Complexity of pediatric chronic disease: cross-sectional study with 16,237 patients followed by multiple medical specialties / Complexidade da doença crônica pediátrica: estudo tranversal com 16.237 pacientes seguidos por múltiplas especialidades médicas

ABSTRACT Objective: To assess demographic data and characteristics of children and adolescents with pediatric chronic diseases (PCD), according to the number of specialties/patient. Methods: We performed a cross-sectional study with 16,237 PCD patients at outpatient clinics in one year. Data were analyzed by an electronic data system, according to the number of physician appointments for PCD. This study assessed: demographic data, follow-up characteristics, types of medical specialty, diagnosis (International Statistical Classification of Diseases and Related Health Problems - ICD-10), number of day hospital clinic visits, and acute complications. Results: Patients followed by ≥3 specialties simultaneously showed a significantly higher duration of follow-up compared to those followed by ≤2 specialties [2.1 (0.4-16.4) vs. 1.4 (0.1-16.2) years; p<0.001] and a higher number of appointments in all specialties. The most prevalent medical areas in patients followed by ≥3 specialties were: Psychiatry (Odds Ratio - OR=8.0; confidence interval of 95% - 95%CI 6-10.7; p<0.001), Palliative/Pain Care (OR=7.4; 95%CI 5.7-9.7; p<0.001), Infectious Disease (OR=7.0; 95%CI 6.4-7.8; p<0.001) and Nutrology (OR=6.9; 95%CI 5.6-8.4; p<0.001). Logistic regressions demonstrated that PCD patients followed by ≥3 specialties were associated with high risk for: number of appointments/patient (OR=9.2; 95%CI 8.0-10.5; p<0.001), day hospital clinic visits (OR=4.8; 95%CI 3.8-5.9; p<0.001), emergency department visits (OR=3.2; 95%CI 2.9-3.5; p<0.001), hospitalizations (OR=3.0; 95%CI 2.7-3.3; p<0.001), intensive care admissions (OR=2.5; 95%CI 2.1-3.0; p<0.001), and deaths (OR=2.8; 95%CI 1.9-4.0; p<0.001). The diagnosis of asthma, obesity, chronic pain, and transplant was significantly higher in patients followed by ≥3 specialties. Conclusions: The present study showed that PCD patients who required simultaneous care from multiple medical specialties had complex and severe diseases, with specific diagnoses.

RESUMO Objetivo: Avaliar dados demográficos e características de crianças e adolescentes com doenças crônicas pediátricas, de acordo com o número de especialidades/paciente. Métodos: Realizou-se um estudo transversal com 16.237 pacientes com doenças crônicas pediátricas durante um ano. A análise foi feita em um sistema eletrônico, de acordo com número de consultas médicas para doenças crônicas pediátricas. Este estudo avaliou dados demográficos, características do seguimento, tipos de especialidades médicas, diagnóstico (10ª Revisão da Classificação Estatística Internacional de Doenças e Problemas Relacionados com a Saúde - CID-10), número de visitas e complicações agudas. Resultados: Os pacientes acompanhados por três ou mais especialidades simultaneamente tiveram seguimento de maior duração comparados com aqueles seguidos por ≤2 especialidades [2,1 (0,4-16,4) vs. 1,4 (0,1-16,2) anos; p<0,001], bem como maior número de consultas em todas as especialidades. As áreas médicas mais comuns em pacientes acompanhados por ≥3 especialidades foram: psiquiatria (Odds Ratio - OR=8,0; intervalo de confiança de 95% - IC95% 6-10,7; p<0,001); dor/cuidados paliativos (OR=7,4; IC95% 5,7-9,7; p<0,001); doenças infecciosas (OR=7,0; IC95% 6,4-7,8; p<0,001); nutrologia (OR=6,9; IC95% 5,6-8,4; p<0,001). As regressões logísticas mostraram que os pacientes com doenças crônicas pediátricas seguidos por ≥3 especialidades tinham alto risco para: maior número de consultas/paciente (OR=9,2; IC95% 8,0-10,5; p<0,001); atendimentos em hospital-dia (OR=4,8; 95%IC3,8-5,9; p<0,001); atendimentos em pronto-socorro (OR=3,2; IC95% 2,9-3,5; p<0,001); hospitalizações (OR=3,0; IC95%2,7-3,3; p<0,001); internação em terapia intensiva (OR=2,5; IC95% 2,1-3,0; p<0,001); óbitos (OR=2,8; IC95%1,9-4,0; p<0,001). Os diagnósticos de asma, obesidade, dor crônica, transplante e infecção do trato urinário foram mais frequentes nos pacientes seguidos por três ou mais especialidades. Conclusões: O presente estudo mostrou que pacientes com doenças crônicas pediátricas que necessitaram de múltiplas especialidades médicas simultaneamente apresentavam doenças complexas e graves, com diagnósticos específicos.

Factors associated with inadequate milk consumption among adolescents: national school health survey - pense 2012 / Fatores associados ao consumo inadequado de leite em adolescentes: pesquisa nacional de saúde do escolar - pense 2012

ABSTRACT Objective: To identify the prevalence and factors associated with inadequate milk consumption among adolescents. Methods: This was a cross-sectional study based on secondary data from the National School Health Survey (2012), a Brazilian survey carried out using a self-administered questionnaire in a representative sample of 9th-grade students from public and private schools. The frequency of milk intake and its association with socio-demographic characteristics, food consumption and physical activity were estimated. A descriptive and inferential analysis of factors associated with inadequate milk consumption (no consumption at least one of the seven days of the week) was performed. A multiple logistic model was adjusted to control confounders. Results: The sample included 108,828 adolescents and inadequate milk consumption ocurred in 58.9%. The final model included nine variables independently associated with inadequate milk intake: breakfast frequency less than 4 days per week (odds ratio [OR]=2.40; p<0.001), unprocessed or minimally processed foods intake less than 5 days per week (OR=1.93; p<0.001), living in the northeast region (OR=1.39; p<0.001), less maternal schooling (OR=1.35; p<0.001), physical inactivity (OR=1.33; p<0.001), attending public school (OR=1.26; p<0.001), not being white (OR=1.14; p<0.001), being older than 14 years old (OR=1.13; p<0.001) and having a habit of eating meals while watching TV or studying (OR=1.04; p=0.036). Conclusions: Inadequate milk consumption is prevalent among Brazilian adolescents. The identification of associated factors suggests the need to develop nutritional guidance strategies for the prevention of diseases that result from low calcium intake.

RESUMO Objetivo: Identificar a prevalência e os fatores associados ao consumo inadequado de leite em adolescentes. Métodos: Estudo transversal com base em dados secundários da Pesquisa Nacional de Saúde do Escolar (PeNSE; 2012), inquérito brasileiro realizado por meio de questionário autoaplicável em amostra representativa de alunos do nono ano do ensino fundamental de escolas públicas e privadas. Estimou-se a frequência da ingestão de leite e sua associação com características sociodemográficas, consumo alimentar e prática de atividade física. Foi realizada análise descritiva e inferencial dos fatores associados ao consumo inadequado de leite (ausência em pelo menos um dos sete dias da semana). Um modelo logístico múltiplo foi ajustado para controle das variáveis de confusão. Resultados: A amostra incluiu 108.828 adolescentes e o consumo inadequado de leite foi de 58,9%. O modelo final incluiu 9 variáveis independentemente associadas à ingestão inadequada de leite: frequência de desjejum inferior a 4 dias semanais (odds ratio [OR]=2,40; p<0,001), consumo de alimentos in natura e minimamente processados inferior a 5 dias semanais (OR=1,93; p<0,001), residir na Região Nordeste (OR=1,39; p<0,001), menor escolaridade materna (OR=1,35; p<0,001), inatividade física (OR=1,33; p<0,001), frequentar escola pública (OR=1,26; p<0,001), não ser da raça branca (OR=1,14; p<0,001), ter idade superior a 14 anos (OR=1,13; p<0,001) e possuir o hábito de realizar as refeições assistindo à TV ou estudando (OR=1,04; p=0,036). Conclusões: O consumo inadequado de leite é frequente entre adolescentes brasileiros. A identificação de fatores associados sugere a necessidade do desenvolvimento de estratégias de orientação nutricional para a prevenção de doenças resultantes da baixa ingestão de cálcio.

Forced international migration for refugee food: a scoping review / Migração internacional forçada e alimentação de refugiados: uma scoping review

Abstract Recent crisis and conflicts in African countries, the Middle East and the Americas have led to forced population migration and rekindled concern about food security. This article aims to map in the scientific literature the implications of forced migration on food and nutrition of refugees. Scoping Review, and database search: databases: PubMed Central, LILACS, SciElo, Science Direct and MEDLINE. Languages used in the survey were: English, Portuguese and Spanish, with publication year from 2013 to 2018. 173 articles were obtained and after removing of duplicates and full reading, 26 articles were selected and submitted to critical reading by two reviewers, resulting in 18 articles selected. From the analysis of the resulting articles, the following categories emerged: Food Inequity; Cultural Adaptation and Nutrition; Emerging Diseases and Strategies for the Promotion of Nutritional Health. Food insecurity is a marked consequence of forced international migration, and constitutes an emerging global public health problem, since concomitant with increasing population displacements also widens the range of chronic and nutritional diseases.

Resumo As recentes crises e conflitos em países Africanos, no Oriente Médio e Américas têm originado migração forçada de populações e reacende a preocupação com os cuidados com a alimentação. O objetivo deste artigo é mapear na literatura científica as implicações da migração forçada sobre a alimentação e nutrição de refugiados. Scoping Review, com buscas nas bases de dados: bases de dados: PubMed Central, LILACS, SciElo, Science Direct e MEDLINE. Os idiomas de pesquisa foram: Inglês, Português e Espanhol, e ano de publicação compreendido entre 2013 e 2018. Obteve-se 173 artigos e após remoção dos duplicados e leitura integral, 26 artigos foram selecionados e submetidos à leitura crítica por dois revisores independentes, resultando em 18 artigos selecionados. Da análise dos resultados dos artigos, emergiram as categorias: Iniquidade Alimentar; Adaptação Cultural e Nutrição; Doenças Emergentes e Estratégias de Promoção da Saúde Nutricional. A insegurança alimentar é consequência marcante da imigração internacional forçada, e se constitui um emergente problema de saúde pública global, pois concomitante aos crescentes deslocamentos populacionais também se ampliam a gama de doenças crônicas e nutricionais.

Estado nutricional y características sociodemográficas en adolescentes embarazadas del programa alimentario nutricional integral Hospital Regional de Encarnación 2016 / Nutritional status and sociodemographic characteristics in pregnant adolescents of the comprehensive nutritional food program Hospital Regional de Encarnación 2016

Introducción: El estado nutricional de las adolescentes embarazadas influye en la salud de la madre y del hijo. Objetivo: Determinar el estado nutricional y características sociodemográficas en adolescentes embarazadas del Programa Alimentario Nutricional Integral. Hospital Regional de Encarnación 2016. Metodología: Estudio observacional descriptivo de corte trasversal con componente analítico. Se utilizaron fichas completas de pacientes embarazadas desde la décima semana de gestación, en el período de enero a diciembre de 2016, considerando los datos de edad, peso, talla, edad gestacional, nivel educativo, ingreso familiar y el diagnóstico nutricional realizado por las tablas de Rosso - Mardones. Resultados: De las 172 fichas utilizadas, el rango etario fue de 12 a 19 años con una mediana de 17 (16,0 ­ 18,0) años, pertenecían a la clasificación de adolescencia temprana el 6% (n= 11) y adolescencia tardía el 94% (n= 161). El nivel educativo predominante fue educación media 39% (n=67) y tercer ciclo de escolar básica 36% (n=62). El ingreso familiar menor a un salario mínimo fue del 63% (n=108), hasta un salario mínimo 37% (n=63). La mediana del peso fue de 58,0 (51,15 ­ 66,0) kg. Una talla promedio de 1.58 ±0.06 m. La mediana de la edad gestacional de ingreso fue de 18 (12 ­ 27) semanas. El estado nutricional de las adolescentes embarazadas evaluadas por Rosso - Mardones presentó 46% bajo peso, 32% adecuado, 13% sobrepeso y 9% obesidad. Conclusiones: De las embarazadas evaluadas al ingreso del Programa Alimentario Nutricional Integral el mayor porcentaje correspondía a bajo peso. No se encontró asociación entre nivel educativo y el estado nutricional, así como tampoco se encontró asociación entre nivel de ingreso y el estado nutricional

Introduction: The nutritional status of adolescents pregnant women influences the health of the mother and the child. Objective: To determine the nutritional status and sociodemographic characteristics of pregnant adolescents women admitted to the PANI program during the year 2016 in the HRE. Methodology: A cross-sectional, observational, cross-sectional study with analytical component and complete records of pregnant patients were used from the tenth week of gestation in the period of January to December 2016, considering data on age, weight, height, gestational age, educational level, and the nutritional diagnosis made by the charts of Rosso - Mardones. Results: Of the 172 medical records used in the 12 to 19 year age range with a median of 17 (16.0 - 18.0) years, 6% (n = 11) and 94% (n=161) belonged to late adolescence and to the early adolescence correspondingly. The predominant educational level was middle education 39% (n = 67) and the third cycle of basic education (36%) (n = 62). Family income less than a minimum wage was of the 63% (and=108), up to a minimum wage of 37% (n = 63). The median weight was 58.0 (51.15 - 66.0) kg. An average size of 1.58 ± 0.06 m. The median gestational age of admission was 18 (12 - 27) weeks. The nutritional status of pregnant adolescents evaluated by Rosso - Mardones charts presented 46% low weight, 32% adequate, 13% overweight, 9% obesity. Conclusions: Of the pregnant women evaluated at the entrance of the Integral Nutritional Feeding Program the highest percentage of correspondence at low weight. The association between educational level and nutritional status was not found, nor was the association between income level and nutritional status found

Relationship between lipid and hematological profiles with adiposity in obese adolescents

Background: An excess of weight including obesity have reached epidemic rates in all age groups, both in developed and developing countries. It is notable that overweight children and adolescents have a higher likelihood of becoming obese adults and to present health-related problems early in life. Objetives: To verify associations of the lipid and hematological profiles with adiposity in obese adolescents beginning multidisciplinary weight loss therapy. Methods: This cross-sectional study was conducted with 85 adolescents of both genders, aged 12-19 years (Tanner staging 3 or 4) and body mass index greater than the 95th percentile. The sum of the triceps, subscapular and calf skinfolds and the waist circumference were used to estimate adiposity. Blood samples were collected from all patients after overnight fasting to analyze blood lipids (total cholesterol, high-density lipoprotein, low-density lipoprotein, very low-density lipoprotein and triglycerides), blood sugar and the hematological profile (hemoglobin, platelets and red blood cells). The Kolmogorov-Smirnov test and Spearman and Pearson correlation coefficients were used for statistical analysis with significance set for p-values ≤ 0.05. Results: There were statistical differences between genders for red blood cells (p-value = 0.000), hemoglobin (p-value = 0.000) and platelets (p-value = 0.002). Positive correlations were found for red blood cells (p-value = 0.031) and hemoglobin (p-value = ...

Estado nutricional en adolescentes, exceso de peso corporal y factores asociados / Nutritional status in adolescents, body excess weight and associated factors

Introducción: la adolescencia es una etapa crucial, con alta prevalencia de trastornos nutricionales, que luego continúan durante la vida adulta y se asocian con complicaciones a corto y a largo plazo. Objetivos: identificar la asociación entre el exceso de peso corporal y los antecedentes patológicos familiares de interés y algunos factores perinatales, la presencia de la hipertensión arterial y su relación con la historia familiar de hipertensión, el exceso de peso corporal y el incremento de adiposidad abdominal; y por último, identificar la presencia de acantosis nigricans y su relación con iguales factores. Métodos: se desarrolló un estudio descriptivo transversal para caracterizar el estado nutricional de los adolescentes de séptimo grado que asisten a la Secundaria Básica José María Heredia, en el curso 2009-2010. La población estuvo constituida por 192 adolescentes, a los cuales, con previo consentimiento de los padres, se les realizaron las mediciones antropométricas (peso, talla, circunferencia de cintura y se calculó el índice de masa corporal), y además se midió la tensión arterial y se buscaron signos clínicos de resistencia insulínica. También se aplicó una encuesta a los padres acerca de los antecedentes patológicos familiares y algunos datos de sus hijos. Resultados: se encontró que el 20,31 por ciento de los adolescentes presentaba sobrepeso u obesidad, lo cual se relacionó de forma significativa con la presencia de hipertensión arterial y signos clínicos de resistencia insulínica. La hipertensión arterial se halló en el 9,9 por ciento de los adolescentes, sin relación con factores hereditarios. Conclusiones: la obesidad y el sobrepeso corporal constituyen un problema de salud en la población adolescente estudiada, lo cual se asocia con la presencia de hipertensión arterial y resistencia insulínica, no existió relación en su comportamiento con factores no modificables (antecedentes patológicos familiares y personales)(AU)

Introduction: the adolescence is a decisive stage with a high level of prevalence of nutritional disorders that latter remains during the adulthood and are associated with short- and long term complications. Objectives: to identify the association between excess of body weight and the interesting family pathological backgrounds and some perinatal risks, the presence of high blood pressure and its relation to the family history of high blood pressure and the increase of abdominal adiposity and finally, to identify the presence of acanthosis nigricans and its relation with the similar factors. Methods: a cross-sectional and descriptive study was conducted to characterize the nutritional status of the adolescents of the seventh grade from the José María Heredia secondary school during 2009-2020. Group included 192 adolescents who with a previous consent of parents underwent anthropometric measurements (weight, height, waist circumference and estimation of the body mass index) and also the blood pressure and search of clinical signs of insulin resistance. A survey to parents on the family pathological backgrounds and on some data of their children was applied. Results: there was that the 20,31 percent of adolescents had excess weight or obesity, which was related in a significant way to the presence of a high blood pressure and clinical signs of insulin resistance. The high blood pressure was present in the 9,9 percent of adolescents without any relation to hereditary factors. Conclusions: obesity and body excess weight are a health problem in study adolescent population, which is associated with the presence of a high blood pressure and insulin resistance; there was not relation in its behavior to non-modifiable factors (family and personal pathological backgrounds)(AU)

Sistema de Vigilância Alimentar e Nutricional (SISVAN) em crianças do Rio Grande do Sul, Brasil: cobertura, estado nutricional e confiabilidade dos dados / Food and Nutritional Surveillance System (SISVAN) in children from Rio Grande do Sul State, Brazil: coverage, nutritional status, and data reliability

Este estudo objetivou avaliar: cobertura do Sistema de Vigilância Alimentar e Nutricional (SISVAN) no Rio Grande do Sul e suas Coordenadorias Regionais de Saúde em 2006; estado nutricional das crianças de 0-10 anos e a confiabilidade dos dados sobre estado nutricional registradas no sistema. Realizou-se estudo transversal descritivo de base secundária com 63.320 crianças. A cobertura baseou-se no número de menores de 10 anos cobertos pela Estratégia Saúde da Família nos municípios. Os índices estatura/idade (E/I) e de massa corporal/idade (IMC/I) foram classificados com base na Organização Mundial da Saúde (OMS). A concordância entre classificações nutricionais registradas no sistema e as geradas neste estudo foi avaliada pelo teste kappa ponderado (nível de 5 por cento). No Rio Grande Sul, a cobertura do sistema foi de 10,5 por cento e encontraram-se frequências de déficit de E/I de 7,1 por cento e de excesso de peso de 8,4 por cento. A concordância entre classificações teve kappa = 0,43. Apontaram-se baixas cobertura do sistema e concordâncias de classificações e a coexistência de excesso de peso e déficit estatural entre os acompanhados.

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 State's 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 percent). The system's coverage in the State of Rio Grande do Sul was 10.5 percent. Low height-for-age was found in 7.1 percent of children and overweight in 8.4 percent. Agreement between the classifications showed a kappa coefficient of 0.43. The system's coverage and agreement between classifications were both low, and the study showed the coexistence of high overweight and stunting rates in this age group.

Repercusión de la obesidad en la morbilidad obstétrica / Obesity repercussion on obstetric morbidity

OBJETIVOS: Identificar la relación existente entre la obesidad y las complicaciones en la gestación, calcular la incidencia de obesidad durante la gestación en el Policlínico Universitario "Juan Gualberto Gómez" del municipio Los Arabos, medir la ganancia media de peso de las pacientes obesas y relacionar la morbilidad durante la gestación, estableciendo una comparación con un grupo control.Métodos: se realizó un estudio observacional analítico transversal retrolectivo, se incluyeron en el estudio todas las gestantes que parieron durante los años 2006 y 2007, se obtuvo una muestra aleatoria sistemática en fase compuesta por 38 gestantes y que deben tener en común un índice de masa corporal >29 Kg/m², se confeccionó un grupo control compuesto por 38 pacientes con la característica de que su IMC debe ser el ideal. Se le aplicaron variables como: incidencia, ganancia media de peso y morbilidad durante la gestación. Para el análisis estadístico se le aplicó el Software Epidat 3.0. Resultados: la incidencia de obesidad en la gestación fue de 14,3 % (IC 95 %) 9,931-18,74. Se apreció en el grupo de obesas mayor frecuencia de enfermedad hipertensiva gravídica (EHG) con 17 pacientes, 44,7 % y un IC (95 %) 27,6-61,8. Infección Urinaria: 1 paciente (28,9 %) IC (95 %) 13,2-44,6, signo de más 7 pacientes (18,4 %), IC (95 %) 4,78-32,0, CIUR 4 pacientes (10,5 %), IC (95 %) 2,94-24,8, Polihidramnio 2 pacientes (5,2 %), IC (95 %) 0,64-17,7 E y Diabetes Mellitus Gestacional 1 paciente (2,6,%), IC (95,%) 0,06-13,8 E. Se observó un aumento exagerado medio de 2,2 kg a las 30 sem y 3 Kg al término de la gestación en el grupo de obesas.Conclusiones: obesidad, procreación tardía, enfermedad hipertensiva gravídica y aumento exagerado de peso tienen relación estrecha para causar morbilidad obstétrica

OBJECTIVES: To identify the relationship between obesity and pregnancy complications, to estimate the obesity incidence during pregnancy in patients from the "Juan Gualberto G¾mez" University Polyclinic from The Arabos municipality, to measure the weight gain in obese patients and to relate the morbidity during pregnancy, establishing a comparison with control group. METHODS: A retrospective, cross-sectional, analytical and observational study was conducted including all pregnants that gave birth during 2006 and 2007; we achieved a systemic randomized sample in the phase composed 38 pregnants and a common rate of body mass > 29 Kg/m²; a control group was created including 38 patients with a probable ideal BMI. Variables applied were: incidence, mean weight gain and morbidity during pregnancy. For statistical analysis we applied 3.0 Epidat Software. RESULTS: Obesity incidence during pregnancy was of 14.3 percent ,a 95 percent CI 9,931-18,74. In obese group we noted a great frequency of gravidity hypertensive disease (GHD) with 17 patients, 44.7 percent and a 95 percent CI 27.6-61.8. Urinary infection: one patient (28,9 percent) a 95 percent CI 13.2-44,6, + sing 7 patients (18.4 percent), a 95 percent CI 4.78-32.0, IUGR 4 patients (10.5 percent), 95 percent IC 2.94-24.8, polyhydramnios 2 patients (5.2 percent) a 95 percent CI 0.64-17.7 E and gestational diabetes mellitus in a patient (2.6 percent) a 95 percent CI 0.06-13.8 E. There was a mean exaggerated increase of 2.2 kgs at 30 weeks and 3 Kg at the pregnancy end in obese group. CONCLUSIONS: Obesity, late procreation, gravidic hypertensive disease and exaggerated weight increase have a close relation to cause obstetric morbidity

Pobreza y procedencia indígena como factores de riesgo de problemas nutricionales de los niños que ingresan a la escuela / Poverty and indigenous origin as risk factors of nutritional problems among children who enroll in school

OBJETIVO:Determinar el efecto de ser indígena y de la pobreza, en los problemas nutricionales de escolares chilenos. MATERIAL Y MÉTODOS:Se usaron bases de datos de niños que ingresaron a la escuela (1997-2004) que tenían información antropométrica, socioeconómica y origen étnico. Se construyeron modelos de regresión logística para talla baja y obesidad controlando el efecto de la pobreza y la etnia por sexo, edad y año de análisis. RESULTADOS:Se estudió a 1580103 niños: indígenas (7.4%), con talla baja (2.9%) y obesidad (16%). Al estratificar por etnia, los más pobres tuvieron mayor riesgo de talla baja: en indígenas RM: 2.30 (IC95%: 2.27-2.33) y no indígenas RM: 2.29 (IC95%: 2.28-2.30). A la inversa, los escolares más pobres tuvieron menos riesgo de ser obesos (RM: 0.63; IC95%: 0.62-0.64). Ser indígena proporcionó 6% más posibilidad de presentar obesidad, comparado con no ser indígena (RM: 1.06; IC95%: 1.05-1.08). CONCLUSIÓN:. En niños chilenos, la pobreza es factor de riesgo de talla baja pero protector de obesidad independiente de la etnia. El mayor riesgo de obesidad en los escolares indígenas, si bien es pequeño, debe ser una voz de alerta para prevenir en ellos el aumento de las cifras.

OBJECTIVE:To estimate the effect of indigenous ancestry and poverty on nutritional outcomes in Chilean schoolchildren. MATERIAL AND METHODS:We used the national database of children entering to the public educational system in 1997-2004. This includes anthropometric assessment, socioeconomic status and parental surnames, used to derive the ethnic origin. Logistic regression models related poverty and ethnicity on stunting and obesity were done, controlling for sex, age and calendar year. RESULTS:Data convey 1580103 children being 7.4% indigenous; 2.9% had stunting and around 16.0% were obese. Stratifying by poverty, it was shown that the poorest had higher risk of stunting both in indigenous (OR= 2.30; CI95%=2.27-2.33) and non indigenous (OR= 2.29; CI95%= 2.28-2.30). Conversely, poverty was a "protective factor" for obesity (OR= 0.63; CI95%= 0.62-0.64). Indigenous origin showed a significant OR slightly over the null. CONCLUSIONS:In Chilean children, poverty is a risk factor for stunting but still protects from obesity, independent of indigenous origin.

Anthropometric evaluation of indigenous Brazilian children under 60 months of age using NCHS/1977 and WHO/2005 growth curves / Avaliação antropométrica de crianças indígenas menores de 60 meses, a partir do uso comparativo das curvas de crescimento NCHS/1977 e OMS/2005

OBJETIVOS: Descrever e analisar comparativamente os dados antropométricos de crianças indígenas Suruí, Xavánte e Wari' menores de 60 meses, a partir dos conjuntos de curvas de crescimento NCHS/1977 e WHO/2005. MÉTODOS: A antropometria seguiu técnica padronizada e os dados foram convertidos em escores z utilizando-se os programas Epi-Info (Versão 3.4) e WHO-Anthro (Versão Beta). Os índices estatura/idade (E/I), peso/idade (P/I) e peso/estatura (P/E) foram os descritores do estado nutricional em todas as crianças menores que 60 meses e também o índice de massa corporal (IMC) nas de 24-59 meses. RESULTADOS: As prevalências de E/I < -2 escores z foram: crianças Suruí, 31,4 (NCHS/1977) e 38,6% (WHO/2005); Xavánte, 30,9 e 42,3%; Wari', 61,7 e 68,3%. As prevalências de P/I < -2 escores z foram: crianças Suruí, 12,4 (NCHS/1977) e 8,5% (WHO/2005); Xavánte, 16,5 e 11,6%; Wari', 51,7 e 45,0%. As prevalências de P/E < -2 escores z para as crianças Suruí foram nulas (NCHS/1977 e WHO/2005); para as Xavánte, 1,7 e 3,3%; e para as Wari', 1,7% e nula. As prevalências de P/E > 2 escores z para as crianças Suruí foram 3,9 (NCHS/1977) e 3,9% (WHO/2005); Xavánte, nula e 0,8%; Wari', nulas para ambas as curvas. Nas crianças Suruí de 24 a 59 meses o percentual com escore z > 2 para o IMC foi de 5,4% (WHO/2005); Xavánte, 9,5%; Wari', 0%. CONCLUSÕES: Há diferenças importantes nos resultados da avaliação nutricional, a depender do conjunto de curvas utilizadas, ainda que o emprego de ambas revele elevadas prevalências de desnutrição. Sugere-se que, inclusive para fins de comparabilidade, estudos com populações indígenas apresentem seus resultados utilizando os dois conjuntos de curvas de crescimento.

OBJECTIVES: To perform a comparative analysis of anthropometric data from Suruí, Xavánte and Wari' indigenous children under 60 months of age using the NCHS/1977 and the WHO/2005 growth curves. METHODS: Anthropometric measurements followed standard procedures and the data obtained were converted into z scores using the Epi-Info (Version 3.4) and WHO-Anthro (Version Beta) softwares. The indices height/age (H/A), weight/age (W/A) and weight/height (W/H) were descriptors of nutritional status for all children under 60 months of age, as well as the body mass index (BMI) for children 24-59 months old. RESULTS: The frequencies of Suruí children < -2 z scores for H/A were 31.4 (NCHS/1977) and 38.6% (WHO/2005); Xavánte 30.9 and 42.3%; Wari' 61.7 and 68.3%. The frequencies of Suruí children < -2 z scores for W/A were 12.4 (NCHS/1977) and 8.5% (WHO/2005); Xavánte 16.5 and 11.6%; Wari' 51.7 and 45.0%. None of the Suruí children were < -2 z scores for W/H (NCHS/1977 and WHO/2005); the frequencies of Xavánte children were 1.7 and 3.3% and Wari' 1.7 and 0.0%. The frequencies of Suruí children > 2 z scores for W/H were 3.9 (NCHS/1977) and 3.9% (WHO/2005); Xavánte 0.0 and 0.8%; Wari' 0.0 and 0.0%. The frequency of Suruí children aged 24-59 months > 2 z scores for BMI was 5.4% (WHO/2005); Xavánte 9.5%; and Wari' 0.0%. CONCLUSIONS: Our findings revealed important differences in the results from nutritional assessment, according to the set of growth curves used; however, the use of both growth curves revealed a high prevalence of malnutrition. Therefore, future studies with indigenous populations should present their results using two sets of growth curves to allow consistent comparison.

Nutritional status of Palestinian children attending primary health care centers in Gaza.

OBJECTIVE: To assess the nutritional status of Palestinian children less than two years old and the associated risk factors. METHODS: The study was descriptive cross-sectional of 102 children attending the main four primary health care centers in the Gaza Strip during summer 2003. Data were collected through medical records and meeting interviews with children's mothers by face to face. Questionnaire was subjected to validity and reliability procedures before being used. Descriptive analyses and cross tabulation were used. RESULTS: The study showed that the prevalence of anemia was 72.8% among children. Anthropometrical indices showed that the prevalence of wasting, stunting, underweight were 34.3%, 31.4%, 31.45% respectively. CONCLUSION: Palestinian children are at high risk of health problems related to malnutrition. Informing Gazean families about the importance of following healthy dietary habits especially breastfeeding could improve child's nutritional status in parallel with overcoming the devastating economic condition.

Mineral content of complementary foods.

OBJECTIVE: To document mineral contents iron, zinc, calcium, energy contents and nutrient densities in complementary foods commonly given to young urban slum children. METHODS: Information on dietary intake was collected from 892 mothers of children aged 13-24 months, using 24 hour dietary recall and standardized measures. Three variations of 27 most commonly prepared recipes were analyzed and their energy (Kcal/g) and nutrient densities (mg/100 Kcal) were calculated. RESULTS: Considerable variations were observed in preparation of all items fed to the children. Cereal-based items predominated their diets with only small amount of vegetables/fruits. Fenugreek was the only leafy vegetable included, but was given to only 1-2% of children. Iron, calcium, zinc contents of staple complementary foods ranged from: 0.33 mg to 3.73 mg, 4 mg to 64 mg, and 0.35 mg to 2.99 mg/100 respectively. Recipes diluted with less water and containing vegetables, spices had higher mineral content. Minerals densities were higher for dals, fenugreek vegetable, khichdi and chapatti. Using the median amounts of the various recipes fed to children, intakes of all nutrients examined especially calcium and iron was low. CONCLUSION: There is an urgent need to educate mothers about consistency, dilution, quantity, frequency, method of preparation, inclusion of micronutrient-rich foods, energy-dense complementary foods and gender equality.

Variables asociadas a la calidad de la dieta en preescolares de Hidalgo, México / Associated factors with diet quality in preschool children from Hidalgo, Mexico

Nutrition and health are both associated with the nutritional status of individuals. In this paper we evaluate the quality of the diet and its association with relevant socioeconomic aspects in preschool children from Hidalgo, México. We obtained data for children 24-59 months of age on weight, height, food intake using 24-hr recall and socioeconomic data. The data was processed in PLANUT 3.0, ANTHRO 2005 and STATA 9.0. The median value of calorie intake was 1090 and 933 Kcall day for boys and girls respectively; higher intakes were observed in urban areas. The group presented deficiencies in calorie intake, retinol, calcium, iron and zinc. Variables that showed significant association with percent adequacy were motherís use of indigenous language, beneficiaries of food programs and weekly food expenditure. The most relevant problems were chronic under nutrition in rural communities (23.9%) and obesity in urban areas (10.6%). Differences in the quality of the diet and nutritional status between rural and urban areas in Hidalgo, México reflect the socioeconomic inequalities in social groups and smaller regions.

La alimentación es el principal factor que determina el estado de nutrición y salud. En este trabajo se pretende evaluar la calidad de la dieta y su asociación con factores socioeconómicos relevantes en preescolares del Estado de Hidalgo, México. Se obtuvieron datos de peso y talla, dieta por recordatorio de 24 horas y datos socioeconómicos de niño(a)s de 24 a 59 meses. Los datos se procesaron en PLANUT 3.0, ANTHRO 2005 y STATA 9.0. La mediana de consumo fue de 1090 para niños y 933 Kcal en niñas, siendo mayor el consumo de energía en localidades urbanas. El grupo estudiado presentó importantes deficiencias en el consumo de energía, retinol, calcio, hierro y zinc. Las variables que mostraron significativa asociación con porcentaje de adecuación fueron uso de lengua indígena en la madre, beneficiarios de programas alimentarios y gasto semanal en alimentos. Los problemas más relevantes fueron la desnutrición crónica en localidades rurales (23,9%) y la obesidad en urbanas (10,6%). Los contrastes de la calidad de la dieta y estado de nutrición entre localidades rurales y urbanas del estado de Hidalgo, México, reflejan la desigualdad socioeconómica entre grupos sociales y micro regiones.

The nutritional status of clinic attendees living with HIV/AIDS in St Vincent and the Grenadines / Estatus nutricional de personas con VIH/SIDA atendidas en clínicas en San Vicente y las Granadinas

OBJECTIVE: The purpose of this study was to assess nutritional status and dietary practices in persons living with HIV/AIDS (PLWHA). METHODS: A case-control design was used. Cases consisted of 36 PLWHA. Controls consisted of 37 persons within the same age range from the general population. Participants filled out a questionnaire consisting of sociodemographic, dietary and health history items. In addition, they had weight, height, upper mid-arm circumference and triceps skinfold measured using standard procedure. Biochemical and clinical data for cases were extracted from their clinic file. RESULTS: HIV-positive persons had significantly lower mean weight, BMI, upper mid-arm circumferences, arm muscle area and arm fat area than persons in the control group. They were also less likely to use multivitamins, dietary supplements, fruit and vegetables than persons in the control group. Correlation coefficients between corrected arm muscle area (CAMA) and BMI and weight ranged from 0.67 to 0.74 in cases and 0.41 to 0.68 for the control group, respectively. Screening for depleted CD4 counts using gender specific CAMA cut-offs indicative of depleted arm muscle reserves resulted in 48% sensitivity and 100% specificity in identifying PLWHA with CD4 counts < 200 cells/µL. CONCLUSION: The findings suggest that PLWHA are at increased risk for poor intakes of fruits and vegetables and depleted lean body mass. In addition, CAMA along with other clinic measures might be useful in the identification of PLWHA who might be responding adequately to treatment.

OBJETIVOS: El propósito de este estudio fue evaluar es estatus nutricional y las prácticas dietéticas de personas que viven con VIH/SIDA (PVVS). MÉTODOS: Se usó un diseño de control de casos. Los casos consistían en 36 PVVS. Los controles consistían en 37 personas en el mismo rango de edad de la población general. Los participantes llenaron un cuestionario contentivo de aspectos socio-demográficos, dietéticos, y cuestiones relacionadas con la historia de la salud. Además, se les determinó el peso, y se les tomó las medidas de la altura, la circunferencia del brazo medio superior, y el pliegue cutáneo del tríceps, usando procedimientos estándar: Los datos bioquímicos y clínicos para los casos, fueron extraídos de sus historias clínicas. RESULTADOS: Las personas VIH positivas tuvieron un promedio de peso, IMC, circunferencias del brazo medio superior, área muscular del brazo, y área adiposa del brazo, significativamente más bajo que las personas en el grupo control. También mostraron una menor tendencia a usar multivitaminas, suplementos dietéticos, frutas y vegetales, que las personas en el grupo control. Los coeficientes de correlación entre el área muscular del brazo corregida (AMBC), y el IMC y el peso tuvieron un rango de 0.67 a 0.74 en los casos y de 0.41 a 0.68 en el grupo control, respectivamente. El pesquisaje para el conteo de células CD4 agotadas usando límites de AMBC específicos del género, indicativos del agotamiento de las reservas musculares del brazo, arrojó un 48% de sensibilidad y un 100% de especificad en la identificación de PVVS con conteos de CD4 < 200 células/µL. CONCLUSIÓN: Los hallazgos sugieren que las PVVS enfrentan un riesgo mayor debido a un consumo pobre de frutas y vegetales, y a una masa corporal magra menguada. Además, la AMBC junto con las otras medidas clínicas, podría ser útil a la hora de identificar PVVS que pudieran esta respondiendo adecuadamente al tratamiento.

Micronutrients and anaemia.

Micronutrient deficiencies and anaemia remain as major health concerns for children in Bangladesh. Among the micronutrient interventions, supplementation with vitamin A to children aged less than five years has been the most successful, especially after distribution of vitamin A was combined with National Immunization Days. Although salt sold in Bangladesh is intended to contain iodine, much of the salt does not contain iodine, and iodine deficiency continues to be common. Anaemia similarly is common among all population groups and has shown no sign of improvement even when iron-supplementation programmes have been attempted. It appears that many other causes contribute to anaemia in addition to iron deficiency. Zinc deficiency is a key micronutrient deficiency and is covered in a separate paper because of its importance among new child-health interventions.

Nutritional bone disease in Indian population.

Syndromes of bone disease and deformities consequent to disorders of nutrition, bone and mineral metabolism constitute a serious national health problem. The studies on this subject are scanty. Data on nutritional bone disease are described and discussed. We had surveyed 337.68 million population residing in 0.39 million villages in 22 States of India during the period 1963 to 2005. Of the 4,11,744 patients identified with the disorders of bone and mineral metabolism, 2,13,760 (52%) had nutritional bone disease, 1,77,200 (43%) had endemic skeletal fluorosis and 20,784 (5%) had metabolic bone disease and in 41 patients (0.19%) the bone disease was rare, mixed or unidentified. Vitamin D deficiency osteomalacia and rickets caused by inadequate exposure to sunlight (290-315 nm), dietary calcium deficiency (<300 mg/day) and fluoride interaction syndromes, calcium deficiency induced osteoporosis and calcium and vitamin D deficiency induced osteoporosis in the elderly, were the commonest disorders responsible for bone disease and deformities, besides caused by endemic skeletal fluorosis as a single entity in endemic fluorosis villages. Calcium deficiency per se dose not cause rickets, as revealed in our long-term follow up study on 47,500 calcium deficient children. Only mothers with severely depleted bone mineral and vitamin D stores gave birth to their babies with congenital rickets. Vitamin D deficiency rickets in children and osteomalacia in the mothers are the commonest disorders prevalent in the rural population of India. These disorders and the syndromes of calcium deficiency and fluoride interactions are largely responsible for the morbidity and mortality in the young and promising individuals, with economic consequences.

Evaluación nutricional durante el embarazo: Nuevo estándar / Nutrition assessment during pregnancy: A new weight chart

Los límites para el aumento de peso ideal de una mujer embarazada y el patrón de ganancia de peso han sido poco estudiados en nuestra región. Los objetivos fueron: 1) construir una nueva curva de distancia del índice de masa corporal (IMC) para evaluación nutricional de la embarazada; 2) calcular la ganancia media de peso semanal y total por trimestres, y 3) comparar la nueva curva con un estándar propuesto como referente. Se incluyeron 326 embarazadas antes de la 16ª semana en el Hospital Sardá (Buenos Aires) entre 2001 y 2002. Se midieron peso, talla, perímetro braquial y pliegue tricipital. Se calcularon media, desviación estándar y coeficiente de variación (CV). Los percentilos reales 3 al 97 del peso y del IMC materno para la edad gestacional entre la 12ª y 42ª semana se calcularon mediante interpolación polinómica. El CV alcanzó un valor máximo del 18.4% después de la 28ª semana. El promedio del IMC preconcepcional fue de 24.2 kg/m² ± 4.5 y el 96% de los recién nacidos fueron de término con un índice ponderal de 2.7 ± 0.2 g/cm³. Los incrementos de peso fueron 0.600 kg ± 0.473, 6.476 kg ± 3.739 y 5.388kg ± 4.233 para el 1°, 2° y 3° trimestres respectivamente. Se observó concordancia entre la media de la nueva curva y el límite superior de la categoría "normal" de la curva actualmente recomendada. Los nuevos estándares de la ganancia de peso según peso e IMC permitirán lograr un adecuado control del incremento de peso gestacional.

Weight charts and patterns of weight gain for pregnant women in Argentina are scarce. The aims of the study were:1) to design a new reference weight gain chart to asses the nutritional status of pregnant women using the body mass index (BMI); 2) to estimate weight gain patterns, and 3) to compare it with a proposed reference chart. In 326 pregnant women before 16th week gestation at enrollment during 2001-2002 at the Sarda' Maternity Hospital (Buenos Aires), weight, height, mid arm circumference and skinfold were measured and body mass index was calculated. Mean, standard deviation, coefficient of variation and polynomial percentiles 3rd through 97th were generated for each gestational age between 12th to 42nd weeks. Maximum variability was 18.4% after 28th week, mean preconcepcional BMI was 24.2 ± 4.5 kg/m² and 96% of newborns were at term with a mean Ponderal Index of 2.7 ± 0.2 g/cm³. Trimesters weight increments were 0.600 kg ± 0.473, 6.476 kg ± 3.739 and 5.388kg ± 4.233 for the 1st, 2nd and 3rd, respectively. Total weight gain achieved was 12.46 Kg ± 3.13. Compared with the reference curve, the new one showed concordance at the 50th percentile with the upper limit of the normal range. The new reference charts of weight gain for pregnant women using maternal weight and BMI may be useful in prenatal care to asses nutritional status during pregnancy.