Risk Factors for Adopting Extreme Weight-Control Behaviors among Public School Adolescents in Salvador, Brazil: A Case-Control Study.

OBJECTIVE: This study identifies the risk factors for extreme weight-control behaviors among adolescents in public school in Salvador, northeastern Brazil. METHODS: A case-control study nested to a cross-sectional study, including 252 adolescents of both sexes, age between 11 to 17 years, with 84 cases and 168 age-matched controls was conducted. The variable outcome is represented by extreme weight-control behaviors, integrated by following the variables: self-induced vomiting and the use of laxatives, diuretics, or diet pills. Covariables included body image dissatisfaction, dieting, prolonged fasting, and self-perception of body weight. The study also investigated the demographic and anthropometric variables and economic conditions of the students' families. Conditional logistic regression was used to identify risk factors for the adoption of extreme weight-control behaviors among adolescents. RESULTS: Among the adolescents investigated, the conditional logistic regression explained 22% the occurrence of extreme weight-control behaviors and showed that these behaviors were positively associated to overweight (odds ratio [OR] = 3.61; 95% confidence interval [CI], 1.42-9.17), body image dissatisfaction (OR = 3.87; 95% CI, 1.75-8.54), and the adoption of a restrictive diet (OR = 2.83; 95% CI, 1.16-6.91). CONCLUSIONS: The results of this study suggest that among adolescents, overweight, body image dissatisfaction, and restrictive diet are important risk factors to adoption of extreme weight-control behaviors.

Nutritional status of indigenous children: findings from the First National Survey of Indigenous People's Health and Nutrition in Brazil.

INTRODUCTION: The prevalence of undernutrition, which is closely associated with socioeconomic and sanitation conditions, is often higher among indigenous than non-indigenous children in many countries. In Brazil, in spite of overall reductions in the prevalence of undernutrition in recent decades, the nutritional situation of indigenous children remains worrying. The First National Survey of Indigenous People's Health and Nutrition in Brazil, conducted in 2008-2009, was the first study to evaluate a nationwide representative sample of indigenous peoples. This paper presents findings from this study on the nutritional status of indigenous children < 5 years of age in Brazil. METHODS: A multi-stage sampling was employed to obtain a representative sample of the indigenous population residing in villages in four Brazilian regions (North, Northeast, Central-West, and Southeast/South). Initially, a stratified probabilistic sampling was carried out for indigenous villages located in these regions. Households in sampled villages were selected by census or systematic sampling depending on the village population. The survey evaluated the health and nutritional status of children < 5 years, in addition to interviewing mothers or caretakers. RESULTS: Height and weight measurements were taken of 6,050 and 6,075 children, respectively. Prevalence rates of stunting, underweight, and wasting were 25.7%, 5.9%, and 1.3%, respectively. Even after controlling for confounding, the prevalence rates of underweight and stunting were higher among children in the North region, in low socioeconomic status households, in households with poorer sanitary conditions, with anemic mothers, with low birthweight, and who were hospitalized during the prior 6 months. A protective effect of breastfeeding for underweight was observed for children under 12 months. CONCLUSIONS: The elevated rate of stunting observed in indigenous children approximates that of non-indigenous Brazilians four decades ago, before major health reforms greatly reduced its occurrence nationwide. Prevalence rates of undernutrition were associated with socioeconomic variables including income, household goods, schooling, and access to sanitation services, among other variables. Providing important baseline data for future comparison, these findings further suggest the relevance of social, economic, and environmental factors at different scales (local, regional, and national) for the nutritional status of indigenous peoples.

The prevalence of wheezing and its association with body mass index and abdominal obesity in children.

OBJECTIVE: To evaluate the relative importance of body mass index (BMI) and abdominal obesity in the prevalence of wheezing in Brazilian children. MATERIALS AND METHODS: This is a cross-sectional study of male and female students, 6-12 years old, from the public elementary schools of São Francisco do Conde, Bahia, Northeast Brazil. Reports of wheezing in the past 12 months were collected using a questionnaire from the International Study of Asthma and Allergies in Childhood Program (ISAAC) phase III, adapted to Portuguese. Anthropometric, demographic, and socioeconomic information was collected. Multivariate logistic regression analyses were used to assess the associations of interest. RESULTS: Of the children surveyed, 10.6% reported wheezing. Excess weight was observed in 16.2%, 10.5%, and 7.9% of the sample, measured by BMI, waist circumference (WC), and the waist-to-height ratio (WHtR), respectively. The percentage of patients with wheezing attributable to BMI ≥ 85th percentile (8.2%) slightly exceeded those identified with abdominal obesity, WC ≥ 80th percentile (7.3%) and WHtR > 0.5 (7.1%). CONCLUSION: The results suggest that an excess of fat deposits, either in the abdominal region or elsewhere in the body, increased the risk of wheezing. Since obesity is an important public health problem worldwide, control of this problem may partially reduce the occurrence of wheezing in youth.

[Body image is associated with anthropometric status in adolescents, but not with lifestyle]. / Imagem corporal está associada com estado antropométrico em adolescentes, mas não com estilo de vida.

Body image is a construct of the multifaceted representation of body identity that involves self-perception, beliefs, attitudes about the body itself, which can be influenced by several factors. This study evaluated the association of body image with anthropometric and lifestyle indicators among adolescents. The sample comprised 465 adolescents aged 10 to 17 years from public schools in the city of Salvador-Bahia. The Silhouettes Scale assessed the body image. The anthropometric data (body mass index and waist circumference), the lifestyle (Physical Activity Questionnaire for Adolescents and television time), economic and demographic data were evaluated. Polytomous logistic regression assessed associations of interest by STATA, version 16.0. Overweight (OR:9,7; CI95%:5,4-17,5) and abdominal obesity (OR:14,0; CI95%: 5,0-39,3) were positively associated with body dissatisfaction. However, there was no association with lifestyle variables (physical activity: OR: 1,7, CI: 0,9-2,9, and TV time: OR:1,2; CI:0,8-1,9). The conclusion reached is that anthropometric status is an essential indicator of adverse body image outcomes in adolescents.

A imagem corporal é um constructo da representação multifacetada da identidade corporal, envolve autopercepção, crenças e atitudes sobre o próprio corpo, podendo ser influenciada por diversos fatores. Este estudo avaliou a associação da imagem corporal com indicadores antropométricos e do estilo de vida em adolescentes. Constituíram a amostra 465 adolescentes de 10 a 17 anos de escolas públicas da cidade de Salvador, na Bahia. A imagem corporal foi avaliada pela Escala de Silhuetas. Os dados antropométricos (índice de massa corporal e a circunferência da cintura), de estilo de vida (Physical Activity Questionnaire for Adolescents e o tempo de televisão), econômicos e demográficos foram avaliados. Regressão logística politômica avaliou as associações de interesse. Os dados foram analisados pelo software STATA, versão 16.0. O sobrepeso/obesidade (OR: 9,7; IC95%: 5,4-17,5) e a obesidade abdominal (OR: 14,0; IC95%: 5,0-39,3) se mostraram positivamente associados à insatisfação corporal, mas não foi observada associação com as variáveis de estilo de vida (atividade física: OR: 1,7; IC95%: 0,9-2,9; e tempo de TV: OR: 1,2; IC95%: 0,8-1,9). Conclui-se que o estado antropométrico é um importante indicador dos desfechos negativos da imagem corporal em adolescentes.

Anthropometric status and lipid profile among children and adolescents: Changes after 18-month follow-up.

BACKGROUND & AIMS: Overweight children and adolescents are more likely to evolve with high cholesterol, be obese adults and develop cardiovascular disease. The objective of this study was to identify the influence of anthropometric status on the changes in the lipid profile of children and adolescents during an 18-month follow-up period. METHODS: A cohort study involving 540 boys and girls from 7 to 15 years of age was conducted over 18 months' follow-up. The outcome variables were the lipid indicators and the principal exposure variable was anthropometric status, measured by different indicators. A generalized estimating equation (GEE) approach was used to identify the associations of interest. RESULTS: Irrespective of age, sex, socio-economic status, physical activity and diet, for each gain of 1 cm in the waist circumference (WC) mean in the adjusted model, triglyceride levels increased by a mean of 0.5 mg/dl (p < 0.000) and there was an increase of 0.21 mg/dL in the total cholesterol after the 18-month period. The increase of 0.1 in the mean body mass index (BMI) Z-score promoted a gain of 2.7 mg/dL in the triglycerides mean levels (p < 0.000) and an increase of 1.5 mg/dL in the total cholesterol mean levels (p = 0.014) after the follow-up period. Regarding the waist-to-height ratio (WHtR) and conicity index (CI), an increment of 40.6 mg/dL (p = 0.02) and of 30.1 mg/dL (p = 0.01) was observed in the triglycerides' mean when the participants increased 0.1 in the WHtR mean and CI mean, and the same was observed in the total cholesterol mean, with an increase of 45.4,g/dL (p = 0.02) and 19.3 mg/dL (p = 0.03), for each indicator, respectively. Changes of the traditional anthropometric indicators (WC and BMI) did not promote variations in the mean levels of LDL-cholesterol. HDL-cholesterol was not influenced by the changes in the anthropometric indicators. CONCLUSIONS: At the baseline, a higher triglyceride mean and lower levels of HDL-c were observed in children and adolescents with altered anthropometric status for all measures. Mean triglyceride and total cholesterol levels are influenced by changes in the anthropometric status, regardless of the measure, after 18 months of follow-up. However, for LDL-cholesterol, it was observed that changes in the traditional anthropometric indicators (WC and BMI) did not promote variations in the mean levels of this biochemical variable, while HDL-c was not influenced by changes in any of the anthropometric indicators.

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.

Imagem corporal está associada com estado antropométrico em adolescentes, mas não com estilo de vida / Body image is associated with anthropometric status in adolescents, but not with lifestyle

Resumo A imagem corporal é um constructo da representação multifacetada da identidade corporal, envolve autopercepção, crenças e atitudes sobre o próprio corpo, podendo ser influenciada por diversos fatores. Este estudo avaliou a associação da imagem corporal com indicadores antropométricos e do estilo de vida em adolescentes. Constituíram a amostra 465 adolescentes de 10 a 17 anos de escolas públicas da cidade de Salvador, na Bahia. A imagem corporal foi avaliada pela Escala de Silhuetas. Os dados antropométricos (índice de massa corporal e a circunferência da cintura), de estilo de vida (Physical Activity Questionnaire for Adolescents e o tempo de televisão), econômicos e demográficos foram avaliados. Regressão logística politômica avaliou as associações de interesse. Os dados foram analisados pelo software STATA, versão 16.0. O sobrepeso/obesidade (OR: 9,7; IC95%: 5,4-17,5) e a obesidade abdominal (OR: 14,0; IC95%: 5,0-39,3) se mostraram positivamente associados à insatisfação corporal, mas não foi observada associação com as variáveis de estilo de vida (atividade física: OR: 1,7; IC95%: 0,9-2,9; e tempo de TV: OR: 1,2; IC95%: 0,8-1,9). Conclui-se que o estado antropométrico é um importante indicador dos desfechos negativos da imagem corporal em adolescentes.

Abstract Body image is a construct of the multifaceted representation of body identity that involves self-perception, beliefs, attitudes about the body itself, which can be influenced by several factors. This study evaluated the association of body image with anthropometric and lifestyle indicators among adolescents. The sample comprised 465 adolescents aged 10 to 17 years from public schools in the city of Salvador-Bahia. The Silhouettes Scale assessed the body image. The anthropometric data (body mass index and waist circumference), the lifestyle (Physical Activity Questionnaire for Adolescents and television time), economic and demographic data were evaluated. Polytomous logistic regression assessed associations of interest by STATA, version 16.0. Overweight (OR:9,7; CI95%:5,4-17,5) and abdominal obesity (OR:14,0; CI95%: 5,0-39,3) were positively associated with body dissatisfaction. However, there was no association with lifestyle variables (physical activity: OR: 1,7, CI: 0,9-2,9, and TV time: OR:1,2; CI:0,8-1,9). The conclusion reached is that anthropometric status is an essential indicator of adverse body image outcomes in adolescents.

The relative influence of polyparasitism, environment, and host factors on schistosome infection.

Where prevalence of geohelminths and schistosomes is high, co-infections with multiple parasite species are common. Previous studies have shown that the presence of geohelminths either promotes or is a marker for greater prevalence and intensity of Schistosoma mansoni infections. Some of this apparent synergy may simply represent shared conditions for exposure, such as poor sanitation, and may not suggest a direct biologic interaction. We explored this question in a study of 13,279 school children in Jequié, Bahia, Brazil, with a survey of demographic characteristics and stool examinations. Cross-sectional analysis revealed a statistically significant increase in the prevalence and intensity of S. mansoni infection with increasing numbers of geohelminth species (OR 2.5, 95% CI 1.38-3.64). Less than 20% of the strength of this association was contributed by socioeconomic status or environmental conditions. Thus, polyparasitism itself, as well as intrinsic host factors, appears to produce greater susceptibility to additional helminth infections.

Hypertriglyceridemic Waist Phenotype and Changes in the Fasting Glycemia and Blood Pressure in Children and Adolescents Over One-Year Follow-Up Period.

BACKGROUND:: The hypertriglyceridemic waist (HTW) phenotype is defined as the simultaneous presence of increased waist circumference (WC) and serum triglycerides (TG) levels and it has been associated with cardiometabolic risk in children and adolescents. OBJECTIVE:: The objective was to evaluate the influence of HTW phenotype in the fasting glycemia and blood pressure in children and adolescents over one-year follow-up period. METHODS:: It is a cohort study involving 492 children and adolescents from 7 to 15 years old, both genders, who were submitted to anthropometric, biochemical and clinical evaluation at the baseline, and also after 6 and 12 months of follow-up. Generalized Estimating Equation (GEE) models were calculated to evaluate the longitudinal influence of the HTW phenotype in the glycemia and blood pressure over one-year. RESULTS:: It was observed a prevalence of 10.6% (n = 52) of HTW phenotype in the students. The GEE models identified that students with HTW phenotype had an increase of 3.87 mg/dl in the fasting glycemia mean (CI: 1.68-6.05) and of 3.67mmHg in the systolic blood pressure (SBP) mean (CI: 1.55-6.08) over one-year follow-up, after adjusting for confounding variables. CONCLUSIONS:: The results of this study suggest that HTW phenotype is a risk factor for longitudinal changes in glycemia and SBP in children and adolescents over one-year follow-up period. FUNDAMENTO:: O fenótipo de cintura hipertrigliceridêmica (CHT) é definido como a presença simultânea de circunferência de cintura (CC) e níveis séricos de triglicérides (TG) aumentados e tem sido associado com risco cardiometabólico em crianças e adolescentes. OBJETIVO:: Avaliar a influência do fenótipo CHT na glicemia de jejum e na pressão arterial em crianças e adolescentes em um período de acompanhamento de um ano. MÉTODOS:: Trata-se de um estudo de coorte envolvendo 492 crianças e adolescentes de 7 a 15 anos de ambos os sexos, que foram submetidos à avaliação antropométrica, bioquímica e clínica no início e também após 6 e 12 meses de seguimento. Os modelos de Equação de Estimulação Generalizada (GEE) foram calculados para avaliar a influência longitudinal do fenótipo CHT na glicemia e na pressão arterial ao longo de um ano. RESULTADOS:: Foi observada uma prevalência de 10,6% (n = 52) do fenótipo CHT nos estudantes. Os modelos GEE identificaram que os estudantes com fenótipo CHT apresentaram aumento de 3,87 mg/dl na média de glicemia em jejum (IC: 1,68-6,05) e de 3,67 mmHg na pressão arterial sistólica media (PAS) (IC: 1,55-6,08) depois de um ano de acompanhamento, após ajuste para variáveis de confusão. CONCLUSÕES:: Os resultados deste estudo sugerem que o fenótipo CHT é um fator de risco para alterações longitudinais da glicemia e da PAS em crianças e adolescentes em um período de um ano de seguimento.

[Determinants of weight and linear growth deficits in children under two years of age]. / Determinantes dos déficits ponderal e de crescimento linear de crianças menores de dois anos.

OBJECTIVE: To identify determinants of protein-energy malnutrition resulting in weight and linear growth deficits in children. METHODS: A cross-sectional study was carried out among 1,041 children (under two years of age) from 10 municipalities in Bahia, Northeastern Brazil, during 1999-2000. Both logistic regression and a hierarchical approach were used to identify factors associated with the anthropometric measures. RESULTS: The basic determinant found in the final model for linear growth retardation was having up to two household appliances (OR=2.9; 95% CI: 1.74-4.90); as an underlying determinant, not attending prenatal visits (OR=2.7; 95% CI: 1.47-4.97); and, among immediate determinants were low birth weight (OR=3.6; 95% CI: 1.72-7.70) and reported hospitalization within 12 months before the interview (OR=2.4; 95% CI: 1.42-4.10). Determinants of weight deficit at the basic, underlying and immediate levels were: per capita monthly income of less than one-fourth of the minimum wage (OR=3.4; 95% CI: 1.41-8.16), not attending prenatal visits (OR=2.1; 95% CI: 1.03-4.35) and low birth weight (OR=4.8; 95% CI: 2.00-11.48) respectively. CONCLUSIONS: Children's weight and linear deficits were accounted for the overlapping of poor material living conditions, limited access to health care and disease burden. Interventions aimed at improving living conditions and better access to health care programs are strategies towards equity in children's health and nutrition.

Symptoms of asthma and associated factors in adolescents from Salvador, Bahia. / Sintomas de asma e fatores associados em adolescentes de Salvador, Bahia.

OBJECTIVE: Identify the factors associated with asthma symptoms in adolescents. METHODS: Cross-sectional study with the participation of 1,176 students between the ages of 11 and 17 years old, in Salvador, Bahia, Brazil. The asthma symptoms were identified by using the standardized questionnaire from The International Study of Asthma and Allergies in Childhood Program (ISAAC), phase III. The subjects' food intake data were collected by a semiquantitative food frequency questionnaire (FFQ) comprised of 97 food items. All of the information was collected during a single interview. Anthropometric, socioeconomic, and demographic data were collected from the study population. The robust Poisson model was adopted to obtain the raw and adjusted PR (prevalence ratio). RESULTS: From the total number of adolescents, 57.6% are female and 83.71% of them were between 13 and 17 years old. The prevalence of asthma symptoms was of 7.6%, being higher among males (9.62%). The prevalence of wheezing in the last 12 months was 8.6%. Among the adolescents with rhinitis and eczema, the prevalence of asthma symptoms was of 15.2 and 14.3%, respectively. After an adjusted analysis, the following factors were identified: females PR = 0.64 (95%CI 0.42 - 0.96), rhinitis PR = 3.23 (95%CI 2.17 - 4.83) and the 2nd tertile of the healthy pattern (moderate consumption) PR = 0.61 (95%CI 0.37 - 0.99). CONCLUSION: Rhinitis and eczema were presented as risk factors for asthma symptoms. The healthy food intake pattern that had been stratified in tertiles, presented the 2nd tertile as a protector for asthma symptoms.

Association between gestational weight gain and birth weight: NISAMI Cohort / Associação entre ganho ponderal na gestação e peso ao nascer: Coorte NISAMI

Abstract Objectives: this study aims to evaluate the association between gestational weight gain and the weight of newborns from one municipality in Recôncavo Baiano region. Methods: this is a prospective cohort (NISAMI Cohort), conducted with 185 pregnant women living in the urban area of the municipality of Santo Antônio de Jesus, using the prenatal service of the Family Health Units, between April 2012 and June 2013. The pregestationalBMI and the third trimester of pregnancy were used to assess maternal anthropometric status.Birth weight data were collected from the Epidemiological Surveillance of the municipality. Stata 12.0 software was used for statistical analysis. Logistic regression analysis was used to evaluate to assess the association. Results: among the 185 women evaluated, 33.5% presented inadequate weight gain during pregnancy. The prevalence of inadequate birth weight was 20% (birth weight ≤ 2.999g and ≥ 4.000 g). It was observed that inadequate weight gain during pregnancy is considered an embarrassing factor for birth weight (OR= 2.6; CI95%= 1.5-3.5); adjusted for the following variables: alcohol consumption, duration of pregnancy, and gestational complications. Conclusion: the research results suggest that weight gain throughout pregnancy influences the weight of the conceptus, indicating the need for nutritional interventions in all trimesters of pregnancy, promoting a healthy weight gain throughout the gestational cycle.

Resumo Objetivos: avaliar a associação entre ganho ponderal na gestação e o peso de recém-nascidos em um município do Recôncavo Baiano. Métodos: trata-se de uma coorte prospectiva (Coorte NISAMI), conduzida com 185 gestantes residentes na zona urbana do município de Santo Antônio de Jesus, captadas no serviço de pré-natal das Unidades de Saúde da Família, entre abril de 2012 a junho de 2013. O IMC pré-gestacional e do terceiro trimestre da gestação foram utilizados para avaliar o estado antropométrico materno. Os dados de peso ao nascer foram coletados da Vigilância Epidemiológica do município. Utilizou-se o software Stata 12.0 para as análises estatísticas. Empregou-se análise de regressão logística para avaliar a associação. Resultados: das 185 mulheres, 33,5% apresentaram ganho ponderal inadequado ao longo da gestação. A prevalência de peso inadequado ao nascer foi de 20% (peso ao nascer ≤2.999g e ≥ 4.000 g). Observou-se que o ganho de peso inadequado no período gestacional é considerado fator constrangedor do peso ao nascer (OR= 2,6; IC95%= 1,5-3,5; ajustado pelas variáveis: consumo de bebida alcoólica, duração da gestação e intercorrências gestacionais. Conclusão: o resultado desta investigação sugere que o ganho de peso ao longo da gestação exerce influência no peso do concepto indicando necessidade de intervenções nutricionais em todos os trimestres da gestação, promovendo um ganho ponderal saudável em todo ciclo gestacional.

Serologic screening of celiac disease in adolescents.

OBJECTIVE: This study aimed to identify the seroprevalence of celiac disease in adolescents from public schools in the city of Salvador, Bahia. METHODS: This was a cross-sectional study with probabilistic sample of 1,213 adolescents, aged 11 to 17 years old, of both genders. The body mass index was used to determine the participants' nutritional status based on the percentiles for age and gender recommended by the World Health Organization. Measurement of the anti-human transglutaminase immunoglobulin A (anti-tTG-IgA) antibody was established as the specific screening test for celiac disease, which involved an enzyme-linked immunosorbent assay (ELISA). Descriptive analysis was performed using proportions and means (standard deviation). RESULTS: The female gender prevailed in the sample, and most of the participants had normal weights. The anti-tTG-IgA antibody was positive in 6/1,213 (0.49%) adolescents. CONCLUSION: The seroprevalence of celiac disease was 0.49% in the investigated adolescents. Further studies are necessary to establish the prevalence of celiac disease in this age range.

Effectiveness of the Brazilian Conditional Cash Transfer Program--Bolsa Alimentação--on the variation of linear and ponderal increment in children from northeast of Brazil.

BACKGROUND: Social programs can improve the conditions required for families provide sufficient care and attention for an adequate health and nutrition. OBJECTIVE: This study evaluates the effectiveness of the Brazilian's conditional cash transfer program--Bolsa Alimentacao (PBA) on children anthropometric status. METHODS: A cohort of 1847 children, followed for 12 months: 1615 PBA children; 232 non-PBA. There were 316 (14.6%) missing children during the study. A quasi-experimental study adopting the before-after strategy was applied and the effectiveness approach was used to assess the impact of the program on children nutritional status. Multilevel analysis with three levels was used in the statistical analysis. The mean increment variations of height-for-age and weight-for-age were the outcome variables and the participation in the PBA was the exposition. Four participation groups were established: children not exposed to the program (internal control group); exposed to the program throughout the 12 months, exposed to the program only in the last 6 months; and exposed to the program only in the first 6 months. Repeated measures were obtained at baseline and at 12 months. RESULTS: It was found that the exposure to the program was associated to a mean variation in weight-for-age of 0.34 Z-score (IC = 0.04; 0.63) and height-for-age of 0.38 (IC = 0.05; 0.70) for children who were regular program beneficiaries during the follow-up. The exposure to the program in other periods was not statistically associated with a mean variation in the indicators. CONCLUSIONS: Cash transfers direct to the family were associated to anthropometric deficits reduction in childhood.

[Hemoglobin concentration in children from birth to one year of age]. / Concentração de hemoglobina em crianças do nascimento até um ano de vida.

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.

[Prevalence of hypovitaminosis A among preschool children from northeastern Brazil, 1998]. / Prevalência da hipovitaminose A em pré-escolares no Estado de Sergipe, 1998.

OBJECTIVE: To determine the prevalence of vitamin A deficiency in a population-based sample. METHODS: This was a cross-sectional study conducted in the State of Sergipe, northeastern Brazil, in May and June, 1998. It involved 607 children aged 6 to 60 months. The information was obtained by means of interviews with the persons responsible for these children, in their homes. Blood samples were collected via venous puncture and serum retinol assays were carried out by means of high performance liquid chromatography (HPLC). In simultaneous analyses of the study variables, p<0.05 was accepted for testing statistically significant associations. RESULTS: A mean serum retinol value of 0.87 micromol/l (+/- 0.38) was found among the children investigated. The prevalence of levels considered low (0.35 to 0.69 micromol/l) was 22.5% and the prevalence of levels considered deficient (<0.35 micromol/l) was 9.6%. Inadequate serum retinol levels were therefore seen in 32.1% of the children. The serum retinol level showed an association with per capita family income and the weight/age indicator. No statistically significant association was found for serum retinol level in relation to the child's age and sex, or the mother's variables. CONCLUSION: Vitamin A deficiency among preschool children is an important public health problem. Hypovitaminosis A is mainly related to low per capita family income and low infant weight.

[Hemoglobin concentration, breastfeeding and complementary feeding in the first year of life]. / Níveis de hemoglobina, aleitamento materno e regime alimentar no primeiro ano de vida.

OBJECTIVE: To assess the relationship between hemoglobin concentration and breastfeeding and complementary feeding during the first years of life. METHODS: Cross-sectional study with 553 children under age 12 months, who attended public healthcare facilities. Hemoglobin concentration was measured by the cyanmethaemoglobin method, using the HemoCue system. Associations of interest were analyzed through multiple linear regression. RESULTS: Hemoglobin concentrations compatible with anemia were identified in 62.8% of the children studied, with greater occurrence among the 6-12 months age group (72.6%). Exclusive breastfeeding during the first six months of life was associated with the highest levels of hemoglobin. The remaining feeding regimes were associated with different levels of reduction in hemoglobin levels, which became compatible with anemia in children fed with formula (p=0.009). Tea and/or water consumption was associated with a reduction in hemoglobin concentration of 0.76 g/dl (p<0.001) among children under age 6 months. For children aged 6-12 months, hemoglobin concentrations increased significantly with the consumption of sugar (p=0.017) and beans (p=0.018), and decreased significantly with the consumption of fruit (p<0.001). CONCLUSIONS: Exclusive breastfeeding until age 6 months and continuation of breastfeeding after this age, combined with qualitatively and quantitatively appropriate feeding may contribute towards an increase in hemoglobin concentration in the first year of life.

Prevalence and factors associated with vitamin A deficiency in children and adolescents.

OBJECTIVE: To identify the prevalence and factors associated with vitamin A deficiency (VAD) in children and adolescents. METHODS: This was a cross-sectional study involving 546 schoolchildren, aged between 7 and 14 years, of both genders, enrolled in public elementary schools. Blood was collected for measurement of serum retinol. The retinol concentration in the samples was determined by high performance liquid chromatography (HPLC). Data were collected on anthropometrics, dietary, demographic, and socioeconomic factors. Polytomous logistic regression was used to evaluate the associations of interest. RESULTS: Approximately 27.5% of the students had retinol values<30 µg/dL. The multivariate analysis showed, after the appropriate adjustments, a positive and statistically significant association of moderate/severe VAD (OR=2.19; 95% CI 1.17 to 4.10) and marginal VAD (OR=2.34; 95% CI 1.47 to 3.73) with age<10 years. There was also association of VAD moderate/severe (OR=2.01; 95% CI 1.01 to 5.05) and borderline VAD (OR=2.14; 95% CI: 1.08 to 4.21) with the anthropometric status of underweight. Lower intake of retinol was detected among those with severe VAD. CONCLUSION: VAD is a health concern among children and adolescents. Lower weight and younger schoolchildren had greater vulnerability to VAD.

[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.