[Changes in composition and appropriate nutrition of family diet in the metropolitan areas of Brazil (1988-1996)]. / Mudanças na composição e adequação nutricional da dieta familiar nas áreas metropolitanas do Brasil (1988-1996).

OBJECTIVE: A new family budget survey carried out in the mid-nineties in Brazil allows an update of the secular trends (1962-1988) of dietary patterns of Brazilian population living in metropolitan areas. METHODS: Data sources are IBGE Institute of Statistics family budget surveys carried out from March 1987 to February 1988 (13,611 households) and from October 1995 to September 1996 (16,014 households) in all metropolitan areas of Brazil. The daily food availability per capita for each household was calculated dividing the total food acquired in a month by the number of individuals living in a household and the month's number of days. Dietary patterns were characterized according to the amount of selected food groups and nutrients relative to the diet caloric input. Comparisons between the two surveys included the metropolitan area population as a whole and subgroups from less (North and Northeast) and more developed (Mid-west, Southeast and South) regions. RESULTS: It was observed an increase in consumption of meat and dairy products (except for butter) and a reduction in eggs consumption in both less and more developed regions. Beans, roots and tubers consumption showed a steady decline in the whole country while cereals consumption remained the same (higher in developed regions) or had a slight increase (in less developed regions). The proportional consumption of vegetal oils and margarine remained constant in the less developed regions but their consumption was greatly reduced in the more developed ones. CONCLUSIONS: An increase in the diet's lipid content in less developed regions and of saturated fat in the country as a whole, associated with a decrease or even no consumption of beans, vegetables, fruits and complex carbohydrates, and a further increase in the excessive sugar consumption are the negative aspects of the trend observed from 1988 to 1996. Changes that may indicate a growing awareness of the population toward a healthier diet, such as a decline in egg intake and a slight reduction in diets with a high total lipid content, were found only in more developed regions.

[Secular trends in childhood in the city of São Paulo, Brazil (1984-1996)]. / Tendência secular da anemia na infância na cidade de São Paulo (1984-1996).

OBJECTIVE: Data from two consecutive households surveys undertaken in mid-80s and mid-90s allow to characterize and analyse secular trends in infant and child anaemia in the city of S. Paulo, Brazil. METHODS: The two surveys included random population samples aged from zero to 59 months (1,016 in the period of 1984-85 and 1,280 in 1995-96). Capillary blood samples, collected by digital puncture in the two surveys, were analysed regarding their haemoglobin concentration. The anaemic status was determined when haemoglobin concentration was below 11 g/dL. For each survey, the study of the social distribution of child anaemia took into account tertiles of the per capita family income. For the study of the determinants of secular trends, hierarchical causal models, multivariate regression analyses and calculations analogous to the ones used to assess population attributable risks were applied. RESULTS/CONCLUSIONS: In the time span from the first to the second survey, there was a significant reduction in the average haemoglobin concentration (from 11.6 g/dl to 11.0 g/dl), as well as a considerable increase in anaemia prevalence (from 35.6% to 46.9%). Unfavourable trends were observed in both sexes, all age groups and all income strata. Trends were still less favourable among the poorest families, aggravating the social burden related to child anaemia. Changes in distal (family income and maternal schooling) and proximal determinants (breast or bottle-feeding) of child anaemia were positive in the study period and therefore they cannot explain the increase in the disease. A low iron diet could explain the high prevalence of anaemia in both surveys but could not explain its further increase.

The stage of nutrition transition in different Brazilian regions.

The stage of nutrition transition in Brazil at the end of the 1980s was evaluated using the data from a nationwide cross-sectional anthropometry survey in Brazil in 1989 (Pesquisa Nacional sobre Saúde e Nutrição-PNSN). Comparable estimates of undernutrition and obesity were produced for children from 6 to 35 months old (n = 3,641), adult males from 20 to 64 years old (n = 14,235) and adult females from 18 to 64 years old (n = 15,669). Body Mass Index (kg/m2) was employed to assess both undernutrition and obesity in adults and weight-for-age (undernutrition) and weight-for-height (obesity) indices were used for children. The 5th and 95th centiles of the distribution of these indices in a reference population were used as limits for the diagnosis of undernutrition and obesity, respectively. Ordering the frequency of the problems in the population showed obesity in women and undernutrition in children to be the two main nutritional disorders in the country. These two problems are the most frequent in the urban population of the North, Northeast and Center-West regions, and in the Southeast and Center-West rural regions. Obesity leads among both adults and children in the urban areas of the Southeast and South regions, and in the rural South. Only in the rural Northeast, the poorest region in the country, undernutrition leads among children, men and women. This mosaic of situations determines the need for a complete reassessment of traditional nutrition policies and programs employed in the country.

[Quality evaluation of a personal dosimetry service]. / Valutazione della qualità del servizio di dosimetria individuale.

In a hospital environment high quality personal dosimetry is demanded by two different considerations: first, the marked reduction in the radiation exposure levels of hospital workers during the last 10 years and second, the recent decrease in the allowed absorbed dose thresholds for the different categories of workers and for the general population. In fact, according to the new Italian Radioprotection Law (D.L. vo 230/95), the dose equivalent limit for the general population has been decreased to 1 mSv per year. This means that a dosimetric system should be able to measure, with acceptable precision and accuracy, dose levels as low as 0.1 mSv per observation period (generally 1 month or 45 days). This is quite a stringent requirement for this kind of dosimetry. During a tender, the performances of the whole body personal dosimetry systems by four Italian service providers were analyzed by irradiating more than 60 test samples for each provider with four different energies in a wide dose interval (0.01-100 mSv). The results show that all systems perform quite well in the 0.2-100 mSv dose range; on the contrary, in the 0.01-0.2 mSv dose range, significant differences appear between the services and TLD based systems perform better than film based ones. In particular, one of the two TLD based systems measured doses as low as 0.01 mSv. To conclude this very high sensitivity level really opens a new "observation window" on the low doses world. The use of higher quality (and, of course, more expensive) materials by this provider seems to be the key of its success.

Patterns of intra-familiar distribution of undernutrition: methods and applications for developing societies.

OBJECTIVE: To propose a method to assess patterns of intra-familiar distribution of undernutrition and apply it to different socioeconomic strata of the Brazilian population. DESIGN: A large nationally representative cross-sectional anthropometric survey undertaken in 1989 is the primary source of information. Undernutrition was defined as body mass index (adults) and weight-for-age (children) below the 5th percentile of a healthy and non-malnourished reference population. Log-linear models were used to assess patterns of intra-familiar distribution of nutritional status in four income strata. SUBJECTS: Two thousand, one hundred and seventy-four families composed by at least one child 6-36 month-old and his/her father and mother. SETTING: All regions in Brazil. RESULTS: Undernutrition was significantly associated among household members only for the 25% poorest families (P < 0.0001). In this group, the presence of undernutrition in the mother or the father increased 1.6-1.9 times the risk of undernutrition in the child and the presence of undernutrition in the father made it 2.7 times more frequent in the mother. The relatively small prevalence ratios suggest that even in extremely poor families only a small proportion of undernutrition could be attributed to common household determinants. CONCLUSION: Our results are consistent with the hypothesis that in transitional societies undernutrition would appear as a global family problem only for those at the earlier stages of the nutrition transition. Policies and strategies to overcome undernutrition should take this fact into account.

The nutrition transition in Brazil.

OBJECTIVE: To describe and analyse changes in child and adult nutritional status in Brazil during the past several decades. DESIGN: Two large nationally representative cross-sectional anthropometric surveys undertaken in 1974 and 1989 are the primary source of information. Child nutritional status was described based on weight-for-age and weight-for-height indices using NCHS/WHO standards. Body mass index was employed to assess adult nutritional status. SUBJECTS: 27,960 children and 94,699 adults in 1974 and 5969 children and 23,544 adults in 1989. SETTING: All regions in Brazil. RESULTS: Undernutrition, although still relevant particularly in children from lower income families, is declining among adults and children of all economic strata. Concurrent increases in adult obesity have been occurring among all groups of men and women with a higher proportion of increase among lower income families. A profound change in the income-obesity relationship determines that in the most recent survey: (1) income and body mass index are inversely related among the 30% richest women; (2) a higher prevalence of female obesity (15.4%) occurs for the 40% middle-income group; and (3) the 30% poorest Brazilian women (9.7% prevalence) can no longer be considered to be protected from obesity. CONCLUSION: Brazil is rapidly shifting from the problem of dietary deficit to one of dietary excess.

[Changes in the diet pattern of the Brazilian urban population (1962-1988)]. / Mudanças no padrão de alimentação da populacão urbana brasileira (1962-1988).

Contemporary changes in food consumption patterns in urban areas of Brazil are described. The main data sources are two national food expenditure surveys undertaken in the early 60's and late 80's (1961-62 and 1987-88) and one national food intake survey undertaken in the mid-70's (1974-75). The analysis is restricted to the seven metropolitan areas represented in the three surveys. Food patterns are described on the basis of the relative consumption of different food groups, proportion of energy from carbohydrates, protein and lipids, proportion of animal and vegetable protein and fats, proportion of complex and simple carbohydrates, ratio between polyunsaturated and saturated fatty acids and relative consumption of cholesterol. Main food changes were similar in the Northeastern and Southeastern cities and involved: 1) reduction in the relative consumption of cereals, beans, roots and tubercles; 2) replacement of lard, bacon and butter by vegetable oils and margarine: and 3) increase in the relative consumption of eggs, milk and dairy products. As a net result of these changes there was, simultaneously, a decrease in the carbohydrate content of the Brazilian diet and an increase in its fat content. Total protein content of the diet remained at around 12% in the three surveys but animal protein increased. Changes in the fat content of the diet involved an increased proportion of vegetable fat, an increased ratio of poly-unsaturated/saturated fatty acids and a reduction in cholesterol intake. Health implications of dietary changes are discussed based on the World Health Organization's dietary guidelines.

[The height census of first grade schoolchildren: data quality and cost analysis in two Brazilian municipalities]. / A coleta da altura de alunos ingressantes nas escolas de primeiro grau em um sistema de vigilância nutricional: qualidade dos dados e análise de custo em dois municípios brasileiros.

The present study describes a first attempt in Brazil to establish a nutrition surveillance system based on the systematic collection of the height of children entering the first grade of primary school. The strategy used recognized the School District as the nuclear institution to operate the system. A quality control system showed that trained people were able to collect anthropometric data with margin of error compatible with the purposes of the system. Costs were low, around 30 cents US per child examined, and they can be further reduced since the system is operated in large scale.

[The height census of first grade schoolchildren: anthropometric data analysis]. / A coleta da altura de alunos ingressantes nas escolas de primeiro grau em um sistema de vigilância nutricional: análise dos dados antropométricos.

The present study aims at identifying prior areas for nutritional programs considering growth scores of children entering the first grade of school. Data were obtained through the nutritional surveillance system in a Brazilian city called Osasco, São Paulo. The analysis was meant to determine the magnitude and distribution of growth retardation. In order to establish the nutritional status of children the indicator height/age expressed by standard deviation scores (z-score) was used. Values below -2 s.d. of the reference population median (NCHS) were considered height retarded. Children's growth was geographically distributed into groups of schools according to height deficit prevalence. Results showed marked differences among the schools with deficit prevalence varying between 0 and 16.1%. This led to the identification of communities with good health and nutrition levels, and communities exposed to different levels of malnutrition. The level of dissociation was such that it was possible to pinpoint areas and micro-areas where social programs and investments are most needed.