Factors associated with the evolution of weight of children in a supplementary feeding program. / Fatores associados à evolução do peso de crianças em programa de suplementação alimentar.

Identifying the influence of socioeconomic, care, and feeding factors on children's nutritional status is important for the evaluation and targeting of public policies based on nutritional interventions. We investigated the sociodemographic and biological factors associated with children aged 6 to 23 months leaving the low weight-for-age condition (weight-for-age z-score < -2) during their participation in a supplementary feeding program (SFP). This is a cohort study with 327 low-income children living in the inland of the state of São Paulo, who joined the SFP with low weight-for-age when they were six months old. The dependent variable was "maintained low weight-for-age during participation in the program" (dichotomous), and the independent variables related to: 1) maternal characteristics: marital status, schooling, age, and work situation; 2) child characteristics: being weaned, gender, birth weight, and age at weighing. We used a multiple multilevel logistic regression for the modeling. Factors positively associated with children's weight gain were higher age at weighing (OR = 1.20; 95%CI 1.08 - 1.34; p = 0.001); higher birth weight (OR = 1.0011; 95%CI 1.0001 - 1.0019; p = 0.022), and being weaned when joining the program (OR = 0.20; 95%CI 0.08 - 0.52; p = 0.001). Actions focused on promoting appropriate birth weight and breastfeeding, and on adequate and timely introduction to healthy complementary feeding are important strategies to maximize the effects of the SFP on weight gain in the first two years of life of children from low-income families.

Identificar a influência dos fatores socioeconômicos, dos cuidados e da alimentação sobre o estado nutricional infantil são importantes para avaliação e direcionamento de políticas públicas baseadas em intervenções nutricionais. Foram investigados os fatores sociodemográficos e biológicos associados à saída de crianças da faixa de baixo peso-para-idade (escore z de peso-para-idade < -2), nas idades de 6 a 23 meses, durante sua participação em programa de suplementação alimentar (PSA). Trata-se de estudo de coorte com 327 crianças de baixa renda residentes no interior do estado de São Paulo, que ingressaram no PSA aos 6 meses de idade com baixo peso-para-idade. A variável dependente foi "permanecer com baixo ­peso-para-idade durante a participação no programa" (dicotômica), e as independentes referem-se a: 1) características maternas: condição conjugal, escolaridade, idade, situação de trabalho; 2) características das crianças: estar desmamada, sexo, peso ao nascer e idade nas pesagens. Foram realizadas modelagens com regressão logística múltipla multinível. Maior idade da criança na pesagem (OR = 1,20; IC95% 1,08 - 1,34; p = 0,001), maior peso ao nascer (OR = 1,0011; IC95% 1,0001 - 1,0019; p = 0,022) e estar desmamada ao ingressar (OR = 0,20; IC95% 0,08 - 0,52; p = 0,001) se associaram positivamente ao ganho de peso das crianças. Ações focadas na promoção do peso adequado ao nascer e do aleitamento materno e na introdução adequada e oportuna da alimentação complementar saudável são estratégias importantes para maximizar o efeito de PSA no ganho de peso nos primeiros dois anos de vida em crianças de famílias de baixa renda.

Fatores associados à evolução do peso de crianças em programa de suplementação alimentar / Factors associated with the evolution of weight of children in a supplementary feeding program

RESUMO: Identificar a influência dos fatores socioeconômicos, dos cuidados e da alimentação sobre o estado nutricional infantil são importantes para avaliação e direcionamento de políticas públicas baseadas em intervenções nutricionais. Foram investigados os fatores sociodemográficos e biológicos associados à saída de crianças da faixa de baixo peso-para-idade (escore z de peso-para-idade < -2), nas idades de 6 a 23 meses, durante sua participação em programa de suplementação alimentar (PSA). Trata-se de estudo de coorte com 327 crianças de baixa renda residentes no interior do estado de São Paulo, que ingressaram no PSA aos 6 meses de idade com baixo peso-para-idade. A variável dependente foi "permanecer com baixo ­peso-para-idade durante a participação no programa" (dicotômica), e as independentes referem-se a: 1) características maternas: condição conjugal, escolaridade, idade, situação de trabalho; 2) características das crianças: estar desmamada, sexo, peso ao nascer e idade nas pesagens. Foram realizadas modelagens com regressão logística múltipla multinível. Maior idade da criança na pesagem (OR = 1,20; IC95% 1,08 - 1,34; p = 0,001), maior peso ao nascer (OR = 1,0011; IC95% 1,0001 - 1,0019; p = 0,022) e estar desmamada ao ingressar (OR = 0,20; IC95% 0,08 - 0,52; p = 0,001) se associaram positivamente ao ganho de peso das crianças. Ações focadas na promoção do peso adequado ao nascer e do aleitamento materno e na introdução adequada e oportuna da alimentação complementar saudável são estratégias importantes para maximizar o efeito de PSA no ganho de peso nos primeiros dois anos de vida em crianças de famílias de baixa renda.

ABSTRACT: Identifying the influence of socioeconomic, care, and feeding factors on children's nutritional status is important for the evaluation and targeting of public policies based on nutritional interventions. We investigated the sociodemographic and biological factors associated with children aged 6 to 23 months leaving the low weight-for-age condition (weight-for-age z-score < -2) during their participation in a supplementary feeding program (SFP). This is a cohort study with 327 low-income children living in the inland of the state of São Paulo, who joined the SFP with low weight-for-age when they were six months old. The dependent variable was "maintained low weight-for-age during participation in the program" (dichotomous), and the independent variables related to: 1) maternal characteristics: marital status, schooling, age, and work situation; 2) child characteristics: being weaned, gender, birth weight, and age at weighing. We used a multiple multilevel logistic regression for the modeling. Factors positively associated with children's weight gain were higher age at weighing (OR = 1.20; 95%CI 1.08 - 1.34; p = 0.001); higher birth weight (OR = 1.0011; 95%CI 1.0001 - 1.0019; p = 0.022), and being weaned when joining the program (OR = 0.20; 95%CI 0.08 - 0.52; p = 0.001). Actions focused on promoting appropriate birth weight and breastfeeding, and on adequate and timely introduction to healthy complementary feeding are important strategies to maximize the effects of the SFP on weight gain in the first two years of life of children from low-income families.

Clinical and immunological profiles of anaemia in children and adolescents with Plasmodium vivax malaria in the Pará state, Brazilian Amazon.

Children and adolescents are at great risk for developing iron deficiency anaemia worldwide. In the tropical areas, malaria and intestinal parasites may also play an important role in anaemia pathogenesis. This study aimed at evaluating clinical and immunological aspects of anaemia in children and adolescents with Plasmodium vivax malaria, in the Pará State, Brazil. A longitudinal study was performed in two Reference Centers for malaria diagnosis in the Brazilian Amazon in children and adolescents with malaria (n = 81), as compared to a control group (n = 40). Patients had blood drawn three times [before treatment (D0), after treatment (D7) and at the first cure control (D30)] and hemogram, autoantibody analysis (anticardiolipin, antibodies against normal RBC membrane components) and cytokine studies (TNF and IL-10) were performed. Stool samples were collected for a parasitological examination. Malaria patients had a 2.7-fold greater chance of anaemia than the control group. At D0, 66.1% of the patients had mild anaemia, 30.5% had moderate and 3.5% had severe anaemia. Positivity to intestinal helminths and/or protozoa at stool examinations had no influence on anaemia. Patients had significantly lower levels of plasmatic TNF than control individuals at D0. Low TNF levels were more prevalent among patients with moderate/severe anaemia than in those with mild anaemia and among anaemic patients than in anaemic controls. TNF levels were positively correlated with the haemoglobin rates and negatively correlated with the interval time elapsed between the onset of symptoms and diagnosis. Both plasma TNF levels and haemoglobin rates increased during the follow-up period. The IL-10 levels were lower in patients than in the controls at day 0 and decreased thereafter up to the end of treatment. Only the anti-anticardiolipin autoantibodies were associated with moderate/severe anaemia and, possibly by reacting with the parasite glycosylphosphatidylinositol (a powerful stimulator of TNF production), may have indirectly contributed to decrease the TNF levels, which could be involved in the malarial vivax anaemia of these children and adolescents. More studies addressing this issue are necessary to confirm these findings and to add more information on the multifactorial pathogenesis of the malarial anaemia.

Sociodemographic factors and overweight in children participating in a government program for fortified milk distribution / Fatores sociodemográficos e excesso de peso em crianças participantes de programa governamental de distribuição de leite fortificado

INTRODUCTION: Previous studies have shown the effectiveness of the VIVALEITE Project for promoting weight gain in children under two years old. Given the program´s effectiveness, children whose weight on entry was close to the normal limit for age may have become overweight during their participation OBJECTIVE: To analyze the association between sociodemographic factors and overweight in participants of the VIVALEITE Project METHODS: A cohort study with data on 1,039 infants from low-income families in the state of São Paulo enrolled on the Vivaleite Program at six months of age with a weight near the upper limit of adequacy between January 2003 and September 2008 was conducted. The proportion of children that became overweight during participation in the program and associations with sociodemographic conditions of each child (breastfeeding at six months, sex and birth weight) and mother/guardian (marital status, age, employment status and education) were investigated. Modeling was performed using multilevel logistic regression of socioeconomic variables and ages at weighing. The Stata program version 10.1 was used for analysis RESULTS: On multilevel analysis, the "yes" category of breastfeeding at six months (OR = 0.29, p = 0.001) and maternal employment (OR = 0.36, p = 0.012) were significantly associated with overweight in the children. The variables birth weight, sex, marital status, maternal age and education were not statistically associated with overweight CONCLUSIONS: The sociodemographic factors "not breastfeeding at six months" and "maternal unemployment" were positively associated with overweight among the infants participating in the program

INTRODUÇÃO: Estudos anteriores mostraram a efetividade do programa VIVALEITE para o ganho de peso de crianças menores de dois anos. Como o programa é efetivo, é possível que crianças ingressantes com peso próximo ao limite considerado adequado para idade o ultrapassem no decorrer de sua participação OBJETIVO: Analisar a associação entre fatores sociodemográficos e excesso de peso em participantes do programa VIVALEITE MÉTODO: Estudo de coorte com dados de 1.039 crianças de famílias de baixa renda do interior do Estado de São Paulo, ingressantes no programa com seis meses de idade e peso próximo ao limite superior de adequação, entre janeiro/2003 e setembro/2008. Investigou-se a proporção de crianças que ficam com excesso de peso durante a participação no programa e associações com as condições sociodemográficas de cada criança (amamentação aos seis meses, sexo, peso ao nascer) e dos respectivos responsáveis (condição conjugal, idade, situação de trabalho, escolaridade). A modelagem foi feita por meio de regressão logística multinível das variáveis socioeconômicas e o conjunto das idades de pesagem. O processamento foi feito com o pacote estatístico Stata 10.1 RESULTADOS: Conforme análise multinível, a categoria sim da variável aleitamento materno aos seis meses (OR=0,29, p=0,001) e a categoria trabalha da variável situação de trabalho materno (OR=0,36, p=0,012) foram associadas significantemente ao excesso de peso das crianças. As demais variáveis não foram associadas estatisticamente a excesso de peso CONCLUSÃO: Não amamentação aos seis meses e ausência de trabalho materno são fatores sociodemográficos positivamente associados ao excesso de peso das crianças participantes do programa

The impact of dark chocolate intake on arterial elasticity in individuals with HIV/AIDS undergoing ART: a randomized, double-blind, crossover trial.

An increase in the frequency of cardiovascular diseases has been observed in the HIV/AIDS population. Studies involving healthy subjects or subjects with other diseases have shown benefits of chocolate supplementation on endothelial function and vasodilation. We evaluate the impact of chocolate consumption on arterial elasticity in people living with human immunodeficiency virus - PLHIV. A double-blind, crossover trial including 110 PLHIV (19 to 59 years) on antiretroviral therapy - ART for at least 6 months and with a viral load of <500 copies per mL was conducted. All subjects were randomly assigned to 15-d dietary supplements containing dark chocolate or placebo with a 15-d washout period. Each participant received one of the two sequences: A (dark chocolate, placebo chocolate); B (placebo chocolate, dark chocolate). Arterial elasticity was measured using the HDI/PulseWave™ CR-2000 CardioVascular Profiling System®. Body composition, lipid profile, C-reactive protein, and thiobarbituric acid reactive substances were also assessed. Analysis of variance (ANOVA) for repeated measures using the Stata 11.0® program was used for cross-over analysis. Most subjects were men (59.0%) and Caucasian (46.1%) and the mean age was 44.6 ± 7.1 years. The mean time since diagnosis of HIV infection was 13.7 ± 5.3 years and the mean duration of ART was 12.9 ± 4.2 years. Chocolate consumption resulted in significant alterations in the large artery elasticity index - LAEI (p = 0.049) and the mean concentration of HDL-c was higher after supplementation with dark chocolate (p = 0.045). This is the first study to evaluate the effect of chocolate on arterial elasticity in PLHIV. The results showed that dark chocolate consumption for 15 days improved the elastic properties of the LAEI in PLHIV. These findings, added to the noninvasive method used, may expand the knowledge of CVDs in this population.

Anemia among pregnant women attending primary healthcare units in the municipality of São Paulo, Brazil: evaluations after the mandatory fortification of wheat and maize flours with iron

BACKGROUND: Improvements in the iron status of a population as result of food fortification are expected at the long term. In Brazil, the effectiveness of mandatory flour fortification with iron has been evidenced mostly from surveys on gestational anemia after 1 or 2 years from its implementation, in 2004. Our aim was to assess hemoglobin (Hb) concentrations and the prevalences of anemia and linked erythrocyte morphology patterns among pregnant women in 2006 and 2008.METHODS: The study design was retrospective and cross-sectional. The analysis was based on secondary data in 546medical records from women at the times of their first prenatal attendance in 13 public primary healthcare units of the Butantan Administrative Region from São Paulo (SP), Brazil. Anemia was evaluated from Hb concentration (cut-off <11.0 g/dL) and erythrocyte morphology patterns from mean corpuscular volume (MCV), mean corpuscular Hb concentration (MHC), and red cell distribution widths (RDW). Recorded sociodemographic and obstetric data included maternal age, gestational age, ethnoracial self-classification, and residence type. Student's t tests, analysis of variance, Chi-squared tests, and multiple linear and logistic regressions were employed in the statistical analysis using a significance level of 5 %.RESULTS:The prevalence of anemia was 9.7 % in 2006 and 9.4 % in 2008 (P= 0.922), with no significant difference in mean Hb concentrations (P= 0.159). Normocytosis (normal MVC), normochromia (normal MHC), and anisocytosis (high RDW) were found in most anemia cases, suggesting that the low Hb concentrations resulted from mixed causes. In multiple regression analysis, gestational age at the first prenatal attendance was an independent predictor of low Hb and of having anemia. Moreover, black ethnoracial self-classification was associated with lower Hb. CONCLUSIONS: The prevalence of gestational anemia was low among women in both of the studied periods, representing a mild public health problem. Our results highlight the importance of early prenatal care as a means of reducing gestation-associated risks. The erythrocyte morphology pattern found in most cases of low Hb levels suggests that, besides iron deficiency, hemoglobin pathies and nutritional deficiencies of folate and vitamin B12 are common complicating factors of gestational anemia in our setting.

Effectiveness of Family Health Strategy on child's health indicators in São Paulo State / Efetividade da Estratégia Saúde da Família sobre indicadores de saúde da criança no Estado de São Paulo

Abstract Objectives: to evaluate the effectiveness of Family Health Strategy (FHS) on child's health indicators in São Paulo State. Methods: longitudinal ecological study involving all the towns in São Paulo State from 1998 to 2009. The outcomes were the coefficients of infant mortality and its components and the rate for pneumonia and diarrhea hospitalizations. The main independent variable was "FHS coverage"; the covariates considered the context of sociodemographic and the health system. Negative binomial regression models of fixed effects and STRATA 11.1 statistical program were used. Results: FHS coverage above 50% showed a protective effect in relation to the postneonatal mortality (RR: 0.93; CI 95%: 0.87-1.00) and coverage up to 50% (RR 0.88 CI95% 0.82-0.99) or above 50% (RR: 0.87; CI95%: 0.82-0.92) were protective factors for pneumonia hospitalizations. Conclusions: the effectiveness of FHS on the outcomes related to child's health may vary according to local and regional contexts.

Resumo Objetivos: avaliar a efetividade da Estratégia Saúde da Família (ESF) sobre indicadores de saúde da criança no Estado de São Paulo. Métodos: estudo ecológico longitudinal envolvendo todos os municípios do estado de São Paulo no período de 1998 a 2009. Os desfechos foram os coeficientes de mortalidade infantil e seus componentes e taxa de internações por pneumonia e diarreia. A variável independente principal foi "cobertura da ESF"; as covariáveis consideraram o contexto sociodemográfico e do sistema de saúde. Utilizaram-se modelos de regressão binomial negativa de efeitos fixos, utilizando o programa estatístico STATA 11.1. Resultados: coberturas da ESF superiores a 50% mostraram efeito de proteção em relação à mortalidade pós-neonatal (RR: 0,93; IC95%: 0,87-1,00) e coberturas de até 50% (RR: 0,88; IC95%: 0,82-0,99) ou superiores a 50% (RR: 0,87; IC95%: 0,82-0,92) foram fatores de proteção para internações por pneumonia. Conclusões: a efetividade da ESF sobre os desfechos relacionados à saúde da criança pode variar em função de contextos locais e regionais.

Influence of adiponectin gene variants and plasma fatty acids on systemic inflammation state association-A cross-sectional population-based study, São Paulo, Brazil.

SCOPE: Interactions between adiponectin genetic variants and plasma fatty acid profile can modulate plasma inflammatory biomarker concentration and the risk for metabolic diseases. The aim of this study was to investigate the interaction between single nucleotide polymorphisms of the adiponectin gene and plasma fatty acid profile in modulating the odds for systemic inflammation in a cross-sectional population-based study. METHODS AND RESULTS: Inflammatory patterns comprised 11 inflammatory biomarkers. Among participants of the Health Survey of São Paulo, 262 adults (19-59 years) met the inclusion criteria. Anthropometric parameters, blood pressure, plasma inflammatory biomarker concentration, and fatty acid profile were measured and five single nucleotide polymorphisms of the adiponectin gene (rs2241766, rs1501299, rs16861209, rs17300539, and rs266729) genotyped. Individuals in the upper 50th percentile for plasma araquidonic acid, n-3 highly unsaturated fatty acid and estimated delta-5-desaturase activity, had reduced odds of being in the inflammatory cluster (OR (95% CI) = 0.55 (0.32-0.95), 0.50 (0.28-0.88) and 0.48 (0.28-0.83), respectively). Gene-plasma fatty acid profile interaction was found between rs2241766 and n-3 (p = 0.019), rs16861209 and araquidonic acid and docosapentaenoic acid (p = 0.044, p = 0.037, respectively), and rs17300539 and saturated fatty acid (p = 0.019). CONCLUSION: Plasma fatty acid profile can interact with adiponectin gene variants to modulate the risk for systemic inflammatory state.

Excesso de peso e sua relação com a duração do aleitamento materno em pré-escolares / Overweight and its relationship with duration of breastfeeding in preschoolers

INTRODUÇÃO: a obesidade vem aumentando, de forma expressiva, em crianças e adolescentes. O aleitamento materno tem sido relacionado como fator preventivo de muitas doenças e, nos últimos anos, tem sido verificado seu papel de proteção contra a obesidade na infânciaOBJETIVO: verificar a prevalência de excesso de peso e sua relação com o aleitamento materno em crianças de 48 a 60 mesesMÉTODO: estudo transversal, no qual foram coletados dados antropométricos de crianças de 48 a 60 meses, de escolas de Município de Minas Gerais, MG, para cálculo de índice de massa corpórea (IMC) e classificação nutricional. Foram coletados, também, dados sobre a duração do aleitamento materno e alimentação atual da criança, além de variáveis demográficas e socioeconômicas. Excesso de peso foi considerado variável desfecho. A variável explanatória principal foi o aleitamento materno e as variáveis de controle foram alimentação atual e as variáveis demográficas e socioeconômicas. A relação entre o desfecho e as variáveis explanatórias foi verificada por meio de regressão de PoissonRESULTADOS: a prevalência de crianças com excesso de peso foi de 9,6%. O aleitamento materno exclusivo (AME) até os 6 meses ou mais foi oferecido a 32,11% das crianças. O estudo aponta uma relação positiva entre a presença de AME e a ausência de excesso de peso em crianças de 48 a 60 meses para a categoria de AME por 6 meses ou mais. Relação semelhante não foi encontrada para o aleitamento materno complementadoCONCLUSÃO: A prevalência do excesso peso das crianças do estudo (9,6%) foi superior a média nacional (7%). O aleitamento materno exclusivo por 6 meses ou mais associou-se à ausência de excesso de peso e o aleitamento materno complementado não apresentou associação com o peso das crianças.

INTRODUCTION: obesity is increasing significantly, even in children and adolescents. Breastfeeding has been implicated as a preventive factor of many diseases and in recent years the protective role of breastfeeding against childhood obesity has been observed OBJECTIVE: to investigate the prevalence of overweight and its relationship with breastfeeding in children aged 48-60 months METHODS: across-sectional study was conducted involving collection of anthropometric data of children aged 48-60 months from public schools of a city located in Minas Gerais-MG, Brazil, for calculation of body mass index (BMI) and nutritional classification. Data on breastfeeding duration and current feeding were also collected, as well as demographic and socioeconomic variables. Overweight was considered the outcome variable. The main explanatory variable was breastfeeding while the control variables were current feeding and demographic and socioeconomic variables. The relationship between the outcome and explanatory variables was assessed using Poisson regression RESULTS: the prevalence of overweight children was 9.6%. Exclusive breastfeeding (EBF) for upto 6 months or loger was given to 32.11% of children. The study showed a positive relationship between the presence of EBF and absence of overweight in children aged 48-60 months for the category EBF for 6 months or longer. A similar relationship was not found for complemented breastfeeding CONCLUSIONS: the prevalence of overweight children in the study (9.6%) was higher than the national average (7%). Exclusive breastfeeding for 6 months or longer was associated with absence of overweight and complemented breastfeeding was not associated with children's weight.

Overweight and its relationship with duration of breastfeeding in preschoolers / Excesso de peso e sua relação com a duração do aleitamento materno em pré-escolares

INTRODUCTION: obesity is increasing significantly, even in children and adolescents. Breastfeeding has been implicated as a preventive factor of many diseases and in recent years the protective role of breastfeeding against childhood obesity has been observed OBJECTIVE: to investigate the prevalence of overweight and its relationship with breastfeeding in children aged 48-60 months METHODS: across-sectional study was conducted involving collection of anthropometric data of children aged 48-60 months from public schools of a city located in Minas Gerais-MG, Brazil, for calculation of body mass index (BMI) and nutritional classification. Data on breastfeeding duration and current feeding were also collected, as well as demographic and socioeconomic variables. Overweight was considered the outcome variable. The main explanatory variable was breastfeeding while the control variables were current feeding and demographic and socioeconomic variables. The relationship between the outcome and explanatory variables was assessed using Poisson regression RESULTS: the prevalence of overweight children was 9.6%. Exclusive breastfeeding (EBF) for upto 6 months or loger was given to 32.11% of children. The study showed a positive relationship between the presence of EBF and absence of overweight in children aged 48-60 months for the category EBF for 6 months or longer. A similar relationship was not found for complemented breastfeeding CONCLUSIONS: the prevalence of overweight children in the study (9.6%) was higher than the national average (7%). Exclusive breastfeeding for 6 months or longer was associated with absence of overweight and complemented breastfeeding was not associated with children's weight.(AU)

INTRODUÇÃO: a obesidade vem aumentando, de forma expressiva, em crianças e adolescentes. O aleitamento materno tem sido relacionado como fator preventivo de muitas doenças e, nos últimos anos, tem sido verificado seu papel de proteção contra a obesidade na infância OBJETIVO: verificar a prevalência de excesso de peso e sua relação com o aleitamento materno em crianças de 48 a 60 meses MÉTODO: estudo transversal, no qual foram coletados dados antropométricos de crianças de 48 a 60 meses, de escolas de Município de Minas Gerais, MG, para cálculo de índice de massa corpórea (IMC) e classificação nutricional. Foram coletados, também, dados sobre a duração do aleitamento materno e alimentação atual da criança, além de variáveis demográficas e socioeconômicas. Excesso de peso foi considerado variável desfecho. A variável explanatória principal foi o aleitamento materno e as variáveis de controle foram alimentação atual e as variáveis demográficas e socioeconômicas. A relação entre o desfecho e as variáveis explanatórias foi verificada por meio de regressão de Poisson. RESULTADOS: a prevalência de crianças com excesso de peso foi de 9,6%. O aleitamento materno exclusivo (AME) até os 6 meses ou mais foi oferecido a 32,11% das crianças. O estudo aponta uma relação positiva entre a presença de AME e a ausência de excesso de peso em crianças de 48 a 60 meses para a categoria de AME por 6 meses ou mais. Relação semelhante não foi encontrada para o aleitamento materno complementado CONCLUSÃO: A prevalência do excesso peso das crianças do estudo (9,6%) foi superior a média nacional (7%). O aleitamento materno exclusivo por 6 meses ou mais associou-se à ausência de excesso de peso e o aleitamento materno complementado não apresentou associação com o peso das crianças.(AU)

Myocarditis associated with Plasmodium vivax malaria: a case report

Malaria remains a major public health problem in Brazil where Plasmodium vivax is the predominant species, responsible for 82% of registered cases in 2013. Though benign, P. vivax infection may sometimes evolve with complications and a fatal outcome. Here, we report a severe case of P. vivax malaria in a 35-year-old Brazilian man from a malaria endemic area, who presented with reversible myocarditis.

Vitamin E concentrations in adults with HIV/AIDS on highly active antiretroviral therapy.

HIV/AIDS patients are probably more predisposed to vitamin E deficiency, considering that they are more exposed to oxidative stress. Additionally, there are an extensive number of drugs in the highly active antiretroviral therapy (HAART) regimens that may interfere with vitamin E concentrations. The objective of this study was to compare serum concentrations of alpha-tocopherol in 182 HIV/AIDS patients receiving different HAART regimens. The patients were divided into three groups according to regimen: nucleoside analog reverse-transcriptase inhibitors (NRTIs) + non-nucleoside analog reverse-transcriptase inhibitors (NNRTIs); NRTIs + protease inhibitors + ritonavir; NRTIs + other classes. Alpha-tocopherol was assessed by high-performance liquid chromatography. Multiple linear regression analysis was used to evaluate the effects of HAART regimen, time of use, and compliance with the regimen on alpha-tocopherol concentrations. Alpha-tocopherol concentrations were on average 4.12 µmol/L lower for the NRTIs + other classes regimen when compared to the NRTIs + NNRTIs regimen (p = 0.037). A positive association (p < 0.001) was observed between alpha-tocopherol and cholesterol concentrations, a finding due, in part, to the relationship between liposoluble vitamins and lipid profile. This study demonstrated differences in alpha-tocopherol concentrations between patients using different HAART regimens, especially regimens involving the use of new drugs. Long-term prospective cohort studies are needed to monitor vitamin E status in HIV/AIDS patients since the beginning of treatment.

Comparação da razão carga/deflexão entre fios ortodônticos de Ni-Ti termoativados 0,014"x0, 025" e 0, 016"x0, 022" / Comparison of the load/deflection ratio between the heat-activated Ni-Ti orthodontic wires 0. 014"x0. 025" and 0. 016"x0. 022"

O conhecimento sobre as propriedades mecânicas dos fios de Níquel-Titânio (NiTi) termoativados das marcas mais acessíveis do mercado nacional ainda é limitado. Diante disso, o objetivo deste estudo foi avaliar e comparar por meio de testes de deflexão em 03 braquetes, os fios NiTi termo ativados retangulares de calibre 0,014''x0,025'' e 0,016"x0,022" de diferentes marcas (MORELLI® ORMCO®, ORTHOSOURCE®, ORTHOMETRIC®, EURODONTO® e ADITEK®). Todos os testes foram realizados na máquina de ensaio universal EMIC DL 2000 sob condições idênticas e controladas a uma temperatura de 36°C ± 0,5°C. Cinco medições (N=5) foram realizadas para cada espessura/marca de fio que foi deflexionado até um limite de 4,0mm a uma velocidade de 1,0mm/min. A cada 0,2mm (ida e volta) de deflexão a força correspondente foi aferida para a construção do gráfico de força x deflexão no programa Tesc versão 3.04. Cada gráfico foi avaliado individualmente segundo as seguintes variáveis: início da transformação martensítica (cN e mm), força máxima (cN), inicio e final do platô de desativação (cN e mm) e comprimento do platô (mm). As médias e o desvio padrão foram calculados para todas as variáveis e a análise estatística foi feita pelos testes ANOVA 2 critérios e Turkey ou Kruskal-Wallis e Dunn, a um nível de significância de 5%. Os resultados evidenciaram que nos testes dos fios 0,014''x0,025'' as marcas ORTHOMETRIC® e ORMCO® apresentaram os melhores resultados, assim como os fios das marcas MORELLI® e ORTHOSOURCE® para os fios 0,016''x0,022''. De uma forma geral, os fios de calibre 0,014''x0,025'' apresentaram níveis de força no platô de desativação até 6 x menores que os de calibre 0,016''x0,022''.

The knowledge of the mechanical properties of nickel-titanium (NiTi) termoactives of the more accessible of the domestic market is still limited. Given this, the objective of this study was to evaluate and compare through deflection tests in brackets NiTi wires 03 term rectangular gauge 0.014" enabled x 0.025" and 0.016" x 0.022" of different brands (MORELLI®, ORMCO® ORTHOSOURCE®, ORTHOMETRIC®, EURODONTO® and ADITEK®). All tests were carried out on universal testing machine EMIC DL 2000 under identical conditions and controlled at a temperature of 36°C ± 0.5°C. Five measurements (N=5) were performed for each thickness/wire tag that was deflected up to a limit of 4.0mm at a speed of 1.0mm/min. Each 0.2mm (round trip) of corresponding strength measured deflection for the construction of the graph of force x deflection at Tesc program version 3.04. Each graphic was evaluated according to the following variables: beginning of the Martensitic transformation (cN and mm), maximum strength (cN), the beginning and end of the plateau of deactivation (cN and mm) and length (mm) plateau. The average and standard deviation were calculated for all variables and statistical analysis was made by ANOVA tests 2 criteria and Turkey or Kruskal-Wallis and Dunn, a 5% level of significance. The results showed that the tests of 0.014"x0.025" ORTHOMETRIC® brands and ORMCO® showed the best results, as well as the wires of the MORELLI® and ORTHOSOURCE® to wires 0.016"x0.022". In General, the gauge wires 0.014"x0.025" showed strength levels on the plateau of deactivation to 6 x smaller than 0.016"x0.022" caliber.

Myocarditis associated with Plasmodium vivax malaria: a case report.

Malaria remains a major public health problem in Brazil where Plasmodium vivax is the predominant species, responsible for 82% of registered cases in 2013. Though benign, P. vivax infection may sometimes evolve with complications and a fatal outcome. Here, we report a severe case of P. vivax malaria in a 35-year-old Brazilian man from a malaria endemic area, who presented with reversible myocarditis.

Multifocal electroretinography after high dose chloroquine therapy for malaria.

PURPOSE: To investigate changes in multifocal electroretinography (mfERG) parameters associated with high dose chloroquine therapy for treatment of malaria in the Amazonia region of Brazil. METHODS: Forty-eight subjects who had received chloroquine treatment for single or multiple malaria infections with a cumulative dose ranging from 1,050 to 27,000mg were included. The control group consisted of 37 healthy aged-matched subjects. Data was collected on amplitude and implicit time of the N1, P1 and N2 waves in the central macular hexagon (R1) and in five concentric rings at different retinal eccentricities (R2-R6). RESULTS: No significant difference was observed in any mfERG parameter between chloroquine treated patients and control subjects. A comparison with previous data obtained from patients with rheumatologic disorders in the same region of Brazil who had received larger cumulative doses of chloroquine and had displayed mfERG changes, indicated that retinal toxicity seems to be dependent on cumulative dose. CONCLUSION: Lack of mfERG changes in the current study suggests that intensive high dose chloroquine therapy for treatment of malaria is not associated with retinal toxicity.

Cellular and humoral immune responses against the Plasmodium vivax MSP-119 malaria vaccine candidate in individuals living in an endemic area in north-eastern Amazon region of Brazil.

BACKGROUND: Plasmodium vivax merozoite surface protein-1 (MSP-1) is an antigen considered to be one of the leading malaria vaccine candidates. PvMSP-1 is highly immunogenic and evidences suggest that it is target for protective immunity against asexual blood stages of malaria parasites. Thus, this study aims to evaluate the acquired cellular and antibody immune responses against PvMSP-1 in individuals naturally exposed to malaria infections in a malaria-endemic area in the north-eastern Amazon region of Brazil. METHODS: The study was carried out in Paragominas, Pará State, in the Brazilian Amazon. Blood samples were collected from 35 individuals with uncomplicated malaria. Peripheral blood mononuclear cells were isolated and the cellular proliferation and activation was analysed in presence of 19 kDa fragment of MSP-1 (PvMSP-119) and Plasmodium falciparum PSS1 crude antigen. Antibodies IgE, IgM, IgG and IgG subclass and the levels of TNF, IFN-γ and IL-10 were measured by enzyme-linked immunosorbent assay. RESULTS: The prevalence of activated CD4+ was greater than CD8+ T cells, in both ex-vivo and in 96 h culture in presence of PvMSP-119 and PSS1 antigen. A low proliferative response against PvMSP-119 and PSS1 crude antigen after 96 h culture was observed. High plasmatic levels of IFN-γ and IL-10 as well as lower TNF levels were also detected in malaria patients. However, in the 96 h supernatant culture, the dynamics of cytokine responses differed from those depicted on plasma assays; in presence of PvMSP-119 stimulus, higher levels of TNF were noted in supernatant 96 h culture of malaria patient's cells while low levels of IFN-γ and IL-10 were verified. High frequency of malaria patients presenting antibodies against PvMSP-119 was evidenced, regardless class or IgG subclass.PvMSP-119-induced antibodies were predominantly on non-cytophilic subclasses. CONCLUSIONS: The results presented here shows that PvMSP-119 was able to induce a high cellular activation, leading to production of TNF and emphasizes the high immunogenicity of PvMSP-119 in naturally exposed individuals and, therefore, its potential as a malaria vaccine candidate.

Adolescent students' consumption of fruit, greens and vegetables

INTRODUCTION: The intake of fruits, vegetables and greens is in accordance with the recommendations in a minority of the population, especially in adolescents, as it has been shown in literature. The importance to increase this food consumption regards to the prevention of non-transmissible chronic diseases. OBJECTIVE: was to estimate and describe the frequency of fruit/juice and vegetable intake, and assess the adequacy of this consumption based on the recommendations of the "Ten steps to healthy eating", in adolescents in Curitiba, Brazil. METHODS: The food intake frequency was categorized as adequate or inadequate. The relationship between the intake and the independent variables (socioeconomic) was verified by simple and multiple logistic regressions. RESULTS: The participants were 341 adolescents, most female and aged between 10 - 12 years. The most frequent maternal educational level was High School, most of them working outside home. Monthly family incomes up to 3 minimum wages were most frequent. Most adolescents had inadequate intake of fruits/juices and greens/ vegetables, with higher inadequacy for the latter. Only 3.5% of them had adequate intake of both groups of food. CONCLUSIONS: The intake of fruit/juice was not associated with any of the analyzed variables. It was found association of inadequate intake of greens/vegetables only for the age range of 14-19 years, which remained after multiple regression...

INTRODUÇÃO: o consumo de frutas, legumes e verduras está de acordo com as recomendações em uma minoria da população, especialmente nos adolescentes, como as pesquisas vem demonstrando. A importância no aumento do consumo desses alimentos diz respeito à prevenção de doenças crônicas não-transmissíveis. OBJETIVO: estimar e descrever a frequência do consumo de frutas/suco natural e legumes/verduras e avaliar a adequação desse consumo com as recomendações dos "Dez passos para uma alimentação saudável", em escolares adolescentes da cidade de Curitiba (PR). MÉTODO: a frequência de consumo dos alimentos foi categorizada em adequada e não adequada. A relação entre o consumo e as variáveis independentes (socioeconômicas) foi verificada por meio de regressão logística simples e múltipla. RESULTADOS: participaram do estudo 341 adolescentes, a maioria do sexo feminino e com idades entre 10 - 12 anos. O nível escolar materno mais frequente foi o 2º grau completo, a maioria delas trabalhava fora do domicílio e a renda familiar mais observada foi de até 3 salários. A maior parte dos adolescentes apresentou consumo inadequado de frutas/sucos e de legumes/verduras, com maior inadequação para estes últimos. Apenas 3,5% deles tinha adequação para o consumo conjunto dos dois grupos de alimentos. CONCLUSÕES: o consumo de frutas/sucos não se associou a qualquer das variáveis analisadas. Verificou-se associação de consumo inadequado de verduras/legumes apenas com a faixa etária de 14 - 19 anos, que se manteve após a regressão múltipla...

Adolescent students' consumption of fruit, greens and vegetables

INTRODUCTION: The intake of fruits, vegetables and greens is in accordance with the recommendations in a minority of the population, especially in adolescents, as it has been shown in literature. The importance to increase this food consumption regards to the prevention of non-transmissible chronic diseases. OBJECTIVE: was to estimate and describe the frequency of fruit/juice and vegetable intake, and assess the adequacy of this consumption based on the recommendations of the "Ten steps to healthy eating", in adolescents in Curitiba, Brazil. METHODS: The food intake frequency was categorized as adequate or inadequate. The relationship between the intake and the independent variables (socioeconomic) was verified by simple and multiple logistic regressions. RESULTS: The participants were 341 adolescents, most female and aged between 10 - 12 years. The most frequent maternal educational level was High School, most of them working outside home. Monthly family incomes up to 3 minimum wages were most frequent. Most adolescents had inadequate intake of fruits/juices and greens/ vegetables, with higher inadequacy for the latter. Only 3.5% of them had adequate intake of both groups of food. CONCLUSIONS: The intake of fruit/juice was not associated with any of the analyzed variables. It was found association of inadequate intake of greens/vegetables only for the age range of 14-19 years, which remained after multiple regression...(AU)

INTRODUÇÃO: o consumo de frutas, legumes e verduras está de acordo com as recomendações em uma minoria da população, especialmente nos adolescentes, como as pesquisas vem demonstrando. A importância no aumento do consumo desses alimentos diz respeito à prevenção de doenças crônicas não-transmissíveis. OBJETIVO: estimar e descrever a frequência do consumo de frutas/suco natural e legumes/verduras e avaliar a adequação desse consumo com as recomendações dos "Dez passos para uma alimentação saudável", em escolares adolescentes da cidade de Curitiba (PR). MÉTODO: a frequência de consumo dos alimentos foi categorizada em adequada e não adequada. A relação entre o consumo e as variáveis independentes (socioeconômicas) foi verificada por meio de regressão logística simples e múltipla. RESULTADOS: participaram do estudo 341 adolescentes, a maioria do sexo feminino e com idades entre 10 - 12 anos. O nível escolar materno mais frequente foi o 2º grau completo, a maioria delas trabalhava fora do domicílio e a renda familiar mais observada foi de até 3 salários. A maior parte dos adolescentes apresentou consumo inadequado de frutas/sucos e de legumes/verduras, com maior inadequação para estes últimos. Apenas 3,5% deles tinha adequação para o consumo conjunto dos dois grupos de alimentos. CONCLUSÕES: o consumo de frutas/sucos não se associou a qualquer das variáveis analisadas. Verificou-se associação de consumo inadequado de verduras/legumes apenas com a faixa etária de 14 - 19 anos, que se manteve após a regressão múltipla...(AU)

Malária falciparum com comprometimento renal (síndrome nefrótica - relato de caso / Falciparum malaria with renal impairment (nephrotic syndrome) - case report

Objetivo: apresentação de um caso de síndrome nefrótica por malária falciparum. Relato decaso: escolar, 8 anos, sexo feminino, admitida no Hospital Municipal de Tailândia, Pará, comquadro de febre alta, seguida de surgimento de edema, urina escura e oligúria.. Evoluiu comanúria e foi transferida para a Fundação Santa de Misericórdia do Pará (FSCM-PA), onderecebeu diagnóstico de síndrome nefrótica secundária à malária por Plasmodium falciparum,com base em dados de anamnese, exame físico e exames complementares. A paciente obteveboa resposta clínica e parasitológica com a terapêutica antimalárica, recebendo alta hospitalarpara controle no Programa de Ensaios Clínicos em Malária do Instituto Evandro Chagas eAmbulatório de Nefrologia. Considerações finais: o acometimento renal é uma dascomplicações graves da malária com possível evolução para insuficiência renal aguda (IRA), eque pode ser fatal. Desenvolvimento de estratégias preventivas de combate aos distúrbios renaisassociados à malária requer conhecimento dos aspectos clínicos e epidemiológicos da doença,diagnóstico precoce e correto, além de terapêutica antimalárica.

Objective: presentation of nephrotic syndrome case due to falciparum malaria. Case report:school child, 8 years old, female, admitted at Municipal Hospital of Tailândia, Pará, with historyof fever, edema, dark urine and oliguria. Because the patient evolved with anuria, she wastransferred to Fundação Santa Casa de Misericórdia do Pará (FSCM-PA), where she wasdiagnosed with nephrotic syndrome secondary to Plasmodium falciparum malaria, based onanamnesis, physical examination, and laboratory exams. The patient had clinical andparasitological response to antimalarial therapy, being discharged to control at Clinical EssayMalaria Program at Evandro Chagas Institute and in a Nephrology Outpatient Unit. Finalconsideration: renal involvement is one of the serious complications of malaria. It can progressto acute renal failure (ARF), and may be fatal. Development of preventive strategies againstkidney disorders due to malaria infection requires knowledge of epidemiological and clinicalfeatures of the disease, accurate and prompt diagnosis and antimalarial therapy.

Consumo alimentar por adolescentes e a relação com fatores socioeconômicos e atividades de lazer sedentárias / Food intake of adolescents and relation with socioeconomic factors and sedentary leisure activities

Evidence on food availability in Brazil indicates that food transition has been unfavorable to obesity prevention, which includes increased intake of soft drinks, snacks and other processed foods, and decreased intake of fruits and vegetables. The purpose of this research was to assess the intake frequency of foods and food groups, analyze the influence of time in sedentary leisure activities and demographic and socioeconomic variables in determining food intake of adolescents. Food intake frequency was categorized as adequate and not adequate. The relation of the explanatory variables with the outcome was verified using multiple logistic regression. The study included 344 adolescents, mostly female between 12 and 13 years old. Most of the adolescents' parents were high school graduates and worked outside the home. Most of the families researched had monthly income up to 3 minimum wages. The 2nd, 3rd and 4th quarters of time spent in sedentary leisure activities were associated with inadequate intake of vegetables, snacks, soft drinks/industrialized juices and sweets. Late adolescence was associated with inadequate intake of vegetables; higher family income was associated with adequate intake of soft drinks; going to "Municipal School 2" was associated with adequacy of sweets intake; and family monthly income between two and three minimum wages was associated with inadequacy of sweets intake. It was possible to conclude that longer sedentary leisure activity time was the most important factor in determining the inadequate food intake of adolescents.

Las evidencias sobre la disponibilidad de alimentos en Brasil indican que la transición alimentaria, que implica un aumento del consmo de refrescos, galletas y otros alimentos procesados, y una disminución del consumo de frutas y verduras, ha dificultado la prevención de la obesidad. Los objetivos de este estudio fueron estimar la frecuencia del consumo de alimentos y grupos alimentares, y analizar la influencia de la variable "tiempo dedicado a actividades de ocio sedentario" y de las variables demográficas y socioeconómicas en la determinación del consumo de alimentos en los adolescentes. La frecuencia de consumo de alimentos fue clasificada como "adecuada" e "inadecuada". La relación entre las variables explicativas y el resultado se verificó mediante regresión logística multiple. Fueron analisados 344 adolescentes, en su mayoría mujeres, de entre 12 y 13 años de edad. La mayoría de los padres de los adolescentes estudiados cursaron hasta segundo grado. La mayoría de las familias tenían ingresos de hasta 3 salarios mínimos. La segunda, tercera y cuarta parte del tiempo dedicado a actividades sedentarias de ocio se asociaron con un consumo inadecuado de hortalizas y verduras, de snacks, de gaseosas o jugos procesados y de dulces. Los adolescentes de más edad consumieron pocas hortalizas y verduras; el mayor ingreso familiar se asoció con una ingesta adecuada de gaseosas; estudiar en la Escuela municipal 2 se asoció a una ingesta adecuada de dulces; los ingresos familiares de 2 y 3 salarios minimos se asociaron con el consumo inadecuado de dulces. Se puede concluir que el exceso de actividades sedentarias de ocio es un factor importante en la determinación del consumo alimentario inadecuado en los adolescentes.

Evidências sobre a disponibilidade de alimentos no Brasil indicam que a transição alimentar tem sido desfavorável quanto à prevenção da obesidade, o que inclui maior ingestão de refrigerantes, biscoitos e demais alimentos industrializados, e queda no consumo de frutas e verduras. O objetivo deste trabalho foi estimar a frequência de consumo de alimentos e de grupos alimentares, além de analisar a influência do "tempo em atividades de lazer sedentárias" e das variáveis demográficas e socioeconômicas na determinação do consumo alimentar de adolescentes. A frequência de consumo dos alimentos foi categorizada em adequada e não adequada. A relação das variáveis explanatórias com o desfecho foi verificada por meio de regressão logística múltipla. Participaram do estudo 344 adolescentes, sendo a maioria do gênero feminino e com idades entre 12 e 13 anos. A maior parte dos pais dos adolescentes cursou até o 2º grau. A maioria das famílias tinha rendimentos de até três salários mínimos. Segundo, terceiro e quarto quartos de tempo gastos nas atividades de lazer sedentárias associaram-se à inadequação do consumo de legumes e verduras, de salgados, de refrigerantes/sucos industrializados e de doces. A maior idade dos adolescentes associou-se ao consumo inadequado de legumes e verduras; a maior renda familiar associou-se ao consumo adequado de refrigerantes; pertencer à Escola Municipal 2 associou-se à adequação do consumo de doces e a renda familiar de 2 a 3 salários mínimos associou-se à sua inadequação. Pode-se concluir que principalmente o maior tempo de atividade de lazer sedentária é fator importante na determinação do consumo alimentar inadequado dos adolescentes.