Weight gain in the first two years of life, asthma and atopy: the SCAALA cohort study.

OBJECTIVE: To evaluate the association between weight gain in the first two years of life and the occurrence of wheezing, asthma, serum IgE, skin reactivity and pulmonary function. DESIGN: Cohort study. SETTING: The metropolitan region of Salvador, Bahia, Brazil. SUBJECTS: The association was studied between 1997 and 2005 in 669 children up to 11 years of age. Data were collected on asthma and risk factors, both current factors and those present in the first years of life. Weight gain was considered fast when the Z-score was >0·67. Poisson regression was used in the multivariate statistical analysis. RESULTS: Wheezing was reported in 25·6 % of the children. Weight gain was considered fast (Z-score >0·67) in 29·6 % of the children and slow (Z-score <-0·67) in 13·9 %. Children in the slow weight gain group had 36 % fewer symptoms of asthma (prevalence ratio = 0·65; 95 % CI 0·42, 0·99). CONCLUSIONS: Slower weight gain in the early years of life may constitute a protective factor against symptoms of asthma. The relevance of this finding for public health is not yet certain, since it is known that children with slow and fast weight gain may be more likely to develop adverse health consequences related to both these situations.

Overweight, asthma symptoms, atopy and pulmonary function in children of 4-12 years of age: findings from the SCAALA cohort in Salvador, Bahia, Brazil.

OBJECTIVE: To evaluate the association between overweight and the occurrence of asthma and atopy in a cohort of children of 4-12 years of age living in the city of Salvador in 2005. DESIGN: Cross-sectional study nested in a cohort. SETTING: The metropolitan region of Salvador, Bahia, Brazil. SUBJECTS: The study included 1129 children of 4-12 years age who presented complete information on the variables used here. Skin tests for allergy, spirometry, faecal parasitology, serum IgE and anthropometric surveys were conducted. Poisson's multivariate regression was adopted. RESULTS: Wheezing was found in 29·1% and asthma in 22·8% of children, both conditions being more common in those under 6 years of age and 34% more common in overweight children (prevalence ratio (PR) = 1·34; 95% CI 1·07, 1·67) following adjustment. The ratio between forced expiratory volume in 1s and forced vital capacity was associated with overweight (PR = 1·35; 95% CI 1·11, 1·61). No statistically significant association was found between overweight and allergen-specific IgE or with wheezing. CONCLUSIONS: These results are in agreement with the hypothesis that overweight is associated with asthma and pulmonary function, even following adjustment for intervening variables known to be associated with the pathogeny of asthma.

Poverty, dirt, infections and non-atopic wheezing in children from a Brazilian urban center.

BACKGROUND: The causation of asthma is poorly understood. Risk factors for atopic and non-atopic asthma may be different. This study aimed to analyze the associations between markers of poverty, dirt and infections and wheezing in atopic and non-atopic children. METHODS: 1445 children were recruited from a population-based cohort in Salvador, Brazil. Wheezing was assessed using the ISAAC questionnaire and atopy defined as allergen-specific IgE ≥ 0.70 kU/L. Relevant social factors, environmental exposures and serological markers for childhood infections were investigated as risk factors using multivariate multinomial logistic regression. RESULTS: Common risk factors for wheezing in atopic and non-atopic children, respectively, were parental asthma and respiratory infection in early childhood. No other factor was associated with wheezing in atopic children. Factors associated with wheezing in non-atopics were low maternal educational level (OR 1.49, 95% CI 0.98-2.38), low frequency of room cleaning (OR 2.49, 95% CI 1.27-4.90), presence of rodents in the house (OR 1.48, 95% CI 1.06-2.09), and day care attendance (OR 1.52, 95% CI 1.01-2.29). CONCLUSIONS: Non-atopic wheezing was associated with risk factors indicative of poverty, dirt and infections. Further research is required to more precisely define the mediating exposures and the mechanisms by which they may cause non-atopic wheeze.

Effect of city-wide sanitation programme on reduction in rate of childhood diarrhoea in northeast Brazil: assessment by two cohort studies.

BACKGROUND: A city-wide sanitation intervention was started in Salvador, Brazil, in 1997 to improve sewerage coverage from 26% of households to 80%. Our aim was to investigate the epidemiological effect of this city-wide sanitation programme on diarrhoea morbidity in children less than 3 years of age. METHODS: The investigation was composed of two longitudinal studies done in 1997-98 before the intervention (the sanitation programme) and in 2003-04 after the intervention had been completed. Each study consisted of a cohort of children (841 in the preintervention study and 1007 in the postintervention study; age 0-36 months at baseline) who were followed up for a maximum of 8 months. Children were sampled from 24 sentinel areas that were randomly chosen to represent the range of environmental conditions in the study site. At the start of each study an individual or household questionnaire was applied by trained fieldworkers; an environmental survey was done in each area before and after introduction of the sanitation programme to assess basic neighbourhood and household sanitation conditions. Daily diarrhoea data were obtained during home visits twice per week. The effect of the intervention was estimated by a hierarchical modelling approach fitting a sequence of multivariate regression models. FINDINGS: Diarrhoea prevalence fell by 21% (95% CI 18-25%)-from 9.2 (9.0-9.5) days per child-year before the intervention to 7.3 (7.0-7.5) days per child-year afterwards. After adjustment for baseline sewerage coverage and potential confounding variables, we estimated an overall prevalence reduction of 22% (19-26%). INTERPRETATION: Our results show that urban sanitation is a highly effective health measure that can no longer be ignored, and they provide a timely support for the launch of 2008 as the International Year of Sanitation.

Determinants of cognitive function in childhood: a cohort study in a middle income context.

BACKGROUND: There is evidence that poverty, health and nutrition affect children's cognitive development. This study aimed to examine the relative contributions of both proximal and distal risk factors on child cognitive development, by breaking down the possible causal pathways through which poverty affects cognition. METHODS: This cohort study collected data on family socioeconomic status, household and neighbourhood environmental conditions, child health and nutritional status, psychosocial stimulation and nursery school attendance. The effect of these on Wechsler Pre-School and Primary Scale of Intelligence scores at five years of age was investigated using a multivariable hierarchical analysis, guided by the proposed conceptual framework. RESULTS: Unfavourable socioeconomic conditions, poorly educated mother, absent father, poor sanitary conditions at home and in the neighbourhood and low birth weight were negatively associated with cognitive performance at five years of age, while strong positive associations were found with high levels of domestic stimulation and nursery school attendance. CONCLUSION: Children's cognitive development in urban contexts in developing countries could be substantially increased by interventions promoting early psychosocial stimulation and preschool experience, together with efforts to prevent low birth weight and promote adequate nutritional status.

Giardia duodenalis infection and anthropometric status in preschoolers in Salvador, Bahia State, Brazil.

The aim of this study was to estimate the association between Giardia duodenalis infection and anthropometric deficits, as measured by weight-for-age and height-for-age. This cross-sectional study included 629 children from 12 to 48 months of age, selected from 30 geographic areas in the city of Salvador, Bahia State, Brazil. Poisson regression and linear regression were used for the multivariate statistical analyses. G. duodenalis was diagnosed in 13.5% of the children. The children's breastfeeding duration and living conditions (garbage collection and paved streets or sidewalks) modified the effect of G. duodenalis infection on anthropometric status. Among infected children, there were statistically significant associations between weight deficit and shorter breastfeeding (PR=2.22; 95%CI: 1.56-3.14) and inadequate paving of streets and sidewalks (PR=2.00; 95%CI: 1.37-2.92), while height deficit was associated with deficient public garbage collection (PR=2.21; 95%CI: 1.31-2.51). In the linear regression, the association with the anthropometric indicators remained positive and statistically significant. The child's unhealthy living environment aggravated the negative effect of G. duodenalis infection on anthropometric status, and breastfeeding was a protective factor in the outcome.

Determinants of early cognitive development: hierarchical analysis of a longitudinal study.

The study describes the relationship between anthropometric status, socioeconomic conditions, and quality of home environment and child cognitive development in 320 children from 20 to 42 months of age, randomly selected from 20,000 households that represent the range of socioeconomic and environmental conditions in Salvador, Bahia, Northeast Brazil. The inclusion criterion was to be less than 42 months of age between January and July 1999. Child cognitive development was assessed using the Bayley Scales for Infant Development, and the Home Observation for Measurement of the Environment Inventory (HOME) was applied to assess quality of home environment. Anthropometric status was measured using the indicators weight/age and height/age ratios (z-scores), and socioeconomic data were collected through a standard questionnaire. Statistical analysis was conducted through univariate and hierarchical linear regression. Socioeconomic factors were found to have an indirect impact on early cognitive development mediated by the child's proximal environment factors, such as appropriate play materials and games available and school attendance. No independent association was seen between nutritional status and early cognitive development.

Community-based monitoring of diarrhea in urban Brazilian children: incidence and associated pathogens.

Community-based monitoring was conducted in order to investigate the occurrence of diarrhea in 'sentinel areas' of Salvador, Brazil, and to establish a preliminary profile of the most common pathogens present in children's diarrhea by screening stool samples. This report describes the results obtained from twice weekly home visits to identify and follow diarrhea episodes and testing of carer-requested stool sample collection over a 6-month period. Participants were selected from a large longitudinal study in 21 areas representing the city's poorer socioeconomic and sanitary conditions. Fecal samples were examined for the presence of pathogenic bacteria, viruses and protozoa. The mean incidence of diarrhea was 4.97 episodes per child-year, and longitudinal prevalence was 13.6 days per child-year (3.7%). Pathogens were found in 44% of the fecal samples examined. Bacteria were the most frequently encountered pathogens (isolated in 22% of samples), followed by protozoa (19.5%) and viruses (16%). Viral and bacterial pathogens were associated with episodes of severe diarrhea, while viral and protozoan pathogens were associated with longer episodes. The study demonstrated the importance of a public health monitoring system based on 'sentinel areas'.

Childhood diarrhoea symptoms, management and duration: observations from a longitudinal community study.

This study examined the evolution and duration of diarrhoea episodes observed in a community setting, with regard to symptoms and carers' responses. The study group comprised 1156 children, aged 0-36 months, who were followed-up with twice-weekly home visits in 30 sampling areas in the city of Salvador, northeast Brazil. A total of 2403 diarrhoea episodes (mean duration: 2.9 days) were recorded. The number of soft/liquid motions per day (3.6) did not vary significantly with duration, but other symptoms were more commonly reported in the longer episodes. However, when the data were analysed by day of the episode, rather than the episode's overall duration, the reported frequency of fever and vomiting declined significantly with time. During the course of an episode, rehydration, medication and care-seeking also showed a decline in frequency after the first or second week. As episodes continue, less rehydration and medical care are provided by carers, whereas they ought to be maintained because of the continued purging and cumulative effect of the symptoms. Since most cases of diarrhoea are managed at home, it is important to understand how to encourage better management of the longer episodes, which cause an increasing proportion of mortality in some countries.

[Breastfeeding duration, infant feeding regimes, and factors related to living conditions in the city of Salvador, Bahia, Brazil]. / Duração do aleitamento materno, regime alimentar e fatores associados segundo condições de vida em Salvador, Bahia, Brasil.

This cross-sectional study aimed to identify breastfeeding duration, infant feeding regimes, and factors related to living conditions among 811 children under 24 months of age in Salvador, Bahia, Brazil. Data were statistically analyzed by survival analysis, Pearson's chi-square test, and multivariate logistic regression. Median duration of exclusive, predominant, and total breastfeeding was 30.6, 73.0, and 131.5 days, respectively. Exclusive or predominant breastfeeding was discontinued in 83.6% of the subjects. Children with poor living conditions were 2.3 times more likely (95%CI: 1.09-5.01) to receive early supplementary food, whereas the figure for the very poor increased to 2.5 (95%CI: 1.20-5.34). Early exclusive or predominant breastfeeding discontinuation was associated with early pregnancy and poor living conditions of the children and their families. Programs directed towards proper breastfeeding and healthy feeding practices in childhood should consider the social factors associated with early introduction of supplementary foods in this population.

Sentinel areas: a monitoring strategy in public health.

Available techniques for monitoring the health situation have proven insufficient, thus leading to a discussion of the need for their improvement based on new data collection strategies allowing for data use by local health systems. This article presents the methodological basis for a strategy to monitor health problems utilizing demarcated intra-urban spaces called "sentinel areas" to collect fundamental social, economic, behavioral, and biological data for public health that allow for a closer approach to the reality of complex social spaces. The authors present an experience that is being developed in Salvador, Bahia, Brazil, to evaluate the epidemiological impact of an environmental sanitation program. They discuss selection criteria for the areas and the potential uses of this strategy allowing for the rapid utilization of epidemiological resources by health services and the timely application of the results to reorient and enhance health intervention practices.

Childhood anemia prevalence and associated factors in Salvador, Bahia, Brazil.

A cross-sectional study was conducted in 1996 to estimate the prevalence of anemia in a stratified sample of 603 preschool children and identify factors associated with the disease. Hemoglobin assays were conducted in finger-prick blood samples using a Hemocue hemoglobinometer. Anemia was defined as hemoglobin below 11.0 g/dl. Logistic regression analysis was used to evaluate the potential associations. Observed anemia prevalence was 46.3%. Associated factors were: the 6-12-month and 12-24-month age brackets, the lowest tertiles for iron density and protein content dietary intake, and any degree of deficit in the height-for-age anthropometric parameter. Inadequate physical, sanitary, and environmental conditions in the home were associated with a significantly increased risk of anemia. Anemia constitutes an important health problem in this study's child population. Improvements in living conditions and dietary quality could contribute to a reduction in anemia prevalence.

[Dietary pattern, asthma, and atopic and non-atopic wheezing in children and adolescents: SCAALA study, Salvador, Bahia State, Brazil]. / Padrão alimentar, asma e sibilo atópico e não atópico em crianças e adolescentes: estudo SCAALA, Salvador, Bahia, Brasil.

A cross-sectional study was conducted on dietary patterns and their influence on the occurrence of wheezing and atopic and non-atopic asthma in a sample of 1,168 children and adolescents in Salvador, Bahia State, Brazil. Wheezing and asthma symptoms in the previous 12 months were obtained using the ISAAC questionnaire. The presence of aeroallergen-specific IgE was identified. A food frequency questionnaire was used to define dietary patterns. The study applied logistic regression and multinomial polytomous logistic regression. Fish consumption was associated with a 27% reduction in wheezing (95%CI: 0.56-0.94), 37% in asthma (95%CI: 0.47-0.83), 51% in non-atopic asthma (95%CI: 0.31-0.79), and 38% in non-atopic wheezing (95%CI: 0.46-0.83). The highest tertile of dietary patterns reduced wheezing by 27% (95%CI: 0.57-0.95), atopic wheezing by 46% (95%CI: 0.30-0.98), asthma by 36% (95%CI: 0.49-0.83), and atopic asthma by 50% (95%CI: 0.28-0.89). Fish consumption may thus have a protective effect against wheezing and non-atopic asthma and dietary pattern against atopic asthma and wheezing.

[Dietary patterns of children under five years of age living in the State capital and other counties of Bahia State, Brazil, 1996 and 1999-2000]. / Padrões alimentares de crianças menores de cinco anos de idade residentes na capital e em municípios da Bahia, Brasil, 1996 e 1999/2000.

This cross-sectional study included 3,817 preschool children, of whom 1,770 in Salvador, Bahia State, Brazil, and 2,047 in urban and rural areas from nine other municipalities (counties) in the same State. The study used 24-hour recall and principal components analysis to identify and compare dietary patterns. The sample was stratified by age and area. In the first six months of life, breast milk composed the second and third patterns, with positive loadings for children in all 10 municipalities. For children under 17 months of age, pattern 1 was characterized by cow's milk, flour, and sugar, except in rural areas. Pattern 2 was similar for children aged 6-17 months and consisted of bread/cookies, rice, beans, and meat. For children 18-23 months of age in urban areas, pattern 1 showed negative loadings for sugar, cow's milk, and flour. In children over 24 months of age, fruits were not part of the first pattern. The study showed low consumption of milk and low variety of fruits and vegetables. This food consumption profile indicates the need for early interventions to promote healthy eating habits.

Environmental indicators of intra-urban hetererogeneity.

A large number of human diseases are related to poor access to water and sewer systems, inadequate solid waste management and deficient storm water drainage. The goal of this study was to formulate environmental sanitation indicators and classify sanitation conditions in specific sewer basins and their respective neighborhoods. The database used contains information on the following sanitation components in these areas: water supply, sewer systems, urban drainage, road pavement, building typology and public cleaning. Data was analyzed using cluster analysis. The key variable of each component was identified, and eight sewer basins and twenty-three neighborhoods were classified into the following categories: good, regular, and poor. The use of environmental sanitation indicators allows decision makers to identify critical areas and define priorities for improving environmental sanitation conditions.

[Weight gain rate in early childhood and overweight in children 5-11 years old in Salvador, Bahia State, Brazil]. / Velocidade de ganho de peso nos primeiros anos de vida e excesso de peso entre 5-11 anos de idade, Salvador, Bahia, Brasil.

Overweight children are more prone to become overweight or obese adults. The most effective prevention is intervention in early childhood. We analyzed the association between early weight gain and overweight/obesity in 1,056 children under 11 years of age. Data were collected on lifestyle, sanitation, socioeconomic status, birth weight, and breastfeeding. Weight gain from birth until different age brackets (< 12, > 12 to 18, > 18 to 24, and > 24 to 60 months) was considered a continuous variable in z-scores. Overweight was defined as body mass index (BMI) > +1 z-score, based on 2006 and 2007 World Health Organization (WHO) guidelines. Poisson regression and linear regression were used in the multivariate statistical analysis. Weight gain rate was associated with BMI, and overweight or obesity in the 5-11-year age bracket increased twofold for each unit increase in the weight gain standard deviation between 24 and 60 months of age (RR = 2.08; 95%CI: 1.87-2.32). For all early childhood age brackets, there was an association between rapid weight gain and subsequent overweight or obesity.

Reductions in the prevalence and incidence of geohelminth infections following a city-wide sanitation program in a Brazilian Urban Centre.

OBJECTIVE: In the city of Salvador, a large urban centre in Northeast Brazil, a city-wide sanitation intervention started in 1997, aimed at improving the sewerage coverage of households from 26% to 80%. Our aim was to study the impact of the intervention on the prevalence and incidence of geohelminths in the school-aged population. METHODS: THE STUDY COMPRISED TWO COMPARABLE COHORTS: the first assembled in 1997, before the intervention, and the second assembled in 2003, after the intervention. Both were sampled from 24 sentinel areas chosen to represent the different environmental conditions throughout the city. Copro-parasitological examinations were carried out on every individual from both cohorts, at baseline and nine months later. Demographic, socio-economic, and environmental data were collected using semi-structured questionnaires and environmental surveys. A hierarchical modelling approach fitting a sequence of Poisson multivariate linear models was undertaken to test the effect of the intervention variables on the prevalence and incidence rate ratios. FINDINGS: 729 and 890 children aged 7-14 years (mean = 10.4 y, SD = 0.05 y) were analysed over the first and the second cohorts, respectively. The adjusted reductions of the prevalence and incidence rates at the second in relation to the first cohort were 27% and 34%, 25% and 32%, 33% and 26%, and 82% and 42% for geohelminths overall, Ascaris lumbricoides, Trichuris trichiura, and hookworm, respectively. Hierarchical modelling showed that a major part of each of these reductions was explained by the intervention. CONCLUSION: Our results show that a city-wide sanitation program may reduce significantly the prevalence and incidence of geohelminths.

Impact of a citywide sanitation program in Northeast Brazil on intestinal parasites infection in young children.

BACKGROUND: Sanitation affects health, especially that of young children. Residents of Salvador, in Northeast Brazil, have had a high prevalence of intestinal parasites. A citywide sanitation intervention started in 1996 aimed to raise the level of sewer coverage from 26% to 80% of households. OBJECTIVES: We evaluated the impact of this intervention on the prevalence of Ascaris lumbricoides, Trichuris trichuria, and Giardia duodenalis infections in preschool children. METHODS: The evaluation was composed of two cross-sectional studies (1998 and 2003-2004), each of a sample of 681 and 976 children 1-4 years of age, respectively. Children were sampled from 24 sentinel areas chosen to represent the range of environmental conditions in the study site. Data were collected using an individual/household questionnaire, and an environmental survey was conducted in each area before and after the intervention to assess basic household and neighborhood sanitation conditions. Stool samples were examined for the presence of intestinal parasites. The effect of the intervention was estimated by hierarchical modeling, fitting a sequence of multivariate regression models. FINDINGS: The prevalence ofA. lumbricoides infection was reduced from 24.4% to 12.0%, T. trichuria from 18.0% to 5.0%, and G. duodenalis from 14.1% to 5.3%. Most of this reduction appeared to be explained by the increased coverage in each neighborhood by the sewage system constructed during the intervention. The key explanatory variable was thus an ecological measure of exposure and not household-based, suggesting that the parasite transmission prevented by the program was mainly in the public (vs. the domestic) domain. CONCLUSION: This study, using advanced statistical modeling to control for individual and ecological potential confounders, demonstrates the impact on intestinal parasites of sanitation improvements implemented at the scale of a large population.

Padrão alimentar, asma e sibilo atópico e não atópico em crianças e adolescentes: estudo SCAALA, Salvador, Bahia, Brasil / Dietary pattern, asthma, and atopic and non-atopic wheezing in children and adolescents: SCAALA study, Salvador, Bahia State, Brazil / Patrón dietético, asma y sibilancias atópicas y no atópicas en niños y adolescentes: estudio SCAALA, Salvador, Bahía, Brasil

Avaliou-se, em estudo transversal, a influência do padrão alimentar sobre a ocorrência de sibilo e asma atópica e não atópica em 1.168 crianças e adolescentes em Salvador, Bahia, Brasil. Sibilo e sintomas de asma nos últimos 12 meses foram obtidos por meio do questionário ISAAC. Atopia foi definida pela presença de IgE específica a aerolérgenos. Questionário de frequência alimentar foi usado para definir padrões alimentares. Empregou-se regressões logística e logística politômica multivariadas. O consumo de pescados reduziu a ocorrência de sibilo em 27% (IC95%: 0,56-0,94) e asma em 37% (IC95%: 0,47-0,83); asma não atópica em 51% (IC95%: 0,31-0,79) e sibilo não atópico em 38% (IC95%: 0,46-0,83). O maior tercil do padrão alimentar reduziu o sibilo em 27% (IC95%: 0,57-0,95), sibilo atópico em 46% (IC95%: 0,30-0,98), asma em 36% (IC95%: 0,49-0,83) e asma atópica em 50% (IC95%: 0,28-0,89). O consumo de pescados pode conferir efeito protetor para sibilo e asma não atópica e o padrão alimentar para sibilo e asma atópica.

A cross-sectional study was conducted on dietary patterns and their influence on the occurrence of wheezing and atopic and non-atopic asthma in a sample of 1,168 children and adolescents in Salvador, Bahia State, Brazil. Wheezing and asthma symptoms in the previous 12 months were obtained using the ISAAC questionnaire. The presence of aeroallergen-specific IgE was identified. A food frequency questionnaire was used to define dietary patterns. The study applied logistic regression and multinomial polytomous logistic regression. Fish consumption was associated with a 27% reduction in wheezing (95%CI: 0.56-0.94), 37% in asthma (95%CI: 0.47-0.83), 51% in non-atopic asthma (95%CI: 0.31-0.79), and 38% in non-atopic wheezing (95%CI: 0.46-0.83). The highest tertile of dietary patterns reduced wheezing by 27% (95%CI: 0.57-0.95), atopic wheezing by 46% (95%CI: 0.30-0.98), asthma by 36% (95%CI: 0.49-0.83), and atopic asthma by 50% (95%CI: 0.28-0.89). Fish consumption may thus have a protective effect against wheezing and non-atopic asthma and dietary pattern against atopic asthma and wheezing.

Este estudio transversal se llevó a cabo para estudiar la influencia de los hábitos alimentarios en la aparición del asma y sibilancias atópicas y no atópicas en una muestra de 1.168 niños y adolescentes en Salvador, Bahía, Brasil. Las sibilancias y síntomas de asma en los últimos 12 meses se han obtenido a partir del cuestionario ISAAC. Se identificó la presencia de IgE específica de alérgeno aéreo. Se utilizó un cuestionario de frecuencia de alimentos para definir hábitos alimentarios. Se aplicó la regresión logística y el modelo logístico multinomial. El consumo de pescado redujo las sibilancias en un 27% (IC95%: 0,56-0,94) y el asma en un 37% (IC95%: 0,47-0,83), las sibilancias atópicas en un 51% (IC95%: 0,31-0,79) y no atópicas en un 38% (IC95%: 0,46-0,83). El tercil más alto de los hábitos alimentarios reduce sibilancias en un 27% (IC95%: 0,57-0,95), sibilancias atópicas en un 46% (IC95%: 0,30-0,98), el asma en un 36% (IC95%: 0,49-0,83) y un 50% en el asma atópico (IC95%: 0,28-0,89). El consumo de pescado puede promover un efecto protector, dentro el patrón de dieta, contra sibilancias atópicas y no atópicas y asma.

Padroes alimentares de criancas menores de cinco anos de idade residentes na capital e em municipios da Bahia, Brasil, 1996 e 1999/2000 / Dietary patterns of children under five years of age living in the State capital and other counties of Bahia State, Brazil, 1996 and 1999-2000 / Patrones de alimentacion de ninos menores de cinco anos de edad que viven en la capital y los municipios de Bahia, Brasil, 1996 y 1999/2000

Estudo transversal com 3.817 pré-escolares, 1.770 residentes em Salvador, Bahia, Brasil, e 2.047 nas áreas urbana e rural de 10 municípios baianos. Utilizou-se recordatório de 24 horas (R24h) e empregou-se análise fatorial por componentes principais com objetivo de identificar e comparar os principais padrões alimentares dessas crianças. Estratificou-se a amostra por idade e área. Antes dos seis meses de vida o leite materno compôs o 2o e 3o padrões com carga positiva para crianças dos dez municípios. Para menores de 17 meses, o padrão 1 foi caracterizado por leite de vaca, farinhas e açúcares. Em áreas urbanas, pão/biscoito, arroz, feijão e carne integraram o padrão 2 aos 6-17 meses. Aos 18-23 meses, o padrão 1 apresentou carga negativa para açúcares, leite de vaca e farinhas, exceto na área rural. Frutas não fizeram parte do padrão 1 no grupo de 24 meses e mais. Observou-se baixo consumo de leite materno e pouca variação de frutas e legumes a partir dos seis meses. Tal perfil de consumo alimentar indica a necessidade de intervenções cada vez mais precoces para promoção de hábitos alimentares saudáveis. .

This cross-sectional study included 3,817 preschool children, of whom 1,770 in Salvador, Bahia State, Brazil, and 2,047 in urban and rural areas from nine other municipalities (counties) in the same State. The study used 24-hour recall and principal components analysis to identify and compare dietary patterns. The sample was stratified by age and area. In the first six months of life, breast milk composed the second and third patterns, with positive loadings for children in all 10 municipalities. For children under 17 months of age, pattern 1 was characterized by cow’s milk, flour, and sugar, except in rural areas. Pattern 2 was similar for children aged 6-17 months and consisted of bread/cookies, rice, beans, and meat. For children 18-23 months of age in urban areas, pattern 1 showed negative loadings for sugar, cow’s milk, and flour. In children over 24 months of age, fruits were not part of the first pattern. The study showed low consumption of milk and low variety of fruits and vegetables. This food consumption profile indicates the need for early interventions to promote healthy eating habits.

Estudio transversal realizado con 3.817 niños en edad preescolar, 1.770 residentes en Salvador, Bahía, Brasil, y 2.047 en las zonas urbanas y rurales de 10 municipios de Bahía. Se utilizó el recordatorio de 24 horas (R24h) y el análisis de componentes principales, con el fin de identificar y comparar los hábitos alimentarios. Se estratificó la muestra según edad y área. Antes de los 6 meses de vida, la leche materna compone los 2o y 3o patrones, con cargas positivas en los niños de 10 municipios. Para los menores de 17 meses, el patrón 1 se caracteriza por leche de vaca, harina y azúcar. El patrón 2 fue similar en niños de 6 a 17 meses y consistía en frijoles, carne, pan/galletas, arroz. Para niños de 18 a 23 meses en las zonas urbanas el patrón 1 mostraron cargas negativas en azúcares, leche y harina. Teniendo en cuenta el grupo de mayores de 24 meses, las frutas no eran parte del primer patrón. Se encontró un bajo consumo de leche y baja variabilidad de frutas y hortalizas. Este perfil indica la necesidad de intervenciones cada vez más tempranas para promover hábitos alimenticios saludables. .