[Estimating the prevalence of height for age deficits based on the prevalence of weight for age deficits among Brazilian children]

Child Nutritional Status in the Changing Socioeconomic Region of the Northern Amazon, Brazil

The living conditions (i.e., socioeconomic, healthcare-related, nutritional, and environmental) to which children are exposed may influence their ability to reach their optimal growth potential. This review focuses on the relationship between the nutritional status of children under five years of age and social and environmental factors in Northern Brazil. Children living in this region have limited access to healthcare and face precarious socioeconomic and environmental conditions. This analysis was based on data from national health surveys, the consolidated food, nutrition surveillance system (SISVAN), and indicators of the DPSEEA (driving force, pressure, state, exposures, health effects, and actions) framework. The northern region has the worst living conditions in the country, and children under five years of age have significant height-for-age, weight-for-age, and weight-for-height deficits. Concomitantly, the prevalence of children who are overweight has increased significantly, although it remains lower than that in more developed Brazilian regions. Insufficient and/or inadequate dietary practices and early exposure to unfavorable living conditions are risk factors for nutritional deviations. Further advances in public health policies that consider regional characteristics, particularly in the north, where progress has been slower, are needed.

Malnutrition in the second year of life and psychosocial care: a case-control study in an urban area of Southeast Brazil

The present study aimed to identify and measure the relationship between malnutrition and psychosocial care in the second year of life. A case-control study compared 101 malnourished 12-23-month-old children (weight-for-age < 5th percentile, WHO/NCHS) to 200 well-nourished children (weight-for-age > 25th percentile) for exposure to various maternal behaviors related to psychosocial care. A psychosocial care score was constructed, based on the number of desirable maternal behaviors that were absent (the higher the score, the worse the quality of childcare). The association was modified by per capita family income. After adjusting for possible confounders, children from higher-income households showed no association between psychosocial care and malnutrition. For children from lower-income households, worse psychosocial care doubled the risk of malnutrition (OR = 7.26; 95%CI: 2.42-21.82) compared to low income alone (OR = 3.08; 95%CI: 1.28-7.42).

Recuperação nutricional de crianças desnutridas e em risco nutricional em programa de suplementação alimentar no Município de Mogi das Cruzes, São Paulo, Brasil

Este estudo teve como objetivo avaliar a recuperação nutricional de crianças inscritas no programa Incentivo ao Combate às Carências Nutricionais (ICCN) no Município de Mogi das Cruzes, São Paulo, Brasil. Foram estudadas 724 crianças de 6 a 24 meses inscritas no ICCN, no período de julho de 1999 a julho de 2001. Para avaliar o estado nutricional inicial, utilizaram-se os índices peso/idade, peso/comprimento e comprimento/idade, sendo considerada eutrófica crianças com escore z > -1; em risco > -2 e < -1, desnutrida moderada < -2 e > -3 e desnutrida grave < -3. A evolução nutricional foi avaliada por meio do comprimento/idade, e os resultados foram analisados segundo a variação média do escore z ao final de 12 meses. A condição nutricional encontrava-se melhor para todas as categorias após 12 meses, cujos melhores resultados foram obtidos pelas crianças que apresentaram deficiência nutricional mais intensa no início. Observaram-se ganhos em comprimento de 1,12, 0,82, 0,57 e 0,45 escore z para os desnutridos graves, moderados, em risco nutricional e eutróficos, respectivamente. A experiência do ICCN em Mogi das Cruzes resultou efetivamente na melhora nutricional dos beneficiários.

Consumo alimentar e estado nutricional de crianças atendidas em serviços públicos de saúde do município de Viçosa, Minas Gerais

OBJETIVO: Avaliar o consumo alimentar e o estado nutricional de 174 crianças, entre 12 e 35 meses de idade, atendidas na rede pública de saúde de Viçosa, Minas Gerais, Brasil. MÉTODOS: O consumo alimentar foi investigado por meio de dois inquéritos dietéticos (recordatório 24 horas e questionário de freqüência de consumo alimentar). O estado nutricional foi avaliado pelos índices antropométricos peso/idade, peso/estatura e estatura/idade, e associado ao consumo alimentar. Utilizou-se o Teste "t" Student para comparar médias, Teste chi2 para verificar associação entre variáveis e Odds Ratio para avaliar fatores de risco envolvidos na ocorrência de déficits nutricionais (p<0,05). RESULTADOS: A quantidade média de energia consumida excedeu a recomendação para ambos os sexos (p<0,0001). A ingestão habitual de energia e nutrientes foi estatisticamente significante e maior entre os meninos (p<0,0001), exceto para vitamina C. Prevalências de inadequação foram observadas para as vitaminas C e A (96,6% e 36,8%) e os minerais ferro e zinco (13,2% e 99,4%). Com relação ao estado nutricional, as prevalências de desnutrição encontradas foram 13,2% para o índice peso/idade, 13,8% para peso/estatura e 4,0% para estatura/idade. Encontrou-se associação positiva entre déficit nutricional e consumo alimentar inadequado. CONCLUSÃO: Estes resultados demonstram que o consumo alimentar inadequado tem contribuído para os déficits nutricionais do grupo pré-escolar. Recomenda-se a realização continuada de estudos de consumo alimentar nessa população, para conhecer sua prática alimentar.

Avaliação antropométrica e dietética de pré-escolares em três creches de Brasília, Distrito Federal

OBJETIVOS: traçar o perfil nutricional de crianças em creches de Brasília, DF, para subsidiar a formulação de estratégias de atendimento e controle dos problemas detectados. MÉTODOS: estudo transversal realizado de março a dezembro de 2001, constante de entrevista sobre a situação socioeconômica das famílias, avaliação antropométrica de 230 crianças (87,5% do total de 263) pelos critérios da OMS e padrão do NCHS e análise do consumo alimentar, por meio de pesagem direta, recordatório 24 horas e freqüência de consumo. RESULTADOS: observaram-se 6,1% de excesso de peso e 4,8% de déficit de estatura. A alimentação das creches apresentou adequada distribuição do percentual de energia proveniente dos macronutrientes. Houve diferença significante entre as faixas etárias, para energia, proteína, ferro, cálcio e vitamina C. O perfil de consumo habitual apresentou-se alto em produtos lácteos, arroz/macarrão, feijão, açúcar, pães e margarina; consumo médio de frutas, hortaliças, carne bovina, frango, ovos, biscoito; baixo consumo de peixes,vísceras sucos/chás e leite materno; além da introdução precoce de snack, refrigerante, fast food, enlatados/embutidos e doces/guloseimas. CONCLUSÕES: a ocorrência de excesso de peso acima do esperado na curva normal pode refletir o padrão alimentar, indicando a necessidade de intervenções de educação e saúde, para prevenir doenças crônicas não transmissíveis e melhorar a qualidade vida.

Fatores determinantes do crescimento infantil

Esta revisão enfoca os fatores que interferem no crescimento de crianças nos primeiros anos de vida. Foram utilizadas informações de artigos publicados em revistas científicas, teses e publicações de organizações internacionais. O crescimento infantil se constitui em um dos melhores indicadores de saúde da criança e o retardo estatural representa atualmente, a característica antropométrica mais representativa do quadro epidemiológico da desnutrição no Brasil. Ressaltando a importância do fator genético no crescimento, a revisão abrange com maior ênfase a atuação dos fatores extrínsecos, sabendo-se que o processo de crescimento resulta da interação entre a carga genética e os fatores do meio ambiente, os quais premitirão a maior ou menor expressão do potencial genético. Face a comprovada natureza multicausal do crescimento infantil, vários estudos têm sido desenvolvidos, buscando relacionar variáveis biológicas, socioeconômicas, maternas, ambientais, culturais, demográficas, nutricionais, entre outras, com a sua etiologia, seu desenvolvimento e sua manutenção. A revisão apresentada reforça o interesse em investigações sobre o crescimento na primeira infância que devem ser permanentes, devido, principalmente, às repercussões a longo prazo sobre a saúde infantil.

Longitudinal growth during infancy and childhood in children from shanghai: predictors and consequences of the age at onset of the childhood phase of growth

The age at onset of the childhood phase of growth, normally occurring between 6 and 12 mo, is recognized to be an important time during postnatal human development. The aims of this present work were to identify predictors for the age at onset of the childhood phase of growth. Furthermore, this work aimed to examine the consequences that this timing would have on the subsequent heights of 1720 Shanghai children. The mean age of the infants at onset of the childhood phase of growth was 11.2 mo in boys and 10.7 mo in girls. Compared with their Swedish counterparts, these means occurred 1.3 mo later in boys and 1.4 mo later in girls. Both age at onset of the childhood phase of growth and length at 6 mo of age significantly (p < 0.05) contributed to the attained height from 12 mo of age onward; 1-mo delay in the onset of the childhood phase of growth reduced height at 5 y of age by 0.4 cm in boys and 0.5 cm in girls. The age at onset of the childhood phase of growth was negatively associated (p < 0.001) with mid-parental height, although positively related (p < 0.001) to height at 6 mo of age. There was a distinct body mass index pattern of Chinese children between birth and 6 y of age in comparison with white values. There was a sharp increase in body mass index in Shanghainese during their first 6 mo of life, followed by a gradual decline up to 24 mo. In conclusion, the age at childhood onset is equally important when studying children from Shanghai as it is with their Swedish counterparts.

A Bayesian approach to estimate the prevalence of low height-for-age from the prevalence of low weight-for-age

Victora et al. (1998) proposed the use of low weight-for-age prevalence to estimate the prevalence of height-for-age deficit in Brazilian children. This procedure was justified by the need to simplify methods used in the context of community health programs. From the same perspective, the present article broadens this proposal by using a Bayesian approach (based on Markov Chain Monte Carlo (MCMC) methods) to deal with the imprecision resulting from Victora et al.'s model. In order to avoid invalid estimated prevalence values which can occur with the original linear model, truncation or a logit transformation of the prevalences are suggested. The Bayesian approach is illustrated using a community study as an example. Imprecision arising from methodological complexities in the community study design, such as multi-stage sampling and clustering, is easily handled within the Bayesian framework by introducing a hierarchical or multilevel model structure. Since growth deficit was also evaluated in the community study, the article may also serve to validate the procedure proposed by Victora et al.

[Understanding the low prevalence of weight-for-height deficit in lower-income Brazilian children: correlations among anthropometric values]

The sample for this study consisted of 386 children from six to 59 months of age. The objective was to study the association between wasting and abdominal circumference. Thirteen anthropometric measurements were taken: weight, height or length, crown-rump length, 4 circumferences, 4 skin fold thicknesses, and 2 breadths. Muscle, fat, and total upper arm areas and leg length were calculated. Indices of body proportionality were obtained by dividing the anthropometric variables by height. Height-for-age, weight-for-age, and weight-for-height deficits were 25.9%, 14.4%, and 3.5%, respectively. The smallest and lightest children were those with the highest abdominal circumferences divided by height. According to this study, abdominal circumference for Brazilian children without height-for-age deficit is, on average, 1.2 cm larger than for US children. Using this as a basis, the study calculated that prevalence of weight-for-height deficit would increase from 3.5% to 7.0% by increasing 2 cm in the abdominal circumference. The low prevalence of wasting and the high prevalence of stunting as indicated by several Brazilian studies could be explained partially by larger mean abdominal circumference values.

[Low prevalence of bodyweight-for-height deficit: comparison of stunned and no-stunned Brazilian children]

OBJECTIVES

The aim of this study was to investigate the relationship between abdominal circumference and weight-for-height in children. The average of 18 anthropometric and body proportionality indexes were compared among four groups of children: stunted and non-stunted Brazilians, Peruvians and North-Americans.

METHODS

There were studied 386 children aged 6-59 months living in a poor neighborhood in Pelotas, Brazil. Anthropometric measurements (weight, recumbent length or height, sitting height or crown-rump length; head, chest, upper arm and abdominal circumferences; triceps, biceps, subescapular and suprailiac skinfold thickness; biacromial and biiliac breadths) were obtained. Muscle, fat, total upper arm areas, leg length and body proportionality indexes were calculated.

RESULTS AND CONCLUSIONS

The study sample showed high levels of morbidity, low parental educational levels, poor access to health services and poor housing conditions. Stunted Brazilian children had lower means for most of the anthropometric measurements when compared to non-stunted Brazilians and North-American children. However, stunted children showed larger abdominal, head and thoracic circumference in relation to their stature than non-stunted children. The low prevalence of weight-for-height among the children of this study is not a result of excess of fat or muscle tissue, and may be partly explained by an increase in head and trunk dimensions (including abdominal circumference) relative to the child's stature.

[Stunting in Brazilian children: relationship with social-environmental conditions and maternal nutritional status]

The relationship between stunting in Brazilian children with their mother's nutritional status and their social-environmental situation was assessed in a probabilistic sample of the Brazilian population in 1989. Data from 12644 mother-son pairs were analyzed. Maternal nutritional status was classified based on the body mass index and stunting was identified in children with stature or length for age Z < or = -2 of the American growth reference curve (NCHS). Stunting was observed in 14.4% of the children (15.9% of boys and 12.9% of girls) There was an inverse relationship between the level of stunting and maternal education, income and house living conditions. Children of illiterate mothers showed more stunting (OR = 17.2) than children whose mothers had had at least 9 years of formal education. Stunting was more frequently observed in children whose mothers were underweight (OR = 2.5), and who were from the first quartile of family income in comparison to the fourth quartile (OR = 11.0) and lived in the poorest living conditions (OR = 7.6). These results suggest a positive association between stunted children and underweight mothers.