Teresa Gontijo de Castro

Anemia e deficiência de ferro em pré-escolares da Amazônia Ocidental brasileira: prevalência e fatores associados

This cross-sectional population-based study investigated prevalence rates and associated factors for anemia, iron deficiency anemia, and iron deficiency among children 6 to 60 months of age in two towns in Acre State, Brazil (N = 624). Hemoglobin, plasma ferritin, and soluble transferrin receptor were measured in venous blood samples. Socioeconomic, demographic, and disease data were obtained using a questionnaire. Prevalence ratios were calculated by Poisson regression in a hierarchical model. Prevalence rates for anemia, iron deficiency anemia, and iron deficiency were 30.6%, 20.9%, and 43.5%, respectively. Children younger than 24 months showed higher risk of anemia, iron deficiency anemia, and iron deficiency. The highest family income tertile was a protective factor against iron deficiency anemia (PR: 0.62; 95%CI: 0.40-0.98). The highest height-for-age quartile was protective against anemia (0.62; 0.44-0.86) and iron deficiency anemia (0.51; 0.33-0.79), and recent history of diarrhea was associated with increased risk of anemia (1.47; 1.12-1.92) and iron deficiency anemia (1.44; 1.03-2.01). Geohelminth infection was associated with increased risk of anemia, iron deficiency anemia, and iron deficiency.

Estado nutricional dos indígenas Kaingáng matriculados em escolas indígenas do Estado do Rio Grande do Sul, Brasil

The studys objective was to characterize the nutritional status of 3,254 Kaingang Indians in indigenous schools in Rio Grande do Sul State, Brazil. This was a school-based study. Weight (W), height (H), and waist circumference (WC) were measured according to World Health Organization guidelines (1995). Childrens nutritional status classification included H/A, W/A, and W/H according to the National Center for Health Statistics (WHO, 1995) and H/A, W/A, and body mass index/age (BMI/A) according to WHO (2006). Adolescents were classified for BMI/A (WHO, 1995 and 2006) and H/A (WHO, 2006). Adults were classified for BMI (WHO, 1995) and WC (WHO, 2003). Adolescents represented 56% of the sample, children 42.5%, adults 1.4%, and elderly 0.1%. Prevalence rates for stunting were 15.1% (WHO, 1983) and 15.5% (WHO, 2006) in children and 19.9% in adolescents. Prevalence rates for overweight were 11% (WHO, 1983) and 5.7% (WHO, 2006) in children, 6.7% in adolescents, and 79.2% in adults. 45.3% of adults were at increased risk of metabolic diseases. A nutritional transition was observed in the group, characterized by significant prevalence of stunting in children and adolescents and prominent overweight in all age groups.

Malnutrition among children under 60 months of age in two cities of the state of Acre, Brazil: prevalence and associated factors

OBJECTIVEnTo investigate the prevalence of malnutrition and associated factors in children under the age of 60 months in two cities in the state of Acre, Brazil.nnnMETHODSnA population-based cross-sectional study was carried out with 667 children living in urban areas of the cities of Acrelândia and Assis Brasil. The prevalence of malnutrition was calculated by height for age (stunting) and weight for height (W/H) indexes, which were calculated with a cutoff point of -2 for Z scores as determined by the 2006 World Health Organization child growth standards. A structured questionnaire was used to gather information on socioeconomic conditions, access to services and child care, birth weight and morbidity. Poisson regression was used to identify the factors associated with child malnutrition.nnnRESULTSnThe prevalence of height-for-age and weight-for-height deficit was 9.9% and 4.1%, respectively. The factors associated with height-for-age deficit were low household wealth index (prevalence ratio [PR]: 1.74; 95% confidence interval [95% CI]: 0.95-3.18); having an illiterate father or stepfather (PR: 1.82; 95% CI: 1.01-3.27); having 2 or more younger siblings (PR: 2.88; 95% CI: 1.45-5.72); biological mother not living in the home (PR: 2.63; 95% CI: 1.32-5.24); and exposure to open wastewater near the home environment (PR: 2.46; 95% CI: 1.51-4.00). Low weight at birth was the only factor associated with weight-for-height deficit (PR: 2.91; CI95%: 1.16-7.24).nnnCONCLUSIONSnIn the cities studied, malnutrition in children under 60 months is an important public health problem, and is associated with indicators of social inequality, access to health services and biological mother not living in the home.

Excess weight in preschoolers: prevalence and associated factors

OBJECTIVEnTo study the prevalence and factors associated with excess weight in children enrolled in public schools in the states of Rio Grande do Sul (RS) and Santa Catarina (SC).nnnMETHODSnThis was a cross-sectional study, carried out with children aged 4 to 6 years. The studied outcome was excess weight, defined by z-score > two standard deviations for body mass index (BMI)/age, compared with the World Health Organization (WHO) reference population of 2006/2007. Anthropometric measurements of body mass and height were measured in duplicate using standard techniques, in accordance with the WHO. Data were double entered using EPI-INFO software, release 6.04. Absolute and relative frequencies were calculated, as well as mean values and standard deviations. Associations between excess weight and other variables were assessed by using Poisson model with robust variance. STATA software release 12.0 was used (p < 0.05).nnnRESULTSnA total of 4,914 children were evaluated (2,578 in RS and 2,336 in SC). In RS, the incidence of excess weight was 14.4% (95% CI = 13.1% to 15.8%) and in SC, 7.5% (95% CI = 6.5% to 8.7%). The variables associated with excess weight were number of household members, maternal education, marital status, number of children, mothers age at birth of first child, gestational age, and birth weight.nnnCONCLUSIONnChildren enrolled in public preschools in RS had a two-fold higher excess weight prevalence than that identified in SC, demonstrating a significant difference in the magnitude of childhood obesity in two Brazilian states located in the same region.

Sistema de Vigilância Alimentar e Nutricional (SISVAN) em crianças do Rio Grande do Sul, Brasil: cobertura, estado nutricional e confiabilidade dos dados

This study aimed to evaluate: the coverage of the Food and Nutritional Surveillance System (SISVAN) in the State of Rio Grande do Sul, Brazil, and it Regional Health Offices in 2006; the nutritional status of children 0-10 years of age; and the reliability of data on nutritional status recorded in the system. A cross-sectional descriptive study was conducted with secondary data on 63,320 children. Coverage was defined as the proportion of children younger than 10 years covered by the Family Health Strategy in the States various municipalities (counties). Height-for-age (H/A) and body mass index for age (BMI/A) were classified according to World Health Organization (WHO) criteria. Agreement between the nutritional classifications recorded in the system and those calculated in this study was evaluated with the weighted kappa coefficient (at 5%). The systems coverage in the State of Rio Grande do Sul was 10.5%. Low height-for-age was found in 7.1% of children and overweight in 8.4%. Agreement between the classifications showed a kappa coefficient of 0.43. The systems coverage and agreement between classifications were both low, and the study showed the coexistence of high overweight and stunting rates in this age group.

Prevalence and distribution of risk factors for non-communicable chronic diseases among adults from Lages city, south of Brazil, 2007.

OBJECTIVEnTo describe prevalence and the distribution of risk factors to non-communicable chronic diseases among adults from Lages, Santa Catarina, Brazil.nnnMETHODSnProbabilistic sample of adult urban population, of both genders and aged from 20 to 59 years old was interviewed (n=2022). The sample process was made through conglomerates. It was applied a structured questionnaire with questions related to demographical, socio-economical, and behavior and self-referred diseases. In this study the following informations, related to the risk/protection factors for non-communicable chronic diseases, were used: gender, age, school background, body mass index, waist circumference, smoking, physical activity, pressure levels, self-referred mellitus diabetes and feeding characteristics. Prevalence for risk/protection factors for non-communicable chronic diseases, in the total population and according to gender and school background, was calculated.nnnRESULTSnThe studied population is prone to non-communicable chronic diseases, presenting substantial proportions of hypertension (33.78%), overweight individuals (33.46%), obesity (23.46%) and abdominal obesity (43.81%). In relation to feeding characteristics, women presented higher prevalence of behaviors considered as protection factors, relative to men. It was found less than 30.0% of physically inactive individuals and 45.9% of smokers or ex-smokers.nnnCONCLUSIONnDescriptive studies such as this could be the basis for the development of public policies specific to the adult population of Lages, in order to guide the organization, planning and quality improvement of health assistance services, aiming the reduction in the occurrence and in the impact of non-communicable chronic diseases.

Bioelectrical impedance values among indigenous children and adolescents in Rio Grande do Sul, Brazil

OBJECTIVEnTo describe the nutritional status of indigenous children and adolescents in Rio Grande do Sul, Brazil, through bioelectrical values, and to compare the nutritional classifications of the anthropometric method to those of the body composition method.nnnMETHODSnA cross-sectional survey was conducted of 3 204 subjects at 35 schools in the 12 Kaingang indigenous lands of Rio Grande do Sul, Brazil. Following World Health Organization recommendations, the weight and height (H) of each subject was measured twice and the body mass index/age (BMI/A) was classified. Body composition was assessed by Bioelectrical Impedance Vector Analysis (BIVA). Resistance (R) and reactance (Xc) were estimated using a bioelectrical impedance analyzer. Divergences between these two methods were performed on RXc graph.nnnRESULTSnOf the sample, 56.8% were adolescents and 50.6% were males. The mean values of phase angle were higher in adolescents, in males, and in individuals overweight by BMI/A. Mean values of R, Xc, R/H, and Xc/H were higher among children and among those with BMI/A < +2 z scores. Divergences in overweight classification were: male children, 94.6%; male adolescents, 77.1%; female children, 85.4%; and female adolescents, 94.8%.nnnCONCLUSIONSnThe mean values of bioelectrical measures observed among the Kaingang children and adolescent were similar to those found for different populations in other studies. For both gender and age groups, differences were observed between nutritional classifications by BMI/age and by BIVA. These results reinforce the importance of employing multiple techniques, such as anthropometry and BIVA, when conducting nutritional assessments of a population.

Waist circumference and waist circumference to height ratios of Kaingáng indigenous adolescents from the State of Rio Grande do Sul, Brazil

The aim of this study was to describe the distribution of waist circumference (WC) and WC to height (WCTH) values among Kaingáng indigenous adolescents in order to estimate the prevalence of high WCTH values and evaluate the correlation between WC and WCTH and body mass index (BMI)-for-age. A total of 1,803 indigenous adolescents were evaluated using a school-based cross-sectional study. WCTH values > 0.5 were considered high. Higher mean WC and WCTH values were observed for girls in all age categories. WCTH values > 0.5 were observed in 25.68% of the overall sample of adolescents. Mean WC and WCTH values were significantly higher for adolescents with BMI/age z-scores > 2 than for those with normal z-scores. The correlation coefficients of WC and WCTH for BMI/age were r = 0.68 and 0.76, respectively, for boys, and r = 0.79 and 0.80, respectively, for girls. This study highlights elevated mean WC and WCTH values and high prevalence of abdominal obesity among Kaingáng indigenous adolescents.

Management, operations, and menus in Kaingáng indigenous schools participating in the National School Nutrition Program in Rio Grande do Sul State, Brazil

Few studies have focused on the National School Nutrition Program (PNAE) in indigenous schools in Brazil. The current study describes the programs operations, management, and menus in 35 Kaingáng indigenous schools in Rio Grande do Sul State, Brazil. A cross-sectional study design was used to obtain information on the program through questionnaires submitted to the Regional Educational Offices (CRE) and to the schools. The menus suggested to the schools by the regional offices were obtained. There were no Centers for Indigenous Education in the regional offices. All the assistant principals were indigenous, 26 schools (74.6%) practiced local management of the meal program, and 34 (97.1%) reported purchasing food from local markets. Most cooks (63.9%) had temporary work contracts with the schools and 65.7% were indigenous. Low offerings of veges, milk and dairy products were observed in around 60% of the menus, and legumes and fruits low in around 80%. It points out the need for more studies about the indigenous PNAE and intends to support public policies in health, food and nutrition for the national indigenous school .Hay pocos estudios sobre el Programa Nacional de Alimentacion Escolar (PNAE) en las escuelas indigenas del pais. El objetivo es describir caracteristicas de la gestion, la operatividad y los menus del PNAE de 35 escuelas Kaingang de Rio Grande do Sul, Brasil. Se trata de un estudio transversal, donde las informaciones del PNAE se obtuvieron por medio de cuestionarios aplicados a las Coordinaciones Regionales de Educacion (CRE) y a las escuelas. Fueron obtenidos los menus sugeridos por las CRE a las escuelas. No existia el Centro para la Educacion Indigena en las CRE. Todos los sub-directores eran indigenas, 26 (74,7%) escuelas tenian gestion escolarizada y 34 escuelas hacian la compra de alimentos en mercados proximos. La mayoria de los cocineros (62,9%) tenia un contrato de trabajo temporal y un 65,7% eran indigenas. Se observo una baja oferta de verduras y leche y derivados en alrededor de 60% de los menus y de leguminosas y frutas en alrededor de un 80%. Se indica la necesidad de mas estudios sobre el PNAE indigena y se pretende subvencionar politicas publicas de salud, alimentacion y nutricion para el espacio escolar indigena nacional.

Características de la gestión, la operatividad y los menús del Programa Nacional de Alimentación Escolar en escuelas Kaingáng de Río Grande do Sul, Brasil

Few studies have focused on the National School Nutrition Program (PNAE) in indigenous schools in Brazil. The current study describes the programs operations, management, and menus in 35 Kaingáng indigenous schools in Rio Grande do Sul State, Brazil. A cross-sectional study design was used to obtain information on the program through questionnaires submitted to the Regional Educational Offices (CRE) and to the schools. The menus suggested to the schools by the regional offices were obtained. There were no Centers for Indigenous Education in the regional offices. All the assistant principals were indigenous, 26 schools (74.6%) practiced local management of the meal program, and 34 (97.1%) reported purchasing food from local markets. Most cooks (63.9%) had temporary work contracts with the schools and 65.7% were indigenous. Low offerings of veges, milk and dairy products were observed in around 60% of the menus, and legumes and fruits low in around 80%. It points out the need for more studies about the indigenous PNAE and intends to support public policies in health, food and nutrition for the national indigenous school .Hay pocos estudios sobre el Programa Nacional de Alimentacion Escolar (PNAE) en las escuelas indigenas del pais. El objetivo es describir caracteristicas de la gestion, la operatividad y los menus del PNAE de 35 escuelas Kaingang de Rio Grande do Sul, Brasil. Se trata de un estudio transversal, donde las informaciones del PNAE se obtuvieron por medio de cuestionarios aplicados a las Coordinaciones Regionales de Educacion (CRE) y a las escuelas. Fueron obtenidos los menus sugeridos por las CRE a las escuelas. No existia el Centro para la Educacion Indigena en las CRE. Todos los sub-directores eran indigenas, 26 (74,7%) escuelas tenian gestion escolarizada y 34 escuelas hacian la compra de alimentos en mercados proximos. La mayoria de los cocineros (62,9%) tenia un contrato de trabajo temporal y un 65,7% eran indigenas. Se observo una baja oferta de verduras y leche y derivados en alrededor de 60% de los menus y de leguminosas y frutas en alrededor de un 80%. Se indica la necesidad de mas estudios sobre el PNAE indigena y se pretende subvencionar politicas publicas de salud, alimentacion y nutricion para el espacio escolar indigena nacional.