Relative validity and reproducibility of WHO indicators for assessment of feeding practices in children under two years of age.

The study aimed to evaluate relative validity and reproducibility of seven WHO indicators of dietary practices in children aged 6-23.9 months. Data from probabilistic sample of children who used primary healthcare services in Rio de Janeiro, Brazil were collected using a 24h dietary recall (24HR) and a closed questionnaire (Q1) on feeding in the day before the study. The last one was reapplied (Q2) around 16 days later. Validity was assessed by comparing the prevalence rates estimated by 24HR and Q1 and calculating the positive (PPV) and negative (NPV) predictive values, sensitivity (Se), specificity (Sp), and accuracy index (AI) for the resulting indicators. For reproducibility, estimated prevalence rates based on Q1 and Q2 were compared and the kappa index and prevalence-adjusted bias-adjusted kappa were estimated. Of the seven estimated indicators, the prevalence of two was overestimated (Continued breastfeeding: 50.0% vs 40.0%; Sweet beverage consumption: 65.1% vs 52.7%) and the prevalence of one was underestimated (Zero vegetable or fruit consumption: 6.5% vs 18.1%). For most indicators, Se and PPV were higher than Sp and NPV. The prevalence rates determined with Q1 and Q2 were similar for 6 indicators. More than half showed good, very good or excellent agreement.

Relative validity and reproducibility of WHO indicators for assessment of feeding practices in children under two years of age / Validade relativa e reprodutibilidade de indicadores da OMS para avaliação da alimentação de crianças menores de dois anos

Abstract The study aimed to evaluate relative validity and reproducibility of seven WHO indicators of dietary practices in children aged 6-23.9 months. Data from probabilistic sample of children who used primary healthcare services in Rio de Janeiro, Brazil were collected using a 24h dietary recall (24HR) and a closed questionnaire (Q1) on feeding in the day before the study. The last one was reapplied (Q2) around 16 days later. Validity was assessed by comparing the prevalence rates estimated by 24HR and Q1 and calculating the positive (PPV) and negative (NPV) predictive values, sensitivity (Se), specificity (Sp), and accuracy index (AI) for the resulting indicators. For reproducibility, estimated prevalence rates based on Q1 and Q2 were compared and the kappa index and prevalence-adjusted bias-adjusted kappa were estimated. Of the seven estimated indicators, the prevalence of two was overestimated (Continued breastfeeding: 50.0% vs 40.0%; Sweet beverage consumption: 65.1% vs 52.7%) and the prevalence of one was underestimated (Zero vegetable or fruit consumption: 6.5% vs 18.1%). For most indicators, Se and PPV were higher than Sp and NPV. The prevalence rates determined with Q1 and Q2 were similar for 6 indicators. More than half showed good, very good or excellent agreement.

Resumo O estudo avaliou a validade relativa e a reprodutibilidade de sete indicadores da OMS sobre alimentação de crianças de 6-23,9 meses. Dados de amostra probabilística de usuários de serviços básicos de saúde na cidade do Rio de Janeiro, Brasil, foram coletados por meio de recordatório alimentar de 24 horas (R24h) e questionário fechado (Q1) sobre alimentação no dia anterior ao estudo. Este último foi reaplicado (Q2) em torno de 16 dias depois. A validade foi avaliada comparando-se as prevalências estimadas pelo R24h e Q1 e calculando-se os valores preditivos positivo (VPP) e negativo (VPN), sensibilidade (Se), especificidade (Esp) e índice de acurácia (IA) dos indicadores resultantes. Para reprodutibilidade, as prevalências estimadas com base em Q1 e Q2 foram comparadas e estimados o índice kappa e o kappa ajustado pela prevalência. Dos sete indicadores estimados, houve superestimação da prevalência de dois (aleitamento continuado: 50,0% versus 40,0%; consumo de bebidas adoçadas: 65,1% vs. 52,7%) e subestimação da prevalência de um (não consumo de frutas e hortaliças: 6,5% vs. 18,1%). Para a maioria deles, Se e VPP foram maiores do que Esp e VPN. As prevalências determinadas com Q1 e Q2 foram semelhantes para seis indicadores. Mais da metade dos indicadores apresentaram concordância boa, muito boa ou excelente.

[Nutritional status of adolescents and its relation with socio-demographics variables: National Adolescent School-based Health Survey (PeNSE), 2009]. / Estado nutricional dos adolescentes e sua relação com variáveis sociodemográficas: Pesquisa Nacional de Saúde do Escolar (PeNSE), 2009.

The aim of this study was to describe the nutritional status of adolescents in the 9th year of public and private schools of the Brazilian capitals and its association with socio-demographic variables. By means of a self-completed questionnaire, information related to sex, race, age, public/private school, macro-region of the country, maternal education and family possessions were recorded. Measures of weight and height were measured according to standardized procedures. Height for age and body mass index for age was evaluated according to the World Health Organization reference. Anthropometric measurements of 58,971 adolescents were obtained, of which 2.9% were stunted and 2.9% underweight. There was 23.0% of overweight and 7.3% of obesity, which were higher in the South and Southeast regions. Deficits in height and weight, overweight and obesity were more prevalent in boys. The deficits were higher at public schools while overweight and obesity at private ones. Adolescents whose mothers were less educated or from poorer families had greater deficits in height and the reverse occurred with overweight and obesity. The findings about the deficits, overweight and obesity highlight the need for nutritional interventions designed to reach this stage of life.

Estado nutricional dos adolescentes e sua relação com variáveis sociodemográficas: Pesquisa Nacional de Saúde do Escolar (PeNSE), 2009 / Nutritional status of adolescents and its relation with socio-demographics variables: National Adolescent School-based Health Survey (PeNSE), 2009

Objetivou-se descrever o estado nutricional dos adolescentes da 9ª série de escolas públicas e privadas das capitais brasileiras e sua associação com variáveis sociodemográficas. Por meio de questionário autopreenchido, foram registradas informações sobre sexo, raça/cor, idade, escola pública/privada, macrorregião do país, escolaridade materna e posse de bens familiares. Peso e altura foram aferidos segundo procedimentos padronizados. A altura para idade e o Índice de Massa Corporal para idade foram avaliados segundo critérios da Organização Mundial da Saúde. Obtiveram-se medidas antropométricas de 58.971 adolescentes, sendo que 2,9 por cento apresentaram déficit estatural e 2,9 por cento magreza. O excesso de peso foi de 23,0 por cento e a obesidade de 7,3 por cento, sendo mais altos no Sul e no Sudeste do país. Déficits de altura e peso, excesso de peso e obesidade foram mais prevalentes nos meninos. Os déficits foram superiores nas escolas públicas, e o excesso de peso e a obesidade nas privadas. Adolescentes cujas mães eram de menor escolaridade ou de famílias mais pobres apresentaram maior déficit de altura; o inverso ocorreu com o excesso de peso e a obesidade. Prevalências de déficits, excesso de peso e obesidade ressaltam a necessidade de intervenções nutricionais direcionadas para esta fase da vida.

The aim of this study was to describe the nutritional status of adolescents in the 9th year of public and private schools of the Brazilian capitals and its association with socio-demographic variables. By means of a self-completed questionnaire, information related to sex, race, age, public/private school, macro-region of the country, maternal education and family possessions were recorded. Measures of weight and height were measured according to standardized procedures. Height for age and body mass index for age was evaluated according to the World Health Organization reference. Anthropometric measurements of 58,971 adolescents were obtained, of which 2.9 percent were stunted and 2.9 percent underweight. There was 23.0 percent of overweight and 7.3 percent of obesity, which were higher in the South and Southeast regions. Deficits in height and weight, overweight and obesity were more prevalent in boys. The deficits were higher at public schools while overweight and obesity at private ones. Adolescents whose mothers were less educated or from poorer families had greater deficits in height and the reverse occurred with overweight and obesity. The findings about the deficits, overweight and obesity highlight the need for nutritional interventions designed to reach this stage of life.

A organização da Vigilância Alimentar e Nutricional no Sistema Único de Saúde: histórico e desafios atuais / Organization of Food and Nutritional Surveillance within the Brazilian National Health System: history and current challenges

A Política Nacional de Alimentação e Nutrição ressalta a importância do Sistema de Vigilância Alimentar e Nutricional - SISVAN, que se destina à identificação do diagnóstico descritivo e analítico da situação alimentar e nutricional da população brasileira, contribuindo para que se conheça a natureza e a magnitude dos problemas nutricionais do país. Este artigo visa apresentar o histórico das ações da Vigilância Alimentar e Nutricional no Brasil, desde sua idealização até a prática atual, destacando a superação das limitações encontradas ao longo dos anos, o fortalecimento obtido por meio dos marcos legais e os desafios enfrentados neste momento. Entende-se hoje que o SISVAN só pode ser conduzido utilizando-se uma combinação de estratégias, sendo as principais: o sistema informatizado do SISVAN, os inquéritos populacionais, as Chamadas Nutricionais, a análise das bases de dados nacionais da saúde, o acesso à produção científica e o financiamento de pesquisas sobre o tema.