Risk of linear growth retardation during the first two years of life: a new approach.

OBJECTIVE: Estimate the risk of linear growth retardation during the first two years of life as a result of household social vulnerability. SETTING: Families who participated in the National Supplementary Feeding Program in the Health Units of the metropolitan area of the city of São Paulo, Brazil. SUBJECTS: Four hundred and thirty-one index-babies, weighing more than 2500 grams and who had at least one young sibling under the age of five who participated in the Program for a minimum of two years. DESIGN: The index-babies were divided into two cohorts: 74.9% coming from 'non-stunted families' (those with normal height siblings) and 25.1% from 'stunted families' (those with stunted siblings). The study design allowed the observation of growth patterns over a period of time and over a childhood growth range. It also allowed the estimation of the stunting and the recovery probabilities at each moment, not only within a given age range. The transition probabilities between 'stunted' and 'non-stunted' index-babies were estimated. The relative risk ratio (RR) was also calculated. RESULTS: The prevalence of stunting in the index-babies at 12 and 24 months of age was significantly greater in 'stunted families' (P < 0.001). Probabilities of becoming stunted began to differ from the fourth month on (confidence intervals non-superposed), and were higher for index-babies from 'stunted families'. The recovery probability of a stunted child was smaller in the 'stunted families' cohort after the 12th month of age. From the third month on, the (RR) was always above 1.5. CONCLUSION: The family context exposes children to failure in growth in the first two years of life when there are already stunted children in the household.

[Anemia and malnutrition in children at public schools in Osasco, São Paulo, Brazil]. / Anemia e desnutrição em escolares da rede pública do município de Osasco, São Paulo, Brasil.

The authors studied a sample of students entering the first grade in the Osasco public school system in order to determine both the prevalence of anemia and nutritional status. Osasco is part of the Greater S o Paulo Metropolitan Area. Diagnosis of anemia was made through the hemoglobin concentration of blood from digital puncture. World Health Organization (WHO) levels were used to define anemia. Nutritional Status assessment. was made through weight/age and height/age indices, using Z score distribution and the National Center for Health Statistics (NCHS) reference levels. Prevalence of anemia was 51%. Prevalence levels varied according to the schools' geographic location: 56.9% in peripheral neighborhoods and 41.7% in central areas. Children with illiterate parents had a higher prevalence of this condition. Risk of anemia was higher for children who were over eight years of age when entering the first grade. Acute malnutrition was not found. Prevalence was higher than expected and points to the urgent need to establish an anemia control program for schoolchildren in this population.

[Linear growth retardation and classroom performance of children from the city of Osasco, São Paulo, Brazil]. / Retardo do crescimento físico e aproveitamento escolar em crianças do Município de Osasco, área Metropolitana de São Paulo, Brasil.

The objective of the present study was to investigate the significance of linear childhood growth retardation in relation to classroom performance. It began with a Height Census carried out in the 1989 school year, involving children attending the first grade of all public and private schools in Osasco (Greater S o Paulo Metropolitan Area, Brazil), which identified the presence of growth retardation. Using a prospective study, classroom performance was evaluated throughout the school year in 170 children entering school and characterized by the height-for-age indice below -2 z scores (NCHS/OMS reference population) and in 205 children entering school and characterized by height-for-age above -1 z score. Classroom performance of stunted school children was lower than that of students without growth retardation. The study indicated that increased risk of school failure of those students remained the same, even after adjustment for possible confounding variables (present nutritional status and socioeconomic variables).

[Assessment of the impact of nutritional rehabilitation programs on preschool children: test of a methodology]. / Medindo o impacto de programas de recuperação nutricional de pré-escolares: teste de uma metodologia.

Two different approaches to the evaluation of the impact of food supplementation given to malnourished children are assessed on the basis of the experience of a program undertaken in the county of Diadema, in the metropolitan area of S. Paulo, Brazil. The first approach--a traditional one--is based on the proportion of children that at the end of one year's participation in the program present no weight deficit (weight for age more than 90% of the expected value). The second approach--proposed in the article--takes into account only the rate of growth and accepts weight increments superior to those expected among well-nourished children as favorable. The advantages of this second approach are fully demonstrated.