Dietas vegetarianas en niños, niñas y adolescentes: revisión bibliográfica / Vegetarian diets in children and adolescents: a literature review / Dietas vegetarianas em crianças e adolescentes: revisão bibliográfica

Las dietas vegetarianas han alcanzado en los últimos tiempos un gran protagonismo como modalidad de alimentación de nuestra población, incluyendo la población pediátrica. Constituyen una opción de alimentación válida si se planifican adecuadamente. Los padres que optan ofrecer a sus hijos este tipo de dietas deben conocer sus riesgos y potenciales beneficios. El médico del primer nivel de atención que asiste a niños, niñas y adolescentes (NNA) tiene una formación limitada sobre nutrición, sin embargo debe supervisar que la alimentación de esta población sea la adecuada. Es necesario conocer los alimentos que integran las dietas vegetarianas, así como las necesidades calóricas, de nutrientes críticos y suplementación de estos NNA según su edad. Realizar una adecuada planificación, es el gold standard para mantener un adecuado estado nutricional, crecimiento y desarrollo. El objetivo de esta publicación es revisar los principios de este tipo de dietas, sus beneficios y riesgos, y se establecen algunas consideraciones y recomendaciones prácticas para su abordaje desde la Atención Primaria de la Salud.

Vegetarian diets have recently reached a great protagonism as a way of feeding our population, including the pediatric population. They are a valid feeding option if properly planned. Parents who choose to offer their children this type of diet should know its risks and potential benefits. The primary care physician who assists children and adolescents (NNA) has limited training in nutrition; however, you must supervise that the diet of this population is adequate. It is necessary to know the foods that make up vegetarian diets, as well as the caloric needs, of critical nutrients and supplementation of these children according to their age. Carrying out adequate planning is the gold standard to maintain adequate nutritional, growth and development status. The objective of this publication is to review the principles of this type of diet, its benefits and risks, and establish some practical considerations and recommendations for its approach from Primary Health Care.

A alimentação vegetariana tem atingido recentemente um grande protagonismo como forma de alimentação de nossa população, inclusive a pediátrica. Ela é uma opção de alimentação válida se devidamente planejada. Os pais que optam por oferecer a seus filhos esse tipo de dieta devem estar conscientes de seus riscos e potenciais benefícios. O médico de atenção primária que assiste crianças e adolescentes (NNA) tem treinamento limitado em nutrição; no entanto, deve-se supervisionar se a alimentação dessa população é adequada. É necessário conhecer os alimentos que compõem a dieta vegetariana, bem como as necessidades calóricas, de nutrientes críticos e de suplementação dessas crianças de acordo com a sua idade. Realizar um planejamento adequado é fundamental para manter o estado nutricional, de crescimento e de desenvolvimento adequado. O objetivo deste paper é revisar os princípios desse tipo de dieta, seus benefícios e riscos, e estabelecer algumas considerações práticas e recomendações para sua abordagem desde a perspectiva da Atenção Primária à Saúde.

Recomendaciones nutricionales para el personal de salud y el personal esencial expuesto a la COVID-19 en Latinoamérica / Nutritional Recommendations for Healthcare and Essential Personnel Exposed to COVID-19 in Latin America

Estas recomendaciones se basan en la evidencia científica actual derivada de meta-análisis y revisiones sistemáticas sobre nutrición y prevención de infecciones respiratorias causadas por los virus SARS-CoV, MERS-CoV o influenza, similares en su estructura al SARS-CoV-2. Están dirigidas al personal en la primera línea de atención de salud y al personal que presta servicios esenciales a la comunidad, con alto riesgo de infección por la COVID-19. Estas personas usan equipo de protección personal, cumplen largos turnos laborales, en ocasiones bajo condiciones extremas, lo que puede llevar a descanso insuficiente, alto nivel de estrés, depresión, pobre calidad en la alimentación y deshidratación. Todos estos factores influyen negativamente en el sistema inmune y podrían conllevar un mayor riesgo de infección. Una ingesta adecuada de micronutrientes y otros compuestos bioactivos es esencial para el desempeño óptimo del sistema inmune. Existe evidencia moderada que avala la suplementación, en forma individual, con vitamina C (2 000 mg), vitamina D (1 000-2 000 UI) y zinc (≤ 40 mg) en la prevención de infecciones respiratorias en adultos. No se encontró evidencia suficiente para avalar la suplementación con vitamina A, niacina, ácido fólico, B12, omega 3, probióticos y polifenoles, aunque si se recomienda el consumo de alimentos ricos en estos nutrientes para apoyar al sistema inmune. Se recomienda al personal seguir la recomendación de consumir 5 porciones/día (400 g) de frutas y vegetales/hortalizas, mantenerse hidratado y limitar la cafeína. No hay evidencia del consumo de alimentos alcalinos para prevenir infecciones. Estas recomendaciones son particularmente importantes durante la pandemia(AU)

These recommendations are based on current scientific evidence obtained through meta-analysis and systematic reviews on nutrition and the prevention of respiratory infections related to SARS-CoV, MERS-CoV or influenza, similar in structure to SARS-CoV-2. They are aimed at primary health care personnel and to those who provide essential services to the community and are, consequently, at high risk of COVID-19 infection. These individuals wear personal protective equipment, work long shifts, sometimes under extreme conditions, which can lead to insufficient rest, high stress levels, depression, poor nutrition and dehydration. Together, these factors have a negative impact on the immune system and could result in an increased risk of infection. An adequate intake of micronutrients and other bioactive compounds is essential for optimal immune performance. There is moderate evidence supporting supplementation, individually, with vitamin C (2 000 mg), vitamin D (1 000-2 000 IU) and zinc (≤40 mg) for the prevention of respiratory infections in adults. Insufficient evidence was found to support supplementation with vitamin A, niacin, folic acid, B12, omega 3, probiotics and polyphenols; however, the consumption of foods rich in these nutrients is recommended to support immune function. It is recommended that workers follow the recommendation of consuming 400 g/day of fruits and vegetables, remain hydrated and limit caffeine. There is no scientific evidence supporting the consumption of alkaline foods to prevent infections. The aforementioned recommendations are particularly relevant during the pandemic(AU)

Are there differences in nutrient intake of Brazilian adults according to weight status? / Há diferenças na ingestão de nutrientes de adultos brasileiros segundo a condição de peso?

Abstract It was assessed the intake and prevalence of inadequate nutrient intake according to weight status among Brazilian adults from urban areas (n=16,198) evaluated in the Brazilian National Dietary Survey (NDS - 2008-2009), that obtained food records from two non-consecutive days. The prevalence of inadequate nutrient intake according to weight status was estimated based on Brazilian and international recommendations, in which usual intake was estimated applying the National Cancer Institute method. From 14 nutrients evaluated, six differed according to weight status in men, and only two among women. For men, the mean proportion of energy derived from lipids and saturated fat and mean intake of cholesterol, zinc, and vitamin B12 were greater among those with excess weight compared to those with normal weight; the inverse was observed for dietary fiber. Mean sodium intake was greater and proportion of energy from added sugar intake was lower among obese women compared to overweight ones. Strategies to encourage food consumption with high micronutrient density should be targeted to adult population regardless of their weight status.

Resumo Avaliou-se a ingestão e a prevalência de ingestão inadequada de nutrientes segundo a condição de peso em adultos brasileiros de áreas urbanas (n = 16.198) investigados no Inquérito Nacional de Alimentação (INA 2008-2009), que obteve o registro alimentar de dois dias não consecutivos. A prevalência de inadequação da ingestão de nutrientes foi estimada segundo a condição de peso e com base em recomendações brasileiras e internacionais, sendo a ingestão usual estimada pelo método do National Cancer Institute. Dos 14 nutrientes avaliados, seis diferiram segundo a condição de peso em homens e apenas dois entre as mulheres. Para os homens, a proporção média de energia proveniente dos lipídios e da gordura saturada e a ingestão média de colesterol, zinco e vitamina B12 eram mais elevadas para aqueles com excesso de peso do que entre os que tinham peso normal; o inverso foi observado para fibra dietética. A ingestão média de sódio foi maior e a proporção de ingestão de energia proveniente do açúcar de adição foi menor entre as mulheres obesas comparadas àquelas com sobrepeso. Estratégias para incentivar o consumo de alimentos com alta densidade de micronutrientes devem ser dirigidas à população adulta independentemente da sua condição de peso.

Avaliação nutricional e dietética de pré-escolares de Montes Claros, Minas Gerais / Dietary and nutritional assessment of pre-school children in Montes Claros, Minas Gerais / Evaluación dietética y nutricional de preescolar en Montes Claros, Minas Gerais

Objetivo: avaliar o estado nutricional e o consumo alimentar das principais fontes de macro e micronutrientes ingeridos por pré-escolares. Método: trata-se de estudo exploratório-descritivo, transversal e com abordagem quantitativa, composto por 269 crianças de ambos os sexos com idade entre 3 e 5 anos dos centros municipais de educação infantil de Montes Claros, Minas Gerais. Realizou-se inquérito alimentar e a avaliação antropométrica no ambiente escolar, mediante a autorização dos pais e/ou responsáveis. Resultados: verifica-se que a maioria das crianças se encontram eutróficas de acordo com todos os critérios avaliados. No inquérito alimentar, apenas o consumo de calorias totais e ferro encontrava-se adequado para a faixa etária. Entre os macronutrientes, o consumo de carboidratos, lipídeos e proteínas estava acima do valor recomendado. Dentre os micronutrientes, observa-se o consumo aumentado de zinco, sódio e vitamina C. No entanto, a ingestão de micronutrientes como o cálcio, magnésio, vitaminas A, D e E encontrava-se abaixo do recomendado, além das fibras. Conclusão: observa-se que o estado nutricional das crianças está adequado, porém há inadequação na ingestão alimentar. Este fator pode contribuir com o aumento no índice de sobrepeso e obesidade, e estar associado com as deficiências nutricionais.(AU)

Objective: to assess the nutritional status and food consumption of the main sources of macro and micronutrients ingested by preschool children. Method: This is an exploratory-descriptive, cross-sectional with a quantitative approach study, composed of 269 children of both sexes aged between 3 and 5 years of child municipal education centers in the city of Montes Claros, Minas Gerais. A food survey and anthropometric evaluation were carried out in the school environment, with the authorization of parents and/or guardians. Results: It appears that most of the children are eutrophic according to all the evaluated criteria. In the investigation of food, only the consumption of calories and iron was appropriate for the age range. Among the macronutrients, the consumption of carbohydrates, lipids and proteins was above the recommended value. Among the micronutrients, an increased consumption of zinc, sodium and vitamin C was observed. However, the intake of micronutrients such as calcium, magnesium, vitamins A, D and E was below the recommended levels, as well as the fibers consumption. Conclusion: It is observed that the nutritional status of children is appropriate, but there is inadequate food intake. This factor may contribute to the increase in overweight and obesity and may also be associated with nutritional deficiencies.(AU)

Objetivo: Valorar el estado nutricional y el consumo de alimentos de las principales fuentes de macro y micronutrientes son ingeridos por preescolar. Método: Este estudio es de tipo exploratorio-descriptivo, transversal de enfoque cuantitativo, compuesta por 269 niños de ambos sexos en edades comprendidas entre los 3 y los 5 años de centros municipales de educación infantil en la ciudad de Montes Claros, en el estado de Minas Gerais. Encuesta alimentaria y se realizó la evaluación antropométrica en el entorno de la escuela, previa autorización de los padres y/o tutores. Resultados: Parece que la mayoría de los niños se encuentra en el estatus nutricional de acuerdo con todos los criterios evaluados. En la investigación de alimentos, sólo el consumo de calorías y el hierro es el adecuado para el rango de edad. Entre los macronutrientes, el consumo de carbohidratos, lípidos y proteínas fue superior al valor recomendado. Entre los micronutrientes, se observó un incremento en el consumo de zinc, sodio y vitamina C. Sin embargo, la ingesta de micronutrientes como el calcio, el magnesio, vitaminas A, D y E, estaba por debajo de los niveles recomendados, así como las fibras. Conclusión: Se observa que el estado nutricional de los niños es adecuada, pero no hay una ingesta insuficiente de alimentos. Este factor puede contribuir al incremento del sobrepeso y la obesidad, y se asocia con deficiencias nutricionales.(AU)

Padrões alimentares e ingestão de nutrientes em idosos: análise com diferentes abordagens metodológicas / Eating patterns and nutrient intake for older people: analysis with different methodological approaches

Resumo Este estudo objetivou analisar os padrões alimentares e a ingestão de nutrientes em cada padrão alimentar de idosos. Trata-se de um estudo transversal, com idosos de Botucatu, São Paulo. Foram analisadas as médias de ingestão diária de nutrientes de indivíduos com alta adesão a padrões alimentares identificados por análise fatorial, comparando a ingestão através de análise de variância. Indivíduos com alta adesão ao padrão "Saudável" apresentaram a maior média de ingestão de retinol, vitamina A e vitamina E. Indivíduos com alta adesão ao padrão "Lanches e refeição de final de semana" apresentaram médias de consumo menores de vitamina B12, vitamina C, fósforo e retinol; e as maiores médias de consumo de ferro, manganês e magnésio. Indivíduos com alta adesão ao padrão "frutas" apresentaram as menores médias de ingestão de fibras. Indivíduos com alta adesão ao padrão "Light e integral" apresentaram as maiores médias de ingestão de vitamina C. Indivíduos com alta adesão ao padrão "Dieta branda" apresentaram menor consumo de proteína e mais de açúcar de adição. Indivíduos com alta adesão ao padrão "Tradicional" apresentaram médias elevadas de ingestão de nutrientes. Foi possível uma melhor caracterização do comportamento alimentar dos idosos que aderem a cada um desses padrões alimentares.

Abstract This study aims to analyse the eating patterns and nutrient intake in different eating patterns of elderly persons. This is a cross-sectional study with elderly people from Botucatu, São Paulo state, Brazil. The mean daily nutrient intake of individuals with high adherence to the eating patterns identified by factor analysis was analysed, comparing the intake by analysis of variance. Individuals with high adherence to the Healthy eating pattern had the highest mean intake of retinol, vitamin A and vitamin E. Individuals with high adherence to the eating pattern Snacks and weekend meal presented lower means of vitamin B12, vitamin C, phosphorus, and retinol intake and the highest means of iron, manganese and magnesium intake. Individuals with high adherence to Fruits had the lowest mean fibre intake. Individuals with high adherence to Light and whole foods had the highest means of vitamin C intake. Individuals with high adherence to Soft diet showed lower protein intake and increased added sugar intake. Individuals with high adherence to the Traditional eating pattern presented high means of nutrient intake. In general, a better characterization of the eating behaviour of elderly people who adhere to each of these eating patterns was possible.

Barreras y facilitadores a la suplementación con micronutrientes en polvo. Percepciones maternas y dinámica de los servicios de salud / Barriers and Facilitators of Micronutrient Powder Supplementation: Maternal Perceptions and Dynamics of Health Services

RESUMEN Objetivos Explorar las barreras y facilitadores para la suplementación con micronutrientes en polvo (MNP) en madres de niños de 6 a 35 meses de edad de Tacna, Loreto, Puno y Lima. Materiales y métodos Estudio cualitativo, exploratorio con enfoque de teoría fundamentada, realizado en Lima, Tacna, Loreto y Puno en el año 2014. Se aplicaron entrevistas a profundidad a madres de niños menores de tres años y observación en establecimientos de salud (ES) para explorar las barreras y facilitadores a la suplementación con MNP. Resultados Se encontró como barreras: a nivel de sistema de salud, a las dificultades para acceder al ES, los rumores negativos al suplemento en la sala de espera y el maltrato del personal de salud; a nivel del producto (MNP), la falta de conocimiento sobre el suplemento, el sabor y los efectos secundarios y a nivel de la madre, aparecen barreras como la falta de tiempo, el olvido, las dificultades en la preparación del MNP y la oposición al uso del suplemento por parte del esposo. Los principales facilitadores fueron: recibir información del personal de salud sobre la mejora del niño, la percepción de la madre de que el niño mejora y testimonios positivos sobre el MNP de familiares o vecinas. Conclusiones Existen barreras relacionadas al sistema de salud, al producto (MNP) y al comportamiento de niños, madres y familia / comunidad, que son necesarios abordar con estrategias que permitan superar estas dificultades, ya que impiden que los niños consuman diariamente, en una preparación adecuada el suplemento de MNP.

ABSTRACT Objectives To explore the barriers and facilitators of micronutrient powder (MNP) supplementation to mothers of children aged 6 to 35 months living in the Peruvian cities of Tacna, Loreto, Puno, and Lima. Materials and methods This qualitative exploratory study with a grounded theory approach was conducted in the Peruvian cities of Lima, Tacna, Loreto, and Puno in 2014. In-depth interviews were conducted with mothers of children younger than 3 years, and observations in health care facilities (HCFs) were made to determine the barriers and facilitators of MNP supplementation. Results The barriers identified at the health care level were limited access to HCFs, negative rumors regarding the MNP in the clinics, and poor care by health personnel. The barrier at the product (MNP) level was the lack of knowledge about the supplement, including taste and side effects. The barrier at the maternal level was lack of time, neglect, difficulties in preparing the MNP, and opposition to the use of the MNP by the husband. The main facilitators were receiving information from health personnel regarding child improvement, mother's perception of child's improvement, and positive testimonies about the effectiveness of the MNP from relatives and neighbors. Conclusions Barriers regarding MNP use at the health care system level and those associated with the behavior mothers and family/community, which prevent children from consuming the MNP supplement daily, need to be addressed through the development of strategies. Strategies must be developed to overcome the barriers related to the health care system, the MNP, and the behavior of children, mothers, and family/community because these barriers prevent children from consuming the MNP daily.

Adherencia a multimicronutrientes y factores asociados en niños de 6 a 35 meses de sitios centinela, Ministerio de Salud, Perú / Adherence to multiple micronutrient powders and associated factors in children aged 6 to 35 months treated in sentinel health facilities, Ministry of Health of Peru

RESUMEN: Introducción: La anemia en el niño es un problema de salud pública, las estrategias actuales incluyen el tratamiento y suplementación con hierro, pero se desconoce su nivel de adherencia o cumplimiento. Objetivo: Considerar la adherencia a los multimicronutrientes y los factores asociados. Métodos: Estudio epidemiológico de vigilancia activa por sitios centinela en 2.024 niños entre los 6 hasta los 35 meses atendidos en establecimientos de salud del Ministerio de Salud del Perú, entre octubre a diciembre de 2014. Se realizaron visitas domiciliarias, en las cuales se aplicaron el conteo de multimicronutrientes, que determinó la adherencia al consumo ≥ 90% de sobres, y un formulario sobre los factores asociados (conocimiento sobre anemia, alimentos ricos en hierro, efectos secundarios, esquema de dosis, medicamentos consumidos y motivación). Se emplearon estadísticas descriptivas, el test del χ², Odds Ratio con IC95% y la regresión logística binaria u OR ajustado (ORa). Resultados: 79,1% tenían entre 6 a 23 meses, 75,9% recibieron multimicronutrientes y la adherencia fue del 24,4% (IC95% 22,3 - 26,6). Los factores: seguir con la suplementación (OR = 3,5; IC95% 1,7 - 7,5); no tener náuseas (OR = 3,0; IC95% 2,0 - 4,3); no tomar antibióticos (OR = 2,5; IC95% 1,7 - 3,6) e intenciones de seguir con el tratamiento (OR = 2,3; IC95% 1,3 - 4,1) se asociaron a la adherencia. El análisis multivariado asoció pensar que debe continuar con el tratamiento (ORa = 2,6; IC95% 1,1 - 6,1); si presentó algún efecto secundario, no suprimió el tratamiento (ORa = 2,5; IC95% 1,4 - 4,3), el niño no tomó antibióticos (ORa = 2,0; IC95% 1,1 - 3,4) y creencia que anemia no solo se cura con medicamentos (ORa = 1,6; IC95% 1,0 - 2,6). Conclusión: Hubo una baja prevalencia de adherencia para un punto de corte exigente (≥ 90% sobres de multimicronutrientes consumidos) y los factores asociados están relacionados con ausencia de infecciones, efectos secundarios y creencias de la madre.

ABSTRACT: Introduction: Anemia in children is a public health issue, and the current strategies include treatment and iron supplementation, but their level of adherence or compliance is unknown. Objective: To consider the adherence to multiple micronutrient powders and the associated factors. Methods: Epidemiological study of active surveillance through sentinel facilities in 2,024 children aged 6 to 35 months treated in health facilities of the Ministry of Health of Peru, from October to December 2014. Household visits were conducted in which counting of multiple micronutrient powders was applied and determined an adherence of consumption ≥ 90% envelopes, besides a form on the associated factors (anemia knowledge, iron-rich food, side effects, dosage regimen, drugs used, and motivation) was applied. Descriptive statistics, χ² test, Odds Ratio with a 95% confidence interval (CI), and binary logistic regression or adjusted Odds Ratio (aOR) were used. Results: Of all, 79.1% participants were aged 6 to 23 months; 75.9% received multiple micronutrient powders; and the adherence was equivalent to 24.4% (95%CI 22.3 - 26.6). The factors: continue supplementation (OR = 3.5; 95%CI 1.7 - 7.5); no nausea (OR = 3.0; 95%CI 2.0 - 4.3); no use of antibiotics (OR = 2.5; 95%CI 1.7 - 3.6); and intention to continue treatment (OR = 2.3; 95%CI 1.3 - 4.1) were associated with adherence. The variables: thought of continuing treatment (aOR = 2.6; 95%CI 1.1 - 6.1); presence of side effects, but no discontinuation of the treatment (aOR = 2.5; 95%CI 1.4 - 4.3); no use of antibiotics (aOR = 2.0; 95%CI 1.1 - 3.4); and belief that not only drugs cure anemia (aOR = 1.6; 95%CI 1.0 - 2.6) were associated in the multivariate analysis. Conclusion: There was a low prevalence of adherence to a demanding cut-off point (≥ 90% of envelopes of multiple micronutrient powders), and the associated factors are associated with absence of infections, side effects, and mother's beliefs.

La deficiencia de zinc: un problema global que afecta la salud y el desarrollo cognitivo / Zinc deficiency: a global problem that affect the health and cognitive development

La deficiencia de zinc afecta aproximadamente un tercio de la población mundial, principalmente en los países en vía de desarrollo, en las áreas rurales y en las comunidades más pobres, donde constituye un importante factor de riesgo asociado a enfermedad. En este trabajo se realiza una revisión de los avances científicos que han permitido conocer el papel fundamental del zinc en el control de la neurogénesis, el funcionamiento del cerebro y el desarrollo cognitivo. Con el fin de generar en los profesionales de salud, interés por la investigación de los efectos de la deficiencia de zinc en el desarrollo neurológico y cognitivo y su impacto negativo en el desarrollo cultural, social y económico de los pueblos(AU)

The zinc deficiency affects approximately a third of the world population, principally in the developing countries, the rural areas and in the poorest communities, where this micronutrient deficiency is one of the most prevalent risk factor for nutrientrelated diseases. This paper compiles scientific advances about the key role of the essential trace element zinc in the neurogenesis control, brain function and cognitive development. The aim of this work is to generate in health professionals, interest about the zinc deficiency effects in neuro-intellectual development and its negative impact in the cultural, economic and social development of the countries(AU)

Micronutrient supplementation adherence and influence on the prevalences of anemia and iron, zinc and vitamin A deficiencies in preemies with a corrected age of six months

OBJECTIVE: To analyze adherence to the recommended iron, zinc and multivitamin supplementation guidelines for preemies, the factors associated with this adherence, and the influence of adherence on the occurrence of anemia and iron, zinc and vitamin A deficiencies. METHODS: This prospective cohort study followed 58 preemies born in 2014 until they reached six months corrected age. The preemies were followed at a referral secondary health service and represented 63.7% of the preterm infants born that year. Outcomes of interest included high or low adherence to iron, zinc and multivitamin supplementation guidelines; prevalence of anemia; and prevalences of iron, zinc, and vitamin A deficiencies. The prevalence ratios were calculated by Poisson regression. RESULTS: Thirty-eight (65.5%) preemies presented high adherence to micronutrient supplementation guidelines. At six months of corrected age, no preemie had vitamin A deficiency. The prevalences of anemia, iron deficiency and zinc deficiency were higher in the low-adherence group but also concerning in the high-adherence group. Preemies with low adherence to micronutrient supplementation guidelines were 2.5 times more likely to develop anemia and 3.1 times more likely to develop zinc deficiency. Low maternal education level increased the likelihood of nonadherence to all three supplements by 2.2 times. CONCLUSIONS: Low maternal education level was independently associated with low adherence to iron, zinc and vitamin A supplementation guidelines in preemies, which impacted the prevalences of anemia and iron and zinc deficiencies at six months of corrected age.

Prácticas, costumbres y complicaciones en la administración de Multimicronutrientes en niños menos de tres años / Practices, customs and complications in the administration of multimicronutrient in children under three years

Objetivo: Evaluar las prácticas y costumbres en la administración de suplementos de multimicronutrientes en niños menores de 3 años en los hogares del ámbito del Centro de Salud Surquillo en el periodo de septiembre-octubre 2014. Material y métodos: Estudio descriptivo, transversal, retrospectivo, se utilizó una ficha de visita domiciliaria entregada por el MINSA. Resultados: El 100% de personas encuestadas respondieron que le administra los suplementos juntos con las comidas, 96% respondieron que es de uso exclusivo del niño, et 67% lo guarda adecuadamente, un 32% presentaron complicaciones que fueron estreñimiento, mal sabor y heces negras y un 67% han continuado administrándolo a pesar de las complicaciones. Conclusiones: Se puede apreciar que la mayoría de las personas del ámbito del C.S. Surquillo administran los suplementos de multimicronutrientes de acuerdo a las indicaciones suministradas por el personal de salud, sin embargo, hay una proporción que no han sido bien informadas al respecto o se resisten a abandonar sus costumbres.

Objectives: To evaluate the practices and customs in multimicronutrient supplementation in children under 3 years in the field of home of the Health Center Surquillo in the period september-october 20 14. Material and Methods: A descriptive, cross- sectional study retrospective, a form of home visits provided by the Ministry of Health was used. Results: 100% of respondents replied that supplements administered together with meals, 96% responded that it is exclusively used by the child, 67% saves properly, 32% had complications that were constipation, bad taste and stools black and 67% have continued administering despite complications. Conclusions: It can be seen that most people in the field of Health Center Surquillo multimicronutrient supplements administered according to the information provided by health workers, however, there is a proportion that has not been informed about or resist to abandon their customs.

Comparison of feeding habits and physical activity between eutrophic and overweight/obese children and adolescents: a cross sectional study / Comparação de hábitos alimentares e atividade física entre crianças e adolescentes eutróficos e portadores de sobrepeso/ obesidade: estudo transversal.

Summary Objective: it is broadly accepted, but little explored, that obese children practice less physical activity and eat more. This study has the objective of comparing feeding habits and physical activity between eutrophic and overweight/obese children and adolescents. Methods: 126 students with ages ranging from 6 to 18 years were evaluated. Eutrophic and overweight/obese students were compared according to calorie intake, macro and micronutrients, prevalence of physical inactivity and ingestion of micronutrients. Results: differences were observed in the amount of calories ingested per unit of BMI (eutrophic, 97.6, and overweight/obese, 70.5, p=0.0061), as well as in calcium intake (eutrophic, 546.2, and overweight/obese, 440.7, p=0.0366). Both groups presented sedentarism, as well as a high prevalence of micronutrient intake deficiency, especially calcium and vitamins A, E, and C, but with no difference observed between eutrophic and overweight/obese subjects. Conclusion: energy and macronutrients consumption, as well as physical activity, were similar between eutrophic and overweight/obese. Calcium intake was lower in the overweight/obese group and the ingestion of vitamin C was lower in the eutrophic group. These results demonstrate the importance of considering all etiologic factors that may lead to obesity, so that new strategies for prevention and control may be added to traditional interventions. .

Resumo Objetivos: considera-se, em geral, que crianças obesas praticam menos atividade física e consomem mais alimentos, mas esse aspecto tem sido muito pouco explorado. O presente estudo objetivou comparar a alimentação e o padrão de atividade física de crianças e adolescentes eutróficos e portadores de sobrepeso/obesidade. Métodos: 126 estudantes com idades entre 6 e 18 anos foram avaliados por meio de antropometria, registro alimentar e grau de atividade física. Eutróficos e portadores de sobrepeso/obesidade foram comparados de acordo com a ingestão de calorias, macro e micronutrientes e de acordo com as prevalências de inatividade física e de ingestão deficiente de micronutrientes. Resultados: observou-se diferença na quantidade de calorias ingeridas por unidade de IMC (eutróficos 97,6 [92,2 - 112,5] e sobrepeso/obesidade 70,5 [72,2 - 90,8], p = 0,0061) e na ingestão de cálcio (eutróficos 546,2 [517,2 - 673,9] e sobrepeso/obesidade 440,7 [404,4 - 523,4], p = 0,0366). Os dois grupos apresentaram sedentarismo e elevada prevalência de deficiência na ingestão de micronutrientes, especialmente cálcio e vitaminas A, E e C, mas sem diferença entre eutróficos e portadores de sobrepeso/obesidade. Conclusões: consumo de energia e de macronutrientes e grau de atividade física foram semelhantes, quando comparados indivíduos eutróficos com portadores de sobrepeso/obesidade. O consumo de cálcio foi menor no grupo sobrepeso/obesidade e o de vitamina C menor no grupo eutróficos. Esses resultados mostram a importância de considerar todos os fatores etiológicos que podem levar à obesidade a fim de que possam associar-se novas estratégias de prevenção e controle às intervenções tradicionais. .

Comparación del consumo de vitaminas y minerales en adultos mayores chilenos según estado nutricional / Nutrient intake of Chilean older people according to body mass index

Background: An adequate consumption of micro and macro nutrients is essential to maintain an adequate health among older people. Aim: To compare the consumption of micro- and macronutrients in older people from three Chilean cities, according to their nutritional status. Material and Methods: Body mass index (BMI) was assessed and a food consumption tendency survey was applied to 976 non-disabled older people, living in the community. Thinness was defined as a BMI < 23 kg/m². Results: Twenty percent of females and 17% of males had a BMI < 23 kg/m². Participants with a higher BMI had a greater intake of micro- and macronutrients. In females, micronutrient intake was adequate among those with higher BMI, although mean intake of calcium and vitamin B-12 were below recommendations. In males, iron, zinc, calcium, magnesium, vitamin A, vitamin B6, vitamin B12 and pantothenic acid intake were below recommendation. Conclusions: Thin older adults, regardless of sex, had a lower intake of calories and micro- and macronutrients. Additionally, an overall low consumption of zinc, calcium, magnesium and vitamin B12 was detected.

Healthy eating index of elderly: description and association with energy, macronutrients and micronutrients intake

The purpose of this study was to define the Healthy Eating Index (HEI) of the elderly of Southern Brazil and its association with energy, macronutrients and micronutrients intake. A cross-sectional study was conducted with 186 elderly aged 60 and older of the Geriatric Service of São Lucas Hospital, Porto Alegre , Brazil. Dietary data were collected by two 24-hour recalls, and diet quality was assessed by HEI adapted to the Brazilian population. The HEI total score was divided into three categories: inadequate diet (below 51 points), diet needs improvement (between 51 and 80 points), and healthy diet (over 80 points). The results showed that the mean HEI score was 58.8±10.5 points (ranging from 31.4 to 79.8). Most elderly (74.2%) showed a diet that needed modification and no elderly individual had a healthy diet. The quality of the diet was associated with greater intake of carbohydrates, and lower intake of total lipids, saturated fatty acids, cholesterol, and sodium. Consumption of vitamins C and D and calcium was shown to be positively correlated with the quality of the diet. Less than 1.1% of the elderly consumed a varied diet. The findings suggest that the diet of the majority of the elderly needs improvement, reinforcing the importance of care in relation to adequate nutrition in this population, and can help in guiding the activities and programs of nutritional education and public policies that stimulate increasingly healthy eating.

Índice de alimentação saudável de idosos: descrição e associação com ingestão de energia, macronutrientes e micronutrientes. O objetivo deste estudo foi descrever o Índice de Alimentação Saudável (IAS) de idosos do Sul do Brasil e sua associação com a ingestão de energia, macronutrientes e micronutrientes. Foi realizado um estudo transversal com 186 idosos com 60 anos ou mais, do Serviço de Geriatria do Hospital São Lucas, Porto Alegre, Brasil. Os dados relativos ao consumo alimentar foram coletados através de dois recordatórios de 24 horas, e a qualidade da dieta foi avaliada pelo IAS, adaptado à população brasileira e o escore total foi dividido em três categorias: dieta inadequada (abaixo de 51 pontos), dieta necessitando de adequação (entre 51 e 80 pontos), e dieta saudável (mais de 80 pontos). Os resultados mostraram que a média do IAS foi 58,8±10,5 pontos (variando de 31,4 a 79,8 pontos). A maioria dos idosos (74,2%) apresentou uma dieta que necessitava de modificação e nenhum idoso tinha uma dieta saudável. A qualidade da dieta foi associada com maior ingestão de carboidrato e baixa ingestão de gordura total, gordura saturada, colesterol e sódio. O consumo de vitaminas C e D e cálcio mostrou-se positivamente correlacionado com a qualidade da dieta. Menos de 1,1% dos idosos consumia uma dieta variada. Os resultados sugerem que a dieta da maioria dos idosos necessita de adequação, reforçando a importância dos cuidados em relação à nutrição adequada desta população e podem auxiliar na orientação de atividades e programas de educação nutricional e políticas públicas que estimulem a prática de uma alimentação mais saudável.

Análisis de la politica pública de fortificación de alimentos con hierro en Perú en el periodo 2000 - 2012 / Analysis of public policy of food fortification with iron in Peru in the period 2000 - 2012

El gobierno peruano desde 1996 ha comenzado a reglamentar la fortificación dealimentos con hierro como una estrategia para disminuir la prevalencia de anemia en la población peruana, en el año 2004 y 2006, en forma obligatoria se incrementa losniveles de fortificación con hierro en la harina de trigo, el presente estudio tiene como Objetivo Realizar un análisis de los alimentos consumidos por la población peruana para identificar posibles vehículos de fortificación con hierro, asi como las barreras y los facilitadores de la política pública Metodología.- Se analizó cuantitativamente dos encuestas de consumo de alimentos, se realizaron entrevistas a actores de la política publica para identificar las barreras y facilitadores de la política pública y se hizo una revisión bibliográfica de los potensiales alimentos vehículos de fortificación con hierro. Resultados Del análisis de las dos encuestas de consumo se encontró alimentos a ser considerados posibles vehículos de fortificación con hierro: el agua (como bebida eingrediente de preparaciones), la sal, el arroz, el azúcar y las leches (evaporada y frescaentera), las barreras mas mencionadas por los actores que están involucrados en el proceso estan relacionadas a costos de la fortificación de alimentos y como facilitadores al conocimiento acerca de anemia y deficiencia de micronutrientes (especialmente enhierro). Conclusiones.- Hay alimentos identificados como vehículos potenciales de la fortificación con hierro, que han demostrado un efecto positivo y es necesario generar compromisos entre los actores involucrados en la política pública de la fortificación de alimentos para avanzar en el tema...

The Peruvian government since 1996 has begun to regulate iron fortification as astrategy to reduce the prevalence of anemia in the Peruvian population, in 2004 and2006, mandatory fortification levels of iron increases in flour wheat. ObjectivePerformed an analysis of the food by the Peruvian population to identify possiblevehicles of iron fortification, as well as identify the barriers and enhancer of publicpolicy Methodology -. Two surveys of food consumption are quantitatively analyzed,interviews with actors of public policy were conducted to identify barriers and enhancerof public policy and scientific literature was reviewed about potentials iron foodfortification. Results The analysis of two surveys foods showed potential vehicles ofiron fortification: water (beverage and ingredient preparations), salt, rice, sugar and milk(evaporated and whole fresh), the most mentioned barrier is the fortification costs andthe most enhancer is the knowledge about anemia and deficiency of micronutrients(particularly focus in iron). Conclusions -. There are foods identified potential vehiclesof iron fortification, that have showned a positive effects and it is necessary to generatecompromises between the actors involved in the public policy of food fortification toadvance the issue...

Diet micronutrient adequacy of women after 1 year of gastric bypass / Adequação de micronutrientes da dieta de mulheres após um ano de bypass gástrico

BACKGROUND: The more effective treatment for severe obesity is bariatric surgery. Gastric bypass is a surgical technique used worldwide; however, as well as other techniques; it has postoperative risks, including nutrient deficiency. AIM: To determine the amounts of dietary iron, calcium, vitamin D and vitamin B12 ingested by patients of a public hospital one year after gastric bypass, and compare with the recommendations of the Recommended Dietary Allowances. METHODS: This was a transverse descriptive study and the sample consisted of 36 women, with at least one year of gastric bypass. Data collected included sociodemographic, anthropometric and diet variables. Dietetic information was collected through a validated food frequency questionnaire. Ingestion of iron, calcium, vitamin D and vitamina B12 was evaluated in comparison with the Recommended Dietary Allowances, as well as correlation of micronutrient ingestion with time of surgery. RESULTS: There was inadequate consumption of iron, calcium and vitamin D. The vitamin B12 intake was considered adequate. There was statistically significant positive correlation between the time of surgery and the ingestion of iron, vitamin B12 and vitamin D. CONCLUSION: The intake of iron, calcium and vitamin D of women one year after gastric bypass was inadequate, emphasizing the importance of multiprofessional monitoring postoperatively to prevent nutrient deficiencies. .

RACIONAL: O tratamento considerado mais eficiente para o grau severo da obesidade é a cirurgia bariátrica. O bypass gástrico é a técnica cirúrgica mais utilizada no mundo; porém, assim como as outras técnicas, oferece riscos no pós-operatório, incluindo a deficiência de nutrientes. OBJETIVO: Determinar as quantidades de ferro, cálcio, vitamina D e vitamina B12 dietéticas ingeridas por pacientes atendidos em um hospital público após um ano de bypass gástrico, e comparar com as recomendações da Recommended Dietary Allowances. MÉTODOS: Estudo transversal descritivo com amostra composta por 36 mulheres com mais de um ano de bypass gástrico. Foram coletados dados sociodemográficos, antropométricos e alimentares. Estes últimos foram realizados por meio de Questionário de Frequência Alimentar validado. Foi feita comparação da ingestão de ferro, cálcio, vitamina D e vitamina B12 com as Recommended Dietary Allowances, assim como a correlação do tempo de pós-operatório com o consumo desses micronutrientes. RESULTADOS: Houve inadequação no consumo de ferro, cálcio e vitamina D. A ingestão de vitamina B12 mostrou-se adequada. Foi encontrada correlação positiva estatisticamente significativa entre o tempo de operação e o consumo de ferro, vitamina B12 e vitamina D. CONCLUSÃO: A ingestão de ferro, cálcio e vitamina D de mulheres um ano após o bypass gástrico foi inadequada, enfatizando a importância do acompanhamento multiprofissional no pós-operatório para prevenção de carências de nutrientes. .

Administración de ácido fólico y otros micronutrientes en mujeres embarazadas de Colombia / Administration of folic acid and other micronutrients to pregnant women in Colombia

OBJETIVO: Caracterizar el consumo de ácido fólico (AF) y otros micronutrientes en forma de medicamentos en un grupo de mujeres gestantes colombianas. MÉTODOS: Estudio observacional descriptivo. Se obtuvo información por medio de entrevistas a gestantes y de sus registros de historia clínica de control prenatal y/o atención del parto en cuatro ciudades de Colombia. La muestra fue de 1 637 mujeres atendidas en 15 instituciones. RESULTADOS: A 1 315 gestantes (80,3%) les recomendaron consumir AF, con prescripción realizada por médico al 84% de ellas; 90,3% adhirieron al tratamiento. A 85,6% el AF les fue suministrado por la empresa aseguradora de salud, y 10,7% lo compró de su bolsillo. La prescripción fue pertinente en 0,2% de las mujeres. Su consumo fue totalmente oportuno en 0,2% y totalmente inoportuno en 41,9% de las gestantes. A 1 192 mujeres (72,8%) les recomendaron otros micronutrientes; a 77,6% de ellas se los recomendó el médico, y 88,7% adhirieron al tratamiento. CONCLUSIONES: Se recomienda y se consume AF y otros micronutrientes de manera inadecuada, sin evaluar las necesidades individuales de las mujeres gestantes. Se invita a reflexionar sobre la utilidad de los programas que promueven el consumo masivo de micronutrientes en forma de medicamento durante el embarazo; los programas parecen desconocer las causas fundamentales de los problemas nutricionales que aquejan a la población.

OBJECTIVE: To characterize the intake of folic acid (FA) and other micronutrients in medicinal form in a group of pregnant women in Colombia. METHODS: Descriptive observational study. Information was obtained from interviews of pregnant women and from the clinical records of their prenatal check-ups and/or delivery in four cities in Colombia. The sample consisted of 1 637 women seen in 15 institutions. RESULTS: A total of 1 315 pregnant women (80.3%) were advised to take FA, and 84% received a prescription, 90.3% of whom adhered to the treatment. FA was provided to 85.6% of them by their health insurance company and 10.7% purchased it themselves. The prescription was appropriate for 0.2% of the women; its use was entirely appropriate for 0.2% of the pregnant women and totally inappropriate for 41.9%. Other micronutrients were recommended to 1 192 women (72.8%), 77.6% of whom received the advice from their physician, with 88.7% adhering to the treatment. CONCLUSIONS: FA and other micronutrients are inappropriately recommended to pregnant women and taken without assessing their individual needs. The usefulness of programs that promote mass consumption of micronutrients in medicinal form during pregnancy should be reexamined. These programs seem not to recognize the fundamental causes of the population's nutritional problems.

Suplementação de zinco e outros micronutrientes através do uso de sprinkles: impacto na ocorrência de doença diarreica e infecções respiratórias em crianças institucionalizadas / Zinc and other micronutrients supplementation through the use of sprinkles: impact on the occurrence of diarrhea and respiratory infections in institutionalized children

OBJETIVO: Avaliar a incidência de doenças diarreicas (DA) e infecção respiratória aguda (IRA) em crianças submetidas à suplementação de zinco e outros micronutrientes através dos sprinkles, bem como a aceitação destes pelos participantes. MÉTODO: Ensaio clínico, duplo cego, randomizado, realizado com 143 crianças institucionalizadas, saudáveis, de seis a 48 meses. As mesmas foram randomizadas em dois grupos e receberam diariamente zinco + micronutrientes - grupo teste (sprinkles), ou apenas micronutrientes sem zinco - grupo controle. As crianças foram suplementadas por 90 dias e acompanhadas quanto aos desfechos de DA e IRA. RESULTADOS: Das crianças randomizadas, 52,45% pertenciam ao grupo teste e 47,55% ao controle. A incidência de DA no teste foi de 14,7%, e no controle, 19,1%. O grupo teste apresentou menor risco de desenvolver DA em relação ao controle, porém esse achado não foi estatisticamente significante (RR = 0,77 [0,37-1,6]; p = 0,5088). A IRA apresentou incidência elevada em ambos os grupos, sendo 60% no teste e 48,5% no controle, com risco maior de apresentar a doença no grupo teste, porém sem significância estatística (RR=1,24 [0,91-1,68]; p = 0,1825). Quanto à aceitação, o percentual médio de consumo, em dias, de todo conteúdo dos sachês contendo sprinkles foi 95,72% (DP = 4,9) e 96,4% (DP = 6,2), para o teste e controle, respectivamente. CONCLUSÕES: A suplementação de zinco através dos sprinkles não reduziu a incidência de DA ou IRA entre as crianças avaliadas. Os sprinkles foram bem aceitos por todos os participantes do estudo.

OBJECTIVE: To evaluate the incidence of diarrheal disease (DD) and acute respiratory infection (ARI) in children undergoing supplementation of zinc and other micronutrients through the use of sprinkles, as well as their acceptance by these participants. METHOD: This was a randomized double-blinded clinical trial of 143 healthy institutionalized children, aged 6 to 48 months. They were randomized into two groups and received daily zinc and micronutrients - test group (sprinkles), or micronutrients without zinc - control group. Children were supplemented for 90 days and followed regarding the outcomes of DD and ARI. RESULTS: Of the randomized children, 52.45% belonged to the test and 47.55% to the control group. The incidence of DD in the test group was 14.7% and was 19.1% in the control group. The test group showed a lower risk of developing DD when compared to controls, but this finding was not statistically significant (RR = 0.77 [0.37 to 1.6], p = 0.5088). ARI had high incidence in both groups, 60% in the test group and 48.5% in the control group, with an increased risk of developing the disease in the test group, but with no statistical significance (RR = 1.24 [0.91 to 1.68], p = 0.1825). Regarding acceptance, the mean percentage of consumption, in days, of the entire content of the sachets containing sprinkles was 95.72% (SD = 4.9) and 96.4% (SD = 6.2) for the test and control groups, respectively. CONCLUSIONS: Zinc supplementation through the use of sprinkles did not reduce the incidence of DD or ARI among the evaluated children. The sprinkles were well accepted by all study participants.

Evaluación del impacto de los multimicronutrientes en polvo sobre la anemia infantil en tres regiones andinas del Perú / Evaluation of the impact of multiple micronutrient powders on children anemia in three andean regiones in Peru

Con el objetivo de determinar el impacto de la administración con multimicronutrientes (MMN) en polvo sobre la anemia infantil en tres regiones andinas del Perú, se estableció un sistema de vigilancia centinela en 29 establecimientos de Andahuaylas, Ayacucho y Huancavelica, en niños de 6 a 35 meses de edad, a quienes se les indicó MMN por un periodo de 12 meses, entre el 2009 y 2011. Además de los datos sociodemográficos de los menores y las madres, se determinó los niveles de hemoglobina al inicio y al final del estudio. Entre los menores que culminaron la suplementación, la prevalencia de anemia se redujo de 70,2 a 36,6% (p<0,01), y se evidenció que el 55,0% y el 69,1% de niños con anemia leve y moderada al inicio del estudio, la habían superado al término del mismo. Se concluye que la suplementación con MMN en polvo puede ser una estrategia efectiva en la lucha contra la anemia.

The aim of this research was to determine the impact of the strategy of multi-micronutrient supplementation (MMN) on the childhood anemia in three Andean regions of Peru. A sentinel surveillance system was established in 29 health centers of Andahuaylas, Ayacucho and Huancavelica (Peru) to monitor a cohort of children of 6 to 35 months of age whom been received MMM for a period of 12 months. Data regarding hemoglobin levels were gathered at the beginning and at the end of the research; they included consumption of MMN, and other data from clinical records and from growth and development charts. Between the child who completed the supplementation, the prevalence of anemia decreased from 70.2% to 36.6% (p value <0.01). 55,0% and 69,1% of children with mild and moderate anemia at the beginning of the supplementation got cured. This research shows that supplementation with MMN could be a valuable strategy to fight anemia.