Undernutrition and associated factors in a Portuguese older adult community / Subnutrição e fatores associados em uma comunidade de idosos Portugueses

OBJECTIVE: To evaluate the prevalence of undernutrition in older adults aged >75 years living in communities and to identify the main factors independently associated with undernutrition. METHODS: A cross-sectional study was conducted using a random sample of family physicians' medical records of 86 older adults aged >75 years living in the community studied. Their nutritional status was evaluated using the Mini Nutritional Assessment. RESULTS: A total of 10.5% of the elderly were undernourished and 41.9% were at undernutrition risk. According to the logistic regression multivariable model, the following characteristics: being widowed (OR=6.7; 95%CI=1.8-24.6); being institutionalized (OR=12.6; 95%CI=1.7-90.5); or having a negative self-perception of health (OR=15.0; 95%CI=3.3-69.1) were independently associated with a significant increase of undernutrition risk. CONCLUSION: The current study shows that undernutrition is highly prevalent in Portuguese older adults aged >75 years living in communities. The major factors independently associated with their undernutrition are being widowed and institutionalized and having negative self-perception of health. The results obtained show that undernutrition and its associated factors are very serious problems for older adults and a challenge in their health care. .

OBJETIVO: Determinar a prevalência de desnutrição em idosos com 75 ou mais anos de idade que vivem em comunidades e identificar os possíveis fatores independentes associados à desnutrição. MÉTODOS: Foi realizado um estudo transversal numa amostra aleatória dos registos de médicos de família de idosos com idades >75 anos. O estado nutricional foi avaliado por meio da Miniavaliação Nutricional. RESULTADOS: Estavam desnutridos 10,5% dos idosos e 41,9% apresentavam risco de desnutrição. De acordo com o modelo de regressão logística multivariável, ser viúvo (OR=6,7; IC95%=1,8-24,6), estar institucionalizado (OR=12,6; IC95%=1,7-90,5) ou ter uma autoperceção de saúde negativa (OR=15,0; IC95%=3,3-69,1) demonstraram estar associados a um aumento significativo do risco de desnutrição. CONCLUSÃO: Segundo o presente estudo, a desnutrição tem uma prevalência elevada em idosos portugueses com idades >75 anos que vivem em comunidades. Os principais fatores associados com a desnutrição são a viuvez, a institucionalização e a autopercepção de saúde negativa. Esses resultados demonstram que a desnutrição e os fatores a ela associados representam um grave problema para os idosos e um desafio para os cuidados de saúde. .

relationship of ethnicity, socio-economic factors and malnutrition in primary school children in north of Iran: a cross-sectional study

The main objective of this study was to assess the malnutrition and some socio-economic related factors based on three ethnic groups among primary school children in north of Iran in 2010. This cross-sectional study was carried out through multistage cluster random sampling on 5698 subjects [2505 Fars-native, 2154 Turkman, and 1039 Sistani] in 112 schools. Well-trained staffs completed the questionnaire and measured students' weight and height. Malnutrition estimated the Z-score less than -2SD for underweight, stunting and wasting were calculated using the cutoffs from WHO references. Generally, malnutrition was observed in 3.20%, 4.93% and 5.13% based on underweight, stunting and wasting respectively. It was more common in girls than in boys and in Sistani than in other ethnic groups. The correlation between malnutrition based on underweight and stunting and ethnicity was statistically significant [P=0.001]. Results of logistic regression analyses showed that the risk of malnutrition was in rural area 1.34 times more than urban area, in girls 1.17 times more than boys, in Sistani ethnic group 1.82 times more than Fars-native ethnic group, in low economic families 2.01 times more than high economic families. Underweight, stunting and wasting are the health problems in primary school children in north of Iran with a higher prevalence in girls, in rural areas, and in Sistani ethnic group

Ecosystem approach to promoting appropriate antibiotic use for children in indigenous communities in Ecuador / Enfoque ecosistémico de promoción del uso adecuado de antibióticos en niños de comunidades indígenas del Ecuador

Objetivo. Recopilar datos iniciales sobre las enfermedades infecciosas y el uso deantibióticos en dos comunidades indígenas andinas del Ecuador, con el objeto de determinar la factibilidad y la aceptabilidad de aplicar un enfoque ecosistémico para abordar los problemas asociados.Métodos. Mediante visitas a 65 hogares con niños menores de 5 años, se valoraron los factores de riesgo ambientales de las enfermedades infecciosas mediante una evaluación rápida. Se identificaron los conocimientos, las actitudes y las prácticas de los cuidadores relacionados con el uso de antibióticos por medio de una encuesta de conocimientos, prácticas y cobertura; el uso de antibióticos se dedujo a partir de lainspección de los botiquines; y se evaluó el estado general de salud de los 91 niños (incluido su estado de nutrición). Se organizó un taller para transmitir los resultadosy para diseñar una intervención de múltiples componentes basada en un marco ecosistémico de la salud. Resultados. Se encontraron numerosos factores de riesgo ambientales, especialmentelos relacionados con el agua y el saneamiento. El análisis del conocimiento, las actitudes y las prácticas reveló el uso de medicamentos tradicionales y occidentales, y profundas brechas de conocimiento. Había antibióticos en 60,9% de los hogares de Correuco y en 46,8% de La Posta; las tasas de desnutrición eran de 22,2% en Correuco y de 26,1% en La Posta; el mes anterior a la encuesta 26,7% de los niños de Correuco y 47,8% de los niños de La Posta habían tenido episodios de diarrea, con prescripción de antibióticos en 50,0% y 47,1% de los casos, respectivamente; y 28,9% de los niños de Correuco y 47,8% de los niños de La Posta habían tenido infecciones respiratorias agudas, con prescripción de antibióticos en 53,8% y 50,0% de los casos, respectivamente...

Objective. To collect baseline data on infectious diseases and antibiotic use in two Andean indigenous communities in Ecuador in order to determine the feasibility and acceptability of applying an ecosystem approach to address associated problems. Methods. In visits to 65 households with children under age 5 years, environmental risk factors for infectious diseases were evaluated through rapid assessment. Caregivers’knowledge, attitudes, and practices related to antibiotic use were determined through a knowledge, practices, and coverage survey; antibiotic use was gleaned from inspection of medicine chests; and overall health of the 91 children (including nutritional status) wasassessed. A workshop was held to share results and to craft a multicomponent intervention using an ecohealth framework. Results. Numerous environmental risk factors were identified, especially related to waterand sanitation. Knowledge, attitudes, and practices revealed use of traditional and Western medicines and serious knowledge gaps. Antibiotics were present in 60.9% of households inCorreuco and 46.8% in La Posta; malnutrition rates were 22.2% in Correuco and 26.1% in La Posta; diarrheic episodes were experienced in the previous month by 26.7% of children in Correuco and 47.8% in La Posta, with antibiotics prescribed in 50.0% and 47.1% of cases, respectively; and acute respiratory infections were incurred by 28.9% of children in Correuco and 47.8% in La Posta, with antibiotics prescribed in 53.8% and 50.0% of cases, respectively. Conclusions. Environmental, social, and cultural factors must be addressed to preventantibiotic resistance in addition to training health personnel. An ecosystem approach is wellsuited for this goal.

Bioelectrical impedance values among indigenous children and adolescents in Rio Grande do Sul, Brazil / Valores de impedancia bioeléctrica en niños y adolescentes indígenas en Rio Grande do Sul, Brasil

OBJECTIVE: To 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. METHODS: A 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. RESULTS: Of the sample, 56.8 percent were adolescents and 50.6 percent 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 percent; male adolescents, 77.1 percent; female children, 85.4 percent; and female adolescents, 94.8 percent. CONCLUSIONS: The 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.

OBJETIVO: Describir el estado nutricional de niños y adolescentes indígenas en Rio Grande do Sul, Brasil, mediante los valores de impedancia bioeléctrica y comparar las clasificaciones nutricionales del método antropométrico con las del método de composición corporal. MÉTODOS: Se llevó a cabo un estudio transversal en 3 204 participantes de 35 escuelas de los 12 territorios indígenas habitados por el pueblo kaingang (o guayaná) del estado de Rio Grande do Sul (Brasil). Según las recomendaciones de la Organización Mundial de la Salud, se midió el peso y la talla (T) de cada participante en dos oportunidades y se clasificó el índice de masa corporal (IMC) según la edad. La composición corporal se evaluó mediante análisis vectorial de impedancia bioeléctrica. La resistencia (R) y la reactancia (Xc) se calcularon con un analizador de impedancia bioeléctrica. Las divergencias entre estos dos métodos se analizaron con un gráfico RXc. RESULTADOS: De la muestra, 56,8 por ciento eran adolescentes y 50,6 por ciento eran varones. Los valores medios del ángulo de fase fueron mayores en los adolescentes, en los varones y en los individuos con sobrepeso según el IMC/edad. Los valores medios de R, Xc, R/T y Xc/T fueron mayores en los niños y en las personas con puntajes z de IMC/edad < +2. Se observaron las siguientes divergencias en la clasificación del sobrepeso: 94,6 por ciento para los niños, 77,1 por ciento para los adolescentes, 85,4 por ciento para las niñas y 94,8 por ciento para las adolescentes. CONCLUSIONES: Los valores medios de las medidas de impedancia bioeléctrica observados en niños y adolescentes kaingang fueron similares a los encontrados en diferentes poblaciones en otros estudios. Se observaron diferencias entre las clasificaciones nutricionales por IMC/edad y por análisis vectorial de impedancia bioeléctrica en ambos sexos y grupos etarios. Estos resultados destacan la importancia de emplear múltiples técnicas, como la antropometría y el análisis vectorial de impedancia bioeléctrica, cuando se efectúan evaluaciones nutricionales de una determinada población.

Estado nutricional y hábitos alimentarios en indígenas embera de Colombia / Nutritional status and food patterns in embera indigenous people from Colombia

Objective: To analyze food habits and nutritional status in indigenous people. Methodology: Study of prevalence of two communities with different patterns of food acquisition: dependency of rainforest resources (Tausig) and farmers with a degree of acculturation (Nusidó). The usual daily intake (24 hours recall and nutrient analysis) and nutritional status by anthropometry (height-age, height-weight andIMC) were studied. Ethnography of foods was undertaken. Results: the traditional dietary ideal (hunting, fishing and harvesting), is not sustainable due to the low productivity and the socio-economic conditions. The prevalence of deficiency in daily intake (Atausí> Nusidó) is high: energy 73,2 percent, roteins 36,6 percent, folic acid 34,2percent,calcium 93,0 percent, vitamin A 61,4 percent and zinc 75,7 percent. Chronic under-nutrition appeared in 68,9 percent (0-10 years), and short stature in 77,1 percent (10-19 years),overweight in 45 percent (adults). Both communities have greater under-nutrition than the national level and the community more dependent on forest (Atausí) has worse nutrition outcomes. Conclusion: Current dietary habits do not guarantee the coverage of food requirements and have influence on under nutrition, along with other factors that increase food insecurity of Embera indigenous compared to the general Colombian population.

Objetivo: analizarlos hábitos alimentarios y el estado nutricional en indígenas. Metodología: estudio de preval encías en dos comunidades con patrones diferenciales para conseguir alimentos: con recursos de selva (Atausí) y campesinos más aculturados (Nusidó). Se estudió la ingesta (por recordatorio de 24 horas) y el estado nutricional por antropometría (estatura-edad, peso-estatura e IMC). Se realizó etnografía sobre la alimentación. Resultados: el ideal dietario (caza, pesca y recolección) tradicional, es insostenible por la baja productividad y las condiciones socioeconómicas. La prevalencia de deficiencia en la ingesta diaria (Atausf>Nusidó) es alta: energía 73,2 por ciento, proteínas 36,6 por ciento, ácido fólico 34,2 por ciento, calcio 93 por ciento, vitamina A 61,4 por ciento y cinc 75,7 por ciento. La desnutrición crónica se presentó en el 68,9 por ciento (0-10 años), y talla baja en 77,1 por ciento (10-19 años), el sobrepeso en el 45 por ciento (adultos) y a otras edades se asoció con el patrón alimentario y la baja estatura. Ambas comunidades poseen mayor desnutrición que el nivel nacional y la más dependiente de la selva (Atausí) presenta mayores problemas nutricionales. Conclusión: los actuales hábitos alimentarios no cubren los requerimientos nutricionales e influyen en la desnutrición crónica encontrada, junto con otros factores que incrementan la inseguridad alimentaria en indígenas embera, en relación a la población general colombiana.

[Prevalence of malnutrition in children under 2 years old and its relationship with mothers background variables in Golestan province]

WHO estimated almost 27% of under 5 years children suffered from under-weight. This study aimed at assessing anthropometric indicators [under-weight, wasting and stunting] in 0-24 months children at Golestan province and the relationship with the background variables of households. This cross-sectional study was done on 1473 children [under 2 years old] whom resided in urban and rural area. Samplimg method was single stage cluster sampling. Constitutional variables in child's mothers, age, educational level, job and child's weight and height are measured by structured questionnair. The data were analysed with chi square, chi square for trend and logistic regression. The under-weight, wasting and stunting [mild to severe] prevalence were 21.4% [CI 95%: 19.3-23.6], 16.5% [CI 95%: 14.7-18.5] and 31.4% [CI 95%: 29.1-33.8] respectively. Maximum sex difference in the malnutrition indicators were seen stunting [boys 14.3%, girls 7.2%] [p<0.05]. The prevalence of under-weight, wasting and stunting are positively correlated with increasing the children's age. The under-weight and stunting linear trend was significant [p<0.05]. The risk of under-weight children were 2.8 fold in illitraced mothers relative to mothers with highschool diploma [CI 95% for adjusted odds ratio: 1.1-7]. The risk was 1.5 fold in stunting [CI 95% for adjusted odds ratio: 0.5-4.3]. The under-weight and wasting [moderate to severe] prevalence are increased relatively ANIS study [1998], but stunting prevalence are not increased. The mothers' illitracy and very low educational level can be suspected risk factors for under-weight and stunting