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1.
Rev Bras Epidemiol ; 22: e190002, 2019 Feb 21.
Artigo em Português, Inglês | MEDLINE | ID: mdl-30810606

RESUMO

Identifying the influence of socioeconomic, care, and feeding factors on children's nutritional status is important for the evaluation and targeting of public policies based on nutritional interventions. We investigated the sociodemographic and biological factors associated with children aged 6 to 23 months leaving the low weight-for-age condition (weight-for-age z-score < -2) during their participation in a supplementary feeding program (SFP). This is a cohort study with 327 low-income children living in the inland of the state of São Paulo, who joined the SFP with low weight-for-age when they were six months old. The dependent variable was "maintained low weight-for-age during participation in the program" (dichotomous), and the independent variables related to: 1) maternal characteristics: marital status, schooling, age, and work situation; 2) child characteristics: being weaned, gender, birth weight, and age at weighing. We used a multiple multilevel logistic regression for the modeling. Factors positively associated with children's weight gain were higher age at weighing (OR = 1.20; 95%CI 1.08 - 1.34; p = 0.001); higher birth weight (OR = 1.0011; 95%CI 1.0001 - 1.0019; p = 0.022), and being weaned when joining the program (OR = 0.20; 95%CI 0.08 - 0.52; p = 0.001). Actions focused on promoting appropriate birth weight and breastfeeding, and on adequate and timely introduction to healthy complementary feeding are important strategies to maximize the effects of the SFP on weight gain in the first two years of life of children from low-income families.


Identificar a influência dos fatores socioeconômicos, dos cuidados e da alimentação sobre o estado nutricional infantil são importantes para avaliação e direcionamento de políticas públicas baseadas em intervenções nutricionais. Foram investigados os fatores sociodemográficos e biológicos associados à saída de crianças da faixa de baixo peso-para-idade (escore z de peso-para-idade < -2), nas idades de 6 a 23 meses, durante sua participação em programa de suplementação alimentar (PSA). Trata-se de estudo de coorte com 327 crianças de baixa renda residentes no interior do estado de São Paulo, que ingressaram no PSA aos 6 meses de idade com baixo peso-para-idade. A variável dependente foi "permanecer com baixo ­peso-para-idade durante a participação no programa" (dicotômica), e as independentes referem-se a: 1) características maternas: condição conjugal, escolaridade, idade, situação de trabalho; 2) características das crianças: estar desmamada, sexo, peso ao nascer e idade nas pesagens. Foram realizadas modelagens com regressão logística múltipla multinível. Maior idade da criança na pesagem (OR = 1,20; IC95% 1,08 - 1,34; p = 0,001), maior peso ao nascer (OR = 1,0011; IC95% 1,0001 - 1,0019; p = 0,022) e estar desmamada ao ingressar (OR = 0,20; IC95% 0,08 - 0,52; p = 0,001) se associaram positivamente ao ganho de peso das crianças. Ações focadas na promoção do peso adequado ao nascer e do aleitamento materno e na introdução adequada e oportuna da alimentação complementar saudável são estratégias importantes para maximizar o efeito de PSA no ganho de peso nos primeiros dois anos de vida em crianças de famílias de baixa renda.


Assuntos
Fenômenos Fisiológicos da Nutrição do Lactente , Estado Nutricional , Aumento de Peso , Peso ao Nascer , Brasil , Aleitamento Materno/estatística & dados numéricos , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Masculino , Fatores de Risco , Fatores Socioeconômicos
2.
Rev Assoc Med Bras (1992) ; 53(1): 75-9, 2007.
Artigo em Português | MEDLINE | ID: mdl-17420899

RESUMO

OBJECTIVE: To evaluate the nutritional status (NS) and its association with physical performance tests (PPT) of elderly in the city of São Paulo, Brazil. METHODS: Design--Cross-sectional epidemiological study, in a population on a household basis as part of a multicenter study (the SABE Survey), coordinated by the Pan-American Health Organization. Setting-- From January/2000 to March/2001, the SABE survey comprised 2143 elderly (>or=60 yrs old), of both genders, selected by probabilistic sampling. Of these, 1894 (88.4%) took part in this study. The elderly were separated by gender and age group (60-69, 70-79 and>or=80 yrs old) for the tests and the NS was evaluated according to the Body Mass Index (BMI): underweight (BMIor=28 kg/m2). The PPTs included timed, repeated "chair stand" (CS), timed "pick up a pen" (PP) and standing balance (SB). The associations (CS and PP) were verified by the Cox Regression analysis and (SB) by the chi square test. RESULTS: There were statistically significant associations between PP and SB and obese women. CONCLUSION: Results showed association between nutritional status and functional capacity for women and obesity was the nutritional condition associated with the worst performance in the tests. Gender and age group should be considered in the association between nutritional status and physical performance.


Assuntos
Envelhecimento/fisiologia , Estado Nutricional , Aptidão Física/fisiologia , Análise e Desempenho de Tarefas , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Brasil/epidemiologia , Métodos Epidemiológicos , Teste de Esforço/métodos , Feminino , Avaliação Geriátrica , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade , Equilíbrio Postural , Distribuição por Sexo
3.
Food Funct ; 8(6): 2212-2219, 2017 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-28513635

RESUMO

An increase in the frequency of cardiovascular diseases has been observed in the HIV/AIDS population. Studies involving healthy subjects or subjects with other diseases have shown benefits of chocolate supplementation on endothelial function and vasodilation. We evaluate the impact of chocolate consumption on arterial elasticity in people living with human immunodeficiency virus - PLHIV. A double-blind, crossover trial including 110 PLHIV (19 to 59 years) on antiretroviral therapy - ART for at least 6 months and with a viral load of <500 copies per mL was conducted. All subjects were randomly assigned to 15-d dietary supplements containing dark chocolate or placebo with a 15-d washout period. Each participant received one of the two sequences: A (dark chocolate, placebo chocolate); B (placebo chocolate, dark chocolate). Arterial elasticity was measured using the HDI/PulseWave™ CR-2000 CardioVascular Profiling System®. Body composition, lipid profile, C-reactive protein, and thiobarbituric acid reactive substances were also assessed. Analysis of variance (ANOVA) for repeated measures using the Stata 11.0® program was used for cross-over analysis. Most subjects were men (59.0%) and Caucasian (46.1%) and the mean age was 44.6 ± 7.1 years. The mean time since diagnosis of HIV infection was 13.7 ± 5.3 years and the mean duration of ART was 12.9 ± 4.2 years. Chocolate consumption resulted in significant alterations in the large artery elasticity index - LAEI (p = 0.049) and the mean concentration of HDL-c was higher after supplementation with dark chocolate (p = 0.045). This is the first study to evaluate the effect of chocolate on arterial elasticity in PLHIV. The results showed that dark chocolate consumption for 15 days improved the elastic properties of the LAEI in PLHIV. These findings, added to the noninvasive method used, may expand the knowledge of CVDs in this population.


Assuntos
Artérias/fisiopatologia , Cacau/metabolismo , Chocolate/análise , Infecções por HIV/fisiopatologia , Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Síndrome da Imunodeficiência Adquirida/fisiopatologia , Síndrome da Imunodeficiência Adquirida/virologia , Adulto , Fármacos Anti-HIV/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Método Duplo-Cego , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/metabolismo , Infecções por HIV/virologia , HIV-1/genética , HIV-1/isolamento & purificação , HIV-1/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Vasodilatação/efeitos dos fármacos , Adulto Jovem
5.
Cad Saude Publica ; 20(1): 266-74, 2004.
Artigo em Português | MEDLINE | ID: mdl-15029329

RESUMO

This study aimed to describe the evolution of hemoglobin concentration considering the following factors: birth weight, growth rate, and food intake. The cross-sectional study focused on infants (<1 year of age) whose growth and development were monitored by public health services in cities located in the five geographic regions of Brazil. Some 51.7% of the children aged 6 to 12 months presented anemia. Estimation of [Hb] concentration by a theoretical equation suggested that endogenous iron is able to maintain normal Hb levels in the first three months of life. Prevalence of reduced Hb was higher in low birth weight infants. Growth rate, verified by the difference between present weight and birth weight in Z scores, was not the relevant factor for hemoglobin concentration. The relevance of breastfeeding was evident in the initial months of life. However, complementary foods did not influence infant Hb concentration. The high prevalence of low Hb levels calls attention to the need for programs to control anemia.


Assuntos
Hemoglobinas/análise , Anemia Ferropriva/epidemiologia , Anemia Ferropriva/prevenção & controle , Peso ao Nascer , Brasil/epidemiologia , Aleitamento Materno , Estudos Transversais , Dieta , Crescimento/fisiologia , Humanos , Lactente , Recém-Nascido/sangue , Deficiências de Ferro
6.
Cad Saude Publica ; 19(5): 1453-60, 2003.
Artigo em Português | MEDLINE | ID: mdl-14666227

RESUMO

This study describes breastfeeding practices with children born in a university hospital in the city of S o Paulo, Brazil, and identifies factors associated with duration of breastfeeding and exclusive breastfeeding. A cohort of 506 children was identified; of these, it was possible to analyze information on feeding practices for 450 infants at least until the second month of life. Daily information on infant feeding was recorded by mothers in a food frequency questionnaire. Survival analysis techniques (Kaplan-Meier and Cox) were used. Median duration of breastfeeding and exclusive breastfeeding were 205 and 23 days, respectively. The principal factors related to exclusive breastfeeding were mother's age (hr young/old = 1.22; 95% CI = 1.006-1.486) and mother's schooling (hr primary/university = 2.13; 95% CI = 1.381-3.307 and hr secondary/university = 1.78; 95% CI = 1.145-2.792), which could be related to knowledge concerning the benefits of exclusive breastfeeding.


Assuntos
Aleitamento Materno/estatística & dados numéricos , Desmame , Brasil , Estudos de Coortes , Escolaridade , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Idade Materna , Comportamento Materno , Estudos Prospectivos , Fatores Socioeconômicos , Fatores de Tempo
7.
Rev. bras. epidemiol ; 22: e190002, 2019. tab, graf
Artigo em Português | LILACS | ID: biblio-985274

RESUMO

RESUMO: Identificar a influência dos fatores socioeconômicos, dos cuidados e da alimentação sobre o estado nutricional infantil são importantes para avaliação e direcionamento de políticas públicas baseadas em intervenções nutricionais. Foram investigados os fatores sociodemográficos e biológicos associados à saída de crianças da faixa de baixo peso-para-idade (escore z de peso-para-idade < -2), nas idades de 6 a 23 meses, durante sua participação em programa de suplementação alimentar (PSA). Trata-se de estudo de coorte com 327 crianças de baixa renda residentes no interior do estado de São Paulo, que ingressaram no PSA aos 6 meses de idade com baixo peso-para-idade. A variável dependente foi "permanecer com baixo ­peso-para-idade durante a participação no programa" (dicotômica), e as independentes referem-se a: 1) características maternas: condição conjugal, escolaridade, idade, situação de trabalho; 2) características das crianças: estar desmamada, sexo, peso ao nascer e idade nas pesagens. Foram realizadas modelagens com regressão logística múltipla multinível. Maior idade da criança na pesagem (OR = 1,20; IC95% 1,08 - 1,34; p = 0,001), maior peso ao nascer (OR = 1,0011; IC95% 1,0001 - 1,0019; p = 0,022) e estar desmamada ao ingressar (OR = 0,20; IC95% 0,08 - 0,52; p = 0,001) se associaram positivamente ao ganho de peso das crianças. Ações focadas na promoção do peso adequado ao nascer e do aleitamento materno e na introdução adequada e oportuna da alimentação complementar saudável são estratégias importantes para maximizar o efeito de PSA no ganho de peso nos primeiros dois anos de vida em crianças de famílias de baixa renda.


ABSTRACT: Identifying the influence of socioeconomic, care, and feeding factors on children's nutritional status is important for the evaluation and targeting of public policies based on nutritional interventions. We investigated the sociodemographic and biological factors associated with children aged 6 to 23 months leaving the low weight-for-age condition (weight-for-age z-score < -2) during their participation in a supplementary feeding program (SFP). This is a cohort study with 327 low-income children living in the inland of the state of São Paulo, who joined the SFP with low weight-for-age when they were six months old. The dependent variable was "maintained low weight-for-age during participation in the program" (dichotomous), and the independent variables related to: 1) maternal characteristics: marital status, schooling, age, and work situation; 2) child characteristics: being weaned, gender, birth weight, and age at weighing. We used a multiple multilevel logistic regression for the modeling. Factors positively associated with children's weight gain were higher age at weighing (OR = 1.20; 95%CI 1.08 - 1.34; p = 0.001); higher birth weight (OR = 1.0011; 95%CI 1.0001 - 1.0019; p = 0.022), and being weaned when joining the program (OR = 0.20; 95%CI 0.08 - 0.52; p = 0.001). Actions focused on promoting appropriate birth weight and breastfeeding, and on adequate and timely introduction to healthy complementary feeding are important strategies to maximize the effects of the SFP on weight gain in the first two years of life of children from low-income families.


Assuntos
Humanos , Masculino , Feminino , Lactente , Aumento de Peso , Estado Nutricional , Fenômenos Fisiológicos da Nutrição do Lactente , Fatores Socioeconômicos , Peso ao Nascer , Brasil , Aleitamento Materno/estatística & dados numéricos , Fatores de Risco , Estudos de Coortes
8.
Rev. bras. crescimento desenvolv. hum ; 28(2): 129-138, Jan.-Mar. 2018. graf, tab
Artigo em Inglês | LILACS | ID: biblio-958518

RESUMO

INTRODUCTION: Previous studies have shown the effectiveness of the VIVALEITE Project for promoting weight gain in children under two years old. Given the program´s effectiveness, children whose weight on entry was close to the normal limit for age may have become overweight during their participation OBJECTIVE: To analyze the association between sociodemographic factors and overweight in participants of the VIVALEITE Project METHODS: A cohort study with data on 1,039 infants from low-income families in the state of São Paulo enrolled on the Vivaleite Program at six months of age with a weight near the upper limit of adequacy between January 2003 and September 2008 was conducted. The proportion of children that became overweight during participation in the program and associations with sociodemographic conditions of each child (breastfeeding at six months, sex and birth weight) and mother/guardian (marital status, age, employment status and education) were investigated. Modeling was performed using multilevel logistic regression of socioeconomic variables and ages at weighing. The Stata program version 10.1 was used for analysis RESULTS: On multilevel analysis, the "yes" category of breastfeeding at six months (OR = 0.29, p = 0.001) and maternal employment (OR = 0.36, p = 0.012) were significantly associated with overweight in the children. The variables birth weight, sex, marital status, maternal age and education were not statistically associated with overweight CONCLUSIONS: The sociodemographic factors "not breastfeeding at six months" and "maternal unemployment" were positively associated with overweight among the infants participating in the program


INTRODUÇÃO: Estudos anteriores mostraram a efetividade do programa VIVALEITE para o ganho de peso de crianças menores de dois anos. Como o programa é efetivo, é possível que crianças ingressantes com peso próximo ao limite considerado adequado para idade o ultrapassem no decorrer de sua participação OBJETIVO: Analisar a associação entre fatores sociodemográficos e excesso de peso em participantes do programa VIVALEITE MÉTODO: Estudo de coorte com dados de 1.039 crianças de famílias de baixa renda do interior do Estado de São Paulo, ingressantes no programa com seis meses de idade e peso próximo ao limite superior de adequação, entre janeiro/2003 e setembro/2008. Investigou-se a proporção de crianças que ficam com excesso de peso durante a participação no programa e associações com as condições sociodemográficas de cada criança (amamentação aos seis meses, sexo, peso ao nascer) e dos respectivos responsáveis (condição conjugal, idade, situação de trabalho, escolaridade). A modelagem foi feita por meio de regressão logística multinível das variáveis socioeconômicas e o conjunto das idades de pesagem. O processamento foi feito com o pacote estatístico Stata 10.1 RESULTADOS: Conforme análise multinível, a categoria sim da variável aleitamento materno aos seis meses (OR=0,29, p=0,001) e a categoria trabalha da variável situação de trabalho materno (OR=0,36, p=0,012) foram associadas significantemente ao excesso de peso das crianças. As demais variáveis não foram associadas estatisticamente a excesso de peso CONCLUSÃO: Não amamentação aos seis meses e ausência de trabalho materno são fatores sociodemográficos positivamente associados ao excesso de peso das crianças participantes do programa

9.
J Nutr Sci Vitaminol (Tokyo) ; 59(6): 496-502, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24477245

RESUMO

Micronutrient deficiency is a common condition in HIV-infected individuals and may occur in all stages of the disease. The objective of this cross-sectional study was to compare the concentrations of vitamin A and beta-carotene, micronutrients related to immunity and oxidative stress, in 182 adults with HIV/AIDS, under different highly active antiretroviral therapy (HAART) regimens. Patients were divided into 3 groups according to their HAART regimen: combination of nucleoside analog reverse transcriptase inhibitors (NRTIs) and non-NRTIs; combination of NRTIs, protease inhibitors, and ritonavir; combination of NRTIs and other classes. Multiple linear regression analysis determined the effect of the treatment regimen, time of use, and compliance with the regimen, on vitamin A and beta-carotene concentrations, controlling for the following variables: gender, age, educational level, smoking, physical activity, body mass index, time of infection with HIV, presence of comorbidities, CD4(+) T lymphocyte count, total cholesterol and fractions, and triglyceride levels. There was no significant difference in vitamin A or beta-carotene concentrations in patients under the different HAART regimens. However, approximately 4% of the patients had deficient/low concentrations of vitamin A (<0.70 µmol/L), and 98% showed concentrations of beta-carotene <1.0 µmol/L. In conclusion, HIV/AIDS patients in this region will not benefit from vitamin A supplementation, independently of the HAART regimen utilized, but beta-carotene may be of importance, considering its antioxidant effect.


Assuntos
Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Terapia Antirretroviral de Alta Atividade/métodos , Vitamina A/sangue , beta Caroteno/sangue , Síndrome da Imunodeficiência Adquirida/sangue , Adulto , Cromatografia Líquida de Alta Pressão/métodos , Estudos Transversais , Feminino , Humanos , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade , Adulto Jovem
10.
Rev Assoc Med Bras (1992) ; 57(6): 657-61, 2011.
Artigo em Inglês, Português | MEDLINE | ID: mdl-22249545

RESUMO

OBJECTIVE: To assess the risk prevalence of overweight and obesity in children enrolled in private and philanthropic preschools in the State of São Paulo. METHODS: Comparison of two cross sectional studies with children enrolled in private preschools (PPS) or philanthropic (PHP) of the São Paulo Metropolitan Region. Both surveys evaluated the children's environment. To determine the risk of overweight, excess weight and obesity, body mass index (BMI) values were transformed into z scores (according to the World Health Organization - 2006 and 2007). RESULTS: The risk prevalence of overweight (≥ 1 BMIz < 2) in PPS was 21.9% and 24.6% in PHP, with PR = 1.12 (95% CI: 0.96-1.32), without statistical difference. Considering the children with overweight or obesity, (BMIz ≥ 2) the prevalence in PPS was 14.3% and in PHP was 9.0%, with PR = 1.54 (95% CI: 1.23-1.93), p = 0.0002. Overweight and obesity prevalence in males in PPS was 16.4% (n = 409) and in PHP, 11.1% (n = 829), PR = 1.48 (95% CI: 1.10-1.98) and in females it was 12.5% (n = 400) in the PPS and 6.6% (n = 698) in PHP, corresponding to PR = 1.90 (95% CI: 1.30-2.78), both significant differences. CONCLUSION: Both groups showed a similar and very high prevalence of weight excess. However, overweight and obesity showed a higher prevalence in children from private preschools. This indicates that even though a better socioeconomic level is still a risk factor for overweight and obesity in preschoolers, the same does not seem to occur when analyzing the risk of overweight.


Assuntos
Obesidade/epidemiologia , Índice de Massa Corporal , Brasil/epidemiologia , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino , Sobrepeso/epidemiologia , Prevalência , Fatores de Risco , Fatores Socioeconômicos , População Urbana
11.
Nutrire Rev. Soc. Bras. Aliment. Nutr ; 41: 1-10, Dec. 2016. tab
Artigo em Inglês | LILACS | ID: biblio-880415

RESUMO

BACKGROUND: Improvements in the iron status of a population as result of food fortification are expected at the long term. In Brazil, the effectiveness of mandatory flour fortification with iron has been evidenced mostly from surveys on gestational anemia after 1 or 2 years from its implementation, in 2004. Our aim was to assess hemoglobin (Hb) concentrations and the prevalences of anemia and linked erythrocyte morphology patterns among pregnant women in 2006 and 2008.METHODS: The study design was retrospective and cross-sectional. The analysis was based on secondary data in 546medical records from women at the times of their first prenatal attendance in 13 public primary healthcare units of the Butantan Administrative Region from São Paulo (SP), Brazil. Anemia was evaluated from Hb concentration (cut-off <11.0 g/dL) and erythrocyte morphology patterns from mean corpuscular volume (MCV), mean corpuscular Hb concentration (MHC), and red cell distribution widths (RDW). Recorded sociodemographic and obstetric data included maternal age, gestational age, ethnoracial self-classification, and residence type. Student's t tests, analysis of variance, Chi-squared tests, and multiple linear and logistic regressions were employed in the statistical analysis using a significance level of 5 %.RESULTS:The prevalence of anemia was 9.7 % in 2006 and 9.4 % in 2008 (P= 0.922), with no significant difference in mean Hb concentrations (P= 0.159). Normocytosis (normal MVC), normochromia (normal MHC), and anisocytosis (high RDW) were found in most anemia cases, suggesting that the low Hb concentrations resulted from mixed causes. In multiple regression analysis, gestational age at the first prenatal attendance was an independent predictor of low Hb and of having anemia. Moreover, black ethnoracial self-classification was associated with lower Hb. CONCLUSIONS: The prevalence of gestational anemia was low among women in both of the studied periods, representing a mild public health problem. Our results highlight the importance of early prenatal care as a means of reducing gestation-associated risks. The erythrocyte morphology pattern found in most cases of low Hb levels suggests that, besides iron deficiency, hemoglobin pathies and nutritional deficiencies of folate and vitamin B12 are common complicating factors of gestational anemia in our setting.


Assuntos
Humanos , Feminino , Gravidez , Anemia Ferropriva/prevenção & controle , Eritrócitos/metabolismo , Eritrócitos/fisiologia , Cuidado Pré-Natal , Atenção Primária à Saúde
12.
Rev. bras. saúde matern. infant ; 16(3): 271-281, July-Sept. 2016. tab, graf
Artigo em Inglês | LILACS | ID: lil-798111

RESUMO

Abstract Objectives: to evaluate the effectiveness of Family Health Strategy (FHS) on child's health indicators in São Paulo State. Methods: longitudinal ecological study involving all the towns in São Paulo State from 1998 to 2009. The outcomes were the coefficients of infant mortality and its components and the rate for pneumonia and diarrhea hospitalizations. The main independent variable was "FHS coverage"; the covariates considered the context of sociodemographic and the health system. Negative binomial regression models of fixed effects and STRATA 11.1 statistical program were used. Results: FHS coverage above 50% showed a protective effect in relation to the postneonatal mortality (RR: 0.93; CI 95%: 0.87-1.00) and coverage up to 50% (RR 0.88 CI95% 0.82-0.99) or above 50% (RR: 0.87; CI95%: 0.82-0.92) were protective factors for pneumonia hospitalizations. Conclusions: the effectiveness of FHS on the outcomes related to child's health may vary according to local and regional contexts.


Resumo Objetivos: avaliar a efetividade da Estratégia Saúde da Família (ESF) sobre indicadores de saúde da criança no Estado de São Paulo. Métodos: estudo ecológico longitudinal envolvendo todos os municípios do estado de São Paulo no período de 1998 a 2009. Os desfechos foram os coeficientes de mortalidade infantil e seus componentes e taxa de internações por pneumonia e diarreia. A variável independente principal foi "cobertura da ESF"; as covariáveis consideraram o contexto sociodemográfico e do sistema de saúde. Utilizaram-se modelos de regressão binomial negativa de efeitos fixos, utilizando o programa estatístico STATA 11.1. Resultados: coberturas da ESF superiores a 50% mostraram efeito de proteção em relação à mortalidade pós-neonatal (RR: 0,93; IC95%: 0,87-1,00) e coberturas de até 50% (RR: 0,88; IC95%: 0,82-0,99) ou superiores a 50% (RR: 0,87; IC95%: 0,82-0,92) foram fatores de proteção para internações por pneumonia. Conclusões: a efetividade da ESF sobre os desfechos relacionados à saúde da criança pode variar em função de contextos locais e regionais.

13.
Rev Saude Publica ; 44(5): 793-801, 2010 Oct.
Artigo em Inglês, Português | MEDLINE | ID: mdl-20877919

RESUMO

OBJECTIVE: To evaluate the effectiveness of a governmental supplementary feeding program in child weight gain. METHODS: A cohort study including secondary data on 25,433 low-income children aged between six and 24 months, participating in a fortified milk distribution program known as Projeto Vivaleite, was performed in the state of São Paulo, Southeastern Brazil, between 2003 and 2008. Weight gain was measured using weight-for-age z-score values, calculated according to the World Health Organization standards (2007). These values were obtained in the program routine, when a child started it and every four months during their stay. Children were divided into three z-score groups when starting the program: weight gain not compromised (z>-1); risk of low weight (-2< or =z <-1); and low weight (z<-2). Multilevel linear regression (mixed model) was used, enabling the comparison, at each age, of adjusted mean z-scores between children starting the program and those who had been participating for at least four months, adjusted for correlation between repeated measurements. RESULTS: The program had a positive effect on child weight gain, varying according to child nutritional status when starting this program; among those who started it with weight gain not compromised, the mean adjusted gain z-score was 0.183; among those with risk of low weight, 0.566; and among those with low weight, 1.005. CONCLUSIONS: The program is effective for weight gain in children younger than two years, with a more pronounced effect on children who start the program under less favorable weight conditions.


Assuntos
Alimentos Fortificados , Fenômenos Fisiológicos da Nutrição do Lactente , Leite , Aumento de Peso , Animais , Brasil , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Ferro da Dieta/administração & dosagem , Masculino , Programas Nacionais de Saúde , Estado Nutricional , Avaliação de Programas e Projetos de Saúde , Fatores Socioeconômicos , Vitamina A/administração & dosagem , Vitamina D/administração & dosagem , Vitaminas/administração & dosagem
14.
Rev Assoc Med Bras (1992) ; 56(5): 572-8, 2010.
Artigo em Inglês, Português | MEDLINE | ID: mdl-21152831

RESUMO

OBJECTIVE: The main objective of this study was to assess the influence of soy protein intake and weight training on resting energy expenditure (REE) in postmenopausal women. METHODS: This 160-week clinical trial enrolled 60 women, with a mean age of 59 (7) years, allocated into four groups: G1 (soy protein plus exercise), G2 (placebo plus exercise), G3 (soy protein and no exercise) and G4 (placebo and no exercise). Soy protein and placebo (maltodextrin) were randomly distributed in powder form in servings of 25 grams/day. Ten weight exercises were performed, three times a week, with three sets of 8-12 repetitions per exercise per session, at a load of 60-80% of the one-repetition maximum (1RM). The REE was calculated from the O2 and CO2 values obtained by indirect calorimetry (Quinton QMC), performed for 30 minutes under controlled temperature and humidity. For statistical analysis, ANOVA, Student t test and multiple regression were performed with the Stata 9.2 software package. Significance was set at p<0.05. RESULTS: The study sample was homogeneous with regard to all variables. Significant increases in REE (p <0.05) were detected in G1 (158 kcal/day, 17%) and G2 (110 kcal/day, 9%), whereas a 4% decrease was detected in G4 (p<0.05). CONCLUSION: Weight training is a determining factor for increased resting energy expenditure in postmenopausal women. This effect can be boosted by dietary consumption of soy protein.


Assuntos
Proteínas Alimentares/farmacologia , Metabolismo Energético/efeitos dos fármacos , Exercício Físico/fisiologia , Pós-Menopausa/efeitos dos fármacos , Descanso/fisiologia , Proteínas de Soja/farmacologia , Análise de Variância , Proteínas Alimentares/administração & dosagem , Metabolismo Energético/fisiologia , Feminino , Humanos , Modelos Lineares , Pessoa de Meia-Idade , Pós-Menopausa/fisiologia , Treinamento Resistido , Proteínas de Soja/administração & dosagem
15.
Rev Saude Publica ; 44(4): 718-25, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20676562

RESUMO

OBJECTIVE: To evaluate working conditions associated with health-related quality of life (HRQL) among nursing providers. METHODS: Cross-sectional study conducted in a university hospital in the city of São Paulo, Southeastern Brazil, during 2004-2005. The study sample comprised 696 registered nurses, nurse technicians and nurse assistants, predominantly females (87.8%), who worked day and/or night shifts. Data on sociodemographic information, working and living conditions, lifestyles, and health symptoms were collected using self-administered questionnaires. The following questionnaires were also used: Job Stress Scale, Effort-Reward Imbalance (ERI) and Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Ordinal logistic regression analysis using proportional odds model was performed to evaluate each dimension of the SF-36. RESULTS: Around 22% of the sample was found to be have high strain and 8% showed an effort-reward imbalance at work. The dimensions with the lowest mean scores in the SF-36 were vitality, bodily pain and mental health. High-strain job, effort-reward imbalance (ERI>1.01), and being a registered nurse were independently associated with low scores on the role emotional dimension. Those dimensions associated to mental health were the ones most affected by psychosocial factors at work. CONCLUSIONS: Effort-reward imbalance was more associated with health than high-strain (high demand and low control). The study results suggest that the joint analysis of psychosocial factors at work such as effort-reward imbalance and demand-control can provide more insight to the discussion of professional roles, working conditions and HRQL of nursing providers.


Assuntos
Recursos Humanos de Enfermagem Hospitalar/psicologia , Qualidade de Vida , Recompensa , Carga de Trabalho/psicologia , Brasil/epidemiologia , Métodos Epidemiológicos , Feminino , Hospitais Universitários , Humanos , Masculino , Saúde Mental/estatística & dados numéricos , Recursos Humanos de Enfermagem Hospitalar/classificação , Estresse Psicológico/epidemiologia , Carga de Trabalho/estatística & dados numéricos
16.
Early Hum Dev ; 86(2): 127-31, 2010 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20181444

RESUMO

OBJECTIVE: To assess the relationship between cortisol concentrations in the last trimester of pregnancy and systemic vascular resistance - SVR in childhood. MATERIALS AND METHODS: This study is part of a cohort involving 130 Brazilian pregnant women and their children, ages 5 to 7years. Maternal cortisol was determined in saliva by an enzyme immunoassay utilizing the mean concentration of 9 samples of saliva (3 in each different day), collected at the same time, early in the morning. SVR was assessed by the HDI/PulseWave CR-2000 Cardiovascular Profiling System(R). Socioeconomic and demographic characteristics and life style factors were determined by a questionnaire. The nutritional status of the women and children was assessed by the body mass index - BMI. The association between maternal cortisol and SVR in childhood was calculated by multivariate linear regression analysis. RESULTS: There were statistically significant associations between maternal cortisol and SVR (p=0.043) and BMI-z score of the children (p=0.027), controlling for maternal BMI, birth weight, age, and gender of the children. CONCLUSION: As far as we know this is the first study in the literature assessing the association between cortisol concentrations in pregnancy and SVR in childhood. Overall, the data suggest that exposure to excess glucocorticoid in the prenatal period is associated to vascular complications in childhood, predisposing to cardiovascular diseases in later life.


Assuntos
Doenças Cardiovasculares/metabolismo , Hidrocortisona/metabolismo , Terceiro Trimestre da Gravidez/metabolismo , Resistência Vascular/fisiologia , Adulto , Índice de Massa Corporal , Brasil/epidemiologia , Doenças Cardiovasculares/epidemiologia , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Idade Gestacional , Humanos , Hidrocortisona/análise , Masculino , Estado Nutricional , Gravidez , Complicações na Gravidez/epidemiologia , Saliva/química , Saliva/metabolismo , Inquéritos e Questionários , Adulto Jovem
17.
Rev. bras. crescimento desenvolv. hum ; 25(1): 89-96, 2015. tab
Artigo em Inglês | LILACS | ID: lil-747951

RESUMO

INTRODUÇÃO: a obesidade vem aumentando, de forma expressiva, em crianças e adolescentes. O aleitamento materno tem sido relacionado como fator preventivo de muitas doenças e, nos últimos anos, tem sido verificado seu papel de proteção contra a obesidade na infânciaOBJETIVO: verificar a prevalência de excesso de peso e sua relação com o aleitamento materno em crianças de 48 a 60 mesesMÉTODO: estudo transversal, no qual foram coletados dados antropométricos de crianças de 48 a 60 meses, de escolas de Município de Minas Gerais, MG, para cálculo de índice de massa corpórea (IMC) e classificação nutricional. Foram coletados, também, dados sobre a duração do aleitamento materno e alimentação atual da criança, além de variáveis demográficas e socioeconômicas. Excesso de peso foi considerado variável desfecho. A variável explanatória principal foi o aleitamento materno e as variáveis de controle foram alimentação atual e as variáveis demográficas e socioeconômicas. A relação entre o desfecho e as variáveis explanatórias foi verificada por meio de regressão de PoissonRESULTADOS: a prevalência de crianças com excesso de peso foi de 9,6%. O aleitamento materno exclusivo (AME) até os 6 meses ou mais foi oferecido a 32,11% das crianças. O estudo aponta uma relação positiva entre a presença de AME e a ausência de excesso de peso em crianças de 48 a 60 meses para a categoria de AME por 6 meses ou mais. Relação semelhante não foi encontrada para o aleitamento materno complementadoCONCLUSÃO: A prevalência do excesso peso das crianças do estudo (9,6%) foi superior a média nacional (7%). O aleitamento materno exclusivo por 6 meses ou mais associou-se à ausência de excesso de peso e o aleitamento materno complementado não apresentou associação com o peso das crianças.


INTRODUCTION: obesity is increasing significantly, even in children and adolescents. Breastfeeding has been implicated as a preventive factor of many diseases and in recent years the protective role of breastfeeding against childhood obesity has been observed OBJECTIVE: to investigate the prevalence of overweight and its relationship with breastfeeding in children aged 48-60 months METHODS: across-sectional study was conducted involving collection of anthropometric data of children aged 48-60 months from public schools of a city located in Minas Gerais-MG, Brazil, for calculation of body mass index (BMI) and nutritional classification. Data on breastfeeding duration and current feeding were also collected, as well as demographic and socioeconomic variables. Overweight was considered the outcome variable. The main explanatory variable was breastfeeding while the control variables were current feeding and demographic and socioeconomic variables. The relationship between the outcome and explanatory variables was assessed using Poisson regression RESULTS: the prevalence of overweight children was 9.6%. Exclusive breastfeeding (EBF) for upto 6 months or loger was given to 32.11% of children. The study showed a positive relationship between the presence of EBF and absence of overweight in children aged 48-60 months for the category EBF for 6 months or longer. A similar relationship was not found for complemented breastfeeding CONCLUSIONS: the prevalence of overweight children in the study (9.6%) was higher than the national average (7%). Exclusive breastfeeding for 6 months or longer was associated with absence of overweight and complemented breastfeeding was not associated with children's weight.


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Aleitamento Materno , Ingestão de Alimentos , Comportamento Alimentar , Estado Nutricional , Obesidade Infantil , Comportamento Sedentário , Urbanização , Antropometria , Índice de Massa Corporal , Estudos Transversais , Fatores Socioeconômicos
18.
Rev Saude Publica ; 43(5): 789-95, 2009 Oct.
Artigo em Inglês, Português | MEDLINE | ID: mdl-19784458

RESUMO

OBJECTIVE: To estimate the prevalence of arterial hypertension among young military personnel and associated factors. METHODS: Cross-sectional study carried out with a sample of 380 male military personnel aged 19 to 35 years of a Brazilian Air Force unit in the city of São Paulo, Southeastern Brazil, in 2000 and 2001. The cut-off points for hypertension were: > or =140 mmHg for systolic pressure and > or = 90 mmHg for diastolic pressure. The studied variables included risk and protective factors for hypertension, such as behavioral and nutritional characteristics. For association analysis, generalized linear model multiple regression was used, with binomial family and logarithmic link, and prevalence ratios were obtained with 90% confidence interval and hierarchical selection of variables. RESULTS: Prevalence of hypertension was 22% (90% CI: 21;29). In the final multiple regression model, it was found that the prevalence of hypertension was 68% higher among ex-smokers when compared to non-smokers (90% CI: 1.13; 2.50). Among subjects with overweight (body mass index - BMI of 25 to 29 kg/m2) and obesity (BMI> 29 kg/m2) the prevalences were, respectively, 75% (90% CI: 1.23;2.50) and 178% (90% CI: 1.82;4.25) higher than among subjects with normal weight. Among those that practiced physical activity regularly, compared to those who did not practice it, the prevalence was 52% lower (90% CI: 0.30;0.90). CONCLUSIONS: Being an ex-smoker and overweight or obese were risk situations for hypertension, while the regular practice of physical activity was a protective factor in young military personnel.


Assuntos
Hipertensão/epidemiologia , Militares/estatística & dados numéricos , Atividade Motora/fisiologia , Sobrepeso/epidemiologia , Fumar/efeitos adversos , Adulto , Pressão Sanguínea , Índice de Massa Corporal , Estudos Transversais , Feminino , Humanos , Hipertensão/etiologia , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/epidemiologia , Prevalência , Fumar/epidemiologia , Adulto Jovem
19.
Rev Saude Publica ; 43(1): 60-9, 2009 Feb.
Artigo em Inglês, Português | MEDLINE | ID: mdl-19169576

RESUMO

OBJECTIVE: To analyze the association of overweight and obesity with breastfeeding and complementary feeding in pre-school children. METHODS: Cross-sectional study with 566 children, enrolled in private schools of the city of São Paulo, Southeastern Brazil, in 2004-2005. The dependent variable was overweight and obesity. Body Mass Index percentile curves were employed to classify children's nutritional status, considering values > or =P85 and or =P95 as obesity. The following explanatory variables were analyzed: child and family socio-demographic characteristics; birth weight; parents' nutritional status; breastfeeding; complementary feeding; and current feeding. Analysis of association between explanatory variables and outcome was performed with simple logistic regression and multiple logistic regression with hierarchical model. RESULTS: Prevalence of overweight and obesity in the population studied was 34.4%. The following were protective factors against overweight and obesity: exclusive breastfeeding for six months or more (95% CI [0.38;0.86]; OR=0.57; p=0.02) and breastfeeding for more than 24 months (95% CI [0.05;0.37]; OR=0.13; p=0.00). CONCLUSIONS: Results suggest that breastfeeding can protect children against overweight and obesity, thus representing yet another advantage of maternal milk.


Assuntos
Aleitamento Materno/estatística & dados numéricos , Fenômenos Fisiológicos da Nutrição do Lactente , Obesidade/prevenção & controle , Fatores Etários , Peso ao Nascer , Índice de Massa Corporal , Brasil/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Estado Nutricional , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Sobrepeso/prevenção & controle , Valores de Referência , Fatores Socioeconômicos , Fatores de Tempo
20.
Arq Bras Cardiol ; 93(5): 498-505, 2009 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-20084312

RESUMO

BACKGROUND: Knowledge on the trends of cardiovascular mortality is important to make hypotheses on its occurrence as well as to support prevention and control measures. OBJECTIVES: To compare mortality for the group of cardiovascular diseases and their main subgroups (ischemic heart diseases and cerebrovascular diseases) in the city of Sao Paulo by age and gender between the periods of 1996 to1998 and 2003 to 2005. METHODS: Data on deaths from the Programa de Aprimoramento das Informações de Mortalidade para o Município(Program of Improvement of Information on Mortality for the City), and population estimates from the SEADE Foundation of the State of Sao Paulo were used. The magnitude of mortality and its changes between the three-year periods were measured using the description of coefficients and relative percentage variation. The Poisson regression model was also used to estimate the change in mortality between the periods. RESULTS: A significant reduction was observed in cardiovascular mortality. The coefficients increased with age in both genders, and were higher in the male population in comparison to the female population, and in the age range of 70 years and older. Mortality coefficients for ischemic heart diseases were higher than those for cerebrovascular diseases among men and women aged 50 years or older. The reduction in the group of cardiovascular diseases was greater among women aged 20 to 29 years (-30%), and among men aged 30 to 39 years (-26%). CONCLUSION: The intensity of cardiovascular mortality decreased between 1996 and 1998, and 2003 and 2005, however with differences between the groups. This reduction may reflect, in part, a greater access to diagnostic and therapeutic methods.


Assuntos
Doenças Cardiovasculares/mortalidade , Adulto , Distribuição por Idade , Idoso , Brasil/epidemiologia , Doenças Cardiovasculares/classificação , Causas de Morte/tendências , Cidades/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição de Poisson , Distribuição por Sexo , Adulto Jovem
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