Milk beverages can reduce nutrient inadequacy among Brazilian pre-school children: a dietary modelling study.

BACKGROUND: Previous studies found high prevalence of inadequate intakes of vitamins E, D and K, calcium and potassium among Brazilian pre-school children, with suboptimal consumption of dairy products. Dietary modelling was applied to determine the theoretical impact of improving dairy products consumption on nutrient adequacy in 4-5-year-old Brazilian children. METHODS: Adherence to the dairy recommendation of two servings/day was calculated using data from the Brazil Kids Nutrition and Health Study (KNHS) (n = 228). Two modelling scenarios were applied to test the impact on nutrient intakes of (1) adding one or two servings of a frequently consumed cow's milk or a widely available fortified alternative: pre-school children milk (PCM), and of (2) substituting the current milk consumed by PCM. Mean nutrient intakes and percentage of children adhering to the nutrient recommendations were determined at baseline and after applying modelling scenarios. RESULTS: Seventy-six percent (n = 174) of children did not meet the recommended daily two servings of dairy products, 56% had less than one serving of dairy products on the day of recall. The mean consumption of whole milk (fortified and unfortified) was 147 g/d, yoghurt 114 g/d and cheese 34 g/d. The addition of one serving of cow's milk demonstrated a 17% reduction in calcium inadequacy, 18% reduction in vitamin A and 3% reduction in zinc inadequacy. Adding one serving of PCM further reduced calcium inadequacy from 87 to 41%, vitamin E from 81 to 37%, and zinc inadequacy by 10%. Replacing the child's current milk with a PCM resulted in further reduction of micronutrient inadequacies, including calcium, vitamin D and vitamin E. CONCLUSIONS: Dairy products consumption in pre-school children should be encouraged to reduce nutrient inadequacies. In particular, consumption of PCM would help to reduce calcium, vitamin D and vitamin E inadequacy, nutrients of concern in this population.

Validity of a questionnaire to estimate vitamin A intake in pregnant women

The objective was to assess the relative validity of a food frequency questionnaire (FFQ) to estimate daily vitamin A intake in pregnant women using two biomarkers as references, maternal serum retinol and breast milk retinol. This is an observational, descriptive, analytical, cross-sectional study. FFQ was applied to 161 pregnant women at the largest public maternity hospital in Ribeirão Preto, Brazil. The FFQ recall period was the last 30 days before childbirth. The mother was asked if she had consumed or not each food item over the last 30 days, how often and which portion size. Samples of maternal blood and breast milk for determination of retinol concentrations were collected. Partial Pearson correlation test, agreement by kappa quadratic statistics, cross-classification into quartiles and the method of triads with two biomarkers were performed. The mean FFQ intake of vitamin A was 875 µg/day and the frequency of inadequate intake was 52.8%. Low correlation coefficients were observed between the FFQ and both biomarkers. In cross-classification, considering foods sources with or without provitamin A, 63.6% to 68.3% of the results fell into the same or adjacent quartiles, respectively; less than 10% of all results were classified into opposite quartiles. The validity coefficient of the FFQ was 0.484. FFQ performed better when considering only food sources of preformed vitamin A and both biomarkers (ρ=0.554). As a conclusion, FFQ provided an estimate of vitamin A intake with moderate accuracy, being suitable to rank pregnant women according to categories of intake(AU)

O objetivo foi avaliar a validade relativa de um Questionário de Frequência Alimentar (QFA) para estimar o consumo de vitamina A em mulheres grávidas usando dois biomarcadores como referência, retinol sérico materno e retinol de leite materno. Trata-se de um estudo observacional, descritivo, analítico e transversal. O QFA foi aplicado a 161 gestantes na maior maternidade pública de Ribeirão Preto. O período de abrangência do QFA foi de 30 dias antes do parto. Questionava-se à mãe se ela havia ingerido ou não cada item de alimento contido em um álbum fotográfico nos últimos 30 dias e qual era a frequência e o tamanho da porção consumida. Foram coletadas amostras de sangue materno e leite materno para determinação das concentrações de retinol. Foi realizado o teste de correlação parcial de Pearson, concordância de kappa, classificação cruzada em quartis e o método de tríades com dois biomarcadores. A ingestão média pelo QFA de vitamina A foi de 875mg / dia e a frequência de ingestão inadequada foi de 52,8%. Baixos coeficientes de correlação foram observados entre o QFA e ambos os biomarcadores. Na classificação cruzada, considerando fontes de alimentos com ou sem provitamina A, 63,6% a 68,3% dos resultados caíram no mesmo quartil ou adjacentes, respectivamente; Menos de 10% de todos os resultados foram classificados em quartis opostos. O coeficiente de validade do QFA foi de 0,484. O QFA apresentou melhor desempenho quando considerou apenas fontes alimentares de vitamina A pré-formada e ambos os biomarcadores (ρ = 0,554). A acurácia do QFA para a estimativa de vitamina A foi considerada moderada, sendo adequado para categorizar as gestantes em categorias de consumo(AU)

Growth and hematological studies on Brazilian children of low socioeconomic level

Anemia and undernutrition are common all over the world, especially in less developed countries. The relationship between low weight, short stature and iron deficiency should be better understood so that appropriate measures might be taken to prevent these problems. A total of 115 institutionalized children aged 12 to 72 months were studied in day-care institutions in the town of Pontal, Southeastern Brazil, during the second semester of 1999. Personal data, weight, height and hematological profile were obtained from all subjects. Food intake was evaluated in 20 children by a direct food-weighing method. The prevalence of low weight for age (2.6), low weight for height (1.7) and low height for age (4.3) was considered low. Anemia was observed in 68.7 of the children. Diet was found to be adequate in terms of the major nutrients evaluated, but food iron supply was of low bioavailability. In conclusion, the population studied revealed a peculiar behavior i.e., the coexistence of fairly good anthropometric nutritional status along with iron-deficiency anemia. The prevention of this kind of malnutrition cannot be limited to an adequate calorie/protein supply but should also be based on the correction of the severe iron deficiency present in this low socioeconomic level preschool children in Brazil.

Growth of exclusively breast-fed infants from a poor urban population

The growth of two groups of infants were evaluated, one of them exclusively breast-fed (105 infants) and the other exclusively bottle-fed (61 infants), and compared with one another and with international standards (NCHS). All infants were evaluated by anthropometry at 1, 2, 3, 4, 5 and 6 months of age. A fourth order polynomial was adopted for each infant and for each anthropometric measurement in order to estimate individual growth, and the 5th, 50th and 95th percentiles for weight and length were obtained. For the age of 6 months, the weights of breast-fed boys and girls were always statistically equal to or higher than those of infants fed cow's milk or those of NCHS standards. Breast-fed boys presented significantly longer length than bottle-fed boys but shorter than NCHS standards, and breast-fed girls presented significantly shorter length than both bottle-fed girls and than NCHS standards. The greater weight of exclusively breast-fed infants when compared to NCHS standards at six months of age, which differentiates the present study from several other ones carried out in developing countries, was probably due to the association of the beneficial effects of breast-feeding with those of pediatric follow-up.

Avaliaçäo do uso do percentil 10 de peso para idade como ponto de corte para detecçäo de crianças sob risco nutricional / Evaluation of the use of the 10§ percentile of weight for age as a cut off point for detection of children under nutritional risk

Objetivo: Avaliar o uso do percentil 10 de peso para idade como ponto de corte para detecçäo de crianças sob risco nutricional, especialmente para programas de suplementaçäo alimentar. Métodos: Foram estudadas 841 crianças com idade entre 10 dias e 60 meses, em uma Unidade Básica de Saúde da periferia de Ribeiräo Preto, SP, Brasil, de forma transversal, obtendo-se idade, sexo, peso e estatura e, posteriormente, os escores z das correlaçöes peso para idade, estatura para idade e peso para estatura, com base nos dados do NCHS. Através de tabelas do tipo 2X2, em que foram comparados os resultados em relaçäo ao percentil 10 (acima ou abaixo desse ponto de corte) e os outros índices(acima ou abaixo de -2 escores z), estimou-se a capacidade do percentil 10 de peso para idade em detectar as crianças com os diferentes déficits antropométricos. Resultados: Os resultados Falsos Negativos foram sempre bastante baixos, variando entre 0 e 1 por cento, ao contrário dos Falsos Positivos que variaram entre 76,3 e 90,5 por cento. Os valores de Sensibilidade/Especificidade foram 100/85,9 por cento; 93,3/83,8 por cento; 82,9/85,7 por cento, respectivamente para os déficits de peso para idade, peso para estatura e estatura para idade. Conclusöes: O percentil 10 de peso para idade mostrou-se adequado para triagem populacional de crianças com déficits do peso para a idade e do peso para a estatura (sensiblidade altas), desde que estas crianças sejam posteriormente melhor avaliadas (muitos falso positivos). Para os déficits de estatura para idade, mostrou-se inadequado

Determinação da influência da escolaridade dos pais no estado nutricional de crianças / Determination of the influence of the parents' educational level on the nutritional status of children

A desnutriçäo protéico-calórica da criança é uma doença de origem multifatorial e trabalhos realizados em outros países mostram que a baixa escolaridade dos pais é um dos fatores possivelmente implicados na sua gênese e perpetuaçäo. O objetivo do trabalho foi avaliar a influência da escolaridade dos pais sobre o estado nutricional dos filhos. Em um corte transversal, foram estudadas 841 crianças com idades entre dez dias e cinco anos, em um bairro da periferia de Ribeiräo Preto, Säo Paulo, Brasil, realizando-se a avaliaçäo do estado nutricional pelo método de Gomez e avaliando-se o grau de escolaridade dos pais. Para a análise estatística se utilizou o método de quiquadrado com alfa de 5 porcento. Tanto a baixa escolaridade do pai como da mäe se relacionaram à subnutriçäo do filho. Com base nessa resultado, procura-se discutir a importância das medidas de promoçäo social para prevenir a desnutriçäo infantil