The tendency of stunting among children under five in the Northern Region of Brazil, according to the Food and Nutrition Surveillance System, 2008-2017

Abstract Objective: To analyze the temporal tendency of stunting prevalence among children under five years of age registered in the Food and Nutritional Surveillance System (SISVAN) in the Brazilian Northern Region, from 2008 to 2017. Methods: Ecological time-series study with data from SISVAN. The annual variation rate for the prevalence of undernutrition, measured by the presence of stunting (low height-for-age index), was estimated for the Northern Region and for each of its states using the Prais-Winsten regression model with and without variable adjustment for SISVAN coverage to explore the relationship between these variables. Results: The Northern Region showed a tendency toward the reduction of chronic child stunting, with an annual variation of -5.30% (95%CI -9.64; -0.77) in the period studied. The states of Acre (-7.19%; 95%CI -12.31; -1.77), Pará (-4.86%; 95%CI -9.44; -0.03), and Tocantins (-6.22%; 95%CI -9.88; -2.41) showed a tendency to reduce the prevalence of stunting, while the other four states showed stability during the period. A strong negative correlation was found between SISVAN coverage and the prevalence of stunting in the states of Acre (beta: -0.725), Amazonas (beta: -0.874), Pará (beta: -0.841), and Tocantins (beta: -0.871), indicating that the increase in system coverage is associated with a reduction of stunting. Conclusions: There is a tendency toward a reduction in the prevalence of stunting particularly in three states and in the North Region as a whole, from 2008 to 2017. The coverage by the system was associated with a reduction in the prevalence of child stunting in four states.

The tendency of stunting among children under five in the Northern Region of Brazil, according to the Food and Nutrition Surveillance System, 2008-2017.

OBJECTIVE: To analyze the temporal tendency of stunting prevalence among children under five years of age registered in the Food and Nutritional Surveillance System (SISVAN) in the Brazilian Northern Region, from 2008 to 2017. METHODS: Ecological time-series study with data from SISVAN. The annual variation rate for the prevalence of undernutrition, measured by the presence of stunting (low height-for-age index), was estimated for the Northern Region and for each of its states using the Prais-Winsten regression model with and without variable adjustment for SISVAN coverage to explore the relationship between these variables. RESULTS: The Northern Region showed a tendency toward the reduction of chronic child stunting, with an annual variation of -5.30% (95%CI -9.64; -0.77) in the period studied. The states of Acre (-7.19%; 95%CI -12.31; -1.77), Pará (-4.86%; 95%CI -9.44; -0.03), and Tocantins (-6.22%; 95%CI -9.88; -2.41) showed a tendency to reduce the prevalence of stunting, while the other four states showed stability during the period. A strong negative correlation was found between SISVAN coverage and the prevalence of stunting in the states of Acre (beta: -0.725), Amazonas (beta: -0.874), Pará (beta: -0.841), and Tocantins (beta: -0.871), indicating that the increase in system coverage is associated with a reduction of stunting. CONCLUSIONS: There is a tendency toward a reduction in the prevalence of stunting particularly in three states and in the North Region as a whole, from 2008 to 2017. The coverage by the system was associated with a reduction in the prevalence of child stunting in four states.

Vigilância epidemiológica da desnutrição infantil na Região Norte brasileira de 2008 a 2017 / Surveillance of child malnutrition in the Brazilian Northern Region from 2008 to 2017

Introdução - A desnutrição crônica infantil é considerada um problema de saúde pública nos primeiros anos de vida por sua magnitude e consequência nas taxas de morbidade e mortalidade infantil. Objetivos - Mapear e sistematizar a produção científica sobre desnutrição crônica infantil nos estados da Região Norte e analisar a tendência temporal da cobertura do Sistema de Vigilância Alimentar e Nutricional Web e da desnutrição crônica infantil em menores de cinco anos, no contexto da atenção primária em saúde da Região Norte brasileira, no período de 2008 a 2017. Metodologia - Realizaram-se duas estratégias metodológicas: revisão sistemática de escopo sobre o déficit de crescimento infantil na Região Norte e fatores associados e dois estudos ecológicos com análise de série temporal da cobertura do índice altura por idade e da prevalência da desnutrição infantil (altura por idade), segundo o Sistema de Vigilância Alimentar e Nutricional Web (SISVAN) do Sistema Único de Saúde, no período de 2008 a 2017. A variação percentual anual (VPA) da cobertura do SISVAN e da prevalência de desnutrição entre menores de cinco anos foram estimadas pelo modelo de regressão de Prais-Winsten, segundo Região Norte, estados e regionais de saúde. Resultados - No estudo de revisão, identificou-se 1.509 documentos, sendo selecionados 34 artigos e documentos técnicos ao final. Dos estudos analisados, a maioria foi realizada no estado do Acre e seis eram de âmbito nacional, mas tinham dados desagregados para a Região Norte. A prevalência descrita pelos autores apontou altas taxas de desnutrição infantil por déficit de crescimento, principalmente em crianças indígenas, nascidas de mães com baixa escolaridade, do sexo masculino e maiores de dois anos de idade, bem como residir na Região Norte. No estudo ecológico de série temporal, observou-se que as coberturas do SISVAN, entre 2008 e 2017, tiveram uma tendência de crescimento na Região Norte, em todos os estados e regionais de saúde, exceto a Regional de Café no estado de Rondônia que apresentou tendência estável. O estado do Acre foi o que apresentou maior variação percentual anual positiva na cobertura do SISVAN. Em relação à tendência temporal da prevalência de desnutrição crônica infantil, observou-se que a Região Norte e os Estados Acre, Pará e Tocantins, apresentaram tendência de redução da prevalência de déficit de altura-para-idade (DAI), enquanto os demais apresentaram estabilidade durante o período. Foi encontrada forte correlação negativa entre a cobertura do SISVAN Web e a prevalência de DAI nos Estados do Amazonas, Pará, Tocantins e Acre, indicando que o aumento da cobertura do sistema está associado à redução da prevalência de DAI. Conclusão: a Revisão de Escopo retrata que a desnutrição crônica infantil ainda é um problema de saúde pública na Região Norte, principalmente em crianças indígenas. Houve aumento da cobertura do SISVAN Web na Região Norte. Ademais, houve tendência de redução da prevalência de DAI em apenas três Estados da Região Norte entre 2008 e 2017. A cobertura do sistema se associou à redução da prevalência de desnutrição infantil em quatro Estados.

Introduction: chronic child malnutrition is considered a public health problem in the early years of life because of its magnitude and consequence in infant morbidity and mortality rates. Objectives: to map and to systematize the scientific production on chronic child malnutrition in the states of the Northern Region and to analyze the temporal trend of the coverage of the Web Food and Nutrition Surveillance System and chronic child malnutrition in children under five years old, in the context of primary care. in the North of Brazil, from 2008 to 2017. Methodology: Two methodological strategies were carried out: systematic scope review on child growth deficit in the Northern Region and associated factors, and two ecological studies with time series analysis of height-by-age coverage and prevalence of child malnutrition. (height by age), according to the Unified Health System's Web Food and Nutritional Surveillance System (SISVAN), from 2008 to 2017. The annual percentage variation (APV) in SISVAN coverage and the prevalence of malnutrition among children under five-year-old were estimated by the Prais-Winsten regression model, according to Northern Region, states and regional health. Results: In the review study, 1,509 documents were identified, and 34 articles and technical documents were selected at the end. Of the studies analyzed, most were conducted in the state of Acre and six were conducted nationwide, but they had disaggregated data for the Northern Region. The prevalence described by the authors pointed to high rates of childhood malnutrition due to growth deficit, especially in indigenous children born to mothers with low education, male and over two years old, as well as living in the Northern Region. In the time series ecological study, it was observed that the coverage of SISVAN, between 2008 and 2017, had a growing trend in the Northern Region, in all states and regional health, except the Coffee Regional in the state of Rondônia which presented stable trend. The state of Acre had the highest positive annual percentage variation in SISVAN coverage. Regarding the temporal trend of the prevalence of chronic childhood malnutrition, it was observed that the Northern Region and the States Acre, Pará and Tocantins showed a tendency to reduce the prevalence of height-for-age deficit (HAD), while the others showed stability during the period. A strong negative correlation was found between SISVAN Web coverage and HAD prevalence in the states of Amazonas, Pará, Tocantins, and Acre, indicating that increased system coverage is associated with reduced prevalence of HAD. Conclusion: The Scope of Review depicts that chronic childhood malnutrition is still a public health problem in the Northern Region, especially in indigenous children. Regarding the coverage of SISVAN Web, it was observed that there was a temporal increase in the analyzed period. In addition, in the case of case of chronic childhood malnutrition, there was a trend of reduction in prevalence in only three. The increased SISVAN Web coverage was negatively associated with the reduced of the prevalence of child malnutrition in four states.

Association between single nucleotide polymorphisms in TLR4, TLR2, TLR9, VDR, NOS2 and CCL5 genes with acute viral bronchiolitis.

BACKGROUND: Acute viral bronchiolitis is the leading cause of hospitalization among infants during the first year of life. Most infants hospitalized for bronchiolitis do not present risk factors and are otherwise healthy. Our objective was to determine the genetic features associated with the risk and a severe course of bronchiolitis. METHODS: We prospectively evaluated 181 infants with severe bronchiolitis admitted at three hospitals over a 2-year period, who required oxygen therapy. The control group consisted of 536 healthy adults. Patients were evaluated for the presence of comorbidities (premature birth, chronic respiratory disease, and congenital heart disease), underwent nasopharyngeal aspirate testing for virus detection by multiplex-PCR, and SNPs identification in immune response genes. Patient outcomes were assessed. RESULTS: We observed association between SNP rs2107538*CCL5 and bronchiolitis caused by respiratory syncytial virus(RSV) and RSV-subtype-A, and between rs1060826*NOS2 and bronchiolitis caused by rhinovirus. SNPs rs4986790*TLR4, rs1898830*TLR2, and rs2228570*VDR were associated with progression to death. SNP rs7656411*TLR2 was associated with length of oxygen use; SNPs rs352162*TLR9, rs187084*TLR9, and rs2280788*CCL5 were associated with requirement for intensive care unit admission; while SNPs rs1927911*TLR4, rs352162*TLR9, and rs2107538*CCL5 were associated with the need for mechanical ventilation. CONCLUSIONS: Our findings provide some evidence that SNPs in CCL5 and NOS2 are associated with presence of bronchiolitis and SNPs in TLR4, TLR2, TLR9, VDR and CCL5 are associated with severity of bronchiolitis.

Influence of thoracic spine postural disorders on cardiorespiratory parameters in children and adolescents with cystic fibrosis.

OBJECTIVES: To assess the impact of increased thoracic kyphosis on pulmonary function and functional capacity in children and adolescents with cystic fibrosis (CF) and to verify the influence of disease severity, age and nutritional status on this deformity. METHOD: This was a cross-sectional, analytical study conducted at a university hospital. It included CF patients with confirmed diagnosis and without pulmonary exacerbation. The sample was submitted to postural assessment, spirometry (FEV1, FVC and FEV1/FVC) and 6-minute walk test distance (6-MWT distance). Data were analyzed using the Mann Whitney test, Spearman correlation and logistic regression. RESULTS: Forty-two patients were enrolled, 61.9% presented increase of thoracic kyphosis. There was no difference in values of FEV1, FVC, FEV1/FVC and 6-MWT distance between the groups with or without thoracic kyphosis (p = 0.407; p = 0.756; p = 0.415; p = 0.294). In the group without alteration, patients with more disease severity had a mean FEV1 of 74.1±21.9% and FVC of 79.8±18.7% while in those of lesser severity higher values were found (95.6±12.2% and 97.6±13.2%, respectively) (p = 0.027 and p = 0.027). The presence of kyphosis was correlated with age (p = 0.048) but not with severity (p = 0.151) and body mass index (p = 0.088). CONCLUSIONS: There was a high prevalence of increased thoracic kyphosis in children and adolescents with CF. The deformity did not affect pulmonary function and functional capacity and there was no relationship with disease severity. Regardless of posture, worsening of disease severity determined worsening of pulmonary function.

Influência da alteração postural da coluna torácica em parâmetros cardiorrespiratórios de crianças e adolescentes com fibrose cística / Influence of thoracic spine postural disorders on cardiorespiratory parameters in children and adolescents with cystic fibrosis

OBJETIVOS: Avaliar a repercussão do aumento da cifose torácica na função pulmonar e na capacidade funcional de crianças e adolescentes com fibrose cística e verificar a influência da gravidade da doença, idade e aspectos nutricionais sobre essa deformidade. MÉTODO: Estudo analítico de corte transversal, realizado em um hospital universitário. Incluiu fibrocísticos com diagnóstico confirmado e fora de exacerbação pulmonar. A amostra foi submetida à avaliação postural, registro de parâmetros espirométricos - volume expiratório forçado no primeiro segundo (VEF1), capacidade vital forçada (CVF) e VEF1/CVF - e da distância percorrida pelo teste de caminhada de 6 minutos. Para análise dos dados, utilizou-se teste de Mann-Whitney, correlação de Spearman e regressão logística, considerando-se nível de significância de 5%. RESULTADOS: No total, 42 pacientes foram incluídos, e 61,9% apresentaram aumento da cifose torácica. Não houve diferença nos valores de VEF1, CVF, VEF1/CVF e distância percorrida pelo teste de caminhada de 6 minutos entre os grupos com e sem cifose torácica (p = 0,407; p = 0,756; p = 0,415; p = 0,294). No grupo sem alteração postural, fibrocísticos mais graves apresentaram média de VEF1 de 74,1±21,9% e CVF de 79,8±18,7%, enquanto naqueles de menor gravidade foram verificados valores superiores (95,6±12,2% e 97,6±13,2%, respectivamente) (p = 0,027 e p = 0,027). A presença de cifose correlacionou-se com a idade (p = 0,048), mas não com a gravidade (p = 0,151) e o índice de massa corporal (p = 0,088). CONCLUSÕES: Observou-se uma alta prevalência de aumento da cifose torácica em crianças e adolescentes com fibrose cística. Essa deformidade não alterou a função pulmonar e a capacidade funcional e não teve relação com a gravidade da doença. Independentemente da postura, a piora da gravidade da doença determinou piora da função pulmonar.

OBJECTIVES: To assess the impact of increased thoracic kyphosis on pulmonary function and functional capacity in children and adolescents with cystic fibrosis (CF) and to verify the influence of disease severity, age and nutritional status on this deformity. METHOD: This was a cross-sectional, analytical study conducted at a university hospital. It included CF patients with confirmed diagnosis and without pulmonary exacerbation. The sample was submitted to postural assessment, spirometry (FEV1, FVC and FEV1/FVC) and 6-minute walk test distance (6-MWT distance). Data were analyzed using the Mann Whitney test, Spearman correlation and logistic regression. RESULTS: Forty-two patients were enrolled, 61.9% presented increase of thoracic kyphosis. There was no difference in values of FEV1, FVC, FEV1/FVC and 6-MWT distance between the groups with or without thoracic kyphosis (p = 0.407; p = 0.756; p = 0.415; p = 0.294). In the group without alteration, patients with more disease severity had a mean FEV1 of 74.1±21.9% and FVC of 79.8±18.7% while in those of lesser severity higher values were found (95.6±12.2% and 97.6±13.2%, respectively) (p = 0.027 and p = 0.027). The presence of kyphosis was correlated with age (p = 0.048) but not with severity (p = 0.151) and body mass index (p = 0.088). CONCLUSIONS: There was a high prevalence of increased thoracic kyphosis in children and adolescents with CF. The deformity did not affect pulmonary function and functional capacity and there was no relationship with disease severity. Regardless of posture, worsening of disease severity determined worsening of pulmonary function.