from cardio-respiratory failure, an investigation was launched in May 2006 by the Maranhao State Health Secretariat, with participation by the Health Surveillance Secretariat of the Brazilian Ministry of Health. The initial diagnostic hypotheses were: disease of unknown etiology, pesticide poisoning, alcohol intoxication, and Guillain-Barre syndrome. News on the disease had great national repercussion, and the investigation changed directions when a physician from the State of Ceara with experience in the Amazon Region telephoned the head of the regional health department in Imperatriz, suggesting the diagnosis of beriberi. The diagnosis was confirmed by a therapeutic test with thiamine administration. The investigation then focused on identifying the determinant factors, and confirmed the prevalence of alcohol abuse and heavy physical labor among the patients. Current studies are concentrating on the population’s food consumption, pesticide exposure, and possible contamination of rice with fungal microtoxins. Among the actions to quell the beriberi outbreak, emergency measures have been taken such as the purchase and supply of thiamine, as well as short and medium term measures like: distribution of basic food baskets; specific training for health workers; epidemiological, food, and nutritional surveillance; installation of Psychosocial Care Centers for Alcohol and Drug Abuse; investigation of rice processing by local mills; food enrichment; intensification in the inspection of marketing and use of pesticides; and systematization of studies under way on beriberi in the region. The Ministry of Health coordinated the creation of an Inter-Ministerial Task Force aimed at planning and implementing these measures, with representatives from: Office of the Chief of Cabinet; Ministry of Social Development and the Fight Against Hunger; Ministry of Agriculture, Livestock, and Supply; Ministry of Agrarian Development; National Council on Food and Nutritional Safety; National Health Surveillance Agency (ANVISA); and the Government of the State of Maranhao (as reported by the Coordinating Division for Food and Nutritional Policy, Ministry of Health, in 2007). The Task Force allowed greater institutional integration and a more holistic understanding of the problem. Despite difficulties in implementing some measures, the experience has been successful. Some issues in the health sector still need to be defined, like the ideal treatment time, criteria for cure and discharge, thiamine supplementation for patients’ family members, and investigation of other risk groups (children and pregnant women). Another relevant issue is the origin of the epidemic in its ecological, social, and economic dimensions. In recent decades, development in the affected area has focused on extensive deforestation and planting of eucalyptus groves to serve the mining and logging companies operating there, in addition to extensive cattle-raising, to the detriment of production of basic food crops, especially rice, beans, corn, cassava, and native foods like Brazil nuts, babacu, and buriti. The result has been the disorganization of the local economy, thus aggravating the prevailing social inequality and further jeopardizing the population’s access to food and quality of life.