Padrões alimentares de crianças de 13 a 35 meses de idade e associação com características maternas / Eating patterns among children aged 13 to 35 months and association with maternal characteristics / Estándares alimentarios en niños de 13 a 35 meses de edad y su asociación con características maternas

Resumo: O objetivo foi identificar os padrões alimentares em crianças e verificar a sua associação com características maternas. Foram estudadas 1.185 crianças de 13 a 35 meses de idade. O consumo alimentar foi investigado por meio do recordatório alimentar de 24 horas e os padrões alimentares identificados pela análise fatorial por componentes principais, seguida de rotação ortogonal varimax. Utilizou-se a modelagem hierarquizada por meio da regressão de Poisson com estimativa robusta da variância para calcular as razões de prevalências. Quatro padrões alimentares foram identificados: comum brasileiro, lácteo/mingau, saudável e não saudável. A variância explicada por esses fatores foi de 34,3%, sendo que o padrão comum brasileiro foi o que mais contribuiu com a variância proporcional. Destaca-se o padrão lácteo/mingau, em que o leite materno apresentou carga fatorial negativa, apontando para a sua substituição pelos leites de vaca e modificados. Os dados revelam que a caracterização dos padrões alimentares das crianças diverge segundo as características maternas, como a idade, escolaridade e número de filhos. Três dos quatro padrões encontrados são representados por alimentos ricos em amido, gordura saturada e açúcar simples, e pobres em vitaminas, minerais e fibras. Multiparidade, menor escolaridade materna e idade materna menor que 20 anos foram associadas ao menor consumo de alimentos considerados saudáveis e importantes para o desenvolvimento infantil.

Abstract: This study sought to identify eating patterns among children and to verify their association with maternal characteristics. We studied 1,185 children aged 13 to 35 months. Food consumption was investigated using the 24h dietary recall and the eating patterns were identified using principal components factor analysis, followed by orthogonal varimax rotation. We carried out a hierarchical modeling using poisson regression with robust variance estimates in order to estimate prevalence ratios. We identified four eating patterns: common Brazilian, dairy/porridge, healthy and unhealthy. The variance explained by these factors was of 34.3% and the common Brazilian pattern was the one that most contributed to proportional variance. We highlight the dairy/porridge pattern, in which breast milk had negative factorial loading, suggesting its substitution by cow and modified milk. The data reveal that the characterization of children's eating patterns diverges according to maternal characteristics, such as age, educational level and number of children. Three of the four patterns we found are represented by foods rich in starch, saturated fat and simple sugar and poor in vitamins, minerals and fibers. Multiparity, lower educational levels and maternal age under 20 years were associated with a lower consumption of foods considered to be healthy and important in child development.

Resumen: El objetivo fue identificar los estándares alimentarios en niños y verificar su asociación con características maternas. Se estudiaron a 1.185 niños de 13 a 35 meses de edad. El consumo alimentario se investigó mediante un recordatorio alimentario de 24 horas, y los estándares alimentarios se identificaron mediante un análisis factorial por componentes principales, seguidos de una rotación ortogonal varimax. Se utilizó un modelado jerarquizado mediante la regresión de Poisson con estimativa robusta de la variancia para estimar razones de prevalencias. Se identificaron cuatro estándares alimentarios: brasileño común, lácteo/papillas, saludable y no saludable. La variancia explicada por esos factores fue 34,3%, donde el estándar común brasileño fue el que más contribuyó a la variancia proporcional. Se destaca el estándar lácteo/papilla, donde la leche materna presentó una carga factorial negativa, apuntando su sustitución por leches de vaca y modificadas. Los datos revelan que la caracterización de los estándares alimentarios de los niños diverge según las características maternas, como la edad, escolaridad y número de hijos. Tres de los cuatro estándares encontrados se representan por alimentos ricos en almidón, grasa saturada y azúcar común y pobre en vitaminas, minerales y fibras. Multiparidad, menor escolaridad materna y edad materna inferior a 20 años se asociaron a un menor consumo de alimentos considerados saludables e importantes para el desarrollo infantil.

Influence of breastfeeding in the first months of life on blood pressure levels of preschool children / Influência do aleitamento materno nos primeiros meses de vida na pressão arterial de pré-escolares

Abstract Objective: To investigate whether breastfeeding in early life affects blood pressure of preschoolers. Methods: Cross-sectional study nested in a cohort from a municipality in the state of Minas Gerais, Brazil. All children in the cohort were invited for this study. Thus, between 2009 and 2010, blood pressure of 230 preschool children and their mothers, in addition to anthropometric variables, previous history, and socioeconomic status were evaluated. Blood pressure measurement was assessed in the morning, using automatic Omron® HEM-714INT and HEM-781INT devices to measure the blood pressure of preschool children and their mothers, respectively. Logistic regression was used to study the association between breastfeeding and blood pressure. The significance level was set at 5%. Results: This study identified 19 (8.26%) preschool children with high blood pressure (values above the 90th percentile). High systolic blood pressure was associated with low birth weight (OR = 5.41; 95% CI = 1.45-20.23) and total breastfeeding duration of less than six months (OR = 4.14; 95% CI = 1.40-11.95). High diastolic blood pressure was not associated with any variable, whereas high systolic blood pressure/diastolic blood pressure ratio was associated with breastfeeding duration of less than six months (OR = 3.48; 95% CI = 1.34-9.1). Conclusion: The results of this study indicate that preschoolers breastfed for a period of less than six months were more likely to have high blood pressure when compared to those breastfed for a longer period, suggesting a protective effect of breastfeeding against high blood pressure in this population.

Resumo Objetivo: Investigar se aleitamento nos primeiros meses de vida tem influência sobre a pressão arterial de pré-escolares. Métodos: Estudo transversal aninhado numa coorte de nascidos num município mineiro. Foram convidadas todas as crianças da coorte. Entre 2009 e 2010, foram avaliados pressão arterial (PA) de 230 pré-escolares e de suas mães, além de variáveis antropométricas e pregressas e condição socioeconômica. A medida da PA foi feita de manhã, com os monitores automáticos de braço Omron® modelo HEM-714INT e HEM-781INT para medir a pressão arterial dos pré-escolares e de suas mães, respectivamente. Para o estudo da relação entre aleitamento materno e pressão arterial usou-se a regressão logística. O nível de significância adotado foi 5%. Resultados: Foram identificados 19 (8,26%) pré-escolares com pressão arterial elevada (valores acima do percentil 90). A pressão arterial sistólica (PAS) elevada se associou ao baixo peso ao nascimento (OR = 5,41; IC 95%= 1,45-20,23) e ao período total de aleitamento materno inferior a seis meses (OR = 4,14; IC 95%= 1,40-11,95). Elevada pressão arterial diastólica (PAD) não se associou a qualquer variável e a PAS/PAD elevadas se associaram ao período de aleitamento materno inferior a seis meses (OR = 3,48; IC 95%= 1,34-9,1). Conclusão: Os pré-escolares amamentados por um período inferior a seis meses, quando comparados com os que amamentaram por um período superior, apresentaram maior chance de estar com pressão arterial elevada, o que sugere efeito protetor do aleitamento materno contra elevação da pressão arterial na população estudada.

Dietary transition difficulties in preterm infants: critical literature review / Dificuldades de transição alimentar em crianças prematuras: revisão crítica de literatura

ABSTRACT OBJECTIVE: To analyze the scientific literature on dietary changes in preterm children during the first years of life. DATA SOURCE: The PubMed database was used for article selection. The texts were analyzed according to their objectives, research design, and research group characteristics. The following were selected to comprise the criteria: (1) publications in the period from 1996 to 2014; (2) participation of infants and children from birth to 10 years of age; (3) development of oral motor skills necessary for feeding; (4) development of the feeding process; and (5) feeding difficulties during childhood. SUMMARY OF THE FINDINGS: There were 282 studies identified, of which 17 were used in the review, and five more articles were identified through the reference list of selected articles, totaling 22 references. CONCLUSION: Very low birth weight preterm newborns are more likely to have feeding problems in early postnatal stages and during childhood when compared with full-term infants. Monitoring the feeding of these infants after hospital discharge is strictly recommended in an early intervention program aiming at better development of feeding skills.

RESUMO OBJETIVO: Analisar a literatura científica sobre alterações alimentares em crianças prematuras durante os primeiros anos de vida. FONTE DOS DADOS: A base de dados do Pubmed foi a precursora para a seleção dos artigos. Os textos foram analisados quanto aos seus objetivos, desenhos da pesquisa e características do grupo pesquisa e foram selecionados os seguintes temas para compor os critérios: (1) publicações de 1996 a 2014; (2) participação de bebês e crianças, do nascimento até os 10 anos; (3) desenvolvimento das habilidades motoras orais necessárias para a alimentação; (4) desenvolvimento do processo de alimentação e (5) dificuldades alimentares durante a infância. SÍNTESE DOS DADOS: Foram identificados 282 estudos, 17 foram usados e cinco artigos foram identificados por meio da lista de referência bibliográfica dos artigos selecionados, totalizando 22 referências bibliográficas. CONCLUSÃO: A revisão permitiu concluir que recém-nascidos pré-termo muito baixo peso (RNPTMBP) são mais propensos a apresentar problemas de alimentação nos estágios iniciais pós-natal e durante a infância quando comparados com crianças a termo. O monitoramento da alimentação após a alta hospitalar é estritamente recomendado em um programa de intervenção precoce com vistas ao melhor desenvolvimento das habilidades alimentares.

Atuação do pediatra nos primeiros mil dias da criança: a busca pela nutrição e desenvolvimento saudáveis / The pediatrician's role in the first thousand days of the child: the pursuit of healthy nutrition and development

Resumo Objetivos: Descrever o conceito dos primeiros mil dias, sua importância para a saúde e ações a serem implantadas, em especial pelos pediatras, para que a criança alcance nutrição e desenvolvimento saudáveis. Fonte dos dados: Revisão não sistemática nas bases SciELO, Lilacs, Medline, Scopus e Web of Science nos últimos dez anos com os termos mil dias, nutrição infantil, desenvolvimento infantil, infância, criança. Busca não sistemática na Internet de organizações que adotam o conceito dos mil dias e emitem recomendações sobre a saúde da criança. Síntese dos dados: Os primeiros mil dias vão da concepção até o fim do segundo ano de vida. É um importante período para intervenções que garantam nutrição e desenvolvimento saudáveis, que trarão benefícios em todo o ciclo de vida. As crianças devem receber alimentação adequada, por meio de nutrição pré-natal adequada, aleitamento materno exclusivo nos primeiros seis meses, adição de alimentos complementares adequados e continuação da amamentação até os dois anos. Face à condição de dependência absoluta de cuidados de um adulto, é fundamental que tenham um ambiente propício e acolhedor necessário para desenvolver laços fortes com seus cuidadores e lançar as bases para um desenvolvimento pleno e saudável. Conclusões: O pediatra, junto com outros profissionais, pode atuar na promoção de ações com ênfase no conceito dos primeiros mil dias que garantam a nutrição e o desenvolvimento saudáveis da criança. Focalizar ações nesse período poderá aumentar as chances de a criança ter uma vida saudável e produtiva no futuro, fortalecer famílias e comunidades e contribuir para quebrar o ciclo intergeracional da pobreza.

Abstract Objectives: To describe the concept of the first 1,000 days, its importance for health, and actions to be implemented, particularly by pediatricians, in order to attain healthy nutrition and development. Sources: A nonsystematic review was carried out in the SciELO, Lilacs, Medline, Scopus, and Web of Science databases, encompassing the last decade, using the terms 1,000 days, child nutrition, child development, childhood, and child. A non-systematic search was performed online for organizations that use the 1,000-day concept and give recommendations on children's health. Summary of the findings: The first 1,000 days range from conception to the end of the second year of life. It represents an important period to implement interventions to ensure healthy nutrition and development, which will bring benefits throughout life. Children should receive adequate nutrition, through proper prenatal diet, exclusive breastfeeding for the first 6 months, addition of adequate complementary foods, and continued breastfeeding up to 2 years of life. Given the condition of absolute dependence on an adult's care, it is crucial to establish an enabling and friendly environment, necessary for the development of strong bonds with caregivers, laying the groundwork for a full and healthy development. Conclusions: The pediatrician, together with other professionals, can act by promoting actions emphasizing the concept of the first 1,000 days to ensure healthy nutrition and development. Focusing on actions in this period may increase the child's chance of having a healthy and productive life in the future, strengthening family and community ties, helping to break the intergenerational cycle of poverty.

Primaquina y recurrencias de malaria por Plasmodium vivax. Metanálisis de estudios clínicos controlados / Primaquine and relapses of Plasmodium vivax. Meta analysis of controlled clinical trials

ANTECEDENTES: La primaquina (PQ) se usa contra recurrencias del paludismo vivax (RPV), pero se desconocen varios aspectos posológicos, como la dosis total (DT) eficaz en determinado número de días. OBJETIVO: Comparar regímenes de PQ contra RPV en estudios clínicos controlados (ECC) aleatorios o no aleatorios. METODOLOGÍA: Metanálisis. Se buscó información hasta el 31 de diciembre de 2012 en Lilacs, SciELO, PubMed (Medline), Cochrane Library, Cochrane Infectious Diseases Group, Embase. Se usaron estudios experimentales o ECC, siempre con grupo control concurrente. Se incluyeron estudios con o sin asignación aleatoria, "close label" o "open label", con tratamiento supervisado o no supervisado No se exigió que el estudio estableciera diferencia entre recaída y reinfección mediante pruebas moleculares. Se aplicaron criterios de inclusión y exclusión a los artículos y satisfacer los de inclusión constituyó calidad adecuada para dejarlos en el metanálisis. RESULTADOS: Se completaron 23 ECC, que reunieron los criterios de selección. Evaluamos 4 esquemas de dosis total (DT) dada en determinados días (DT mg número de días): 210 14 = 210 mg en 14 días; 210 7 = 210 mg en 7 días; 45 a 150 mg en 3 a 10 días; 0 (no PQ). La ausencia de PQ llevó a la recurrencia de 34,48% frente a 19,66% con PQ 210 14 (diferencia significativa); 210 14 mostró eficacia igual a la de 210 7. Cada esquema 210 7 y 210 14 es mejor estadísticamente que 45 a 150. CONCLUSIONES: El uso de PQ es necesario para reducir las recurrencias y la DT 210 mg dada en 7 ó en 14 días es la que mejor eficacia tiene pero se requieren más estudios con el esquema 210 7. .

BACKGROUND: Primaquine (PQ) is used against relapses of vivax malaria (RVM) but several aspects about dosage are unknown, as the total effective dose (TD) in a number of days. OBJECTIVE: To compare PQ regimens against RVM in randomized or non randomized controlled clinical trials (CCTs). METHODOLOGY: Meta analysis. Information was sought until 31 December, 2012 in Lilacs, SciELO, PubMed (Medline), Cochrane Library, Cochrane Infectious Diseases Group, Embase. Experimental studies or CCT were used, always with concurrent control group. No matter whether or not the design was randomized, close label, supervised. It is not required that the study established difference between relapse and reinfection by molecular evidence. Inclusion and exclusion criteria for articles were applied and meet the inclusion criteria constituted adequate quality to be left in the meta analysis. RESULTS: 23 ECC with or without random allocation of treatment met the selection criteria. Include four schemes of TD (TD mg number of days): 210 14 = 210 mg in 14 days; 210 7 = 210 mg in 7 days, 45 to 150 mg in 3 to 10 days, 0 (not PQ). If PQ is absent, recurrences occurr 34.48% versus 19.66% with PQ 210 14 (significant difference), 210 14 showed effectiveness equal to that of 210 7. Treatments 210 7 and 210 14 were statistically better than 45 to 150 effectiveness. CONCLUSIONS: The use of PQ is necessary to reduce recurrences and TD 210 mg given at 7 or 14 days is which is more effective but more studies are required to treatment 210 7. .

Influência das variáveis nutricionais e da obesidade sobre a saúde e o metabolismo / Influence of nutritional variables and obesity on health and metabolism

A obesidade é um tema recorrente na literatura científica da atualidade. Isso se deve ao aumento exponencial de sua prevalência em todas as camadas da sociedade. A popularidade deste tema fez também com que assuntos associados a ele emergissem e ganhassem maior notabilidade em publicações da área da saúde. Com objetivo de avaliar o que vem sendo estudado no campo da obesidade e nutrição, esta revisão realiza um apanhado de todos os artigos publicados dentro destes temas em algumas das principais revistas científicas brasileiras nos últimos dois anos. Dentre os subtemas selecionados neste trabalho, aqueles relacionados à obesidade infantil chamaram atenção por aparecerem com maior frequência. Estes foram subdivididos em: prevalência, influências intrauterinas e do aleitamento que podem levar ao desenvolvimento desta condição, consequências na qualidade de vida, sistema cardiovascular e metabolismo e possíveis estratégias de prevenção. Além disso, foram explorados temas relacionados à obesidade em adultos como seus fatores de risco e novas estratégias de prevenção, com atenção especial aos muitos estudos avaliando diferentes aspectos relacionados à cirurgia bariátrica. Finalmente, abordou-se o tema da desnutrição e o impacto da deficiência de micronutrientes específicos como selênio, vitamina D e vitamina B12. A partir dos resultados, tornou-se possível concluir a real importância da obesidade e da nutrição na manutenção da saúde e também as diversas frentes de pesquisa que a envolvem na atualidade. Dessa forma, é essencial que se criem novas formas de atualização que sejam rápidas e eficientes, direcionadas aos profissionais de saúde envolvidos no tratamento destes indivíduos.

Obesity is a recurring theme in current scientific literature. This can easily be explained by its exponential increase in all layers of society. The popularity of this subject has also given rise to associated questions, which have achieved greater prominence in health-related publications. In order to assess what has been studied in the field of obesity and nutrition, an overview of all articles published on these subjects in some of the main Brazilian scientific journals over the past two years was performed. Among the subthemes selected for this study, those related to childhood obesity attracted attention due to their greater frequency. These were subdivided into: prevalence, intrauterine and breastfeeding influences that may lead to the development of this condition, impact on quality of life, cardiovascular system and metabolism, and possible prevention strategies. Furthermore, issues related to obesity in adults were explored, such as risk factors and new strategies for prevention, with special attention given to the many studies evaluating different aspects of bariatric surgery. Finally, the subject of malnutrition and the impact of the deficiency of specific micronutrients such as selenium, vitamin D, and vitamin B12 were assessed. Based on the results, it was possible to assess the actual importance of obesity and nutrition in health maintenance, and also the several lines of research regarding these issues. Thus, it is essential to create new methods, which must be quick and efficient, to update health professionals involved in the treatment of obesity.

Experience in managing severe malnutrition in a government tertiary treatment facility in Bangladesh.

Children with severe acute malnutrition, defined as weight-for-height <70% of the reference median or bilateral pedal oedema or mid-arm circumference <110 mm having complications, were managed in the Nutrition Unit of the Chittagong Medical College Hospital (CMCH) following the guidelines of the World Health Organization, with support from Concern Worldwide Bangladesh and ICDDR,B. In total, 171 children aged less than five years (mean +/- SD age 23.5 +/- 15.3 months) were admitted during June 2005-May 2006. Of them, 66% were aged less than two years, and 84.2% belonged to households with a monthly income of less than US$ 40. The main reason for bringing children by their families to the hospital was associated major illnesses: bronchopneumonia (33%), oedema (24%), diarrhoea (11%), pulmonary tuberculosis (9%), or other conditions, such as meningitis, septicaemia, and infections of the skin, eye, or ear. The exit criteria from the Nutrition Unit were: (a) for children admitted without oedema, an absolute weight gain of > or = 500 and > or = 700 g for children aged less than two years and 2-5 years respectively; and for children admitted with oedema, complete loss of oedema and weight-for-height >70% of the reference median, and (b) the mother or caretaker has received specific training on appropriate feeding and was motivated to follow the advice given. Of all the admitted children, 7.6% of parents insisted for discharging their children early due to other urgent commitments while 11.7% simply left with their children against medical advice. Of the 138 remaining children, 88% successfully graduated from the Nutrition Unit with a mean weight gain of 10.6 g/kg per day (non-oedematous children) and loss of -1.9 g/kg per day (oedematous children), 86% graduated in less than three weeks, and the case-fatality rate was 10.8%. The Nutrition Unit of CMCH also functions as a training centre, and 197 health functionaries (82 medical students, 103 medical interns, and 12 nurses) received hands-on training on management of severe malnutrition. The average cost of overall treatment was US$ 14.6 per child or approximately US$ 1 per child-day (excluding staff-cost). Food and medicines accounted for 42% and 58% of the total cost respectively. This study demonstrated the potential of addressing severe acute malnutrition (with complications) effectively with minimum incremental expenditure in Bangladesh. This public-private approach should be used for treating severe acute malnutrition in all healthcare facilities and the treatment protocol included in the medical and nursing curricula.

Nutrition: basis for healthy children and mothers in Bangladesh.

Recent data from the World Health Organization showed that about 60% of all deaths, occurring among children aged less than five years (under-five children) in developing countries, could be attributed to malnutrition. It has been estimated that nearly 50.6 million under-five children are malnourished, and almost 90% of these children are from developing countries. Bangladesh is one of the countries with the highest rate of malnutrition. The recent baseline survey by the National Nutrition Programme (NNP) showed high rates of stunting, underweight, and wasting. However, data from the nutrition surveillance at the ICDDR,B hospital showed that the proportion of children with stunting, underweight, and wasting has actually reduced during 1984-2005. Inappropriate infant and young child-feeding practices (breastfeeding and complementary feeding) have been identified as a major cause of malnutrition. In Bangladesh, although the median duration of breastfeeding is about 30 months, the rate of exclusive breastfeeding until the first six months of life is low, and practice of appropriate complementary feeding is not satisfactory. Different surveys done by the Bangladesh Demographic and Health Survey, United Nations Children's Fund (UNICEF), and Bangladesh Breastfeeding Foundation (BBF) showed a rate of exclusive breastfeeding to be around 32-52%, which have actually remained same or declined over time. The NNP baseline survey using a strict definition of exclusive breastfeeding showed a rate of exclusive breastfeeding (12.8%) until six months of age. Another study from the Abhoynagar field site of ICDDR,B reported the prevalence of exclusive breastfeeding to be 15% only. Considerable efforts have been made to improve the rates of exclusive breastfeeding. Nationally, initiation of breastfeeding within one hour of birth, feeding colostrum, and exclusive breastfeeding have been promoted through the Baby-Friendly Hospital Initiative (BFHI) implemented and supported by BBF and UNICEF respectively. Since most (87-91%) deliveries take place in home, the BFHI has a limited impact on the breastfeeding practices. Results of a few studies done at ICDDR,B and elsewhere in developing countries showed that the breastfeeding peer-counselling method could substantially increase the rates of exclusive breastfeeding. Results of a study in urban Dhaka showed that the rate of exclusive breastfeeding was 70% among mothers who were counselled compared to only 6% who were not counselled. Results of another study in rural Bangladesh showed that peer-counselling given either individually or in a group improved the rate of exclusive breastfeeding from 89% to 81% compared to those mothers who received regular health messages only. This implies that scaling up peer-counselling methods and incorporation of breastfeeding counselling in the existing maternal and child heath programme is needed to achieve the Millennium Development Goal of improving child survival. The recent data showed that the prevalence of starting complementary food among infants aged 6-9 months had increased substantially with 76% in the current dataset. However, the adequacy, frequency, and energy density of the complementary food are in question. Remarkable advances have been made in the hospital management of severely-malnourished children. The protocolized management of severe protein-energy malnutrition at the Dhaka hospital of ICDDR,B has reduced the rate of hospital mortality by 50%. A recent study at ICDDR,B has also documented that home-based management of severe protein-energy malnutrition without follow-up was comparable with a hospital-based protocolized management. Although the community nutrition centres of the NNP have been providing food supplementation and performing growth monitoring of children with protein-energy malnutrition, the referral system and management of complicated severely-malnourished children are still not in place.

Abordagem do diabetes melito na primeira infância / Management of diabetes mellitus in young children: [review]

A ocorrência de diabetes melito tipo 1 em crianças abaixo de 5 anos é rara, mas vem apresentando um aumento em sua incidência em vários países do mundo. O diagnóstico é comumente postergado e a criança em geral encontra-se em estado avançado de descompensação. Um dos desafios do acompanhamento desses casos é estimular o total envolvimento da família, já que a criança é dependente de seus cuidados. A atenção com os pequenos pacientes deve ser intensa, já que dificilmente há queixas que possam sugerir a hipoglicemia. A aceitação alimentar e as atividades físicas são irregulares e imprevisíveis e a sensibilidade insulínica é maior. A terapêutica com insulina necessita ser individualizada, e a monitorização glicêmica domiciliar é fundamental para que o melhor controle seja obtido.

The occurrence of type 1 diabetes mellitus in children under 5-years-old is rare, but its incidence has been growing all over the world. The diagnosis is usually delayed and the patient presents advanced states of ketoacidosis. After the diagnosis, it is extremely crucial the involvement of the family in the treatment from the beginning, due to the dependency of the young children. The attention focused on the patient must be intense, since there are no evident hypoglycemic symptoms, the food intake and physical activities are irregular and there is higher insulin sensitivity. Insulin administration has to be individualized, and glucose monitoring is essential to obtain a good control.

A escola promovendo hábitos alimentares saudáveis: uma proposta metodológica de capacitação para educadores e donos de cantina escolar / Promotion of healthy eating habits by schools: a methodological proposal for training courses for educators and school cafeteria owners

O projeto A Escola Promovendo Hábitos Alimentares Saudáveis estimula, desde 2001 no Distrito Federal, Brasil, a formação de bons hábitos alimentares na comunidade escolar, no contexto da promoção de estilos de vida saudáveis e prevenção das doenças crônicas não- transmissíveis. Este trabalho apresenta e avalia uma metodologia desenvolvida em 2006, para capacitação de educadores do ensino infantil e fundamental até a 4ª série e donos de cantina escolar. As oficinas tiveram aulas expositivas, atividades práticas, jogos educativos, entre outros. Como indicadores de avaliação analisaram-se itens relacionados à ampliação e aplicabilidade dos conhecimentos, além da implantação dos 10 passos da cantina escolar saudável. As atividades pedagógicas propostas foram verificadas pela análise dos portfólios dos educadores. A avaliação geral foi positiva, houve ampliação dos conhecimentos (p < 0,05) dos participantes em três módulos desenvolvidos. Os objetivos dos portfólios foram alcançados por 44 por cento dos educadores. Na implantação da cantina saudável, resultados positivos foram observados comparando-se os períodos anterior e posterior à capacitação. A metodologia utilizada levou à ampliação de conhecimento nos dois públicos, destacando o ambiente escolar como espaço concreto de promoção da alimentação saudável.

The project entitled Promotion of Health Eating Habits by Schools, operating in the Federal District of Brazil since 2001, encourages good eating habits in the school community within the context of promoting healthy lifestyles and preventing chronic non-communicable diseases. The current article presents and analyzes a methodology to train preschool and elementary educators and school cafeteria owners. The workshops included theoretical classes, practical activities, and educational games and were evaluated on the basis of expansion and applicability of knowledge, in addition to implementation of the 10 steps to a healthy school cafeteria. The proposed pedagogical activities were verified by an analysis of the teachers' workshop folders. The overall evaluation was positive, with expansion of knowledge (p < 0.05) among participants for the three workshop modules. The objectives laid out in the workshop folders were reached by 44 percent of the teachers. In the implementation of the healthy cafeteria, positive results were observed when comparing the pre and post-training periods. The methodology helped expand knowledge for both teachers and cafeteria owners, highlighting the school community as a prime space for promoting healthy eating.

The negative effects of poverty & food insecurity on child development.

This paper addresses the importance of the first three years of life to the developing child, examines the importance of early childhood nutrition and the detrimental effects on child health and development due to poverty and food insecurity. As development experts learn more about the importance of the first three years of life, there is growing recognition that investments in early education, maternal-child attachment and nurturance, and more creative nutrition initiatives are critical to help break the cycle of poverty. Even the slightest forms of food insecurity can affect a young child's development and learning potential. The result is the perpetuation of another generation in poverty. Conceptualizing the poorly developed child as an embodiment of injustice helps ground the two essential frameworks needed to address food insecurity and child development: the capability approach and the human rights framework. The capability approach illuminates the dynamics that exist between poverty and child development through depicting poverty as capability deprivation and hunger as failure in the system of entitlements. The human rights framework frames undernutrition and poor development of young children as intolerable for moral and legal reasons, and provides a structure through which governments and other agencies of the State and others can be held accountable for redressing such injustices. Merging the development approach with human rights can improve and shape the planning, approach, monitoring and evaluation of child development while establishing international accountability in order to enhance the potential of the world's youngest children.

Associação entre estado nutricional e atividade física em escolares da Rede Municipal de Ensino em Corumbá - MS / Association between nutritional status and physical activity in Municipal Schools in Corumbá - MS

O sedentarismo é fator de risco para o desenvolvimento de sobrepeso e obesidade infantil, condições que se associam à dislipidemia, hipertensão arterial e resistência insulínica, entre outras alterações. O objetivo deste estudo foi avaliar o estado nutricional e a associação com o padrão de atividade física em escolares da Rede Municipal de Ensino de Corumbá (MS). Foi realizado estudo analítico transversal em uma amostra de 403 escolares, com idade entre sete e 10 anos, no qual se consideraram com risco de sobrepeso e sobrepeso as crianças com percentis de IMC < 85 e < 90 e < 90, respectivamente. O índice de atividade física foi determinado por meio de questionário elaborado especificamente para o estudo, obtendo-se dados sobre a duração (minutos), intensidade (equivalente metabólico) e gasto calórico (kcalorias) das atividades físicas ativas e sedentárias. Verificou-se prevalência de 6,2 por cento e 6,5 por cento para risco de sobrepeso e sobrepeso, respectivamente, com prevalência maior nas meninas do que nos meninos. A maioria das atividades físicas realizadas pelas crianças foi leve (< 3 METs) e moderada (3 a 6 METs) e nenhuma atividade física vigorosa (> 6 METs) foi registrada. Quanto maior a idade, menor o tempo despendido nas atividades físicas ativas. Constatou-se que crianças eutróficas são mais ativas, praticam atividades físicas mais intensas e gastam menos tempo assistindo à televisão e jogando videogames do que as crianças com sobrepeso. Os dados evidenciam a importância em promover mudanças no estilo de vida com a adoção de hábitos saudáveis, desde a infância, e a sua manutenção por toda a vida. Crianças ativas favorecem uma população adulta também ativa e saudável contribuindo, conseqüentemente, para a redução da incidência de morbidade e mortalidade na idade adulta.

A sedentary life style is a factor of risk for the development of overweight and childhood obesity, conditions associated with dyslipidemia, arterial hypertension and insulin resistance, among other disorders. The objective of this study was to evaluate the nutritional status and the association with the profile of physical activity in Municipal Schools in Corumbá - MS. A cross-sectional study was carried out in a sample of 403 pupils, aged 7-10 years, in which children with Body Mass Index (BMI) values > 85th and < 95th and > 95th percentile were classified in risk of overweight and overweight, respectively. The index of physical activity was determined by a specific questionnaire for the study, to obtain data about duration (minutes), intensity (metabolic equivalent) and energy expenditure (kcalories) of both active and sedentary physical activities. A prevalence of 6.2 percent e 6.5 percent to risk of overweight and overweight, respectively, was verified, with higher prevalence in girls than in boys. Most physical activities performed by children were light (< 3 METs) and moderated (3 a 6 METs); no vigorous (> 6 METs) physical activity was recorded. The older the children, the lesser the time spent in active physical activities. Normal-weight children are more active, practice more intense physical activities and spend less time watching television and playing video-games than overweight children. The data emphasize the importance of promoting changes in the life-style through the introduction of healthy habits, since infancy, and their maintenance for the whole life. Active children favor an active healthy adult population too, which can contribute, consequently, for a reduction in the incidence of morbidity and mortality at adulthood.

El sedentarismo es el factor de riesgo principal para el desarrollo de sobrepeso y la obesidad infantil, creando condiciones que asocian la dislipidemia, hipertensión arterial y la resistencia a la insulina, entre otras alteraciones. El objetivo de este estudio fue el de evaluar el estado nutritivo y la asociación con un modelo de actividad física en los escolares de la Red Municipal de Ensino en Corumbá (MS). Se realizó un estudio analítico que fue cumplido en una muestra de 403 escolares, con edades entre 7 y 10 años considerando riesgo de sobrepeso y sobrepeso los niños con percentil de CMI < 85 y < 90 y < 90, respectivamente. El índice de actividad física fue medido a través de una encuesta elaborada específicamente para este estudio, obteniéndose los datos sobre la duración (minutos), intensidad (equivalente metabólico) y el gasto calórico (el kcalorias) de las actividades físico en los activos y los sedentarios. Se verificó un predominio de 6,2 por ciento y 6,5 por ciento para el riesgo de sobrepeso y sobrepeso, respectivamente, con el predominio más grande en las muchachas que en los muchachos. La mayoría de las actividades físicas lograda por los niños eran ligeras (< 3 METs) y moderadas (3 a 6 METs) aún así, cualquier actividad física vigorosa (> 6 METs) fue registrada. Cuanto más grande la edad, más pequeño el tiempo gastato en las actividades físico activas. Se verificó que los niños eutróficos son más activos, que practican las actividades físicas más intensas y gastan menos tiempo asistiendo a la televisión y jugando con video-juegos que los niños con el sobrepeso. Los datos evidencian la importancia de la promoción de los cambios en el estilo de vida con la adopción de hábitos saludables, desde la niñez, y el mantenimiento de la misma para una vida. Los niños activos también favorecen una población adulta contribuyendo a una vida activa y saludable, por consiguiente, para la reducción de la incidencia del morbilidad y mortalidad...

Estado nutricional de crianças índias terenas: evolução do peso e estatura e prevalência atual de anemia / Nutritional status of Terena indian children from Mato Grosso do Sul, Brazil: follow up of weight and height and current prevalence of anemia

OBJETIVO: Comparar o peso e a estatura de crianças índias Terenas menores de 10 anos avaliadas em dois períodos diferentes (1995 e 2002) e verificar a prevalência de anemia nessa população no ano de 2002. MÉTODOS: O estudo foi transversal, sendo avaliadas 253 crianças índias Terenas menores de 10 anos em 1995 e 244 em 2002, pertencentes às aldeias Limão Verde e Córrego Seco, em Aquidauana (MS). O peso e a estatura foram relacionados com a referência do NCHS (Epi-Info versão 6.2). A concentração da hemoglobina foi determinada com o emprego de um fotômetro portátil. RESULTADOS: As proporções de crianças com déficit (escore z < -2 desvios padrão) de peso para a idade foram 4 e 2,9 por cento, respectivamente, em 1995 e 2002. Os déficits de peso para a estatura foram 3,6 e 0,8 por cento, respectivamente. Os déficits de estatura para a idade foram, respectivamente, 15 e 11,1 por cento. A comparação das medianas dos escores z entre 1995 e 2002 revelou aumento estatisticamente significante (p < 0,05) nos seguintes indicadores: peso-idade e peso-estatura nos menores de 24 meses, peso-idade e estatura-idade entre os 24 e 60 meses. Não se observou redução estatisticamente significante de nenhum dos indicadores nas três faixas etárias. A prevalência de anemia foi 86,1 por cento entre as idades de 6 e 24 meses (n = 43), 50,8 por cento entre os 24 e 60 meses (n = 65) e 40,7 por cento entre 60 e 120 meses (n = 59). CONCLUSÃO: Entre 1995 e 2002, observou-se melhora nos indicadores nutricionais de peso e estatura. A prevalência de anemia é muito elevada, indicando a necessidade de seu combate com celeridade.

Assessment of growth and feeding practices in children with cleft lip and palate.

Feeding difficulties in cleft lip and palate (CLP) infants is commonly observed and is the most traumatic experience the family has to face. These infants are undernourished and have compromised growth. The purpose of this study was to 1) assess general health and growth parameters in children with CLP and in normal children; and 2) investigate the feeding methods of CLP infants and normal infants. A total of 221 children from birth to six years of both sexes, with CLP (60 children) and normal (161 children) were selected. The CLP and normal children were divided into three subgroups by age. The practice of feeding the infants in subgroup I was assessed using standard piloted questionnaires. The assessment of growth was done at baseline and at six months in all the subgroups.The general well being of the children was assessed by noting the number of common infections. Results showed that a significantly higher percentage of mothers with normal babies (p < 0.01) had a positive attitude towards breast feeding. When compared to normal children, CLP children were more susceptible to infections (p < 0.05) and measured significantly lower on the height growth curve(p < 0.05). Hence, height can be used to monitor growth in CLP children.

Relação entre proteína dietética e calciúria em crianças e adolescentes com nefrolitíase / Relation between diet protein and calciuria in children and adolescents with nephrolitiasis

PURPOSE: The objective was to evaluate the quality of diet and the relationship between protein diet and calciuria in children and adolescents with nephrolithiasis. METHODS: Forty-nine children and adolescents (28 male and 21 female; 10.1 +/- 3.16 years old) with nephrolithiasis were included in study. Diet evaluation was performed over a 3 day period in order to determine nutrient consumption. The analysis of diets were carried out by DietWin Clínico 3.0 software. One 24-hour urine sample was collected for the measurement of calcium. Nutritional status was also assessed by Body Mass Index (BMI). RESULTS: The diet of patients containe insufficient energy and calcium. High levels of protein (69.64 +/- 16.42 gm), mainly animal source (65.81 +/- 11.45%) and low levels of calcium (500.95 +/- 284.64 mg) was observed (95%). Analysis of 24 hour urine samples revealed that 25.0% of the patients presented hypercalciuria. A positive correlation (r = 0.26680) between animal protein intake and calciuria was found, in opposite of vegetable protein and calciuria correlation (r = -0.2675). CONCLUSIONS: Animal protein of the diet has a significant effect in urinary excretion of calcium in patients with nephrolithiasis.

Intestinal parasitoses and the nutritional status of Veddah children in Sri Lanka.

This study describes and compares the intestinal parasitoses and nutritional statuses of primary school children of Veddah (local indigenous population) and Sinhalese (more advanced society) in rural Sri Lanka. Children attending years 1-3 (age range 6-15 years) at Dambana Primary School (Veddah) and Wewatta Primary School (Sinhalese) were included in the study. Stools and blood samples were examined for evidence of intestinal parasites and anemia. The heights and weights of the children were measured and anthropometric indices calculated. There was a high prevalence of G. intestinalis and B. hominis (Giardia 7.8% and 6.2%; Blastocystis 17.2% and 17.3% at Dambana and Wewatta, respectively) in both communities, the predominant helminth being N. americanus (20.3% at Dambana and 14.8% at Wewatta; p>0.05). Other geohelminth infections were scarce in both communities. A greater proportion of boys than girls were underweight and stunted in both communities. Wasting and anemia was significantly high among the Veddah children.

Association of vitamin A and zinc status with altered intestinal permeability: analyses of cohort data from northeastern Brazil.

To examine the association of intestinal barrier function with vitamin A deficiency and whether supplementation of micronutrients improves intestinal function and/or linear growth, height-for-age z-score (HAZ), concentrations of serum retinol and zinc, and intestinal permeability were determined in a cross-sectional sample of 75 children in northeastern Brazil. Effects of vitamin A and supplementation of zinc on intestinal permeability and growth were also determined comparing results before and after treatment in 20 children and age-matched controls. Lactulose:mannitol (L/M) permeability ratios inversely correlated with serum retinol concentrations (r = -0.55, p < 0.0005). Increased L/M permeability ratios with reduced concentrations of serum retinol were predominantly attributable to lower absorption of mannitol (r = 0.28, p = 0.02). L/M permeability ratios (p = 0.001) and HAZ scores (p = 0.007) improved with supplementation. It is concluded that impaired intestinal barrier function and linear growth shortfalls improve following supplementation of vitamin A and zinc in this setting.

Food habits and nutrient density of diets of Pakistani children living in different urban and rural settings.

Food habits and nutrient density of diets of six groups of rural and urban school children aged 10-12 years were compared. Data were collected from three-day food records. In the UK, data were collected during October-November 1994 and in Pakistan during April-May 1995. Based on the apparent level of urbanism, the six groups were arbitrarily assigned urbanization rank 1-6. Patterns of their food and intake of nutrients were different from each other in various aspects and were not always associated with the apparent level of urbanism of the group. With urbanization, the intake of fat and sugar increased steadily. The intake of carbohydrate, fibre, riboflavin, and vitamin E decreased with urbanization. The intake of vitamin C, vitamin B12, and folates was higher among group 4, 5, and 6 than other groups. Due to various factors, in terms of micronutrient density, diets of various urban groups could have more differences than similarities. While these differences point toward the need for comprehensive nutrition education and community nutrition surveys, they also indicate the possibility of having healthy diets in urban settings.

Comparison of the nutrient content of fresh fruit juices vs commercial fruit juices.

OBJECTIVE: To compare the types and quantities of carbohydrate, electrolytes, pH and osmolarity of fresh fruit juices and commercial fruit juices. MATERIAL AND METHOD: Forty kinds of fresh fruits available in Thai markets were analyzed for types and quantities of carbohydrate, electrolyte, pH and osmolarity and compared with previously obtained data for commercial fruit juices. RESULTS: Most fresh fruit juices did not contain sucrose, whereas, commercial fruit juices mostly have sucrose in the range of 3-112 g/L. Although both fruit juices were acidic (pH varied from 3.6-6.7 and 3.2-5.8 of fresh juice and commercial juice), fresh fruit juices had a more neutral pH than commercial fruit juices. Apple, guava, orange, pear, and pineapple juices from commercial fruit juices had a high osmolarity compared with fresh fruit juices. All types of fresh fruit juices contained less sodium than commercial ones, whereas, most fresh fruit juices contained more potassium, phosphorus, and magnesium than commercial fluids. CONCLUSION: The nutrient content of fresh fruit juices and commercial fruit juices from the same kinds of fruits are not the same, possibly due to the manufacturing process. Therefore, physicians should know the composition of fruit juices in order to advise patients properly.

Nutritional status of the Indian population.

High prevalence of low birth weight, high morbidity and mortality in children and poor maternal nutrition of the mother continue to be major nutritional concerns in India. Although nationwide intervention programmes are in operation over two decades, the situation has not changed greatly. In addition, the Indian population is passing through a nutritional transition and is expected to witness higher prevalences of adult non-communicable diseases such as diabetes, hypertension and coronary heart disease according to the theory of 'fetal origin of adult disease'. Clearly, there is a need for examining several issues of nutritional significance for effective planning of interventions. In particular, maternal nutrition and fetal growth relationship, long term effects of early life undernutrition, interactions of prenatal nutritional experiences and postnatal undernutrition are some of the major issues that have been discussed in the present paper with the help of prospective data from various community nutrition studies carried out in the department.