Agreement between Dietary Intake of Older Adults and Proxy Respondents Assessed by a Food Frequency Questionnaire.

OBJECTIVE: To evaluate the degree of agreement of dietary intake reported by the patient subject with the dietary intake reported by a respondent (a next-of-kin or a caregiver), collected by a validated Food Frequency Questionnaire (FFQ). METHODOLOGY: 126 adults, both sexes, the average age was 65.9 years for patients and 54.4 years for respondents. They were recruited from the General Practice Clinic at the Clinical Hospital of São Paulo (AGD-FMUSP). The agreement between the responses given by patients and respondents was assessed using Spearman, weighted Kappa and Bland Altman tests. RESULTS: The analysis for accuracy between responses (Spearman test) showed a moderate degree of agreement (0.31-0.39) for Energy, Total fat, Total Saturated Fatty Acids (SFA), Total Monounsaturated Fatty Acids (MUFA). Regarding food groups a moderate agreement was found for the majority of the foods (fruits (0.30), dairy products (0.50), natural juices (0.45), beans (0.48), butter/margarine (0.55), coffee (0.41) and soda (0.45), with the exception of vegetables (0.12) and rice (0.63). The ingestion differences did not exceeded the limit of the two standard deviations for the majority of the pairs (Bland Altman). A respondent subsample composed only of husband/wives (N = 36) revealed a moderate agreement concordance for most macronutrients studied (0.30 - 0.58), except polyunsaturated fats (0.25). CONCLUSION: The results of this study show that, the FFQ may be used in cases where is impossible to get the answers directly from the patients.

Is overweight a risk factor for wheezing in pre-school children? A study in 14 Brazilian communities.

OBJECTIVE: To evaluate the association between overweight and wheezing in pre-school children in 14 small Brazilian communities. METHODS: Cross-sectional epidemiological study, conducted between 2001 and 2002. A sample of 3453 children under 5 years of age was taken from nine communities in the state of Bahia and five in the state of São Paulo. Data on housing, family and children were obtained by applying structured questionnaires in loco. Weight and height for each child were also measured. The association between wheezing and overweight was assessed by unconditional logistic multivariate regression models. RESULTS: Overweight children had a greater frequency of wheezing and an odds ratio of 2.57 (95% confidence interval 1.51-4.37) was estimated after controlling for several potential confounding variables. The magnitude of the risk was not affected by several different model specifications. CONCLUSION: Excess weight is associated with increased risk for wheezing in this population of children below 5 years of age.

Malnutrition and susceptibility to enteroparasites: reinfection rates after mass chemotherapy.

The evidence that relates malnutrition to enteroparasite infections arises from studies that demonstrate the improvement of nutritional indicators after antiparasitism treatment. However, the role of malnutrition as an aggravating factor to the susceptibility to enteroparasite infections is still not fully understood. We investigated the correlation between malnutrition and enteroparasite infection after mass chemotherapy, in a poor city of São Paulo State, Brazil. The sample comprised 759 children between 1 and 10 years of age of whom 585 were followed up for a period of 1 year and periodically assessed for reinfection with enteroparasites. One year of follow-up after mass chemotherapy demonstrated that 38 of the undernourished children were reinfected with enteroparasites, as compared with 25 of the eutrophic children (P = 0.033). The survival multivariate analysis demonstrated that, after controlling for the potential confounding variables, maternal literacy and per capita income rate, malnutrition was associated with susceptibility to reinfection (P = 0.13). We demonstrate that, although maternal literacy and per capita income rate are indeed confounding variables, malnutrition contributes to an increase in the risk of enteroparasite infections.

Ascaris-Trichuris association and malnutrition in Brazilian children.

This work was designed to evaluate the role of intestinal parasites on nutritional status in three rural areas of Brazil. A total of 520 children aged 1-12 years were studied through a questionnaire concerning housing, socio-economic conditions and a 24-h food intake recall. Measurements of weight and height were also performed, and three stool samples were collected on consecutive days for parasitological analysis. Scores of the standard deviation (z-scores) for the weight-for-height and height-for-age were used to characterise the growth profile. A high prevalence of intestinal parasites was detected, with Giardia lamblia (44%), Endolimax nana (43%), Ascaris lumbricoides (41%) and Trichuris trichiura (40%) being the most prevalent. Eleven per cent of the children were classified as showing stunting. Inadequate daily caloric intake was observed in 78% of the population and the proportion of those with inadequate protein intake was 34%. Logistic regression analysis was employed for the multivariate study. Stunting was significantly associated with estimators of low economic income, inadequate protein intake and polyparasitism, especially the association between Ascaris lumbricoides and Trichuris trichiura.

PIP: This study was designed to assess the association between stunting and helminthic infections by studying children aged 1-12 years living in a rural area near Sao Paolo, Brazil. A total of 520 children were studied through a questionnaire concerning housing, socioeconomic conditions and a 24-hour food intake recall. Measurement of weight and height were also performed, and three stool samples were collected on consecutive days for parasitological analysis. The study has demonstrated a positive association between intestinal parasites and stunting in children. Intestinal parasites were present in 79% and stunting in 11.5% of children from the sample. 56.7% of the children with stunting were between 5 and 12 years of age, which justified the unusual inclusion of children above 5 years of age. The most prevalent intestinal parasites detected were Giardia lamblia (44%), Endolimax nana (43%), Ascaris lumbricoides (41%), and Trichuris trichiura (40%). In the study, no children reported diarrhea and/or fever. Nevertheless, the mechanism of parasitic infections includes anorexia, type of food intake, intestinal villus damage, competition for nutrients, facilitation of bacterial colonization, increase in energy requirements, decrease in hepatic protein synthesis, protein-losing enteropathy, and blood loss. Inadequate daily caloric intake was observed in 78% of the population, and the proportion of those with inadequate protein intake was 34%. Stunting was significantly associated with estimators of low economic income, inadequate protein intake and polyparasitism.