Qualidade nutricional de dietas e estado nutricional de vegetarianos de municípios do centro oeste paulista / Nutritional quality of diets and nutritional status of vegetarians from cities of the midwest region of São Paulo / Calidade nutricional de las dietas y estado nutricional de los vegetarianos de municipios del oeste de São Paulo

Introdução: A Sociedade Vegetariana Brasileira considera vegetariano aquele que exclui de sua alimentação todos os tipos de carne, aves, peixes e seus derivados, podendo ou não utilizar laticínios ou ovos. Vegetarianismo inclui o veganismo, prática de não utilizar produtos oriundos do reino animal para quaisquer fins. Diversas razões justificam o crescimento dessas dietas na atualidade - questões ligadas aos direitos dos animais, à ética, ao meio ambiente, à religião, entre outras. Objetivos: Identificar os riscos e benefícios associados à restrição alimentar presente na dieta vegetariana através das quantidades diárias de proteínas, vitamina B12, ferro e cálcio; determinar o índice de massa corporal dos voluntários, sua frequência alimentar, estado nutricional, tempo de prática da dieta, acompanhamento nutricional, suplementação e motivos e benefícios associados. Material e Método: Trata-se de um estudo transversal descritivo quali-quantitativo realizado por meio da aplicação de questionários. Resultados: As deficiências nutricionais predominantes foram as de vitamina B12 e cálcio, especialmente nos adeptos do vegetarianismo estrito. Além disso, uma tendência ao sobrepeso foi observada na população estudada, estando relacionada ao maior consumo de alimentos industrializados e ultraprocessados. Conclusão: Recomenda-se atenção especial a alimentos contendo proteínas, vitamina B12, ferro e cálcio no planejamento da alimentação dos adeptos ao vegetarianismo, sobretudo os adeptos ao vegetarianismo estrito.(AU)

Introduction: The Brazilian Vegetarian Society considers vegetarian who excludes all types of meat, poultry, fish and their derivatives from their diet, whether or not they can use dairy products or eggs. Vegetarianism includes veganism, the practice of not using products from the animal kingdom for any purpose. Several reasons justify the growth of these diets today - issues related to animal rights, ethics, the environment, religion, among others. Objectives: To identify the risks and benefits associated with the dietary restriction present in the vegetarian diet through the daily amounts of proteins, vitamin B12, iron and calcium; to determine the volunteers' body mass index, their food frequency, nutritional status, time on the diet, nutritional monitoring, supplementation and associated reasons and benefits. Material and Method: This is a cross-sectional qualitative and quantitative study carried out through the application of questionnaires. Results: The predominant nutritional deficiencies were those of vitamin B12 and calcium, especially in adherents of strict vegetarianism. In addition, a tendency to overweight was observed in the studied population, being related to the higher consumption of processed and ultra-processed foods. Conclusion: Special attention is recommended to foods containing proteins, vitamin B12, iron and calcium when planning food for those who adhere to vegetarianism, especially those who adhere to strict vegetarianism.(AU)

Introducción: La Sociedad Vegetariana Brasileña considera a los vegetarianos que excluyen todos los tipos de carne, pollo, pescado y sus derivados de su dieta, ya sea que puedan o no usar productos lácteos o huevos. El vegetarianismo incluye el veganismo, la práctica de no usar productos del reino animal para ningún propósito. Varias razones justifican el crecimiento de estas dietas hoy en día: cuestiones relacionadas con los derechos de los animales, la ética, el medio ambiente, la religión, entre otros. Objetivos: Identificar los riesgos y beneficios asociados con la restricción dietética presente en la dieta vegetariana a través de las cantidades diarias de proteínas, vitamina B12, hierro y calcio; determinar el indice de masa corporal de los voluntarios, su frecuencia de alimentos, estado nutricional, tiempo en la dieta, seguimiento con un nutricionista, suplementos y razones y beneficios asociados. Material y Método: Estudio transversal cualitativo y cuantitativo realizado mediante la aplicación de cuestionarios. Resultados: Las deficiencias nutricionales predominantes fueron las de vitamina B12 y calcio, especialmente en adherentes del vegetarianismo estricto. Además, se observó una tendencia al sobrepeso en la población estudiada, relacionada con el mayor consumo de alimentos procesados y ultraprocesados. Conclusión: Se recomienda prestar especial atención a los alimentos que contienen proteínas, vitamina B12, hierro y calcio al planificar los alimentos para aquellos que se adhieren al vegetarianismo, especialmente aquellos que se adhieren al vegetarianismo estricto.(AU)

¿Existe alguna asociación entre la concentración de vitamina D y la ferropenia en los niños? / Is there an association between vitamin D level and iron deficiency in children?

Introducción.La vitamina D afecta la eritropoyesis.Objetivo: evaluar, en niños de 6 meses a 5 años, la asociación entre concentraciones de 25-hidroxi vitamina D (25-OHD) en la madre/niño, ferropenia y anemia ferropénica (AF). Población y métodos. Se incluyeron los niños que asistieron a la consulta entre septiembre de 2014 y enero de 2016. Se excluyeron aquellos con infección aguda/crónica, desnutrición, enfermedades crónicas y prematuros. Se realizó hemograma, hierro sérico, capacidad fijación del hierro, ferritina y 25-OHD. Se investigó suplemento con hierro y vitamina D durante lactancia y embarazo.Resultados. Se incluyeron 117 niños: 67 tenían ferropenia/AF [Grupo 1, edad (años): 2,05 ± 1,24 (0,5-5)] y 50 niños sanos [Grupo 2, edad (años): 1,87 ± 1,12 (0,58-5)]. Más niños y madres tuvieron deficiencia de vitamina D en Grupo 1 que en Grupo 2 (niños, 49,3 % vs 20 %, p = 0,002, y madres: 94 % vs 64 %; p= < 0,001, respectivamente). Hubo correlación positiva entre la hemoglobina en niños y la 25-OHD en madres/niños. Factores independientes de riesgo de AF fueron más tiempo de lactancia (OR: 0,35; IC 95 % [0,155-0,789]; p = 0,011), más breve suplementación con hierro durante la lactancia (OR: 1,69; IC 95 % [1,148-2,508]; p = 0,008) y embarazo (OR: 1,39; IC 95 % [1,070-1,820]; p = 0,014) y concentraciones < 25-OHD en madres (OR: 1,16; IC del 95 % [1,034-1,292]; p = 0,011). Conclusiones. La deficiencia de vitamina D en madres/niños está asociada con ferropenia/AFen los niños.

Introduction. Vitamin D (VitD) affects the erythropoiesis. The aim of this study was to evaluate the association between maternal/child 25-OH VitD (25-OHD) levels and iron deficiency (ID) and anemia (IDA) in children aged 6 months-5 years. Population and methods. Between September 2014 and January 2016 children who were admitted to outpatient clinic were included to study. We excluded the children with acute or chronic infection, malnutrition, chronic disease and preterm birth history. Complete blood count, serum iron, total iron binding capacity, ferritin, 25-OHD levels were examined from children and their mothers. Iron and VitD supplementation during infancy and pregnancy and breastfeeding history were questioned.Results. The study included totally 117 children. There were 67 children with ID/IDA [Group 1, mean age (years):2.05±1.24 (0.5-5)] and 50 normal children [Group 2, mean age (years): 1.87±1.12 (0.58-5)]. There were more VitD deficient children and mothers in Group 1 than in Group 2 (respectively, children 49.3 % vs. 20 % p=0.002; mothers 94 % vs.64 %, p=<0.001). There was a positive correlation between hemoglobin levels of children and maternal/child 25-OHD. The independent risk factors for IDA in children were longer exclusively breastfeeding time (odds ratio [OR], 0.35; 95 % confidence interval [CI], 0.155-0.789; p=0.011), shorter duration of regular iron supplementation during infancy and pregnancy (infancy: OR,1.69; 95 % CI 1.148-2.508; p=0.008. pregnancy: OR,1.39; 95 % CI,1.070-1.820; p=0.014) and lower maternal 25-OHD level (OR,1.16; 95 % CI,1.034-1.292; p=0.011). Conclusions. Maternal/child VitD deficiency is associated with ID/IDA in children aged 6 months-5 years.

Identificación de &-talasemia en anemias microcíticas hipocrómicas refractarias al tratamiento con hierro en Nicaragua / Identification of &-thalassemia in hypochromic microcytic anemias refractory to iron treatment in Nicaragua

Resumen Justificación y objetivo: gran parte de los casos descritos de anemias microcíticas-hipocrómicas corresponden a anemias ferropénicas y síndromes talasémicos. El diagnóstico diferencial se complementa con pruebas de laboratorio como el hierro sérico, ferritina, entre otras; sin embargo, estas son de baja disponibilidad en países en vías de desarrollo. En Nicaragua, el diagnóstico de estas patologías se basa en el historial clínico y análisis hematológicos de rutina. El objetivo de este trabajo fue la implementación de la técnica de cuantificación de hemoglobina A2 en el diagnóstico clínico de β-talasemia. Métodos: se realizó un estudio transversal con 30 pacientes que mostraban microcitosis e hipocromía después de 3 meses de tratamiento con sales de hierro. Se realizó electroforesis de hemoglobina y se utilizó el kit de la casa comercial Beta-Thal HbA2 Quik Column para cuantificar la hemoglobina A2 en cada paciente. El análisis estadístico utilizado fue la prueba de t de student. Se consideraron significativas las diferencias a p<0,05. Esta investigación respetó los principios éticos que conciernen. Se contó con la aprobación del Comité de Ética Institucional, UNAN-Managua. Los participantes dieron su consentimiento informado. Resultados: al aplicar el método para cuantificación de hemoglobina A2, se obtuvo que el 67 % de las muestras presentaron una concentración de hemoglobina A2 mayor al valor de referencia establecido (3,3 %), siendo pacientes diagnosticados para β-talasemia menor. El 33 % restante presentó valores normales de hemoglobina A2 con microcitosis e hipocromía. Se encontraron diferencias estadísticamente significativas entre las medias de glóbulos rojos, volumen corpuscular medio, hemoglobina corpuscular media y hemoglobina A2, entre ambos grupos. Conclusión: el diagnóstico diferencial de anemias microcíticas hipocrómicas refractarias al tratamiento con hierro, se realiza inicialmente por el historial clínico del paciente, pero es necesario contar con pruebas diagnósticas como la cuantificación de hemoglobina A2 que permitan identificar las diversas patologías que cursan con microcitosis e hipocromía.

Abstract Justification and objective: much of the described cases of microcytic-hypochromic anemias are ferropenic anemias and Thalassemia syndromes. The differential diagnosis is complemented by laboratory tests as serum iron, ferritin, among others; However, these are of low availability in developing countries. In Nicaragua, the diagnosis of these diseases is based on clinical history and routine blood analysis. The objective of this work was to implement a technique for quantification of hemoglobin A2 in the clinical diagnosis of β-Thalassemia. Methods: We conducted a cross-sectional study with 30 patients showing hypochromia and microcytosis after 3 months of treatment with iron salts. Hemoglobin electrophoresis was performed, a kit from Beta-Thal HbA2 Quik Column was used to quantify the hemoglobin A2 in each patient. The statistical analysis used was the student's t test. The differences were considered significant at p < 0.05. This research respected ethical principles that concern. It had the approval of the committee of ethics institutional, UNAN-Managua and the participants gave their informed consent. Results: when applying the method for quantification of hemoglobin A2, 67% of samples presented a concentration of hemoglobin A2 greater than the reference value set at 3.3%, these patients were diagnosed with β-Thalassemia minor. The remaining 33% presented normal values of hemoglobin A2 with hypochromia and microcytosis. Statistically significant differences between the averages of red blood cells, mean corpuscular volume, mean corpuscular hemoglobin and hemoglobin A2 between the two groups was observed. Conclusion: The differential diagnosis of microcytic hypochromic anemias refractory to treatment with iron, is initially performed by the clinical history of the patient, but it is necessary to have diagnostic tests such as the quantification of hemoglobin A2, which allow the identification of patients with β-Thalassemia minor within this group. In our study 67% of the studied samples were identified as β-Thalassemia minor.

Potential of the physiological response of pea plants (Pisum sativum L. ) to iron deficiency (direct or lime- induced) / Potencial da resposta fisiológica das plantas de ervilha (Pisum sativum L. ) à deficiência de ferro (direta ou induzida pelo calcário)

Pea (Pisum sativum L.) is an important food crop in Tunisia, where calcareous soils represents the major limiting factor for agriculture production. In the present study a greenhouse experiment was conducted to assess the effects of direct and bicarbonate- induced iron deficiency on plant growth, chlorophyll fluorescence, photosynthesis, spad index and iron nutrition in two Tunisian pea genotypes (Pisum sativum L.). Plants were grown hydroponically and iron deficiency was induced for 3 weeks. Iron deficiency decreased all the above physiological parameters. The direct Fe deficiency is more drastic than bicarbonate- induced Fe deficiency. A close relationship between plant growth, photosynthesis and SPAD index was observed. Fe use efficiency for plant growth and Fe use efficiency for photosynthesis discriminates clearly the studied genotypes and seems to be the main reason of the tolerance of Kelvedon, as compared to Lincoln.

A ervilha (Pisum sativum L.) é uma cultura alimentar importante na Tunísia, onde os solos calcários representam o principal fator limitante para a produção agrícola. No presente estudo, foi conduzido um experimento em estufa para avaliar os efeitos da deficiência de ferro direta e induzida por bicarbonato sobre o crescimento de plantas, a fluorescência da clorofila, a fotossíntese, o índice SPAD e a nutrição de ferro em dois genótipos de ervilha da Tunísia (Pisum sativum L.). As plantas foram cultivadas hidroponicamente e a deficiência de ferro foi induzida durante 3 semanas. A deficiência de ferro diminuiu todos os parâmetros fisiológicos acima. A deficiência de Fe direta é mais drástica do que a deficiência de Fe induzida por bicarbonato. Observou-se uma estreita relação entre o crescimento das plantas, a fotossíntese e o índice SPAD. A eficiência de uso de Fe para o crescimento de plantas e a eficiência de uso de Fe para a fotossíntese discriminam claramente os genótipos estudados e parecem ser a razão principal da tolerância de Kelvedon, em comparação com a de Lincoln.

Encapsulación de hierro: Otra estrategia para la prevención o tratamiento de la anemia por deficiencia de hierro / Iron encapsulation: Another strategy for the prevention or treatment of iron deficiency anemia

RESUMEN La anemia por deficiencia de hierro afecta a un tercio de la población mundial, causando severos problemas de salud. Las estrategias de prevención y tratamiento se basan en la suplementación oral y fortificación de alimentos, pero su eficacia no ha sido la esperada. Una de las causas se debe a que los compuestos de hierro utilizados tienen baja biodisponibilidad y producen efectos indeseados. Por esto, se han buscado nuevas tecnologías que pudiesen evitar estos problemas, como la encapsulación. Esta tecnología mejora la biodisponibilidad del hierro, reduce alteraciones organolépticas de los productos fortificados, y disminuye los trastornos gastrointestinales del uso de suplementos, entre las principales ventajas. Estos productos de hierro encapsulados han sido estudiados in vitro, y también aplicados en estudios in vivo para determinar su eficacia contra la anemia por deficiencia de hierro, con promisorios resultados. Por tanto, el objetivo de esta revisión fue recopilar información acerca de las tendencias actuales de encapsulación de hierro como una herramienta para prevenir o tratar la anemia por deficiencia de hierro.

ABSTRACT Iron deficiency anemia affects one third of the world population, causing severe health problems. Prevention and treatment strategies are based on oral supplementation and fortification of foods, but the effectiveness of these strategies has not been as expected. One explanation is that the iron compounds used have low bioavailability and produce undesired effects. Therefore, new technologies that could avoid these problems, like the encapsulation, have been explored. This technology improves the bioavailability of iron, reduces organoleptic alterations of fortified products, and decreases gastrointestinal disorders related to supplement use. These encapsulated iron products have been studied in vitro and also applied in in vivo studies to determine their efficacy against iron deficiency anemia, with promising results. Therefore, the objective of this review was to gather information about current trends in iron encapsulation as a tool to prevent or treat iron deficiency anemia.

Identificação de transcritos diferencialmente expressos por Pasteurella multocida em condições de privação de ferro / Identification of differentially expressed transcripts by Pasteurella multocida iron-starved condition

Ferro (Fe) é um elemento essencial e a capacidade de adquiri-lo in vivo têm sido descrita em diversos agentes patogênicos através de fatores de virulência. Análises de transcritos durante a privação de Fe tem sido descritos através da técnica de "microarray", entretanto a técnica de RNA-seq recentemente tem demonstrado resultados superiores. Neste trabalho, o isolado de Pasteurella multocida (Pm 16759) altamente patogênico em suínos foi cultivado em duas condições com diferentes concentrações de Fe (controle e privação) com o objetivo de analisar transcritos diferencialmente expressos. O RNA total das duas condições foi extraído e sequenciado através da plataforma de nova geração Ion Torrent. Os dados foram analisados no Software Ion Reporter(tm) e processados no programa Rockhopper. Foram obtidas 1.341.615 leituras com tamanho médio de 81pb, com 96% de alinhamento com o genoma de Pasteurella multocida subsp. multocida 3480 e 98,8% de acurácia. No mapeamento das leituras das duas condições, observou-se 2,652 transcritos e destes, 177 (6,7%) foram diferencialmente expressos, sendo 93 na condição controle (Fe+) e 84 na condição de privação (Fe-). Na condição de privação de Fe, o perfil de transcritos foram associados a função de transporte celular (fbp ABC, permease de alta afinidade com Fe2+/Pb2+ e proteína periplasmática de alta afinidade com Fe2+ ), reguladores transcricionais e proteínas hipotéticas. O perfil na condição controle (Fe+) apresentou transcritos diferencialmente expressos associados ao RNAs anti-sense (asRNA) e genes do metabolismo energético (fructose-1,6-bisfosfatase). O estudo comprovou que a restrição de Fe aumenta a expressão de genes envolvidos no transporte celular, reguladores transcricionais, proteínas hipotéticas e desconhecidas e permitiu ainda a identificação de novos genes como a permease de alta afinidade com Fe2+/Pb2+ e proteina periplasmática de alta afinidade com Fe2+ , que configuram uma possível via alternativa de absorção de Fe.(AU)

Iron (Fe) is an essential element and the ability to acquire it in vivo has been described in several pathogens as virulence factors. Global analyses of transcripts during iron deprivation have been described by microarray studies, however recently RNA-seq analysis showed superior results. The high pathogenic swine strain of Pasteurella multocida (BRMSA 1113) was grown in two conditions with different concentrations of Fe (control and deprivation) in order to analyze the differentially expressed transcripts. The total RNA of the two conditions was extracted and sequenced by new generation Ion Torrent plataform. Data were analyzed in Ion Reporter(tm) Software and processed in Rockhopper software. Sequence analysis shows 1,341,615 readings with median length of 81pb, with 96% of alignment to the reference genome Pasteurella multocida strain 3489, and 98.8% accuracy. Reads mapping to genome of P. multocida in these two conditions detected 2,652 transcripts, which 177 (6.7%) were differentially expressed, with 93 in the control condition (Fe+) and 84 provided with iron deprivation condition (Fe-). In condition (Fe-), differential expressed transcript profile were associated to function of cellular transport (fbpABC, high-affinity Fe2+/Pb2+ permease and periplasmic protein probably involved in hight-affinity Fe2+ ), transcptional regulators and hypothetical proteins. The control condition (Fe+) shows differential expressed transcripts profile associated to RNA anti-sense (asRNA) energetic metabolism genes (fructose-1,6-bisphosphatase). The study showed that the Fe restriction increases the expression of genes involved in cellular transport, transcriptional regulators, hypothetical and unknown proteins, and also allowed the identification of High-affinity Fe2+/Pb2+ permease e Periplasmic protein probably involved in high-affinity Fe2+, that constitute a possible alternative route for Fe absorption.(AU)

Micronutrient supplementation adherence and influence on the prevalences of anemia and iron, zinc and vitamin A deficiencies in preemies with a corrected age of six months

OBJECTIVE: To analyze adherence to the recommended iron, zinc and multivitamin supplementation guidelines for preemies, the factors associated with this adherence, and the influence of adherence on the occurrence of anemia and iron, zinc and vitamin A deficiencies. METHODS: This prospective cohort study followed 58 preemies born in 2014 until they reached six months corrected age. The preemies were followed at a referral secondary health service and represented 63.7% of the preterm infants born that year. Outcomes of interest included high or low adherence to iron, zinc and multivitamin supplementation guidelines; prevalence of anemia; and prevalences of iron, zinc, and vitamin A deficiencies. The prevalence ratios were calculated by Poisson regression. RESULTS: Thirty-eight (65.5%) preemies presented high adherence to micronutrient supplementation guidelines. At six months of corrected age, no preemie had vitamin A deficiency. The prevalences of anemia, iron deficiency and zinc deficiency were higher in the low-adherence group but also concerning in the high-adherence group. Preemies with low adherence to micronutrient supplementation guidelines were 2.5 times more likely to develop anemia and 3.1 times more likely to develop zinc deficiency. Low maternal education level increased the likelihood of nonadherence to all three supplements by 2.2 times. CONCLUSIONS: Low maternal education level was independently associated with low adherence to iron, zinc and vitamin A supplementation guidelines in preemies, which impacted the prevalences of anemia and iron and zinc deficiencies at six months of corrected age.

Deficiências de micronutrientes em crianças brasileiras assistidas em creches: revisão da literatura / Micronutrient deficiencies in Brazilian children attending daycare centers: a review of the literature

Resumo Objetivos Revisar os artigos sobre o estado nutricional de ferro, vitamina A e zinco em crianças brasileiras assistidas em creches, enfocando métodos diagnósticos, prevalências das respectivas deficiências e fatores associados. Métodos A pesquisa de artigos foi efetuada nas bases PubMed, Lilacs e SciELO. Foram incluídos estudos observacionais com amostras representativas aleatórias que utilizaram indicadores bioquímicos para avaliar o estado nutricional de ferro, vitamina A e zinco de crianças assistidas em creches. Calcularam-se as prevalências médias ponderadas de anemia e de deficiência de vitamina A. Computaram-se as variáveis associadas à anemia. Resultados Foram incluídos 21 estudos, nos quais o estado nutricional de ferro, vitamina A e zinco foi analisado em 17, quatro e três, respectivamente. As prevalências médias ponderadas de anemia e de deficiência de vitamina A foram de 42,7% e 12,5%, respectivamente. Crianças de menor idade e de pior condição socioeconômica representaram as principais condições explicativas para a ocorrência de anemia. Conclusões Os resultados sugerem altas prevalências de anemia e de deficiência de vitamina A entre as crianças brasileiras assistidas em creches com perspectivas etiológicas centradas nas doenças infecciosas.

Abstract The scope of the study was to review the scientific publications on the nutritional status of iron, vitamin A and zinc among Brazilian children attending daycare centers, focusing on diagnostic methods, the prevalence of respective deficiencies and associated factors. A review of the literature was conducted in the PubMed, LILACS and SciELO databases. Observational studies with random representative samples using biochemical indicators to evaluate the nutritional status of iron, vitamin A and zinc of children attending public daycare centers were included. The average weighted prevalence for anemia and vitamin A deficiency was estimated. The variables associated with anemia were computed. Twenty-one observational studies were included, in which the nutritional status of iron, vitamin A and zinc were analyzed in 17, 4 and 3, respectively. The average weighted prevalence of anemia and vitamin A deficiency were 42.7% and 12.5%, respectively. Young children and children living in less favorable socioeconomic situations represented the main explanatory conditions predominantly associated with the occurrence of anemia. The results suggest a high prevalence of anemia, as well as vitamin A deficiency in Brazilian children attending daycare centers, with etiological prospects focused on infectious diseases.

Guía de práctica clínica para el diagnóstico y tratamiento de la anemia por deficiencia de hierro en niñas, niños y adolescentes en establecimientos de salud del primer nivel de atención / Clinical practice guideline for the diagnosis and treatment of iron deficiency anemia in children and adolescents in primary care health facilities

Contribuir en la mejora del estado de salud de las niñas, niños y adolescentes en el marco de la atención integral de salud. Estandarizar los criterios técnicos para el diagnóstico y tratamiento de la anemia por deficiencia de hierro en las niñas, niños y adolescentes em establecimientos de salud del primer nivel de atención.

Iron deficiency and anemia are associated with low retinol levels in children aged 1 to 5 years / Deficiência de ferro e anemia estão associadas com baixos níveis de retinol em crianças de 1 a 5 anos

OBJECTIVE: To analyze the occurrence of anemia and iron deficiency in children aged 1 to 5 years and the association of these events and retinol deficiency. METHODS: This was an observational analytic cross-sectional study conducted in Vitoria, ES, Brazil, between April and August of 2008, with healthy children aged 1 to 5 years (n = 692) that lived in areas covered by primary healthcare services. Sociodemographic and economic conditions, dietary intake (energy, protein, iron, and vitamin A ingestion), anthropometric data (body mass index-for-age and height-for-age), and biochemical parameters (ferritin, hemoglobin, and retinol serum) were collected. RESULTS: The prevalence of anemia, iron deficiency, and retinol deficiency was 15.7%, 28.1%, and 24.7%, respectively. Univariate analysis showed a higher prevalence of anemia (PR: 4.62, 95% CI: 3.36, 6.34, p < 0.001) and iron deficiency (PR: 4.51, 95% CI: 3.30, 6.17, p < 0.001) among children with retinol deficiency. The same results were obtained after adjusting for socioeconomic and demographic conditions, dietary intake, and anthropometric variables. There was a positive association between ferritin vs. retinol serum (r = 0.597; p < 0.001) and hemoglobin vs. retinol serum (r = 0.770; p < 0.001). CONCLUSIONS: Anemia and iron deficiency were associated with low levels of serum retinol in children aged 1 to 5 years, and a positive correlation was verified between serum retinol and serum ferritin and hemoglobin levels. These results indicate the importance of initiatives encouraging the development of new treatments and further research regarding retinol deficiency. .

OBJETIVO: Analisar a ocorrência de anemia e de deficiência de ferro em crianças de 1 a 5 anos e a associação destes desfechos com a deficiência de retinol. MÉTODOS: Trata-se de um estudo observacional analítico do tipo transversal, realizado no município de Vitória - ES, entre abril e agosto de 2008, com crianças (n = 692) saudáveis de 1 a 5 anos, residentes em áreas de abrangência de Unidades Básicas de Saúde. Foram avaliados dados sociodemográficos, econômicos, dietéticos (ingestão de energia, proteína, ferro e vitamina A), antropométricos (índice de massa corporal-por-idade e estatura-por-idade) e bioquímicos (níveis séricos de ferritina, hemoglobina e retinol). RESULTADOS: Detectou-se anemia, deficiência de ferro e deficiência de retinol em 15,7%, 28,1% e 24,7% das crianças, respectivamente. A análise univariada evidenciou maior ocorrência de anemia (RP: 4,62; IC 95%: 3,36; 6,34, p < 0.001) e de deficiência de ferro (RP: 4,51; IC 95%: 3,30; 6,17, p < 0.001) entre crianças que apresentavam deficiência de retinol. As mesmas relações se mantiveram após o ajuste pelas variáveis socioeconômicas, demográficas, dietéticas e antropométricas. Houve relação positiva entre os valores de ferritina sérica vs. retinol (r = 0,597; p < 0,001) e hemoglobina vs. retinol (r = 0,770; p < 0,001). CONCLUSÕES: A anemia e a deficiência de ferro mostraram-se associadas com baixos níveis de retinol em crianças de 1 a 5 anos, e houve correlação positiva dos níveis de retinol com os de ferritina sérica e hemoglobina. Isto torna importante iniciativas que estimulem o desenvolvimento de novos tratamentos e a ampliação de pesquisas em relação à deficiência ...

Anemia in inflammatory bowel disease: prevalence, differential diagnosis and association with clinical and laboratory variables / Anemia na doença inflamatória intestinal: prevalência, diagnóstico diferencial e associação com variáveis clínicas e laboratoriais

CONTEXT AND OBJECTIVES: Anemia is the most frequent extraintestinal complication of inflammatory bowel disease. This study aimed to: 1) determine the prevalence of anemia among patients with inflammatory bowel disease; 2) investigate whether routine laboratory markers are useful for diagnosing anemia; and 3) evaluate whether any association exists between anemia and clinical/laboratory variables. DESIGN AND SETTING: Cross-sectional at a federal university. METHODS: 44 outpatients with Crohn's disease and 55 with ulcerative colitis were evaluated. Clinical variables (disease activity index, location of disease and pharmacological treatment) and laboratory variables (blood count, iron laboratory, vitamin B12 and folic acid) were investigated. RESULTS: Anemia and/or iron laboratory disorders were present in 75% of the patients with Crohn's disease and in 78.2% with ulcerative colitis. Anemia was observed in 20.5% of the patients with Crohn's disease and in 23.6% with ulcerative colitis. Iron-deficiency anemia was highly prevalent in patients with Crohn's disease (69.6%) and ulcerative colitis (76.7%). Anemia of chronic disease in combination with iron deficiency anemia was present in 3% of the patients with Crohn's disease and in 7% of the patients with ulcerative colitis. There was no association between anemia and disease location. In ulcerative colitis, anemia was associated with the disease activity index. CONCLUSIONS: Most patients present iron laboratory disorders, with or without anemia, mainly due to iron deficiency. The differential diagnosis between the two most prevalent types of anemia was made based on clinical data and routine laboratory tests. In ulcerative colitis, anemia was associated with the disease activity index. .

CONTEXTO E OBJETIVOS: Anemia é a mais frequente complicação extraintestinal na doença inflamatória intestinal. Este estudo objetivou: 1) determinar a prevalência de anemia em portadores de doença inflamatória intestinal; 2) investigar se os marcadores laboratoriais de uso rotineiro são úteis para o diagnóstico da anemia; 3) avaliar se existe associação entre anemia e variáveis clínico-laboratoriais. TIPO DE ESTUDO E LOCAL: Estudo transversal em uma universidade federal. MÉTODOS: Foram avaliados 44 pacientes ambulatoriais com doença de Crohn e 55 com retocolite ulcerativa. Foram investigados aspectos clínicos (índice de atividade da doença, localização da doença e tratamento farmacológico) e laboratoriais (hemograma, ferrocinética, vitamina B12 e ácido fólico). RESULTADOS: Anemia e/ou anormalidades na ferrocinética estavam presentes em 75% dos pacientes com doença de Crohn e em 78,2% dos pacientes com retocolite. Anemia foi observada em 20,5% do grupo com doença de Crohn e em 23,6% do grupo com retocolite. Anemia por deficiência de ferro predominou entre os pacientes com doença de Crohn (69,6%) e com retocolite (76,7%). Anemia de doença crônica associada à anemia ferropriva estava presente em 3% dos pacientes com doença de Crohn e em 7% daqueles com retocolite. Na retocolite, a anemia estava associada com o índice de atividade da doença. CONCLUSÕES: A maioria dos pacientes apresentava alterações na ferrocinética com ou sem anemia, principalmente decorrente da ferropenia. O diagnóstico diferencial entre os dois tipos mais prevalentes de anemia foi baseado nos dados clínicos e nos testes laboratoriais de rotina. Anemia estava associada com o índice de atividade na retocolite. .

Breastfeeding exclusively and iron deficiency anemia during the first 6 months of age / Aleitamento materno exclusivo e anemia ferropriva nos seis primeiros meses de vida.

Objective The objective was to determine the prevalence of iron deficiency and iron deficiency anemia among exclusively breastfed infants from one to six months of life and to identify associated risk factors. Methods This is a cohort study of the hemoglobin and serum ferritin levels of 102 healthy full-term infants, weighing more than 2500 grams (5.5 pounds) at birth, evaluated for growth development and supported to promote exclusive breastfeeding. Hemoglobin and ferritin levels were measured in the first, fourth, and sixth months of life. The hemoglobin and ferritin levels of the mothers were also measured in the first month postpartum. Results At four months, 5.7% presented iron deficiency and 3.4% had iron deficiency anemia. At six months, the percentage of children with iron deficiency increased more than four times, reaching 26.1%, while iron deficiency anemia was present in 23.9% of the infants studied. Iron deficiency at six months of age was significantly correlated to growth velocity. Conclusion According to the results of this study, exclusive breastfeeding protects infants from iron deficiency and iron deficiency anemia for the first four months of life. After this age, in accordance with the literature, the findings of this study demonstrated an increase in anemia and iron deficiency rates, adding to evidence that supports the monitoring of iron levels in exclusively breastfed children presenting higher weight gains beginning at four months of age. .

Objetivo Determinar a prevalência da deficiência de ferro e anemia ferropriva em crianças, de um aos seis meses de vida, alimentadas exclusivamente ao seio materno e identificar os fatores de risco associados. Métodos Estudo de coorte dos valores de hemoglobina e ferritina sérica de 102 lactentes a termo, saudáveis, nascidos com peso maior que 2500 g, acompanhados quanto ao crescimento e desenvolvimento e com apoio à promoção do aleitamento materno exclusivo. Hemoglobina e ferritina sérica foram dosadas no primeiro, quarto e sexto mês de vida. Hemoglobina e ferritina sérica também foram dosadas nas mães no primeiro mês pós-parto. Resultados Aos quatro meses, 5,7% dos lactentes apresentaram deficiência de ferro e 3,4%, anemia ferropriva. Aos seis meses, o percentual de crianças com deficiência de ferro aumentou mais de quatro vezes, atingindo a proporção de 26,1%, enquanto a anemia ferropriva esteve presente em 23,9% dos lactentes da amostra. A deficiência de ferro aos seis meses foi associada significativamente com maior ganho ponderal. Conclusão Neste estudo, o aleitamento materno exclusivo protegeu as crianças da deficiência de ferro e da anemia ferropriva nos primeiros quatro meses de vida. Após essa idade, concordando com dados da literatura, esse estudou mostrou aumento na taxa de anemia e da deficiência de ferro, o que fornece mais uma evidência para apoiar a vigilância do estado do ferro, a partir dos quatro meses, para crianças em aleitamento materno exclusivo e que apresentem ganho de peso acima da média. .

Rastreio de síndrome poliglandular autoimune em uma população de pacientes com diabetes melito tipo 1 / Screening for autoimmune polyglandular syndrome in a cohort of patients with type 1 diabetes mellitus

OBJETIVO: Caracterizar uma população de pacientes com diabetes melito tipo 1 (DMT1) relativamente à presença de outras entidades autoimunes que permitam estabelecer o diagnóstico de síndrome poliglandular autoimune (SPGA). SUJEITOS E MÉTODOS: Incluímos 151 pacientes com DMT1. Analisamos os seguintes parâmetros clínicos: gênero, idade atual, duração da doença, antecedentes pessoais de patologia autoimune e antecedentes familiares de diabetes melito. Submetemos cada doente a um estudo laboratorial com o objetivo de detectar a presença de marcadores imunológicos para a tireoidite, insuficiência adrenocortical, gastrite e doença celíaca, e eventual disfunção associada. RESULTADOS: Coorte com 51,7% homens, idade média atual de 33,4 ± 13 anos e duração da doença de 14,4 ± 9,6 anos. Antecedentes pessoais de autoimunidade presentes em 2% da amostra e história familiar de diabetes melito em 31,1%. A frequência de marcadores imunológicos foi de 24% para a tireoidite, 9,4% para a insuficiência adrenocortical, 17,2% para a gastrite e 2% para a doença celíaca. Foi diagnosticada SPGA em 25,2% dos pacientes. O risco de SPGA e tireoidite autoimune foi superior em mulheres. A duração da doença correlacionou-se diretamente com a presença de autoanticorpos gástricos e inversamente com a positividade dos anticorpos anti-ilhota, antiglutamato descarboxilase e antitirosina fosfatase. Constatou-se a existência de uma associação entre os marcadores imunológicos da tireoidite e gastrite, bem como entre a doença celíaca e insuficiência adrenocortical. CONCLUSÃO: Atendendo à frequência e ao prognóstico inerente à SPGA, a necessidade de realizar rastreio em pacientes com DMT1 é enfatizada. O diagnóstico atempado de outras doenças autoimunes permitirá individualizar o tratamento e seguimento do doente.

OBJECTIVE: To characterize a cohort of patients with type 1 diabetes mellitus (T1DM) on the presence of other autoimmune disorders that could establish the diagnosis of autoimmune polyglandular syndrome (APS). SUBJECTS AND METHODS: We included 151 patients with T1DM. The following clinical parameters were analyzed: gender, current age, disease duration, previous history of autoimmune disorders, and familial history for diabetes mellitus. Each patient was analyzed to detect autoimmune markers of thyroiditis, adrenocortical insufficiency, gastritis, and celiac disease, as well as possible associated dysfunctions. RESULTS: A cohort with 51.7% males, average current age of 33.4 ± 13 years and disease duration of 14.4 ± 9.6 years was analyzed. Previous history of autoimmunity was found in 2%, and familial history for diabetes mellitus in 31.1% of the cohort. Frequency of autoimmune markers was 24% for thyroiditis, 9.4% for adrenocortical insufficiency, 17.2% for gastritis, and 2% for celiac disease. APS was diagnosed on 25.2% of the patients. APS and autoimmune thyroiditis risk was higher in females. Disease duration correlated directly with gastric autoantibodies, and inversely with positive islet cell, glutamic acid decarboxylase, and tyrosine phosphatase antibodies. We noticed a correlation between autoimmune markers for thyroiditis and gastritis, as well as between celiac disease and adrenocortical insufficiency. CONCLUSION: Considering APS prevalence and prognosis, the need for APS screening in patients with T1DM is emphasized. Early diagnosis of other autoimmune disorders will enable us to adjust each patient treatment and follow-up.

Deficiência de micronutrientes e crescimento linear: revisão sistemática de estudos observacionais / Micronutrient deficiencies and linear growth: a systematic review of observational studies

O objetivo do artigo é avaliar a associação das deficiências de ferro, vitamina A e zinco com o déficit de crescimento linear. Revisão sistemática nas bases de dados eletrônicas PubMed, LILACS e SciELO. Foram selecionados artigos publicados entre janeiro de 1995 e março de 2010, considerando os descritores: (growth OR nutritional status) AND (child, preschool OR infant) AND (zinc AND iron AND vitamin A) OR (zinc AND iron) OR (zinc AND vitamin A) OR (iron AND vitamin A). Foram revisados 14 estudos de delineamento observacional. Dos estudos tipo coorte (dois), um indicou associação estatística entre o estado nutricional de ferro e o déficit de estatura; o outro apontou associação estatística entre as concentrações de ferritina sérica e o ganho de estatura. Dez estudos transversais investigaram a associação estatística entre as deficiências de micronutrientes e o déficit de estatura, resultando três deles na associação para o ferro, dois para a vitamina A e nenhum para o zinco. O esclarecimento sobre a associação entre o déficit de estatura e as deficiências de ferro, vitamina A e zinco dificulta-se por fatores de caráter biológico e relacionados à magnitude das deficiências, o que sugere a importância da padronização metodológica dos estudos.

This article seeks to evaluate the association of iron, vitamin A and zinc deficiencies with linear growth retardation. A systematic review of electronic databases in PubMed, LILACS and SciELO was conducted. Scientific papers published between January 1995 and March 2010 were selected, inserting the key words: (growth OR nutritional status) AND (child, preschool OR infant) AND (zinc AND iron AND vitamin A) OR (zinc AND iron) OR (zinc AND vitamin A) OR (iron AND vitamin A). Fourteen observational design studies were reviewed. In the cohort studies (two), one indicated a statistical association between iron levels and stunting; and the other revealed a statistical association between serum ferritin concentrations and an increase in height. Ten cross-sectional studies investigated the statistical association between micronutrient deficiencies and stunting, three of which resulted in an association with iron, two with vitamin A and none with zinc. Elucidation of the association between stunting and iron, vitamin A and zinc deficiencies involves difficulties of a biological nature and also related to the magnitude of these deficiencies, indicating the importance of a methodological standardization of the studies.

Crescimento e deficiências de micronutrientes: perfil das crianças assistidas no núcleo de creches do governo da Paraíba, Brasil / Growth and micronutrient deficiencies: profile of children attendied at the day care center for the government of Paraiba, Brazil

O objetivo deste artigo é avaliar o perfil de crescimento das crianças assistidas no Núcleo de Creches do Governo da Paraíba e a contribuição relativa das deficiências de vitamina A, ferro e zinco. Estudo transversal em 240 crianças pré-escolares. Foram consideradas as categorias de diagnóstico nutricional: déficit ponderal, déficit de estatura e sobrepeso. As concentrações séricas de retinol, zinco e de hemoglobina foram determinadas para avaliar a deficiência de vitamina A (< 0,70 µmol/L), deficiência de zinco (< 65 Μmol/L) e anemia (< 110 g/L), respectivamente. A prevalência de déficit de estatura foi de 5,8%, a de sobrepeso de 3,8%, e a de déficit de peso de 0,4%. A média de Escore-Z para o índice P/E foi menor e estatisticamente significante quando a mãe da criança foi diagnosticada com baixa estatura ou com baixo peso e nas crianças de 12-36 meses de idade. Para o índice E/I, a média de Escore-Z foi menor e estatisticamente significante quando a criança nasceu com baixo peso e quando a mãe da criança apresentou baixa estatura. Crianças de 12-36 meses e sem o beneficio do Programa Bolsa Família tiveram média de hemoglobina menor. Verificou-se ausência de associação significante entre as deficiências de vitamina A, ferro e zinco e os índices antropométricos estudados.

This article seeks to evaluate the growth of children attending public day care centers of the Government of the State of Paraiba and the relative significance of vitamin A, iron and zinc deficiencies. It involved a cross-sectional study of 240 preschool children. The following categories of nutritional status were considered: underweight (W/H < -2 z-scores), stunting (H/A < -2 z-scores) and overweight (W/H > +2 z-scores). Serum concentrations of retinol, zinc and hemoglobin were established to assess vitamin A deficiency (< 0.70 mmol/L), zinc deficiency (< 65 mmol/L) and anemia (< 110 g/L), respectively. The prevalence of stunting was 5.8%, that of overweight 3.8%, and that of underweight 0.4%. W/H z-scores were lower and statistically significant in children aged 12-36 months. An association was also found between W/H z-scores and maternal height. This association was also observed regarding body mass index. H/A z-scores were lower and statistically significant in low birth weight children. Lower hemoglobin concentrations were detected in children aged 12-36 months who were not receiving the financial support of the Bolsa Familia (Family Allowance) program. There was no significant association between vitamin A, iron and zinc deficiencies and the anthropometric indices studied.

Eficacia del hierro aminoquelado en comparación con el sulfato ferroso como fortificante de un complemento alimentario en preescolares con deficiencia de hierro, Medellín, 2011 / Effectiveness of iron amino acid chelate versus ferrous sulfate as part of a food complement in preschool children with iron deficiency, Medellín, 2011

Introducción. La disminución de los depósitos de hierro constituye el primer eslabón de la cadena conducente a la deficiencia de hierro, la carencia nutricional más prevalente y principal causa de anemia en todo el mundo, situación que puede prevenirse mediante la fortificación de alimentos. Objetivo. Comparar la eficacia del hierro aminoquelado con el sulfato ferroso como fortificante de un complemento alimentario en preescolares con deficiencia de hierro. Materiales y métodos. Se llevó a cabo un ensayo clínico triple ciego con distribución aleatoria de grupos. Se analizaron 56 preescolares con deficiencia de hierro (ferritina menor de 24 ng/ml) a los que se les dio diariamente 13 g de leche con 12,5 mg de hierro,. Después de dos meses se midieron los niveles de hemoglobina, hematocrito y ferritina sérica. Resultados. En el grupo con sulfato ferroso la concentración de ferritina sérica aumentó de 18,8 a 24,1 ng/ml, mientras que dicha variación fue de 18,4 a 29,7 ng/ml con el hierro aminoquelado, en ambos casos con diferencias significativas. El nivel de ferritina final difirió según el grupo de estudio, siendo mayor en el grupo con hierro aminoquelado (p=0,022). La hemoglobina y el hematocrito no variaron después de la intervención. Las reacciones adversas en el grupo con sulfato ferroso fueron de 35,7 %, en contraste con el 42,9 % en el grupo con hierro aminoquelado; cinco niños presentaron infección de las vías respiratorias, sin diferencias estadísticas. Conclusiones. Los dos compuestos aumentan los niveles de ferritina, siendo mayor el aumento entre quienes toman leche con hierro aminoquelado. No fue diferente la incidencia de reacciones adversas o de infecciones entre los grupos.

Introduction: Iron depleted deposits are the first link in the chain of events leading to iron deficiency which is the most prevalent nutritional shortage and main cause of anemia worldwide. This situation can be prevented through food fortification. Objective: To compare the efficacy of amino acid chelate iron with ferrous sulfate as fortifier of a dietary complement in preschoolers with iron deficiency. Materials and methods: This study was a blinded clinical trial with randomized groups. We analyzed 56 preschoolers with iron deficiency (ferritin < 24 ng/ml) that received 13 g of milk with 12.5 mg of iron, either amino acid chelate or in the ferrous sulfate form. After two months, hemoglobin, hematocrit and serum ferritin concentrations were measured. Results: In the ferrous sulfate group, ferritin concentration increased from 18.8 ng/ml to 24.1 ng/ml, while the variation was of 18.4 ng/ml to 29.7 ng/ml in the amino acid chelate group, with statistically differences in both cases. Serum ferritin was different between groups, being higher in iron amino acid chelate group (p=0.022). Hemoglobin and hematocrit levels did not change after the intervention. Adverse reactions in the ferrous sulfate group were 35.7%, compared with 42.9% in the iron amino acid chelate group; 5 children had respiratory tract infection, without statistical differences. Conclusions: Both compounds increased serum ferritin concentration, with a higher increase in those who were given milk with iron amino acid chelate. There were no differences in the adverse reactions and infections incidences between the groups.

Iron, zinc, copper and magnesium deficiencies in Mexican adults from the National Health and Nutrition Survey 2006 / Deficiencias de hierro, zinc, cobre y magnesio en adultos mexicanos. Encuesta Nacional de Salud y Nutrición 2006

OBJECTIVE: To describe the prevalence of serum iron and zinc deficiencies and low serum concentrations (LSC) of copper and magnesium in Mexican adults. MATERIALS AND METHODS: Blood samples from subjects (>20 years, both genders) participating in the 2006 National Health and Nutrition Survey were used to measure the serum concentrations of s-ferritin, soluble- transferrin-receptor (s-TfR), zinc, copper, and magnesium. RESULTS: The prevalence of s-ferritin<12ug/L was 18.1 and 3.6% while s-TfR>6mg/L was 9.5 and 4.4%, for females and males, respectively. The prevalence of zinc deficiency was 33.8% females and 42.6% males; LSC of copper were 16.8 and 18.2%, and 36.3 and 31.0% for magnesium, for females and males, respectively. CONCLUSIONS: The prevalence of deficiencies in iron (in females), and zinc are still high in the adult population. LSC of copper and magnesium are published for the first time and show significant prevalence of deficiencies. Corrective actions are necessary in order to diminish these nutritional deficits in the Mexican population.

OBJETIVO: Describir la prevalencia de deficiencias de hierro y zinc y valores bajos (VB) de cobre y magnesio en adultos mexicanos. MATERIAL Y MÉTODOS: Se utilizaron muestras de sangre de individuos (>20 años, ambos sexos) de la Encuesta Nacional de Salud y Nutrición 2006 para medir concentraciones séricas de s-ferritina, receptor soluble de transferrina (s-TfR), zinc, cobre y magnesio. RESULTADOS: La prevalencia de s-ferritina<12ug/L fue de 18.1 y 3.6%, s-TfR>6mg/L de 9.5 y 4.4% para mujeres y hombres, respectivamente. Para zinc fue de 33.8% mujeres y 42.6% hombres. Para VB de cobre fue 16.8 y 18.2%; y magnesio 36.3 y 31.0% en mujeres y hombres, respectivamente. CONCLUSIONES: Las prevalencias de deficiencia de hierro (mujeres) y zinc aún son altas en la población adulta. VB de cobre y magnesio se publican por primera vez en una muestra representativa de adultos y muestran prevalencias importantes. Son necesarias medidas correctivas para combatir estos problemas en la población mexicana.

Magnitude, tendência temporal e fatores associados à anemia em crianças do Estado da Paraíba / Magnitude, time trends and factors associate with anemia in children in the state of Paraíba, Brazil

OBJETIVO: Estimar a prevalência da anemia em crianças, sua tendência temporal e identificar fatores associados. MÉTODOS: Estudo de corte transversal, de base populacional, envolvendo 1.108 crianças, com idade entre seis e 59 meses, de ambos os sexos, do Estado da Paraíba, em 2007. A hemoglobina foi analisada em sangue venoso com contador automático. Foram considerados para anemia valores < 11,0 g/dL, forma leve 9-11g/dL, moderada 7-9 g/dL e grave < 7,0 g/dL. As condições socioeconômicas e demográficas das crianças foram obtidas por meio de questionário aos pais ou responsáveis. As proporções foram comparadas pelo teste do qui-quadrado de Pearson, e a associação entre as concentrações de hemoglobina e potenciais fatores de riscos foi testada pelo modelo de regressão de Poisson. A tendência temporal da anemia foi avaliada pelo incremento/redução na prevalência de anemia nos anos de 1982, 1992 e 2007. RESULTADOS: A prevalência de anemia foi de 36,5% (IC95% 33,7;39,3). Observa-se que 1,3% (IC95% 0,7;1,8) foi na forma grave, 11,1% (IC95% 9,4;13,5) na forma moderada e 87,6% (IC95% 79,1;91,2) na forma leve. Houve um incremento de 88,5% nos casos de anemia no período entre 1982 e1992 e uma estabilização na prevalência entre 1992 e 2007. A análise ajustada no modelo de Poisson mostrou maior suscetibilidade à anemia nas crianças de seis a 24 meses de idade, naquelas amamentadas por seis meses ou mais, que co-habitavam com mais de quatro pessoas no mesmo domicílio e moravam em casas com menos de cinco cômodos. CONCLUSÕES: A alta prevalência de anemia mostra que continua sendo um importante problema de saúde pública no Estado da Paraíba. Apesar da estabilização na prevalência entre 1992 e 2007, a anemia apresenta-se em elevado patamar, o que impõe medidas mais efetivas de prevenção e controle.

OBJECTIVE: To estimate the magnitude of the anemia, to analyze the time trends and investigate the factors associated with this disturbance in children in the state of Paraíba, Brazil. METHODS: A cross-sectional survey, of population-based, with 1108 children, aged 6 to 59 months, both sexes in the state of Paraíba. Hemoglobin (Hb) in venous blood was analyzed with an automatic counter. The social-economic and demographic characteristics of children were obtained by questionnaire. Proportions were compared by Pearson's chi-squared test, and the association between hemoglobin concentrations and potential risk factors was tested by regression model Poisson. The time trend of anemia was assessed by the increase/decreased in the prevalence of anemia, using as comparison the prevalence observed in the years 1982, 1992 and 2007. RESULTS: The prevalence of anemia (Hb < 11.0 g/dl) in the state of Paraíba was 36.5% (CI95% 33.7 to 39.3). It was observed that 1.3% (CI95% 0.7 to 1.8) were in severe form (Hb <7.0 g/dl), 11% (CI95% 9.4 to 13.5) in a moderate form and 87.6% (CI95% 79.1 to 91.2) in the mild form. There was an increase 88.5% in cases of anemia between the years 1982-1992 and stabilization in the prevalence between the years 1992-2007. The analysis adjusted Poisson model showed a greater susceptibility to anemia in children 6 to 24 months of age, those breastfed for six months or more, who co-inhabited with more than 04 people in the same household and lived in houses with less than 05 rooms. CONCLUSIONS: The results revealed that anemia remains an important public health problem in the state of Paraíba and despite having been shown an stabilization in the prevalence of anemia between 1992-2007, differently the prevalence observed between 1982-1992, this deficiency presents in high level, witch requires more effective measures of prevention and control.