Two-year follow-up study of elderly residents in S. Paulo, Brazil: methodology and preliminary results.

INTRODUCTION: Previous cross-sectional studies have shown a high prevalence of chronic disease and disability among the elderly. Given Brazil's rapid aging process and the obvious consequences of the growing number of old people with chronic diseases and associated disabilities for the provision of health services, a need was felt for a study that would overcome the limitations of cross-sectional data and shed some light on the main factors determining whether a person will live longer and free of disabling diseases, the so-called successful aging. The methodology of the first follow-up study of elderly residents in Brazil is presented. METHOD: The profile of the initial cohort is compared with previous cross-sectional data and an in-depth analysis of nonresponse is carried out in order to assess the validity of future longitudinal analysis. The EPIDOSO ('Epidemiologia do Idoso') Study conducted a two-year follow-up of 1,667 elderly people (65+), living in S. Paulo. The study consisted of two waves, each consisting of household, clinical, and biochemical surveys. RESULTS AND CONCLUSIONS: In general, the initial cohort showed a similar profile to previous cross-sectional samples in S. Paulo. There was a majority of women, mostly widows, living in multigenerational households, and a high prevalence of chronic illnesses, psychiatric disturbances, and physical disabilities. Despite all the difficulties inherent in follow-up studies, there was a fairly low rate of nonresponse to the household survey after two years, which did not actually affect the representation of the cohort at the final household assessment, making unbiased longitudinal analysis possible. Concerning the clinical and blood sampling surveys, the respondents tended to be younger and less disabled than the nonrespondents, limiting the use of the clinical and laboratory data to longitudinal analysis aimed at a healthier cohort. It is worth mentioning that gender, education, family support, and socioeconomic status were not important determinants of nonresponse, as is often the case.

[Eating patterns among the elderly of different socioeconomic groups living in a urban area of southeastern Brazil]. / Padrão alimentar de idosos de diferentes estratos socioeconômicos residentes em localidade urbana da região sudeste, Brasil.

Two hundred and eight three male and female elderly subjects were studied. They participated in the Multicentric project: "Health assessment of elderly people living in the urban area of S. Paulo", Brazil, and were stratified by socio-economic level in three areas of S. Paulo city. The food frequency questionnaire was applied in order to discover their food pattern. The results show that for the energy-producing foods more than 90% of the total sample eat tubers, rice, bread and pasta; however, only the rice and bread are consumed daily. As for protein, 70% or more of the elderly people eat beans, beef, poultry, milk and eggs but for the daily consumption there are differences between the 3 regions. More than 85% of the subjects eat fruits, leafy and other vegetables; nevertheless, the frequency of their daily consumption is bigger in the wealthier area. The dietetic information shows that the group analysed has the same food pattern as other population groups as far the energy-producing foods are concerned; there are, however, some difference as regards the protein foods and fruit and vegetables.

Incidence of postcesarian febrile morbidity as related to prenatal care and nutritional state before pregnancy

Two hundred and eight-three patients were studied regarding prenatal care and nutritional state as related to incidence of postcesarean febrile morbidity. Regarding place of prenatal care, the results showed a statistically higler incidence in patients not attended at the Service of the Hospital Säo Paulo, Escola Paulista de Medicina. No difference of postecesarean febrile morbidity could be observed between patients attended at the Hospital Säo Paulo and those attende elsewhere regarding number of medical examinations during prenatal care. In regard to the nutritional state before pregnancy, obese and undernourished patients presented a statistically higher incidence when compared to eutrophic patients

Alimentaçäo no desmame em áreas periurbanas de quatro capitais brasileiras: resultados preliminares

Säo analisadas as dietas e o estado nutricional de 466 crianças abaixo de dois anos de idade, em áreas periurbanas de quatro capitais brasileiras. A principal mistura de alimentos encontrada foi de leite artificial, amido, e açucar (68%), sendo os alimentos da dieta da família pouco utilizados no processo de desmame das crianças. As dietas säo inadequadas quantitativamente, especialmente no segundo ano de vida quando a maioria das crianças (57%) näo conseguiram 80% das suas necessidades energéticas. As dietas foram inadequadas qualitativamente em zinco e ferro, sendo adequadas para proteína, vitamina A e vitamina C, desde que preenchidas as necessidades energéticas. A desnutriçäo mostrou-se mais grave nos locais (Nordeste) e faixas etárias (segundo ano) onde a dieta se apresentou mais inadequada

The recent revival of breast-feeding in the city of São Paulo, Brazil.

A random sampling of children under age five in Sao Paulo, Brazil, 1984/85, disclosed the median duration of breast-feeding to be 3.5 months and the duration of exclusive breast-feeding, 2.0 months. A comparison of these figures with those of a similar survey carried out in the same city in 1973/74 revealed a substantial increase in both the frequency and duration of breast-feeding. The trend was evident in all socioeconomic strata but most marked among women from higher income and educational levels.

[Enteral feeding at home]. / Nutrição enteral domiciliar.

Enteral nutrition was used for the purpose of providing an adequate alimentary support to patients who had been discharged from the hospital. Ten of them received the enteral diet in their own homes by means of a Dobbhoff tube. Six patients, however, had been receiving it during their hospitalization period, and four had started the treatment in their own houses, thus avoiding need for hospitalization. Enteral feeding was the only nutritional support used in the case of six patients. For the others, an oral diet was free to be used, even though the enteral diet provided all the required calories and proteins. All patients did very well and improvement of their nutritional condition was observed, without any intercurrence due to the enteral nutrition. Development of this procedure allows provision of adequate nutritional support to patients in their own homes, even in more complex situations. The low-cost enteral diet is easy to prepare and administer, thus enabling low-income patients to receive it in their own homes. Furthermore, it shortens the hospitalization period, and avoids the risk of discontinuing adequate nourishment of ill persons after their discharge from the hospital.

Suporte nutricional em pacientes hospitalizados: experiencia de um ano. / Nutritional support in hospitalized patients: experience of 1 year

A equipe de nutricao clinica da Escola Paulista de Medicina (EPM) atende aos pedidos de interconsulta das diversas enfermarias do Hospital Sao Paulo que estao sob a responsabilidade de diferentes disciplinas da EPM. De outubro de 1982 a outubro de 1983, a equipe avaliou o estado nutricional e indicou a conduta de suporte nutricional em 89 doentes. Quando a alimentacao enteral foi a indicada, a dieta formulada foi adaptada a cada caso,segundo as necessidades energeticas e, quando necessario, com restricoes de nutrientes, tais como proteina, sodio e agua. A prevalencia de desnutricao proteico-calorica foi de 68%. A nutricao enteral foi indicada em 80 pacientes, sendo instalada em 57 dos quais 24 receberam-na, durante a hospitalizacao, por tempo medio de 32 dias e 4 receberam-na no hospital e, depois da alta, em seus domicilios, por tempo medio de 46 dias.Esses pacientes mostraram melhora do estado nutricional e nao apresentaram complicacoes decorrentes da terapeutica nutricional aplicada

[Breast feeding in different income classes in the Municipality of São Paulo]. / Aleitamento natural em diferentes classes de renda no Município de São Paulo.

PIP: The relationship between breast feeding and socioeconomic factors in children below 2 from different social classes in Sao Paulo, Brazil is analyzed. Of a total 200 children, 46 were malnourished and 31 belonged to the lower socioeconomic classes. 39% of mothers from the lower income families breastfed for 6 months, as compared to 13% of mothers from families with higher incomes 18% and 36% of mothers from the 2 classes did not breastfeed; mothers from the middle class breastfed for an average 28 days. The problem of protein-calorie malnutrition in young children is a growing one in Brazil, even in a relatively rich city such as Sao Paulo; one of the factors responsible for this problem is undoubtedly early weaning. Reasons given for early weaning in a group of 351 mothers were deficient amount of milk (49.6%), medical advice (11.1%), "bad" milk (14.3%), and only 1.4% because of occupation outside of the home. When interviewed about their opinion on the best type of milk for infants, 45% out of a group of 500 mothers indicated artificial milk, 37% maternal milk, and 16.2% cow's milk. Out of 492 mothers, 77% had 4 prenatal visits at a public health center, 11% had no prenatal visits, and 12% had 1-3 visits. Prenatal care does not influence attitude in favor of breast feeding; 45.5% of mothers who had not had any prenatal care breastfed for 6 months or more, as compared to 20% of those with 1-3 visits, and 17.5% of those with 4 visits. Those who delivered in a hospital tended to breastfeed more than those who delivered at home. It is obvious that not only mothers but health workers as well must be educated on the importance of breast feeding to fight infant malnutrition in Brazil.^ieng