Anaemia and iron deficiency associate with polymorphism TMPRSS6 rs855791 in Brazilian children attending day care centres.

Fe-deficiency anaemia is a major public health concern in children under 5 years of age. TMPRSS6 gene, encoding matriptase-2 protein, is implicated in Fe homoeostasis and has been associated with anaemia and Fe status in various populations. The aim of this cross-sectional study was to investigate the associations between the single nucleotide polymorphism (SNP) TMPRSS6 rs855791 and biomarkers of anaemia and Fe deficiency in Brazilian children attending day care centres. A total of 163 children aged 6-42 months were evaluated. Socio-economic, demographic, biochemical, haematological, immunological and genotype data were collected. Multiple logistic and linear regressions with hierarchical selection were used to assess the effects of independent variables on categorised outcomes and blood marker concentrations. Minor allele (T) frequency of rs855791 was 0·399. Each copy of the T allele was associated with a 4·49-fold increased risk of developing anaemia (P = 0·005) and a 4·23-fold increased risk of Fe deficiency assessed by serum soluble transferrin receptor (sTfR) (P < 0·001). The dose of the T allele was associated with an increase of 0·18 mg/l in sTfR concentrations and reductions of 1·41 fl and 0·52 pg in mean corpuscular volume (MCV) and mean corpuscular haemoglobin (MCH), respectively. In conclusion, the T allele of SNP TMPRSS6 rs855791 was significantly associated with anaemia and Fe deficiency assessed by sTfR in Brazilian children attending day care centres. The effect was dose dependent, with each copy of the T allele being associated with lower MCV and MCH and higher concentrations of sTfR.

Vitamin E deficiency in childhood: a narrative review.

Vitamin E is an important nutrient from the earliest stages of life. It plays key roles as an antioxidant and in the maintenance of the immune system, among others. Vitamin E deficiency (VED), which occurs more frequently in children, is rarely addressed in the literature. This narrative review aims to summarise the chemistry, biology, serum indicators and clinical trials that have evaluated the impact of fortification and other relevant aspects of vitamin E, in addition to the prevalence of its deficiency, in children worldwide. Vitamin E intake in recommended amounts is essential for this nutrient to perform its functions in the body. Serum α-tocopherol is the most widely used biochemical indicator to assess the prevalence of VED. VED has been associated with symptoms secondary to fat malabsorption and may lead to peripheral neuropathy and increased erythrocyte haemolysis. Reduced concentrations of α-tocopherol may be caused by the combination of diets with low amounts of vitamin E and inadequate consumption of fats, proteins and calories. The lowest prevalence of VED was found in Asia and the highest in North America and Brazil. High proportions of VED provide evidence that this nutritional deficiency is a public health problem in children and still little addressed in the international scientific literature. The planning, evaluation and implementation of health policies aimed at combatting VED in the paediatric population are extremely important.

Prevalence of Vitamin D and Calcium Deficiency and Insufficiency in Women of Childbearing Age and Associated Risk Factors: A Systematic Review and Meta-Analysis.

Vitamin D deficiency and insufficiency as well as low serum calcium levels can trigger negative health outcomes in women of childbearing age. Therefore, we aimed to estimate the prevalence of serum vitamin D and calcium deficiencies and insufficiencies and associated risk factors in Brazilian women of childbearing age and to assess whether there are differences in prevalence according to regions of the country and the presence or absence of pregnancy. The systematic literature review was performed using the following databases: PubMed, LILACS, Embase, Scopus, and Web of Science. Cross-sectional, cohort, and intervention studies were included. Among pregnant women, the prevalence of vitamin D deficiency ranged from 0% to 27% and of vitamin D insufficiency from 33.9% to 70.4%. Among non-pregnant women, the prevalence of vitamin D deficiency ranged from 0% to 41.7% and of vitamin D insufficiency from 38.5% to 69.3%. We found a high prevalence of vitamin D deficiency and insufficiency in women of childbearing age, with insufficiency affecting more than half of these women. The highest prevalence of vitamin D deficiency and insufficiency was observed in the South region. It was not possible to assess the prevalence and factors associated with calcium deficiency.

Evaluation of dietary folate in children assisted in Family Health Strategy units: A cross-sectional study.

BACKGROUND AND AIMS: Folate is an indispensable nutrient in human food and its deficiency may affect growth and development, and influence the risk of infant morbidity and mortality. The objective was to analyze the consumption of folic acid and its association with socioeconomic, environmental, maternal and anthropometric data of children aged 12-14 months assisted in Family Health Strategy units in a Brazilian capital. METHODS: This is a cross-sectional study included in a pragmatic clinical trial conducted with 101 children. Food intake was analyzed by means of a 24-h recall, a simple and multiple linear regression analysis was performed in a hierarchical model, and the outcome variable Dietary Folate Equivalents (DFE) was calculated. A hierarchical model was used at three levels (distal: sociodemographic; medial processes: maternal characteristics; proximal: individual processes of the child) in the adjustment of the model, in which the variables presenting p < 0.20 in the crude analysis were inserted in the adjusted analysis, from distal to proximal block, in the increasing order of magnitude of association with the outcome. RESULTS: Regarding folic acid consumption, 10.9% (n = 11) of children presented deficiency according to the calculated DFE considering the evaluation by Estimated Average Requirement (EAR), and 42.6% (n = 43) had excessive intake according to the calculated DFE considering the evaluation by the Tolerable Upper Intake Levels (UL). After multiple linear regression analysis flour intake was associated with an increase in DFE intake by 2.05 µg (95% CI: 1.72-2.45) and the presence of at least one more child under 5 years of age with an increase in DFE intake by 0.77 µg (95% CI: 0.67-0.89), while receiving the Bolsa Família Program is associated with an increase in DFE intake by 1.39 µg (95% CI: 1.07-1.65) in the model adjusted for birthweight and maternal age, regardless of the child's age. CONCLUSION: Data from this study showed low prevalence of deficient consumption and high percentage of excessive consumption of folic acid in the children. In addition, receiving the Bolsa Família Program, consuming flour and the number of children under 5 years of age were positively associated with the calculated DFE.

Effect of Fortification with Multiple Micronutrient Powder on the Prevention and Treatment of Iron Deficiency and Anaemia in Brazilian Children: A Randomized Clinical Trial.

Fortification with multiple micronutrient powder has been proposed as a public health intervention able to reduce micronutrient deficiencies in children. Our objective was to compare the effectiveness of fortification with multiple micronutrient powder with drug supplementation in the prevention and treatment of iron deficiency and anaemia. This was a cluster trial with anemic and non-anaemic children between six and 42 months old, in randomization data. Non anaemic children received fortification with multiple micronutrient powder or standard drug supplementation of ferrous sulfate associated with folic acid in a prevention dose. Anaemic children who were randomized to receive multiple micronutrient powder also received the recommended iron complementation for anaemia treatment. A total of 162 children were evaluated. The prevalence of anaemia decreased from 13.58 to 1.85%. Iron deficiency decreased from 21.74% to 7.89% (by serum ferritin) and iron deficiency decreased from 66.81 to 38.27% (by soluble transferrin receptor). No difference was identified between interventions for hemoglobin (p = 0.142), serum ferritin (p = 0.288), and soluble transferrin receptor (p = 0.156). Fortification with multiple micronutrient powder was effective in preventing iron deficiency and anaemia in children aged six to 48 months. In anaemic children; it was necessary to supplement the dose of multiple micronutrient powder with ferrous sulfate.

The impact of home fortification with multiple micronutrient powder on vitamin A status in young children: A multicenter pragmatic controlled trial in Brazil.

Home fortification with multiple micronutrient powder (MNP) is effective in the prevention of anemia in young children. However, the impact on their vitamin A status remains controversial. This study aimed to evaluate the effect of MNP on vitamin A status in young Brazilian children. A multicenter pragmatic, controlled trial was carried out in primary health centers in four Brazilian cities. In the beginning of the study, the control group (CG) consisted of children 11-14 months old (n = 395) attending in routine pediatric health care. In parallel, the intervention group (IG) was composed of children 6-8 months old (n = 399), in the same health centers, who followed the intervention with MNP for 2-3 months. The analysis of the effect of MNP on vitamin A status was performed by comparing the IG with the CG after a 4- to 6-month follow-up when IG children had reached the age of the controls. The prevalence of vitamin A deficiency (VAD; serum retinol <0.70 µmol/L) in the CG was 16.2%, while in the IG was 7.5%-a 55% reduction in the VAD [prevalence ratio (95% confidence interval) = 0.45 (0.28; 0.72)]. This reduction was also significant when stratifying the study centers by coverage of the Brazilian Vitamin A Supplementation Program. The adjusted mean of vitamin A serum concentrations improved in the IG compared with CG children, with a shift to the right in the vitamin A distribution. Home fortification with MNP was effective in reducing VAD among young Brazilian children.

Vitamin A status and associated factors in infants attending at Primary Health Care in Goiânia, Goiás, Brazil.

OBJECTIVE: This study aimed to assess the nutritional status of vitamin A and associated factors in children assisted in Primary Care Health in Goiânia, Goiás, Brazil. METHODS: This is a cross-sectional study with a sample of 228 children 12 to 16 months of age. The nutritional status of vitamin A was assessed by serum retinol concentration, determined by high performance liquid chromatography. Multiple linear regression models with hierarchical selection of independent variables were used to evaluate the correlation with serum retinol as the dependent variable. RESULTS: The vitamin A deficiency (retinol < 0,7 µmol/L) was observed in 14,0% of the children. Maternal schooling and hemoglobin concentration were positively correlated with serum retinol concentration, while C-reactive protein showed a negative correlation (R2 = 0,1648). CONCLUSION: The vitamin A deficiency in one-year-old children attended in Basic Health Units in Goiânia configures itself as a moderate public health problem. Actions to promote maternal education, morbidity control and prevention of other micronutrient deficiencies are important for prevention and control of the vitamin A deficiency in this population.

Vitamin A status and associated factors in infants attending at Primary Health Care in Goiânia, Goiás, Brazil / Estado nutricional de vitamina A e fatores associados em lactentes atendidos em Unidades Básicas de Saúde de Goiânia, Goiás, Brasil

This study aimed to assess the nutritional status of vitamin A and associated factors in children assisted in Primary Care Health in Goiânia, Goiás, Brazil.

Este estudo teve por objetivo avaliar o estado nutricional de vitamina A e fatores associados em crianças atendidas em Unidades Básicas de Saúde de Goiânia, Goiás.

Factors associated with obesity in Brazilian children enrolled in the School Health Program: a case-control study / Factores asociados a la obesidad en niños brasileros inscriptos en el programa de salud en la escuela: un estudio de caso control

Case-control studies evaluating the factors associated with childhood obesity are scarce in Brazil. We aimed to analyze the factors associated with obesity in Brazilian schoolchildren enrolled in the School Health Program.A case-control study was conducted on 80 schoolchildren aged 7 to 9 years, 40 of them obese and 40 of normal weight according to the cut-off points established by the World Health Organization (2007). Weight, height and waist circumference were obtained. Socioeconomic, demographic, health, eating behavior and lifestyle data were collected by applying a questionnaire to the person responsible and by determining his/her nutritional status. A binary unconditional logistic regression model (univariate and multivariate) was used for data analysis. The prevalence of obesity was 7.21%. The final model showed that duration of breast-feeding ≥6 months of age (OR 5.3; 95% CI: 1.3-22.1), excess weight of the person responsible (OR 7.1; 95% CI: 1.2-40.2), a sedentary level of physical activity (OR 4.1; 95% CI: 1.1- 15.5), and fast chewing (OR 7.4; 95% CI: 2.1-26.9) were significantly associated with childhood obesity. The factors associated with obesity in schoolchildren were duration of breast-feeding ≥6 months, persons responsible with excess weight, and sedentary children who chew fast. The present study contributes information to be used for the health actions planned by the School Health Program (AU)

La obesidad infantil es un problema creciente de salud pública mundial. Objetivamos analizar los factores asociados a la obesidad en escolares del Programa Salud en la Escuela. Se realizó un estudio caso control con 80 escolares de 7 a 9 años de edad, entre los cuales 40 obesos y 40 eutróficos de acuerdo con los puntos de corte establecidos por la World Health Organization (2007), en 2011- 2012. Se obtuvo el peso, la altura y la circunferencia de la cintura. Se colectaron datos socioeconómicos, demográficos, de salud, comportamiento alimentar y de estilo de vida con aplicación de un cuestionario al responsable, y su evaluación nutricional. Se usó un modelo de regresión logística binario incondicional para el análisis de los datos. La prevalencia de obesidad fue de 7,21%. El modelo final mostró que el período de lactancia materna ≥6 meses de edad (OR 5,3; 95% CI: 1,3 - 22,1), el exceso de peso del responsable (OR 7,1; 95% CI: 1,2- 40,2), nivel de actividad física sedentario (OR 4,1; IC 95%: 1,1-15,5) y masticación rápida (OR 7,4; IC 95%: 2,1-26,9) se asociaron significativamente con la obesidad infantil. Este fue el primer estudio a identificar los factores asociados a la obesidad en niños de 7 a 9 años de edad y el más reciente a demostrar la prevalencia de obesidad entre escolares de una ciudad brasileña. Los factores asociados con la obesidad en escolares fueron el período de lactancia materna ≥6 meses, responsables con exceso de peso, y niños sedentarios que mastican rápidamente. Este estudio contribuye con subsidios para las acciones para la salud previstas en el Programa Salud en la Escuela (AU)

Consumo alimentar e perfil antropométrico de bailarinos de uma companhia de dança contemporânea de Goiânia, Goiás / Dietary intake and anthropometric profile of dancers from a contemporary dance compay in Goiânia, Goiás, Brazil

Objetivo: Avaliar o consumo alimentar e o perfil antropométrico, comparar a composição corporal entre os sexos e analisar a adequação da ingestão alimentar às necessidades de bailarinos profissionais e semiprofissionais. Métodos: Foram analisados 16 bailarinos de ambos os sexos, com idade entre 20 e 35 anos de uma companhia de dança contemporânea, de nível internacional, de Goiânia (GO). Foram coletados peso; altura, dobras cutâneas tricipital, peitoral, subescapular, axilar média, suprailíaca, abdominal e da coxa; e dois recordatórios de 24 horas. Para ingestão energética, as recomendações utiizadas foram a do Institute of Medicine e para o s macronutrientes, Institute of Medicine e American College of Sports Medicine. Os dados foram digitados no Epi Info 6.04 e analisados no Statistical Package for Social Sciences 18.0. Foram aplicados os testes Shapito-Wilk, Mann Whitney e Wilcoxon com nível de significância de 0,05. Resultados: A única medida corporal que diferiu entre os grupos foi, no caso das mulheres, a dobra tricipital, com menor valor no grupo profissional (p=0,03). As dobras cutâneas tricipital e da coxa (p,0,001), peitoral (p=0,007) e suprailíaca (p=0.009) diferiram entre os sexos, sendo maiores entre as mulheres. A ingestão energética foi inferior às necessidades tanto para as mulheres (p=0,01), quanto para os homens (p=0,02). Conclusão: Não houve diferença significativa na composição entre indivíduos do mesmo sexo. A porcentagem de gordura e as dobras cutâneas tricipital, peitoral, suprailíaca e da coxa foram maiores entre as mulheres. Os consumos de energia, carboidratos e proteínas foram inferiores às recomendações

Treatment and prevention of anemia with ferrous sulfate plus folic acid in children attending daycare centers in Goiânia, Goiás State, Brazil: a randomized controlled trial.

The objective of this study was to assess the prevalence of anemia and the therapeutic and prophylactic response to ferrous sulfate and folic acid. A double-blind, randomized, controlled clinical trial was conducted with 196 children 6 to 24 months of age enrolled in municipal daycare centers in Goiânia, Goiás State, Brazil. The children were assigned to two treatment groups that received a daily dose (5 times a week) of either 4.2mg/kg/day of ferrous sulfate + folic acid (50microg) or 4.2mg/kg/day of ferrous sulfate + folic acid placebo. One of the prevention groups received 1.4mg/kg/day of ferrous sulfate + folic acid (50microg/day) and the other 1.4mg/kg/day of ferrous sulfate + folic acid placebo. Supplementation lasted approximately three months. Baseline anemia prevalence was 56.1% (95%CI: 48.9-63.1). After treatment, anemia prevalence in the folic acid group (14%) was lower than in the placebo group (34.9%) (p = 0.02). After prophylaxis in the non-anemic children, the incidence of anemia did not differ between the groups, but there was an increase in hemoglobin level in the folic acid group (p = 0.003). Iron plus folic acid was effective for the treatment of anemia and improvement of hemoglobin level in non-anemic children.

Treament and prevention of anemia with ferrous sulfate plus folic acid in children attending daycare centers in Goiânia, Goiás State, Brazil: a randomized controlled trial / Resposta terapêutica e profilática com ferro e ácido fólico na anemia em crianças de creches públicas em Goiânia, Goiás, Brasil: ensaio clínico randomizado

The objective of this study was to assess the prevalence of anemia and the therapeutic and prophylactic response to ferrous sulfate and folic acid. A double-blind, randomized, controlled clinical trial was conducted with 196 children 6 to 24 months of age enrolled in municipal daycare centers in Goiânia, Goiás State, Brazil. The children were assigned to two treatment groups that received a daily dose (5 times a week) of either 4.2mg/kg/day of ferrous sulfate + folic acid (50µg) or 4.2mg/kg/day of ferrous sulfate + folic acid placebo. One of the prevention groups received 1.4mg/kg/day of ferrous sulfate + folic acid (50µg/day) and the other 1.4mg/kg/day of ferrous sulfate + folic acid placebo. Supplementation lasted approximately three months. Baseline anemia prevalence was 56.1 percent (95 percentCI: 48.9-63.1). After treatment, anemia prevalence in the folic acid group (14 percent) was lower than in the placebo group (34.9 percent) (p = 0.02). After prophylaxis in the non-anemic children, the incidence of anemia did not differ between the groups, but there was an increase in hemoglobin level in the folic acid group (p = 0.003). Iron plus folic acid was effective for the treatment of anemia and improvement of hemoglobin level in non-anemic children.

Avaliar a prevalência de anemia e a resposta terapêutica e profilática do sulfato ferroso e ácido fólico. Realizou-se um ensaio clínico controlado randomizado, duplo-cego, com 196 crianças de 6 a 24 meses, dos Centros Municipais de Educação Infantil de Goiânia, Goiás, Brasil. As crianças foram alocadas em dois grupos de tratamento que receberam dose diária (5x/semana) com 4,2mg/kg/dia de sulfato ferroso + ácido fólico (50µg) ou 4,2mg/kg/dia de sulfato ferroso + placebo de ácido fólico. Um dos grupos de prevenção recebeu 1,4 mg/kg/dia de sulfato ferroso + ácido fólico (50µg/dia) e o outro 1,4mg/kg/dia de sulfato ferroso + placebo de ácido fólico. A suplementação durou cerca de três meses. A prevalência de anemia inicial foi de 56,1 por cento (IC95 por cento: 48,9-63,1). Após o tratamento, a prevalência de anemia no grupo ácido fólico (14 por cento) foi menor que no grupo placebo (34,9 por cento; p = 0,02). Após profilaxia dos não anêmicos, a incidência de anemia não diferiu entre os grupos, porém, houve incremento da hemoglobina no grupo ácido fólico (p = 0,003). O ferro associado com ácido fólico foi eficaz no tratamento da anemia e na melhoria da hemoglobina nos não anêmicos.

Anemia do lactente / Anemia in infant: etiology, risk factors and humoral immunity

Objetivos: Verificar a prevalência de anemia e da etiologia ferropriva em lactentes, e identificar os seus fatores de risco; avaliar um novo método indireto para estimativa dos riscos de anemia, e a imunidade humoral destas crianças. Métodos: Estudo transversal foi realizado com 110 lactentes a termo, de 6 a 12 meses de idade, em uma unidade pública de saúde em Goiânia, Brasil. Realizou-se inquéritos socioeconômico, demográfico, reprodutivo, antropométrico e dietético. Colheu-se sangue venoso, em jejum, para análise da hemoglobina, amplitude de distribuição dos eritrócitos (RDW), ferritina, ferro sérico, proteína C-reativa, imunoglobulinas séricas IgA, IgM, e IgG e suas subclasses (IgG1, IgG2, IgG3, IgG4) e os componentes do complemento C3c e C4. Resultados: A prevalência de anemia observada foi de 60,9 por cento. Ao se considerar no diagnóstico da anemia a alteração da hemoglobina mais dois índices entre volume corpuscular médio (VCM), hemoglobina corpuscular média (HCM), ferritina ou ferro sérico, a prevalência de etiologia ferropriva foi de 87 por cento. Porém, ao se incluir entre os índices o RDW, a prevalência foi de 97,8 por cento. As melhores correlações entre as variáveis bioquímicas e hematológicas foram hemoglobina e hematócrito (r = 0,95) e HCM com o VCM (r = 0,95). Os fatores de risco identificados pela regressão logística múltipla foram o sexo masculino (OR=2,38), lactentes cujas mães eram donas de casa (OR = 5,01) e residências com mais de três membros (OR = 3,08). A introdução da carne após os 6 meses foi também um fator de risco (OR = 3,3). Houve um efeito dose resposta entre o consumo de leite e a prevalência de anemia ajustada pelo sexo e idade (Efeito = 0,12; IC 95 por cento: 0,02, 0,22). A densidade de ferro (6 aos 9 meses) e a velocidade de ganho de peso (9 aos 12 meses) afetaram significativamente a probabilidade do lactente ter anemia. A anemia e a deficiência de ferro não alteraram a imunidade humoral dos lactentes, ao se utilizar a ferritina como parâmetro. Os níveis de IgG, IgG1, IgG2, C3c e C4 foram significativamente maiores naqueles com redução do ferro sérico. As principais imunoglobulinas que tiveram os níveis aumentados nos anêmicos e não anêmicos foram a IgG, IgG1, e componentes C3c e C4 do complemento...

Epidemiologia moderna na prática pediátrica-tipos de estudos / Modern epidemiology in the pediatrics

No intuito de melhor conhecer a saúde da populaçäo, os fatores que a determinam, a evoluçäo do processo da doença e a repercussäo das açöes propostas para a cura ou erradicaçäo de seu curso, a ciência desenvolveu várias formas de abordagem e investigaçäo. Sendo assim, na prática pediátrica, a epidemiologia tem papel preponderante na atençäo à saúde, contribuindo no conhecimento das relaçöes entre doenças infantis graves, na etiologia de doenças controladas por vacinaçäo, e ainda no estabelecimento das condiçöes sociais e econômicas como determinantes dos perfis de morbidade e mortalidade infantis. Na investigaçäo de um tema, os estudos epidemiológicos podem ser observacionais ou experimentais. Os estudos observacionais incluem os descritivos (transversais) e analíticos (coorte e caso-controle)...