Estratégias para prevenção e manejo da desnutrição crônica em crianças menores de cinco anos / Strategies for the prevention and management of chronic malnutrition in children under five years of age

O problema: A desnutrição se refere a deficiências, excessos ou desequilíbrios na ingestão de energia e/ou nutrientes. O déficit de altura resulta em baixa estatura para a idade, e geralmente está associada a condições socioeconômicas adversas, saúde e nutrição materna precárias, doenças frequentes e/ou alimentação e cuidados inadequados das crianças no início da vida. No Brasil, estima-se que a prevalência de baixa estatura para a idade é de 7% em crianças menores de cinco anos. Esta revisão teve como objetivo identificar opções para políticas de prevenção e manejo de déficit de altura em crianças menores de cinco anos. Opções para enfrentar o problema: As buscas nas bases de dados recuperaram 558 revisões sistemáticas (RS), sendo complementadas por sete RS identificadas em busca manual. Após processo de seleção, 28 RS atenderam aos critérios de elegibilidade e foram incluídas nesta revisão narrativa. As estratégias de prevenção e manejo de déficit de altura em crianças menores de 5 anos analisadas nas RS foram categorizadas conforme similaridade em oito opções, apresentadas a seguir. Efeitos positivos foram relatados nas RS para uma variedade de estratégias, no entanto, algumas incertezas também foram apontadas. Com relação à qualidade metodológica, sete RS foram classificadas como de confiança alta, uma confiança moderada, oito confiança baixa e doze confiança criticamente baixa.

The problem: Malnutrition refers to deficiencies, excesses or imbalances in energy and/or nutrient intake. Height deficit results in low height for age, and is usually associated with adverse socioeconomic conditions, poor maternal health and nutrition, frequent illnesses and/or inadequate feeding and care of children in early life. In Brazil, it is estimated that the prevalence of low height for age is 7% in children under five years of age. This review aimed to identify policy options for the prevention and management of stunting in children under five years of age. Options to deal with the problem: Searches in the databases retrieved 558 systematic reviews (SR), complemented by seven SRs identified in a manual search. After the selection process, 28 SR met the eligibility criteria and were included in this narrative review. The height deficit prevention and management strategies in children under 5 years of age analyzed in the SR were categorized according to similarity in eight options, presented below. Positive effects were reported on the SR for a variety of strategies, however, some uncertainties were also pointed out. Regarding methodological quality, seven SR were classified as having high confidence, one moderate confidence, eight low confidence and twelve critically low confidence.

Alimentación familiar e indicadores antropométricos en escolares de una unidad educativa urbana, Quito, Ecuador / Family nutrition and anthropometric indicators in schoolchildren of an urban educational unit, Quito, Ecuador

La malnutrición infantil es un problema de salud pública. La investigación tuvo el objetivo de determinar la asociación entre los indicadores antropométricos de los escolares (talla, peso e índice de masa corporal) y la alimentación de padres o tutores legales de los menores, en una institución educativa de la ciudad de Quito, Ecuador, durante diciembre de 2019. El estudio tuvo un enfoque cuantitativo y de tipo observacional, descriptivo y de corte transversal, en el que participaron 38 escolares con edades de 5 a 11 años (20 niños y 18 niñas) y los 32 respectivos padres o tutores legales. El 68,75% de los padres requería hacer cambios hacia una alimentación saludable, el 68,42% de los niños presentaban talla normal, el 23.68% de los niños tenía riesgo de sobrepeso. Los valores p de la prueba Tau C de Kendall fueron mayores que 0,05, no existiendo relación entre las variables estudiadas. Se concluyó que la mayoría de los padres o tutores legales requerían mejorar la calidad de su nutrición. La mayoría de los escolares tenía sobrepeso o riesgo de padecerlo; así como, talla normal. No existió asociación estadísticamente significativa entre la alimentación de los progenitores y el índice de masa corporal.

Child malnutrition is a public health problem. This research aimed to determine the association between the anthropometric indicators of schoolchildren (height, weight, and body mass index) and the nutrition of parents or legal guardians of minors, in an educational institution in the city of Quito, Ecuador, during December 2019. The study had a quantitative and observational, descriptive, and cross-sectional approach, in which 38 schoolchildren aged 5 to 11 years (20 boys and 18 girls) and 32 parents (or legal guardians) participated. 68.75% of the parents requi-red to make changes towards a healthy diet, 68.42% of the children had normal height, 23.68% of the children were at risk of being overweight. The p values of the Kendall Tau C test were greater than 0.05, with no relationship between the variables studied. It was concluded that most of the parents or legal guardians needed to improve the quality of their nutrition. Most of the schoolchildren were overweight or at risk of being overweight, as well as normal size. There was no statistically significant association between the parents' diet and body mass index

Estratégias para prevenção e manejo de desnutrição aguda em crianças menores de cinco anos / Strategies for the prevention and management of acute malnutrition in children under five years of age

O problema: A Organização Mundial da Saúde (OMS) ressalta que cerca de 45% das mortes de crianças menores de cinco anos estão relacionadas à desnutrição, e que elas ocorrem principalmente em países de baixa e média renda. No Brasil, estudo recente estimou uma prevalência de 2,9% de crianças brasileiras com baixo peso para a idade. A Política Nacional de Alimentação e Nutrição propõe a implementação de ações específicas para o combate ao binômio infecção-desnutrição que afeta principalmente crianças provenientes de classes econômicas com reduzido poder aquisitivo, em regiões com baixos índices de desenvolvimento econômico e social. Esta síntese rápida de evidências teve como objetivo identificar opções para políticas de enfrentamento da desnutrição aguda em crianças abaixo de cinco anos de idade. Opções para enfrentar o problema: De 1.261 registros recuperados das bases de dados, após processo de seleção e elegibilidade, vinte e quatro revisões sistemáticas (RS) foram incluídas nesta síntese narrativa. Os resultados foram organizados em doze opções para prevenir ou tratar o déficit de peso em crianças menores de cinco anos. Efeitos positivos foram relatados nas RS para uma variedade de estratégias, no entanto, algumas incertezas também foram apontadas. Com relação à qualidade metodológica, cinco RS foram classificadas como de confiança alta, sete de confiança baixa e doze de confiança criticamente baixa.

The problem: The World Health Organization (WHO) points out that around 45% of deaths among children under five are related to malnutrition, and that these occur mainly in low- and middle-income countries. In Brazil, a recent study estimated a prevalence of 2.9% of Brazilian children with low weight for age. The National Food and Nutrition Policy proposes the implementation of specific actions to combat the infection-malnutrition binomial that mainly affects children from economic classes with low purchasing power, in regions with low levels of economic and social development. This rapid synthesis of evidence aimed to identify options for policies to address acute malnutrition in children under five years of age. Options for tackling the problem: From 1,261 records retrieved from the databases, after the selection and eligibility process, twenty-four systematic reviews (SR) were included in this narrative synthesis. The results were organized into twelve options for preventing or treating underweight in children under five years of age. Positive effects were reported on the SR for a variety of strategies, however, some uncertainties were also pointed out. With regard to methodological quality, five SR were classified as having high confidence, seven as low confidence and twelve as critically low confidence.

Malnutrición en una población de escolares en Santiago, República Dominicana / Malnutrition of an elementary school population in Santiago, Dominican Republic

Introducción: la malnutrición infantil representa uno de los problemas de salud pública más importantes de la República Dominicana (RD) y el mundo. A pesar de esto, actualmente, no existen estudios en la RD que describa el estado nutricional en los niños de la escuela primaria. Material y métodos: este estudio transversal describió las principales variables antropométricas en niños de 1ero a 6to de primaria en Santiago, RD, además de determinar la relación existente entre la antropometría y variables sociodemográficas. Resultados: de los 2,271 estudiantes estudiados, la media del peso fue 33,2 ± 11,4 kg, la talla fue 1,36 ± 0,13 m. La media del percentil fue 65,33 %. El 3.92 % (n=89) estuvo en bajo peso, el 17.57 % (n=399) estuvo en sobrepeso y el 22.94 % (n=521) estuvo en obesidad. Conclusión: el sobrepeso y la obesidad infantil fueron los trastornos más comunes en zonas rurales y urbanas, y tanto en centros privados como públicos

Introduction: Child malnutrition represents one of the most important public health issues in the Dominican Republic (DR) and the whole world. Despite this reality, there are currently no studies in the DR that describe the nutritional status in primary school children. Material and method: This cross-sectional study described the main anthropometric variables in children from elementary schools in Santiago, RD, in addition to determining the relationship between anthropometry status and some sociodemographic variables. Results: 2,271 participants were analyzed; the mean weight was 33.2 ± 11.4 kg, height was 1.36 ± 0.13 m. The mean percentile was 65.33%. 3.92% (n=89) were underweight, 17.57% (n=399) were overweight, and 22.94% (n=521) were obese. Conclusion: Childhood overweight and obesity was the most prevalent disorder, both in rural and urban areas, and both in private and public centers

Situación nutricional y acciones implementadas en niños internados en salas de cuidados intermedios y moderados de un hospital pediátrico de alta complejidad de la ciudad de Buenos Aires / Nutritional status and actions implemented in children admitted to intermediate and moderate care wards of a tertiary-care pediatric hospital in the city of Buenos Aires

Introducción: La malnutrición es un estado de deficiencia o exceso de nutrientes que provoca efectos nocivos y puede alterar el crecimiento aumentando la morbi-mortalidad. Materiales y métodos: estudio retrospectivo, descriptivo. Incluyó niños/as de 1-18 años hospitalizados entre 2016-2018. Se obtuvieron datos de caracterización de la muestra y antropométricos. La herramienta de tamizaje nutricional pediátrico (HTNP) se utilizó para detectar riesgo nutricional y en este subgrupo se analizó: variación de peso, intervención nutricional, complicaciones infecciosas y estadía hospitalaria. El análisis de variables se realizó con SPSS Statistics 20. Resultados: Se evaluaron 745 pacientes, 373 niñas (50,1%). Mediana de edad 7,3 años. Estancia hospitalaria media de 4 días (1-123). Se observó 5,9% emaciados, 56,4% eutróficos, 16,8% sobrepeso y 20,9% obesidad. Con baja talla 13%. Se detectó riesgo nutricional con HTNP en 50,7% de los ingresos. Las patologías de base más frecuentes fueron cardiopatías y neoplasias. En pacientes con riesgo nutricional: estadía hospitalaria media de 5 días, 13,5% cursó con infecciones intrahospitalarias, 68% mantuvo o aumentó de peso durante la internación, 13,5% requirió apoyo nutricional (más utilizado el gavage en 59%). Conclusiones: El niño hospitalizado se encuentra en una situación de vulnerabilidad, por lo que el tamizaje y evaluación nutricional resultan acciones claves para prevenir el deterioro nutricional. En los niños con malnutrición las acciones llevadas a cabo por el Nutricionista Clínico como integrante del equipo de atención, revisten un rol clave para promover y garantizar el derecho de los pacientes a la alimentación adecuada y así mejorar su condición nutricional. (AU)

Introduction: Malnutrition is a state of nutrient deficiency or excess that causes harmful effects and can alter growth increasing morbidity and mortality. Materials and methods: retrospective, descriptive study. Children aged 1-18 years admitted to the hospital between 2016-2018 were included. Sample characterization and anthropometric data were collected. The pediatric nutritional screening tool (PNST) was used to identify nutritional risk and in this subgroup we analyzed: weight variation, nutritional intervention, infectious complications, and length of hospital stay. The analysis of variables was performed with SPSS Statistics 20. Results: 745 patients were evaluated, 373 were girls (50.1%). Median age was 7.3 years. Mean hospital stay was 4 days (1- 123). Among the patients, 5.9% were emaciated, 56.4% eutrophic, 16.8% overweight, and 20.9% obese. Thirteen percent of the patients had short stature. Nutritional risk was detected using HTNP in 50.7% of the admitted patients. The most frequent underlying diseases were heart disease and cancer. In patients at nutritional risk: mean hospital stay was 5 days, 13.5% had hospital-acquired infections, 68% maintained or gained weight during the hospital stay, 13.5% required nutritional support (gavage was the most frequently used in 59%). Conclusions: Hospitalized children are in a vulnerable situation, therefore nutritional screening and evaluation are key actions to prevent nutritional deterioration. In children with malnutrition, the Clinical Nutritionist, as a member of the health care team, plays a key role in promoting and guaranteeing the right of patients to adequate food and thus improve their nutritional condition (AU)

Parâmetros hematológicos de crianças desnutridas após intervenção nutricional: ensaio clínico randomizado / Parámetros hematológicos de niños desnutridos después de intervención nutricional: ensayo clínico aleatorizado / Hematological parameters of malnourished children after nutritional intervention: a randomized clinical trial

Resumo Objetivo Avaliar parâmetros hematológicos de crianças desnutridas após intervenção nutricional com farinha da castanha de caju. Métodos Ensaio clínico randomizado, controlado, cego. O estudo foi realizado no período de abril a dezembro de 2017, em duas Unidades Básicas de Saúde. A amostra foi composta de crianças menores de 5 anos que preencheram os critérios de inclusão, sendo 15 no Grupo Intervenção (farinha da castanha de caju) e 15 crianças no Grupo Controle (farinha de carboximetilcelulose), alocadas nos grupos de forma randômica aleatória simples. Foram analisados os parâmetros de eritrócitos, hemoglobina e hematócrito (série vermelha) e de leucócitos, neutrófilos, segmentados, eosinófilos, monócitos e linfócitos (série branca). A coleta de sangue foi realizada em dois momentos: o primeiro antes da implementação da intervenção e o segundo após 32 semanas de utilização da farinha da castanha de caju. Para avaliação da normalidade e homogeneidade da amostra, utilizaram-se os testes de Shapiro-Wilk e de variância de Bartlett, respectivamente. Utilizou-se o teste T pareado dentro de cada grupo e, para avaliar possíveis associações entre os Grupos Intervenção e Controle e o nível de leucócitos (abaixo, normal e acima), utilizaram-se o teste exato de Fisher e/ou o teste Fisher-Freeman-Halton. Resultados Houve incremento na média das células individuais da série vermelha do hemograma, sobretudo nos padrões de hemoglobina de crianças desnutridas do Grupo Intervenção (p<0,05). A investigação também apontou diferença intragrupo no parâmetro da hemoglobina, tanto no Grupo Controle (p=0,007) como no Intervenção (p<0,001), bem como no parâmetro hematócrito para ambos os grupos (p=0,001). Especificamente na série branca, após a intervenção, evidenciou-se diminuição significativa nos leucócitos (p=0,04) e linfócitos (p<0,01) Conclusão Após intervenção, a utilização da farinha da castanha de caju melhorou os parâmetros hematológicos das crianças desnutridas. Registro Brasileiro de Ensaios Clínicos (REBEC): U1111.1213.9219

Resumen Objetivo Evaluar parámetros hematológicos de niños desnutridos después de la intervención nutricional con harina da castaña de cajú. Métodos Ensayo clínico aleatorizado, controlado, ciego. El estudio se realizó en el período de abril a diciembre de 2017, en dos Unidades Básicas de Salud. La muestra se compuso por niños menores de 5 años que cumplieron con los criterios de inclusión, 15 en el Grupo Intervención (harina de castaña de cajú) y 15 niños en el Grupo Control (harina de carboximetilcelulosa), repartidas en los grupos de forma muestreo aleatorio simple. Se analizaron los parámetros de eritrocitos, hemoglobina e hematocrito (serie roja) y de leucocitos, neutrófilos, segmentados, eosinófilos, monocitos e linfocitos (serie blanca). La muestra de sangre se realizó en dos momentos: el primero antes de la implementación de la intervención y el segundo después de 32 semanas de utilización de la harina da castaña de cajú. Para la evaluación de la normalidad y la homogeneidad de la amuestra, se utilizaron los tests de Shapiro-Wilk y de varianza de Bartlett, respectivamente. Se utilizó la prueba T pareada dentro de cada grupo y, para evaluar posibles asociaciones entre los Grupos Intervención y Control y el nivel de leucocitos (debajo, normal y superior), se utilizó la prueba exacta de Fisher o prueba de Fisher-Freeman-Halton. Resultados Hubo un aumento en el promedio de las células individuales de la serie roja del hemograma, sobre todo en los estándares de hemoglobina de niños desnutridos del Grupo Intervención (p<0,05). La investigación también apuntó una diferencia intragrupo en el parámetro de la hemoglobina, tanto en el Grupo Control (p=0,007) como en la Intervención (p<0,001), así como en el parámetro hematocrito para ambos grupos (p=0,001). Específicamente en la serie blanca, después de la intervención, se evidenció una disminución significativa en los leucocitos (p=0,04) y linfocitos (p<0,01) Conclusión Después de la intervención, la utilización de la harina de la castaña de cajú mejoró los parámetros hematológicos de los niños desnutridos.

Abstract Objective To assess hematological parameters of malnourished children after nutritional intervention with cashew nut flour. Methods This is a randomized, controlled, blind trial. The study was conducted from April to December 2017, in two Basic Health Units. The sample consisted of children under 5 years of age who met the inclusion criteria, 15 in the Intervention Group (cashew nut flour) and 15 children in the Control Group (carboxymethylcellulose flour), randomly allocated to the groups. The parameters of erythrocytes, hemoglobin and hematocrit (red blood cells) and leukocytes, neutrophils, segmented, eosinophils, monocytes and lymphocytes (white blood cells) parameters were analyzed. Blood collection was performed in two moments: the first before intervention implementation and the second after 32 weeks of use of cashew nut flour. To assess the sample normality and homogeneity, Shapiro-Wilk and Bartlett variance tests were used, respectively. The paired t-test was used within each group and, to assess possible associations between the Intervention and Control Groups and the level of leukocytes (below, normal and above), Fisher's Exact test and/or Fisher-Freeman-Halton test were used. Results There was an increase in the mean of the individual red blood cell count, especially in the hemoglobin patterns of malnourished children in the Intervention Group (p<0.05). The investigation also showed an intragroup difference in the hemoglobin parameter, both in the Control Group (p=0.007) and in the Intervention (p<0.001) as well as in the hematocrit parameter for both groups (p=0.001). Specifically in the white blood cells, after intervention, there was a significant decrease in leukocytes (p=0.04) and lymphocytes (p<0.01) Conclusion After intervention, the use of cashew nut flour improved the hematological parameters of malnourished children. Brazilian Clinical Trial Registry (REBEC): U1111.1213.9219

Valoración del estado nutricional antropométrico de escolares venezolanos de 3 a 18 años / Assessment of the anthropometric nutritional status of Venezuelan schoolchildren aged 3 to 18 years

Introducción. La insuficiencia de ingresos en la familia para alimentarse y la inoperancia del programa de alimentación escolar, son factores que afectan el estado nutricional y favorecen el ascenso de la deserción escolar. Objetivo. Determinar el estado nutricional de grupos de niños, niñas y adolescentes de 13 escuelas en comunidades vulnerables. Materiales y métodos. Estudio transversal descriptivo en 7.252 escolares de 3 a 18 años, siete en el estado Bolívar (EB) y seis Distrito Capital (DC) y Estado Miranda (EM), realizado entre mayo y junio, 2019. El análisis se realizó en preescolares de 3 a 5 años y en escolares de 6 a 18 años, según localidad y sexo. Se determinó el estado nutricional con peso-talla (P/T) y talla-edad (T/E) en preescolares y el Índice de Masa Corporal (IMC) en escolares. Valores de referencia y puntos de corte OMS. Resultados: El porcentaje de desnutrición aguda en preescolares fue (1,5%) en ambas localidades y el riesgo EB 3,1% y DC-EM 3,3%. RC 8,2%, más alto EB (8,5%) y en sexo masculino (8,2%). En escolares, la delgadez- delgadez severa (6%), la talla baja y muy baja (6,8%) y el sobrepeso muy bajo (1%-1,4%). Conclusión. En los preescolares, el RC supera la DA, resultados que resumen la magnitud del retraso en los primeros 1.000 días y el impacto de la desnutrición infantil que va dejando huella en la talla baja. Las cifras de desnutrición aguda, retraso de crecimiento y delgadez más bajas que en otros estudios, posiblemente reflejan la presencia de algunos factores de protección que se deben investigar(AU)

Introduction. Insufficient income in the family to feed themselves and the ineffectiveness of the school feeding program are factors that affect the nutritional status and favor the rise of school dropouts. Objective. Determine the nutritional status of a group of children and adolescents from 13 schools in vulnerable communities. Materials and methods. Descriptive cross-sectional study in 7,252 schoolchildren from 3 to 18 years old, seven in the Bolívar state (EB) and six in the Capital District (DC) and Miranda State (EM), carried out between May and June, 2019. The analysis was carried out in preschoolers of 3 to 5 years and in schoolchildren from 6 to 18 years, according to location and sex. Nutritional status was determined with weight-height (W/T) and height-age (T/E) in preschoolers and the Body Mass Index (BMI) in schoolchildren. Reference values and WHO cut-off points. Results: The percentage of acute malnutrition in preschool children was (1.5%) in both localities and the EB risk was 3.1% and DC-EM 3.3%. CR 8.2%, higher EB (8.5%) and male (8.2%). In schoolchildren, thinness-severe thinness (6%), short and very short stature (6.8%) and very low overweight (1%-1.4%). Conclusion. In preschool children, the CR exceeds the AD, results that summarize the magnitude of the delay in the first 1,000 days and the impact of child malnutrition that leaves its mark on short stature. The lower figures for acute malnutrition, growth retardation and thinness than in other studies possibly reflect the presence of some protective factors that should be investigated(AU)

Desnutrición crónica en niños menores de cinco años de la comunidad indígena awá, Barbacoas (Nariño, Colombia), 2019 / Chronic Malnutrition in Children under 5 Years Old in the Awá Indigenous Community, Barbacoas (Nariño ­ Colombia) in 2019 / Desnutrição crônica em crianças menores de cinco anos da comunidade indígena Awá, Barbacoas (Nariño, Colombia), 2019

Introducción: la desnutrición crónica en menores de 5 años se define como el retraso en el crecimiento, resultado de recurrentes carencias nutricionales, asociadas con pobreza, de salud y nutrición materna. El objetivo fue identificar la prevalencia de desnutrición crónica y factores asociados en menores de 5 años de la comunidad indígena awá, atendidos en la ips Unidad del Pueblo Indígena Awá (unipa) de Barbacoas (Nariño, Colombia) durante 2019. Materiales y métodos: estudio de corte transversal con enfoque analítico. Se incluyeron 527 niños menores de 5 años de la comunidad awá acudientes al programa de crecimiento y desarrollo de la ipsunipa. Se evaluó como desenlace la desnutrición crónica y, como factores asociados, características sociodemográficas, nutricionales y otras del estado de salud. Se consideró un valor de p menor al 5 % cuando se utilizó chi cuadrado, test exacto de Fisher y U de Mann-Whitney para determinar asociación estadística; además, se ajustó la relación a través de un modelo de regresión logística múltiple. Resultados: el 17.6 % de los niños pre-sentó desnutrición crónica. Se encontró asociación estadística con ser hijo de madre adolescente (p = 0.006), esquema de vacunación incompleto (p = 0.012), la edad (p = 0.017) y el peso al nacer (p = 0.017). Conclusión: en menores de 5 años de la comunidad awála frecuencia de desnutrición crónica está por encima de la media para esta población en general en Colombia. Es importante priorizar la búsqueda activa de desnutrición crónica en niños cuyas madres son adolescentes, niños con bajo peso al nacer y vacunación incompleta

Introduction: Chronic malnutrition in children under 5 years old is defined as stunting due to recurrent nutritional deficiencies associated with poverty, maternal health, and nutrition. This study aimed to iden-tify the prevalence of chronic malnutrition and associated factors in children under 5 years old from the indigenous Awá community, at Barbacoas, Nariño in 2019. Materials and methods: A cross-sectional study was conducted, which included 527 children under 5 years old from the Awá community who attended a health institution for growth and development program. Chronic malnutrition was evaluated as an outcome, whereas sociodemographic, nutritional and other health characteristics as associated factors. Chi-square, Fisher's exact, and Mann­Whitney's U test were used to determine statistical association. Additionally, the relationship was adjusted through a multiple logistic regression model. Results: Chronic malnutrition was found in 17.6% of children. The statistical association was found in children of the ado-lescent mother, incomplete vaccination schedule, and age and birth weight. Conclusion: In children under 5 years old in the Awá community, the frequency of chronic malnutrition is above the average for the general population in Colombia. Prioritizing the active search for chronic malnutrition in children whose mothers are adolescents and those with low birth weight and incomplete vaccination is important

Introdução: a desnutrição crônica em crianças menores de cinco anos é definida como retardo de crescimento como resultado de deficiências nutricionais recorrentes associadas à pobreza, saúde materna e nutrição. O objetivo é identificar a prevalência de desnutrição crônica e fatores associados em crianças menores de 5 anos da comunidade indígena Awá, atendidas na Unidade ips do Povo Indígena Awá (unipa) de Barbacoas, Nariño durante 2019. Materiais e métodos: estudo transversal de abordagem analítica. Foram incluídas 527 crianças menores de 5 anos da comunidade Awá que participaram do programa de crescimento e desen-volvimento da ipsunipa. A desnutrição crônica foi avaliada como desfecho e as características sociodemo-gráficas, nutricionais e outras características de saúde como fatores associados. Um valor de p inferior a 5% foi considerado quando o qui-quadrado, o teste exato de Fisher e o U de Mann Whitney foram usados para determinar a associação estatística, além disso, a relação foi ajustada por meio de um modelo de regressão logística múltipla. Resultados: 17,6% das crianças apresentavam desnutrição crônica. Associação estatística foi encontrada com os fatores ser filho de mãe adolescente (valor p: 0,006), esquema vacinal incompleto (valor p: 0,012), idade (valor p: 0,017) e peso ao nascer (valor p: 0,017). Conclusão: em crianças menores de 5 anos da comunidade Awá, a frequência de desnutrição crônica está acima da média geral para esta popu-lação na Colômbia. É importante priorizar a busca ativa da desnutrição crônica em crianças cujas mães são adolescentes, em crianças com baixo peso ao nascer e com esquema de vacinação incompleto

Redução do déficit de estatura e a compra de alimentos da agricultura familiar para alimentação escolar no Brasil / Reduction of stature deficit and purchase of family agriculture produce for school meals in Brazil / Reducción del déficit de estatura y de la agricultura familiar en la alimentación escolar en Brasil

O objetivo do artigo é analisar o efeito da compra direta de alimentos da agricultura familiar para alimentação escolar sobre o déficit de estatura em crianças menores de cinco anos, entre 2013 e 2017, no Brasil. O método utilizado é o estudo ecológico e longitudinal, em que a coleta de dados ocorreu em diferentes bancos de dados. A análise foi realizada por meio do teste t para amostras independentes, a fim de comparar as médias entre as variáveis déficit de estatura e compras da agricultura familiar. Além disso, uma análise multivariável foi feita por meio da regressão linear múltipla. Verificou-se uma diferença de médias na prevalência do déficit de estatura significativa entre os municípios que compraram menos de 30% e aqueles que adquiriram 30% ou mais de alimentos da agricultura familiar para alimentação escolar, com 1,47 pontos de diferença. O modelo de regressão linear mostrou que a cada ponto percentual de aumento na compra de alimentos da agricultura familiar para a alimentação escolar pelo município, haverá, em média, uma diminuição 0,55 pontos na prevalência do déficit de estatura, independentemente das demais variáveis. Assim, conclui-se que a compra de alimentos da agricultura familiar para alimentação escolar no Brasil pode contribuir para a redução da prevalência do déficit de estatura em crianças menores de cinco anos.

The objective of this work is to analyze the effect of direct purchase of food from family farms for school meals on the deficit of stature in children under 5 years of age between 2013 and 2017 in Brazil. Method: Ecological and longitudinal study in which data collection occurred in different databases. The analysis was performed using the t-test for independent samples in order to compare the means between the variables stature deficit and purchases from family agriculture. In addition, a multivariable analysis was conducted through multiple linear regression. Results: There was a difference in means in the prevalence of significant stature deficit between the municipalities that bought < 30% and ≥30% of food from family farms for school feeding, with 1.47 points of difference. The linear regression model showed that for each percentage point of increase in the purchase of food from family farms for school feeding by the municipality, there will be on average a decrease of 0.55 points in the prevalence of stature deficit, independent of the other variables. Conclusion: the purchase of food from family agriculture for school feeding in Brazil may contribute to the reduction of the prevalence of stature deficit in children under five years old.

Objetivo: Analizar el efecto de la compra directa de alimentos de las granjas familiares para la alimentación escolar en el déficit de estatura de los niños menores de cinco años entre 2013 y 2017 en Brasil. Método: Estudio ecológico y longitudinal en el que se recogieron datos en diferentes bases de datos. El análisis se llevó a cabo mediante la prueba t para muestras independientes con el fin de comparar las medias entre las variables déficit de estatura y compras de la agricultura familiar. Además, se hizo un análisis multivariable a través de una regresión lineal múltiple. Resultados: Se produjo una diferencia de medias en la prevalencia del déficit de estatura significativo entre los municipios que compraron < 30% y ≥ 30% de los alimentos de las granjas familiares para la alimentación escolar, con 1,47 puntos de diferencia. El modelo de regresión lineal mostró que por cada punto porcentual de aumento en la compra de alimentos de las granjas familiares para la alimentación escolar por parte del municipio, habrá, en promedio, una disminución de 0,55 puntos en la prevalencia del déficit de estatura, independientemente de las demás variables. Conclusión: la compra de alimentos de las granjas familiares para la alimentación escolar en el Brasil puede contribuir a reducir la prevalencia del déficit de estatura en los niños menores de cinco años.

Time to Discharge and its Predictors among Children Aged 1-60 Months with Severe Acute Malnutrition Admitted to the Therapeutic Feeding Center in A Tertiary Hospital, North West Ethiopia

BACKGROUND: Standard treatment of severe acute malnutrition with medical complication and/or failed appetite test is admission in therapeutic feeding centers for stabilization. Once stabilized, patients will be linked to Outpatient treatment program for rehabilitation. Information regarding time to discharge from inpatient therapeutic feeding centers is limited in Ethiopia. The main objective of this study was to assess the time to discharge and its predictors among children1-60 months with Severe Acute Malnutrition admitted to University of Gondar Hospital. METHODS: Hospital Based retrospective follow up study was conducted in Gondar University Hospital among 282 children aged 1-60 months admitted to inpatient Therapeutic Feeding Center from June 2018 to December 2020. Participants were selected by Simple random sampling technique. Time to discharge from inpatient treatment was estimated using Kaplan-Meir procedure and Log Rank test was used to test observed difference between covariates. Identification of predictors for time to discharge was done by Stratified cox regression model. RESULTS: Overall 282 children were studied; 242 (85.8%) were discharged improved and 40 (14.2%) were censored. The median time to Discharge was 13 days (IQR: 9-18) and the Incidence of discharge was found to be 6.4 (95% CI: 5.6-7.2) per 100 person- day observations. Kwash-dermatosis (AHR=2.4, 95% CI: 1.17-4.8), Anemia (AHR=1.7, 95% CI: 1.1-2.6), pneumonia at admission (AHR=1.6, 95% CI: 1.01-2.63) and Hospital acquired infection (AHR=4.4, 95% CI: 2.4-8.2) were predictors of time to discharge. CONCLUSION: Hospital stay at the stabilization center was prolonged.Pneumonia, anemia, kwash dermatosis and Nosocomial infections were significant predictors of time to discharge

Les indicateurs de l'alimentation du nourrisson et du jeune enfant prédicteurs de la malnutrition chez les enfants 6-23 mois dans la zone de santé de Kapolowe, Haut-Katanga, R D Congo / NA

Introduction. L'étude visait évaluer les indicateurs de l'alimentation du nourrisson et du jeune enfant liés à l'état nutritionnel dans la zone de santé de Kapolowe, province du Haut Katanga avant les essais cliniques. Matériel et méthodes. Nous avons conduit une étude descriptive transversale dans la communauté auprès des 568 couples mère-enfant 6-23 mois évalués sur les indicateurs nutritionnels associés à la malnutrition. Résultats. L'allaitement maternel optimal était observé chez 10,7% des couples mère-enfant et l'alimentation complémentaire adéquate bénéficiée par 5,5% des enfants. Presque 25,6% des ménages utilisaient des toilettes améliorées, 98,8% des ménages buvaient l'eau des sources protégées et 12,1% des mères pratiquaient un minimum de lavage de mains. Le premier aliment complémentaire donné à la moitié des enfants (46%) était importé, mais 60,3 % des mères utilisaient le mélange farine de maïs + huile + sucre comme aliment de complément. La prévalence de la malnutrition aiguë, de la malnutrition chronique et de l'insuffisance pondérale était respectivement de 11,9%, 37% et 26,8%. La malnutrition aiguë était associée à l'occupation de la mère, au niveau socio-économique du ménage, à la Religion de la mère, à la consultation prénatale suivie par la mère, au Minimum de Diversité Alimentaire, à l'allaitement maternel non optimal, aux infections récurrentes et au faible poids de naissance. L'insuffisance pondérale était associée au sexe, à l'occupation de la mère, au niveau socio-économique, à la religion de la mère, au minimum de diversité alimentaire, à l'allaitement maternel non optimal, aux infections récurrentes et au faible poids de naissance. La malnutrition chronique était associée au sexe, au niveau socio-économique,

Introduction. The aim of the study was to assess infant and young child feeding indicators related to nutritional status in the Kapolowe health zone, Haut Katanga province prior to the clinical trials. Material and methods. We conducted a descriptive cross-sectional study in the community among568 mother-child pairs 6-23 months of age assessed on nutritional indicators associated with malnutrition. Results. Optimal breastfeeding was observed in 10.7% of the mother-child pairs and adequate complementary feeding in 5.5%. Almost 25.6% of households used improved toilets, 98.8% of households drank water from protected springs and 12.1% of mothers practiced minimal hand washing,12.1% of mothers practiced minimal handwashing. The first supplementary food given to half of the children (46%) was imported food, but 60.3% of mothers used maize flour + oil + sugar as a complementary food. The prevalence of acute malnutrition, chronic malnutrition and under weight were 11.9%, 37% and26.8% respectively. Acute malnutrition was associated with the mother's occupation, household socio-economic level, mother's religion, prenatal consultation attended by the mother, minimum dietary diversity, non-optimal breastfeeding, recurrent infections, and low birth weigh. Underweight was associated with gender, maternal occupation, socio-economic level, maternal religion, minimum dietary diversity, non-optimal breastfeeding, recurrent infections and low birth weight. Chronic malnutrition was associated with gender, socio-economic level, minimum meal frequency, type of toilet used, non-optimal breastfeeding, recurrent infections, and low birth weight. Conclusion. The prevalence of malnutrition, in all its forms, is still very high and worrying among children aged 6-23 months. The feeding practices are predictors of it.

Determinants of developmental milestones among children 0- 23 months at Kabale Hospital, Uganda

BACKGROUND :Approximately 200 million children globally fail to fulfil their development potential due to malnutrition, poor health, and unstimulating environments. Children in Kabale, Uganda, may be at particularly high risk as the rate of malnutrition in the region is likely to impact development. The study aimed to identify possible determinants influencing developmental milestones of breastfed and non-breastfed children aged 0-23 months. MATERIALS AND METHODSThe study was conducted at the young child clinic of Kabale hospital, among 250 children aged 0-23 months and their caregivers, for two months. The study adopted a comparative cross-sectional design, and systematic random sampling was used to select the respondents for the study. The socio-demographic characteristics, nutritional status, and feeding practices were assessed using structured pretested questionnaires. Developmental milestones of the children (communication, motor, fine motor, problem-solving, and social skills) were assessed using the modified ages and stages questionnaires. The data collected was tabulated, analysed statistically, and the results interpreted. RESULTS :Developmental scores were not associated with breastfeeding and minimum meal frequency. A milestone achievement of communication skills was associated with caregiver's education, caregiver's age and length-for-age. Gross motor scores were associated with the caregiver's age, weight-for-age, and length for age. Achievement of fine motor skills was associated with caregiver's education, caregiver's age, child's age, length for age, and children who met the minimum dietary diversity score. Problem-solving scores were associated with child's age, weight for age, length for age, and children who met the minimum dietary diversity. Personal social scores were associated with lower caregiver's age and normal weight for age Conclusion: Developmental scores were not associated with breastfeeding and minimum meal frequency. Development in early childhood was mainly associated with caregiver's age, caregiver's education, child's age, weight for age, length for age, and minimum dietary diversity score. Children under the care of younger caregivers and those who attained normal nutrition status had significantly more developed motor and social skills compared to children with older caregivers and undernourished children, respectively.

La desnutrición infantil en Ecuador. Una revisión de literatura / Child malnutrition in Ecuador. A literature review

La desnutrición infantil constituye un grave problema de salud, afectando los sectores sociales más desfavorecidos. La desnutrición causa disminución del crecimiento y del desempeño escolar, altera el estado bioquímico e incrementa la morbimortalidad infantil. Entre las principales causas de desnutrición están la dieta inadecuada, la presencia de infecciones que interfieren con la utilización adecuada de nutrientes, inequidad e insuficiente disponibilidad de alimentos. En América Latina, aproximadamente 2,3 millones de niños de 0 a 4 años se ven afectados por desnutrición moderada o grave y 8,8 millones presentan baja talla para su edad, con alta prevalencia de desnutrición crónica, lo que es atribuible a determinantes sociales, económicos y políticas de salud deficientes en la mayoría de países de la región. En Ecuador existe una prevalencia de desnutrición de 23,2%, situación que se agrava en el contexto rural, presentando más frecuencia en la Sierra (32%), la Costa (15,7%), la Amazonía (22,7%) y la zona Insular (5,8%), y aun cuando se han implementado programas de nutrición, los logros positivos de indicadores nutricionales, no han alcanzado impactar lo suficiente en algunas comunidades indígenas en las que se estima una tasa de desnutrición crónica infantil por encima de 50%. La presente investigación muestra los principales rasgos de la desnutrición infantil en Ecuador, partiendo de un diseño cualitativo, interpretativo y análisis documental con el objetivo de sistematizar el conocimiento y fortalecer las bases teórico-metodológicas de planes y estrategias necesarios para disminuir los efectos negativos de la desnutrición en el desarrollo infantil(AU)

Infant malnutrition constitutes a serious health problem, affecting the most disadvantaged social sectors. Malnutrition causes a decrease in growth and school performance, an alteration in the biochemical state and an increase in infant morbidity and mortality. Among the main causes of malnutrition are an inadequate diet, the presence of infections that interfere with the adequate use of nutrients, inequity, and insufficient food availability. In Latin America, approximately 2.3 million children aged 0 to 4 are affected by moderate or severe malnutrition and 8.8 million are short for their age, with a high prevalence of chronic malnutrition, which is attributable to social determinants economic, economic and health policies in most countries of the region. In Ecuador there is a prevalence of malnutrition of 23.2%, a situation that worsens in the rural context, presenting more frequency in the Sierra (32%), the Coast (15.7%), the Amazon (22.7%) and the Insular zone (5.8%), and even when nutrition programs have been implemented, the positive achievements of nutritional indicators have not had a sufficient impact on some indigenous communities in which a rate of chronic child malnutrition is estimated by above 50%. This research shows the main features of child malnutrition in Ecuador, starting from a qualitative, interpretive design and documentary analysis with the aim of systematizing knowledge and strengthening the theoretical-methodological bases of plans and strategies necessary to reduce the negative effects of the malnutrition in child development(AU)

Perspectivas comunitarias alrededor de la desnutrición infantil en tres comunidades wayúus de La Guajira (Colombia) / Community Perspectives around Child Malnutrition in Three Wayuu Communities in La Guajira (Colombia) / Perspectivas da comunidade sobre a desnutrição infantil em três comunidades wayuus de La Guajira (Colômbia)

Resumen Introducción: la desnutrición infantil es un problema de salud pública que afecta la supervivencia de algunas comunidades indígenas. Varios estudios la han abordado desde la visión biomédica, pero son pocos desde la mirada de dichas comunidades. El objetivo de este artículo es comprender las perspecti vas comunitarias relacionadas con la desnutrición en niños de 0 a 7 años de edad en las comunidades wayúus de Taiguaicat, Pañarrer y Limunaka del resguardo Manaure (La Guajira, Colombia). Desarrollo: se realizó un estudio cualitativo como parte de una investigación participativa basada en la comunidad. Se llevaron a cabo 21 entrevistas semiestructuradas, 3 foros comunitarios y un ejercicio de fotovoz con 12 participantes. Se analizó la información con herramientas analíticas de la teoría fundamentada. Los hallazgos alrededor de las perspectivas comunitarias de la desnutrición infantil se agruparon en dos categorías analíticas: a) las prácticas arijunas (o las realizadas por los que no son indígenas), de la pér dida de lo ancestral a la enfermedad del hambre, y b) la enfermedad del hambre: su relación con la ali mentación del binomio madre-hijo, durante la gestación y después de esta. Conclusiones: la desnutrición infantil en los wayúus es un fenómeno complejo e histórico, con un trasfondo de desigualdades sociales y de estructuras de poder injustas. De acuerdo con los participantes, la supervivencia de la niñez wayúu está siendo amenazada por la desnutrición, la cual afecta principalmente al binomio madre-hijo, ocasio nada por el poco acceso y disponibilidad a los alimentos, por las inadecuadas prácticas occidentales en el territorio y por la pérdida de las prácticas tradicionales como la siembra y el pastoreo.

Abstract Introduction: Child malnutrition is a public health problem that has affected the survival of some indige nous communities. Several studies have approached it from the biomedical perspective, although only a few have analyzed it from these communities' perspective. The objective of the present article is to under stand the community perspectives related to malnutrition in children aged 0-7 years in the Wayuu commu nities of Taiguaicat, Pañarrer, and Limunaka del Resguardo Manaure, La Guajira, Colombia. Development: A qualitative study was performed. Additionally, as a part of a participatory community-based research, 21 semi-structured interviews, 3 community forums, and a photovoice exercise were performed with 12 participants. The information was analyzed with analytical tools of the grounded theory. The findings around the community perspectives of child malnutrition were grouped into two analytical categories: (a) the Arijuna practices (or those carried out by non-indigenous people), from the loss of the ancestral to the disease of hunger, and (b) the disease of hunger and its relationship with the feeding of the moth er-child binomial during and after pregnancy. Conclusions: Child malnutrition in the Wayuu is a complex historical phenomenon, with a background of social inequalities and unjust power structures. According to the participants' responses, the survival of Wayuu children is threatened by malnutrition, which mainly affects the mother-child relationship caused by poor access to food and its limited availability, inadequate western practices in the territory, and the loss of traditional practices, such as planting and grazing.

Resumo Introdução: a desnutrição infantil é um problema de saúde pública que afeta a sobrevivência de algumas comunidades indígenas. Vários estudos têm abordado o tema a partir da perspectiva biomédica, mas pou cos são os estudos baseados na perspectiva dessas comunidades. O objetivo deste artigo é compreender as perspectivas da comunidade em relação à desnutrição em crianças de 0 a 7 anos nas comunidades Wayuu de Taiguaicat, Pañarrer e Limunaka del Resguardo Manaure, em La Guajira, na Colômbia. Desenvolvimento: foi realizado um estudo qualitativo no âmbito de uma pesquisa participativa de base comunitária, foram realizadas 21 entrevistas semiestruturadas, 3 fóruns comunitários e um exercício de fotovoz com 12 par ticipantes. As informações foram analisadas com ferramentas analíticas da Teoria Fundamentada. As des cobertas em torno das perspectivas da comunidade sobre a desnutrição infantil foram agrupadas em duas categorias analíticas: a) as práticas arijunas, da perda do ancestral à doença da fome, e b) a doença da fome: sua relação com a alimentação do binômio mãe-filho, durante e após a gestação. Conclusões: a desnutrição infantil nos wayuu é um fenômeno complexo e histórico, com um pano de fundo de desigualdades sociais e estruturas de poder injustas. Segundo os participantes, a sobrevivência das crianças wayuu está sendo ameaçada pela desnutrição, que atinge principalmente o binômio mãe-filho, causada pelo pouco acesso e disponibilidade de alimentos, pelas práticas ocidentais inadequadas no território e pela perda de práticas tradicionais como a semeadura e o pastejo.

Hábitos alimentarios antes y durante la pandemia por COVID-19 en un grupo de niñas/os de La Pampa / Eating patterns before and during the COVID-19 pandemic in a group of children from La Pampa

Introducción: los cambios de hábitos alimentarios en la infancia durante la pandemia por COVID-19 podrían predisponer a futuras enfermedades. Objetivos: explorar hábitos alimentarios y actividad física en la niñez durante la pandemia; estimar satisfacción corporal, sobrepeso y obesidad; describir hábitos que influyen en el estado nutricional. Materiales y métodos: se realizó una encuesta con Google Form disponible durante cuatro meses en 2020 que se difundió en medios de comunicación. Se obtuvieron 306 encuestas de niñas y niños, entre 6 y 12 años, de la provincia de La Pampa. Resultados: se observó una reducción en la realización de actividad física durante la pandemia en un 27% de la muestra. Se evidenció un escaso consumo de pescado, frutos secos, legumbres y semillas. Solamente el 15% de los encuestados manifestó diariamente comer verduras y el 50% frutas y lácteos. El 40% consumía jugos, gaseosas y bebidas azucaradas tres a cuatro veces por semana y 32% agregaba sal a las comidas como hábito diario. El 19% de la muestra expresó la autopercepción que durante la pandemia empeoró su alimentación. Se demostró un aumento tanto en las horas de sueño como frente a las pantallas. Se destacó como positivo el aumento de la participación en la preparación de comidas caseras y la comensalidad familiar. En relación a los datos antropométricos, el índice de masa corporal indicó: 15% sobrepeso y 7% obesidad. El 70% estaba conforme con su peso, 26% le gustaría bajar y 4% aumentar. Conclusiones: la escasa frecuencia de consumo de frutas y verduras podría ocasionar deficiencias nutricionales. En general, la situación de confinamiento exigida por la emergencia sanitaria significó un deterioro en la calidad alimentaria y un aumento en los niveles de sedentarismo. Los resultados antropométricos concuerdan con los estudios argentinos de prevalencia de sobrepeso y obesidad y, a su vez, alarman sobre la situación de disconformidad corporal

Introduction: changes in eating habits in childhood during the COVID-19 pandemic could create predisposition to future diseases. Objectives: to explore eating habits and physical exercise in childhood during the pandemic; to estimate body satisfaction, overweight and obesity; to describe habits that influence nutritional status. Materials and methods: a survey was carried out with Google Form, available for a period of four months in 2020 and disseminated in the media. 306 surveys of girls and boys, between 6 and 12 years old, from the province of La Pampa were obtained. Results: a reduction in physical activity during the pandemic was observed in 27% of the sample group. Low consumption of fish, nuts, legumes and seeds was evident. Only 15% of those surveyed stated that they eat vegetables daily and 50% fruits and dairy products. 40% consumed juices, sodas and sugary drinks 3 to 4 times a week and 32% added salt to their meals as a daily habit. 19% of the sample group said that their diet was worsened during the pandemia. An increase in both, the hours of sleep and the hours in front of the screens, was demonstrated. The increase in participation in the preparation of home-cooked meals and family dining was highlighted as positive. In relation to the anthropometric data, the Body Mass Index indicated: 15% were overweight and 7% obese. 70% were satisfied with their weight, 26% would like to lose weight and 4% would like to increase it. Conclusions: the low frequency of consumption of fruits and vegetables could cause nutritional deficiencies. In general, the situation of confinement imposed by the health emergency, resulted in a deterioration of food quality and increasing sedentarism. The anthropometric results agree with the Argentine studies of the prevalence of overweight and obesity and in turn alarm about the situation of body discomfort

Childhood hunger experiences and chronic health conditions later in life among Brazilian older adults / Experiencias de hambre en la niñez y enfermedades crónicas en etapas posteriores de la vida en adultos mayores de Brasil / Experiência de passar fome na infância e problemas crônicos de saúde posteriores em idosos no Brasil

ABSTRACT Objectives. To assess the association between childhood hunger experiences and the prevalence of chronic diseases later in life. Methods. A cross-sectional study was conducted using baseline data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil), a nationally representative study of persons aged 50 years and older (n = 9 412). Univariate and bivariate analyses were used to describe the sample, and multivariate logistic regressions to examine the association between childhood hunger and hypertension, diabetes, arthritis and osteoporosis. Adjusted odds ratios and predicted probabilities were calculated. Results. 24.7% of Brazilians aged 50 and over experienced hunger during childhood. This harmful exposure was significantly more common among non-white people, individuals with lower educational attainment, lower household income and heavy manual laborers. Regional variation was also observed, as the prevalence of individuals reporting childhood hunger was higher in the North and Northeast regions. The multivariate analysis revealed that older adults who reported having experienced hunger during childhood had 20% higher odds of developing diabetes in adulthood (aOR = 1.20, 95% CI: 1.02 - 1.41) and 38% higher odds of developing osteoporosis (aOR = 1.38, 95% CI: 1.15 - 1.64) than adults who did not experience hunger during childhood, after controlling for covariates. Conclusions. The study showed an association between childhood hunger and two chronic diseases in later life: diabetes and osteoporosis. This work restates that investing in childhood conditions is a cost-effective way to have a healthy society and provides evidence on relationships that deserve further investigation to elucidate underlying mechanisms.

RESUMEN Objetivos. Evaluar la asociación entre las experiencias de hambre en la niñez y la prevalencia de enfermedades crónicas en las etapas posteriores de la vida. Métodos. Se realizó un estudio transversal utilizando como línea de base los datos del Estudio Longitudinal del Envejecimiento en Brasil (ELSI-Brasil), un estudio nacional representativo de personas de 50 años o más (n = 9 412). Se emplearon análisis univariado y bivariado para describir la muestra, y regresión logística multivariada para examinar la asociación entre el hambre en la niñez y la hipertensión, la diabetes, la artritis y la osteoporosis. Se calcularon las razones de posibilidades ajustadas y las probabilidades previstas. Resultados. El 24,7% de los brasileños de 50 años o más pasó hambre en la niñez. Esta experiencia perjudicial fue considerablemente más común en las personas no blancas, las personas con menor nivel de instrucción, las personas con ingresos familiares bajos y los trabajadores de mano de obra pesada. También se observó una variación regional, puesto que la prevalencia de individuos que expresaron haber pasado hambre en la niñez fue mayor en las regiones Norte y Nordeste. Luego de controlar las covariables, el análisis multifactorial reveló que los adultos mayores que dijeron haber pasado hambre en la niñez tenían una probabilidad 20% mayor de tener diabetes en la edad adulta (aOR = 1,20, IC 95%: 1,02 - 1,41) y 38% mayor de tener osteoporosis (aOR = 1,38, IC 95%: 1,15 - 1,64) que los adultos que no habían pasado hambre en la niñez. Conclusiones. El estudio reveló una asociación entre el hambre en la niñez y dos enfermedades crónicas en las etapas posteriores de la vida: la diabetes y la osteoporosis. Este trabajo reafirma que invertir en las condiciones de vida de las personas en la niñez es una manera costoeficaz de tener una sociedad saludable, al tiempo que aporta evidencia acerca de relaciones que merecen investigarse más a fin de esclarecer los mecanismos subyacentes.

RESUMO Objetivos. Avaliar a associação entre a experiência de passar fome na infância e a prevalência posterior de doenças crônicas. Métodos. Um estudo transversal foi realizado a partir de dados básicos do Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brasil), uma pesquisa com representatividade nacional realizada com pessoas de 50 anos ou mais (n = 9.412). Análises univariadas e bivariadas foram usadas para descrever a amostra e a regressão logística multivariada foi aplicada para examinar a associação entre passar fome na infância e hipertensão, diabetes, artrite e osteoporose. Foram calculadas razões de chances (odds ratio, OR) ajustadas e probabilidades previstas. Resultados. Verificou-se que 24,7% dos brasileiros com 50 anos ou mais passaram fome na infância. Esta exposição prejudicial foi significativamente mais frequente em pessoas não brancas, com nível de instrução menor e renda familiar mais baixa e em trabalhadores braçais. Observou-se também uma variação regional, com uma maior prevalência de pessoas que relataram ter passado fome na infância nas Regiões Norte e Nordeste. Na análise multivariada, nos idosos que informaram ter passado fome na infância, a probabilidade foi 20% maior de ter diabetes na idade adulta (ORaj 1,20; IC 95% 1,02-1,41) e 38% maior de ter osteoporose (ORaj 1,38, IC 95% 1,15-1,64) em comparação aos adultos que não passaram fome na infância, após o controle de covariáveis. Conclusões. O estudo demonstrou associação entre passar fome na infância e duas doenças crônicas na vida adulta: diabetes e osteoporose. Este trabalho reitera que investir na infância é uma maneira custo-efetiva de se criar uma sociedade saudável e fornece evidências sobre relações que devem ser pesquisadas mais a fundo para esclarecer os processos subjacentes.

Les métaux lourds plus polluant dans la malnutrition chez l'enfant de moins de 5 ans à Lubumbashi / NA

Introduction : Lubumbashi, première ville du Katanga et deuxième grande ville de la République Démocratique du Congo, est une zone minière et le poumon économique du pays. De ce fait, elle constitue le siège d'une effervescence d'activités minières artisanales et industrielles. Ce travail vise à évaluer la bioaccumulation ou l'intoxication des métaux lourds dans la population des enfants malnutris. Matériel et méthodes : Le cobalt, le chrome, l'antimoine et le Plomb ont été dosés dans le sérum chez les enfants de moins de 5ans (n = 311). L'ICP OES ou le spectrophotomètre d'absorption atomique couplé à un spectrophotomètre à émission optique ont été utilisés pour le dosage. Trois cent onze enfants ont été colligés au cours de la période allant du 1 Juillet 2013 au 31 décembre 2014. Les analyses statistiques ont été réalisées au moyen du logiciel Epi Info 7.1.1.0. Résultats : Parmi les métaux lourds, l'antimoine s'est révélé moins toxique que les autres, tandis que les prévalences et risques de pollution significatifs suivants ont été observés chez les enfants malnutris : 76 % (OR [IC 95 %] : 1,5[1,04-2,25]) pour le chrome, 58 % (OR [IC 95 %] : 1,7[1,18-2,59]) pour le cobalt et 58 % pour le Plomb (OR [IC 95 %] : 1,7[1,15-2,65]). Conclusion : L'intoxication aux métaux lourds reste un problème de santé à Lubumbashi dans la population en général, particulièrement chez les malnutris. Plus l'enfant est jeune, de sexe féminin plus, il était exposé à l'intoxication aux métaux lourds plus polluants dans la majorité des cas. Pour la plupart les zscores PPA et TPA étaient au-delà de 2 avec une différence statistique hautement significative.