Factors associated with inflamm-aging in institutionalized older people.

The increase in inflammatory cytokines associated with a reduction in the bioavailability of zinc has been used as a marker for inflammation. Despite the high inflammatory state found in institutionalized older individuals, few studies have proposed verifying the factors associated with this condition in this population. To verify the factors associated with inflamm-aging in institutionalized older people. A total of 178 older people (≥ 60 years old) living in nursing homes in Natal/RN were included in the study. Cluster analysis was used to identify three groups according to their inflammatory state. Analysis anthropometric, biochemical, sociodemographic, and health-related variables was carried out. In sequence, an ordinal logistic regression was performed for a confidence level of 95% in those variables with p < 0.20 in the bivariate analysis. IL-6, TNF-α, zinc, low-density lipids (LDL), high-density lipids (HDL), and triglycerides were associated with inflamm-aging. The increase of 1 unit of measurement of LDL, HDL, and triglycerides increased the chance of inflammation-aging by 1.5%, 4.1%, and 0.9%, respectively, while the oldest old (≥ 80 years old) had an 84.9% chance of presenting inflamm-aging in relation to non-long-lived older people (< 80 years). The association between biochemical markers and inflamm-aging demonstrates a relationship between endothelial injury and the inflammatory state. In addition, the presence of a greater amount of fat in the blood may present a higher relative risk of death.

Factors associated with sarcopenia in institutionalized elderly.

BACKGROUND: The diagnosis of sarcopenia is based on the analysis of strength, functionality and muscle mass. The objective was to verify the factors associated with sarcopenia in institutionalized elderly. METHODS: In total, 219 elderly individuals (≥60 years old) living in long-term institutions in Natal/RN were included in the study. After defining the elderly as sarcopenic or non-sarcopenic, anthropometric, biochemical, sociodemographic and health-related were analyzed. The Student t-test and Mann-Whitney test were used to analyze the quantitative, while the chi-square test was used for the qualitative variables. Finally, Poisson regression was used to provide prevalence ratios for those variables that presented differences in the bivariate analyses. RESULTS: Physical capacity and anthropometry were associated with sarcopenia. For each 1 cm of knee height, the elderly presented 2.71% more chance of not having sarcopenia, and eutrophic or overweight individuals (according to BMI) presented 37.71 and 91.81% chances, respectively, of not presenting sarcopenia. Elderly individuals who ambulate have a 30.08% chance of not being considered sarcopenic. In addition, biochemical and anthropometric indicators demonstrated a relationship of sarcopenia with malnutrition. CONCLUSION: Sarcopenia is associated with a loss of body mass, not only selective muscle mass, and greater physical inability to ambulate.

High Prevalence of Hypovitaminosis D in Institutionalized Elderly Individuals is Associated with Summer in a Region with High Ultraviolet Radiation Levels.

Vitamin D may play a significant role in regulating the rate of aging. The objective of the study was to assess vitamin D status and its associated factors in institutionalized elderly individuals. A total of 153 elderly individuals living in Nursing Homes (NH) were recruited into the study. Serum 25-hydroxyvitamin D [25(OH)D] concentration was used as the biomarker of vitamin D status, and it was considered as the dependent variable in the model. The independent variables were the type of NH, age-adjusted time of institutionalization, age, sex, skin color, body mass index, waist and calf circumference, physical activity practice, mobility, dietary intake of vitamin D and calcium, vitamin D supplementation, use of antiepileptics, and season of the year. Serum 25(OH)D concentrations less than or equal to 29 ng/mL were classified as insufficient vitamin D status. The prevalences of inadequate dietary intake of vitamin D and calcium were 95.4% and 79.7%, respectively. The prevalence of hypovitaminosis D was 71.2%, and the mean serum concentration of 25(OH)D was 23.9 ng/mL (95% confidence interval [CI]: 22.8-26.1). Serum 25(OH)D concentration was associated with the season of summer (p = 0.046). There were no associations with other independent variables (all p > 0.05). The present results showed that a high prevalence of hypovitaminosis D was significantly associated with summer in institutionalized elderly individuals.

Frequency of metabolic syndrome and associated factors in institutionalized elderly individuals.

INTRODUCTION: Population aging generally accompanies an increase in chronic noncommunicable diseases, such as metabolic syndrome (MS). Nursing homes have provided a solution for the decreased ability of elderly individuals for self-care and familial difficulties in meeting the health care needs of elderly individuals. PURPOSE: The aim of the present study was to determine the frequency of MS and its associated factors in elderly individuals living in nursing homes. PATIENTS AND METHODS: This cross-sectional study was conducted with 202 institutionalized elderly individuals. MS was diagnosed according to the National Cholesterol Education Program - Adult Treatment Panel III criteria. Sociodemographic, clinical, and lifestyle factors were assessed to verify their association with MS by logistic regression. RESULTS: The MS frequency was 29.2%. The most frequent MS components were low high-density lipoprotein cholesterol level (63.9%) and abdominal obesity (42.7%). Factors associated with MS were female sex (prevalence ratio [PR]=2.16; 95% CI, 1.04-4.49), age-adjusted institutionalization time >50% (PR=2.38, 95% CI, 1.46-3.88), and high concentrations of interleukin-6 (PR=2.01; 95% CI, 1.21-3.32) and tumor necrosis factor-α (PR=1.70; 95% CI, 1.05-2.77). Moreover, it was verified that the likelihood of having MS was 1.85-fold higher (95% CI, 1.11-3.10) in the group with a diet characterized by very high energy, very low fat, and high dietary fiber. CONCLUSION: The occurrence of MS in institutionalized elderly individuals was higher in females, and individuals with longer age-adjusted institutionalization time, higher concentrations of immunologic biomarkers, and a dietary intake consisting of higher energy and fiber and lower total fat. The results of the study are useful for guiding health care programs aimed at institutionalized elderly individuals.

Caracterização do trabalho de enfermeiros e profissionais do Núcleo de Apoio à Saúde da Família na Atenção Primária / Characterization of work of nurses and health professionals in Support Center for Family Health in Primary Health Care

INTRODUÇÃO: Avaliar o trabalho dos profissionais de saúde da atenção básica pode revelar informações importantes relacionadas à forma de produção de cuidado, essenciais para sua qualificação e atendimento das necessidades de saúde da população. OBJETIVO: Este estudo se propôs caracterizar o trabalho de enfermeiros da Estratégia Saúde da Família e profissionais de saúde de Núcleos de Apoio à Saúde da Família em um município da Paraíba, Brasil. MÉTODOS: Trata-se de um estudo transversal no qual foram incluídos enfermeiros da Estratégia Saúde da Família e profissionais de saúde dos Núcleos de Apoio à Saúde da Família da cidade de Campina Grande, totalizando 52 profissionais, 20 enfermeiros e 32 de outras formações da área de saúde. Utilizou-se um questionário estruturado com informações sobre formação profissional, características do trabalho e satisfação profissional. O projeto teve aprovação pelo Comitê de Ética em Pesquisa da Universidade Estadual da Paraíba. RESULTADOS: Os enfermeiros destacaram falta de solidariedade no trabalho e de reconhecimento. A maioria dos profissionais dos Núcleos de Apoio à Saúde da Família mostrou insegurança decorrente de instabilidade laboral e medo de ficar sem trabalho. Ambos os grupos de profissionais indicaram baixa satisfação com a estrutura física, o atendimento individual à demanda e as reuniões com a comunidade. CONCLUSÃO: Os profissionais da Atenção Primária à Saúde do município têm que lidar com limitações impostas por um cenário estrutural pouco favorável das unidades de saúde e vínculos trabalhistas marcados por insegurança, falta de solidariedade e baixo reconhecimento.

INTRODUCTION: Assessing the work of primary care health professionals can reveal important information related to the way of providing care, essential for their qualification and meeting the health needs of the population. OBJECTIVE: This study aimed to characterize the work of nurses in the Family Health Strategy and health professionals in the Centers for Family Health Support in a city from Paraíba, Brazil. METHODS: This was a cross-sectional study in which nurses from the Family Health Strategy and health professionals from the Family Health Support Centers of the city of Campina Grande were enrolled, comprising 52 professionals, 20 nurses and 32 from other health training. A structured questionnaire with information about professional formation, working characteristics and professional satisfaction was used. The project was approved by the Research Ethics Committee of the State University of Paraíba. RESULTS: Nurses highlighted lack of solidarity and recognition at work. Most professionals from the Centers for Family Health Support showed uncertainty due to work instability and fear of being dismissed. Both professional groups expressed low satisfaction with the physical structure, the unaccompanied attention to population and meetings with the community. CONCLUSION: The city professionals of Primary Health Care must deal with restrictions imposed by structural problems in the health units and labor bonds marked by insecurity, lack of solidarity and low recognition.

Plasma zinc in institutionalized elderly individuals: Relation with immune and cardiometabolic biomarkers.

Changes in zinc metabolism caused by aging and the institutionalization process may contribute to zinc deficiency in elderly individuals. Hypozincemia results in changes in glycemic, lipid, and inflammatory profiles. The aim of this study was to evaluate plasma zinc concentrations and their relationships with sociodemographic, dietary, inflammatory, and cardiometabolic biomarkers in institutionalized elderly individuals. A cross-sectional study was carried out including 255 elderly adults living in nursing homes. The associations between plasma zinc and dietary zinc intake, sociodemographic indicators, and glycemic, lipid, and inflammatory biomarkers were evaluated. Independent variables were analyzed according to quartiles of plasma zinc concentrations (Q1: <71.1 µg/dL; Q2: 71.1-83.3 µg/dL; Q3: <83.3-93.7 µg/dL; Q4: >93.7 µg/dL). The relationship between plasma zinc concentrations and predictor variables was also tested. In Q1, higher concentrations of the following variables were observed, compared with those in other quartiles: total cholesterol and low-density lipoprotein cholesterol (LDL-c; Q1 > Q2, Q3, Q4; all p <0.001); triglycerides (Q1 > Q3, Q4; all p < 0.001); interleukin (IL)-6 (Q1 > Q3, Q4; p = 0.024 and p = 0.010, respectively); tumor necrosis factor (TNF)-α (Q1 > Q3, p = 0.003). A significant reduction in plasma zinc concentrations was observed with increasing age-adjusted institutionalization time (Δ = - 0.10; 95% confidence interval [CI]: -0.18 to -0.01). The concentrations of total cholesterol (Δ = - 0.19; 95% CI: -0.23 to -0.15), LDL-c (Δ = - 0.19; 95% CI: -0.23 to -0.15), triglycerides (Δ = - 0.11; 95% CI: -0.16 to -0.06), IL-6 (Δ = - 1.41; 95% CI: -2.64 to -0.18), and TNF-α (Δ = - 1.04; 95% CI: -1.71 to -0.36) were also significantly increased. In conclusion, decreased plasma zinc concentrations were associated with longer institutionalization time and worse lipid and inflammatory profiles in elderly institutionalized individuals.

O trabalho educativo do Agente Comunitário de Saúde nas visitas domiciliares em dois municípios do Brasil / The educational work of community Health Workers in Home visits in two municipalities of Brazil / El trabajo educativo del Agente Comunitario de Salud en las visitas domiciliares en dos municipios de Brasil

Resumo O estudo objetivou descrever e analisar possíveis diferenças nas atividades de educação em saúde realizadas por agentes comunitários de saúde durante a visita domiciliar. Foram analisados os dados de dois estudos transversais no contexto das Unidades Básicas de Saúde da Família dos municípios de Campina Grande (2010) e Queimadas (2011), no estado da Paraíba, Brasil. Em Campina Grande, foram elegíveis mulheres com crianças menores de um ano, selecionadas por sorteio sistemático, de 30% das unidades de saúde (n= 508). Em Queimadas, foram elegíveis todas as mulheres com crianças nascidas durante o ano de 2009, residentes no município e atendidas em todas as 16 unidades de saúde (n= 204). As mães foram questionadas sobre as atividades educativas desenvolvidas pelos agentes durante as visitas domiciliares. Uma maior proporção de mulheres indicou não receber visitas domiciliares no município de Campina Grande, foram encontradas deficiências relacionadas a orientações sobre o cuidado com a saúde da criança nos dois municípios e maior frequência de atividades educativas entre os agentes de Queimadas. As diferenças relativas ao trabalho dos agentes comunitários de saúde podem envolver fatores como desvalorização profissional e precárias condições de trabalho. Destaca-se a importância da capacitação e preparação dos enfermeiros para a supervisão do trabalho dos agentes.

Abstract The study aimed to describe and analyze possible differences in the activities of health education performed by community health workers during a home visit. Data of two transversal studies were analyzed in the context of Family Health Units in the municipalities of Campina Grande (2010) and Queimadas (2011), in the state of Paraíba, Brazil. In Campina Grande, women whose children were younger than one year old were eligible, selected by systematic lottery, from 30% of the health units (n=508). In Queimadas, all women whose children were born within the year of 2009, those who resided in the municipality and those who were treated in any of the 16 health units (n=204) were eligible. The mothers were questioned about the educational activities developed by the agents during the home visits. A larger proportion of women indicated not to receive home visits in the municipality of Campina Grande, and deficiencies were found related to orientation on how to care for children's health in the two municipalities, and there was a higher frequency of educational activities in the agents from Queimadas. The differences related to the work of community health workers may involve elements such as professional devaluation and precarious work conditions. It must be emphasized the importance of the training and preparation of nurses for the supervision of the health workers.

Resumen El estudio objetivó describir y analizar posibles diferencias en las actividades de educación en salud realizadas por agentes comunitarios de salud durante la visita domiciliar. Fueron analizados los datos de dos estudios transversales en el contexto de las Unidades Básicas de Salud de la Familia de los municipios de Campina Grande (2010) y Queimadas (2011), en el estado de Paraíba, Brasil. En Campina Grande, fueron elegibles mujeres con niños menos de un año, seleccionadas por sorteo sistemático, de 30% de las unidades de salud (n=508). En Queimadas, fueron elegibles todas las mujeres con niños nascidos durante el año de 2009, residentes en el municipio y atendidas en todas las 16 unidades de salud (n=204). Las mamas fueron cuestionadas sobre las actividades educativas desarrolladas por los agentes durante las visitas domiciliares. Una mayor proporción de mujeres indicó no recibir visitas domiciliares en el municipio de Campina Grande, fueron encontradas deficiencias relacionadas a orientaciones sobre el cuidado con la salud del niño en los dos municipios y mayor frecuencia de actividades educativas entre los agentes de Queimadas. Las diferencias relativas al trabajo de los agentes comunitarios de salud pueden envolver factores como desvalorización profesional y precarias condiciones de trabajo. Destaca-se la importancia de la capacitación y preparación de los enfermeros para la supervisión del trabajo de los agentes.

[Factors associated with linear growth of socially vulnerable children of the State of Paraíba, Brazil]. / Fatores associados ao crescimento linear de crianças socialmente vulneráveis do Estado da Paraíba, Brasil.

This study set out to examine the associated factors, including zinc deficiency, of stunting in children attended in daycare centers in the State of Paraíba. It is a cross-sectional study, involving 353 children aged 6-72 months old. Data on biological characteristics, health situation and socioeconomic conditions of children were obtained by a questionnaire. Children with height for age indices two z scores below the median value of the reference population were considered to be stunted. The level of zinc in hair was determined by atomic absorption spectrophotometry. The prevalence of stunting was 7.36%. Low birth weight, age range 6-36 months, incomplete immunization, low maternal weight, per capita income of less than 0.5 minimum wages and living in a given/donated or invaded house were significantly associated with height for age index deficit. Stunted children were more prone to zinc deficiency, however, without statistical difference with normal growth children. Thus, there is a clear differential in linear growth that favors the children of higher socioeconomic status and favorable maternal history and health.

Fatores associados ao crescimento linear de crianças socialmente vulneráveis do Estado da Paraíba, Brasil / Factors associated with linear growth of socially vulnerable children of the State of Paraíba, Brazil

Resumo Este trabalho objetivou examinar fatores associados ao déficit de estatura em crianças assistidas em creches do Estado da Paraíba, incluindo a deficiência de zinco. Trata-se de um estudo transversal envolvendo 353 crianças de 6-72 meses de idade. Os dados relativos às características biológicas, à situação de saúde e às condições socioeconômicas foram obtidos através de questionário. O déficit estatural foi determinado por índices de estatura para idade dois escores z abaixo do valor mediano da população de referência. Os níveis de zinco no cabelo foram determinados por espectrofotometria de absorção atômica. A prevalência de baixa estatura foi de 7,36%. O baixo peso ao nascer, a faixa etária de 6-36 meses, o esquema de vacinação incompleto, a baixa estatura materna, o baixo peso materno, a renda familiar per capita inferior a 0,5 salários mínimos e a residência em casa cedida/doada ou invadida apresentaram associação estatística significante com o déficit estatural. As crianças de baixa estatura apresentaram maior exposição à deficiência de zinco, porém sem diferença estatística em relação àquelas de estatura normal. Assim, indica-se claro diferencial do crescimento linear que favorece as crianças de melhor condição socioeconômica e de antecedentes maternos e de saúde favoráveis.

Abstract This study set out to examine the associated factors, including zinc deficiency, of stunting in children attended in daycare centers in the State of Paraíba. It is a cross-sectional study, involving 353 children aged 6-72 months old. Data on biological characteristics, health situation and socioeconomic conditions of children were obtained by a questionnaire. Children with height for age indices two z scores below the median value of the reference population were considered to be stunted. The level of zinc in hair was determined by atomic absorption spectrophotometry. The prevalence of stunting was 7.36%. Low birth weight, age range 6-36 months, incomplete immunization, low maternal weight, per capita income of less than 0.5 minimum wages and living in a given/donated or invaded house were significantly associated with height for age index deficit. Stunted children were more prone to zinc deficiency, however, without statistical difference with normal growth children. Thus, there is a clear differential in linear growth that favors the children of higher socioeconomic status and favorable maternal history and health.

Deficiência de zinco: diagnóstico, estimativas do Brasil e prevenção / Zinc deficiency: diagnostic, Brazil estimates and prevention

OBJECTIVES: To highlight the main aspects related to the population diagnosis of zinc nutritional status, describe the estimates of zinc deficiency magnitude in Brazil and emphasize the main interventions for improving zinc nutritional status. Data source: Publications were selected in SciELO, LILACS and MEDLINE/PUBMED databases, using the search terms "zinc deficiency e Brazil" and "diet supplementation and zinc and Brazil". Data synthesis: The use of a set of three indicators has been recommended to obtain the best estimate of zinc deficiency risk: i) biochemical indicator (serum zinc deficiency), ii) dietary indicator (inadequate zinc intake), iii) functional indicator (height-for-age deficit in children). According to these indicators, Brazil is a country with moderate zinc deficiency risk. The main strategies that can be implemented to improve zinc nutritional state in populations or population subgroups in risk are diet supplementation, fortification and modification/diversification. CONCLUSIONS: It is estimated that zinc deficiency is a public health problem in Brazil. The planning of new research becomes important for a better understanding of the risk factors, the identification of population groups with more vulnerability and the selection of appropriate intervention strategies

OBJETIVOS: Destacar os principais aspectos relacionados ao diagnóstico populacional do estado nutricional relativo ao zinco; descrever as estimativas sobre a magnitude da deficiência de zinco no Brasil; e ressaltar as principais intervenções para a melhoria do estado nutricional relativo ao zinco. Fonte de dados: Foram selecionadas publicações nas bases de dados SciELO, LILACS e MEDLINE/PUBMED, utilizando-se os termos de busca "deficiência de zinco e Brasil" e "suplementação dietética e zinco e Brasil". Síntese dos dados: Recomenda-se a utilização de um conjunto de três indicadores para obter a melhor estimação do risco de deficiência de zinco: i) indicador bioquímico (deficiência de zinco sérico), ii) indicador dietético (ingestão dietética de zinco inadequada), iii) indicador funcional (déficit de estatura para idade em crianças). Segundo esses indicadores, o Brasil se mostra como um país com risco moderado de deficiência de zinco. As principais estratégias que podem ser implementadas para melhorar o estado nutricional de zinco nas populações ou subgrupos populacionais em risco são a suplementação, a fortificação e a modificação/diversificação da dieta. CONCLUSÕES: Estima-se a deficiência de zinco como problema de saúde pública no Brasil. O planejamento de novas pesquisas se faz importante para um melhor entendimento dos fatores de risco, para a identificação dos segmentos da população de maior vulnerabilidade e para a seleção de estratégias de intervenção apropriadas

Características sociodemográficas efatores importantes para a manutenção dasaúde em mulheres / Sociodemographic characteristics and important factors for health maintenance in women

Investigar fatores importantes para a manutenção da saúde e as característicassocioeconômicas e demográficas de mulheres usuárias de Unidades Básicas de Saúde.Métodos: Estudo observacional, transversal e analítico, realizado em 2011, envolvendo204 mulheres assistidas em 16 unidades do município de Queimadas, Paraíba. Obtiveramseinformações referentes às características demográficas (local de moradia, cor da pele,idade e situação conjugal), socioeconômicas (nível de escolaridade e recebimento doBolsa Família), e hábitos de vida (alimentação, tabagismo, consulta médica, sedentarismo,ingestão de bebidas alcoólicas, controle do peso e do estresse) por meio de questionário, aoqual aplicou-se estatística descritiva e razão de prevalência. Resultados: As participantesapresentaram idade média de 28,22 anos (DP=6,49). A maioria residia na zona rural (n=126;61,76%), declarou saber ler ou escrever (n=184; 90,2%) e receber o benefício BolsaFamília (n=153; 75,0%). Os fatores mais importantes para a manutenção da saúde foram aalimentação saudável (n=126; 61,8%), o não tabagismo (n=21; 10,3%) e a consulta médicaregular (n=19; 9,3%). As variáveis socioeconômicas e demográficas não apresentaramassociações estatisticas significativas com os fatores importantes para manutenção da saúde.Conclusão: A população estudada reconhece a alimentação saudável, o não tabagismo e asconsultas médicas regulares como os fatores mais importantes para a manutenção da saúde...

Brazilian indigenous children: Review of studies about nutritional status / Crianças indígenas brasileiras: revisão dos estudos sobre o estado nutricional

Objective: To systematize studies on the anthropometric nutritional status of Brazilian indigenous children in order to examine the ability to address the totality of biological, anthropological, and ecological aspects, as well as to characterize the main analytical results of the determinants of nutritional status of Brazilian indigenous children. Methods: MedLine and Lilacs were searched using the intersection of "South American Indians" and "nutritional status" descriptors (the search in MedLine also included the descriptor "Brazil"). Results: Overall, 65 studies were identified, and 23 were considered relevant to this study. The systematization of these studies highlights the concentration of studies in the midwestern and northern regions of Brazil, as well as the lack of cultural, biochemical, and food consumption approaches. Regarding nutritional status, we found: 1) greater vulnerability of younger children, especially in relation to stunting; 2) absence of differences in nutritional status according to sex; 3) socioeconomic determination of nutritional status; 4) differences in nutritional status between children from different villages. Conclusion: The nutritional status of Brazilian indigenous children is associated with age, socioeconomic status, and ethnic characteristics. Efforts are needed to understand the ethnic and cultural influence on nutritional status and on its causal network, as well as of various factors minimally discussed. .

Objetivo: Sistematizar os estudos sobre o estado nutricional antropométrico de crianças indígenas brasileiras a fim de examinar a capacidade de abordar a integralidade dos aspectos biológicos, antropológicos e ecológicos, bem como caracterizar os principais resultados analíticos dos determinantes do estado nutricional das crianças indígenas brasileiras. Métodos: Realizou-se busca bibliográfica nas bases de dados MedLine e Lilacs, por meio da interseção dos descritores "índios sul-americanos" e "estado nutricional" (a busca no MedLine também incluiu o descritor "Brazil"). Resultados: Identificaram-se 65 estudos, dos quais 23 foram considerados relevantes para o presente trabalho. A sistematização dos estudos revisados destaca a concentração nas regiões centro-oeste e norte, assim como a carência de abordagens cultural, bioquímica e sobre o consumo alimentar. Em relação ao estado nutricional, sugerem-se: 1) maior vulnerabilidade nas crianças menores, principalmente em relação ao déficit de estatura; 2) ausência de diferenças no estado nutricional segundo o sexo; 3) determinação socioeconômica do estado nutricional; 4) diferenças no estado nutricional entre crianças de diferentes aldeias. Conclusão: O estado nutricional das crianças indígenas brasileiras apresenta determinação etária, socioeconômica e étnica, sendo necessários esforços para compreender a influência étnico-cultural no estado nutricional e na sua rede causal, bem como fatores vários abordados minimamente. .

Isolated and combined prevalence of anemia, vitamin A deficiency and zinc deficiency in preschool children 12-72 months for the government of Paraíba / Prevalências isoladas e combinadas de anemia, deficiência de vitamina A e deficiência de zinco em pré-escolares de 12 a 72 meses do Núcleo de Creches do Governo da Paraíba

OBJECTIVE: To estimate the isolated and combined prevalence of anemia, vitamin A deficiency and zinc deficiency in pre-school children, as well as the distribution of isolated deficiencies according to gender, age and prior supplementation with vitamin A. METHODS: Cross-sectional study with pre-school children in the state of Paraíba, Brazil. Analysis of the average concentrations of hemoglobin, serum retinol and serum zinc, according to gender, age and previous vitamin A supplementation of children were carried out as well as the risk of simultaneous occurrence of micronutrient deficiencies in the presence of these deficiencies. RESULTS: The prevalence of anemia, vitamin A deficiency and zinc deficiency were 15.4%, 23.3% and 13.8%, respectively. The anemia was significantly associated with age (p<0.01). Children previously supplemented by vitamin A had higher serum retinol concentrations than children without supplements, an effect that was not observed for concentrations of hemoglobin or serum zinc. The prevalence of anemia associated with vitamin A deficiency was 5.8%, with the chance of vitamin A deficiency and anemia coexist 2.21 times (95%CI=1.03-4.84) higher in the case of vitamin A deficiency or anemia rather than in the absence of these conditions. CONCLUSION: The high prevalence of micronutrient deficiencies which are important in child growth, as well as the coexistence of nutritional deficiencies, point out the need to strengthen nutrition intervention strategies that consider this issue. .

OBJETIVO: Estimar as prevalências isoladas e combinadas de anemia, deficiência de vitamina A e deficiência de zinco em crianças pré-escolares, bem como a distribuição das deficiências isoladas segundo sexo, idade e suplementação prévia com vitamina A. MÉTODOS: Estudo transversal com crianças pré-escolares do Estado da Paraíba. Foram realizadas análises das concentrações médias de hemoglobina, retinol sérico e zinco sérico, de acordo com o sexo, a idade e a suplementação prévia com vitamina A das crianças, bem como o risco de ocorrência simultânea de deficiências de micronutrientes na presença de uma dessas deficiências. RESULTADOS: As prevalências de anemia, deficiência de vitamina A e deficiência de zinco foram de 15,4%, 23,3% e 13,8%, respectivamente. A anemia mostrou-se significativamente associada à idade (p<0,01). Crianças suplementadas previamente com vitamina A apresentaram maiores concentrações de retinol sérico do que crianças não suplementadas, efeito não observado para as concentrações de hemoglobina e de zinco sérico. A prevalência de anemia associada à deficiência de vitamina A foi de 5,8%, sendo a chance da deficiência de vitamina A e da anemia coexistir 2,21 vezes (IC95%= 1,03-4,84) maior no caso de deficiência de vitamina A ou de anemia do que na ausência dessas condições. CONCLUSÃO: As elevadas prevalências de deficiências de micronutrientes importantes no crescimento infantil, bem como a coexistência de carências nutricionais, evidenciam a necessidade de fortalecer as estratégias de intervenção nutricional que considerem essa problemática. .

[Infectious diseases among Brazilian preschool children attending daycare centers]. / Doenças infecciosas em crianças pré-escolares brasileiras assistidas em creches.

The scope of this article is to analyze the prevalence and factors associated with the development of infectious diseases that affect children in daycare centers, namely respiratory infections, diarrheal disease and parasitic infections. Bibliographic research was conducted in the MEDLINE, LILACS and SciELO databases, and observational studies were included. 129 studies were identified, of which 21 were considered relevant to this study, namely two longitudinal and 19 cross-sectional studies. The systematization of the reviewed studies highlighted: i) the presence of intestinal parasites was the main outcome analyzed, followed by respiratory infections; ii) only one study investigated the occurrence of diarrheal disease; iii) the Giardia lamblia was the most prevalent parasitosis; iv) the variables that were most often associated with the development of intestinal parasitosis were child age, family income and maternal education; v) the attendance at daycare centers was a risk factor for intestinal parasites and respiratory infections. Respiratory and parasitic infections are major problems in institutionalized children in daycare centers. The reduction of such diseases involves a complex web of socio-economic, sanitation and daycare center infrastructure aspects.

Parâmetros bioquímicos do estado nutricional de micronutrientes e seu significado para as ações de saúde pública / Biochemical parameters of nutritional status of micronutrients and its significance for public health interventions

As deficiências de ferro, zinco e vitamina A constituem um problema de saúde pública em diversos países em desenvolvimento, atingindo percentuais elevados de grupos populacionais biologicamentevulneráveis, tais como as crianças. Os indicadores bioquímicos do estado nutricional de micronutrientesconstituem uma ferramenta importante nos programas de combate a essas carências nutricionais na medida em que possibilitam identificar áreas e populações com elevados índices de déficit nutricional. Para tanto, torna-se imprescindível a interpretação correta dos resultados das análises laboratoriais, a fim de garantir a fidedignidade dos dados de prevalência de deficiência de micronutrientes napopulação. Tal processo exige um conhecimento prévio acerca das características dos indicadoresbioquímicos, das interações metabólicas entre os micronutrientes e da influência dos processosinfecciosos subclínicos sobre as concentrações de micronutrientes. Neste contexto, o presente trabalho objetiva realizar uma revisão bibliográfica acerca das deficiências de ferro, zinco e vitamina A, no contexto do seu diagnóstico bioquímico, com a finalidade de apoiar as decisões relacionadas com as análises de estudos epidemiológicos e da saúde pública.

Deficiencies of iron, zinc and vitamin A are a public health problem in many developing countries, reaching high percentages of biologically vulnerable population groups such as children. Biochemical indicators of nutritional status of micronutrients are an important tool in programs to combat nutritional deficiencies such as it possible to identify areas and populations with high rates of malnutrition. For this, it is essential to accurately interpret the results of laboratory tests, to ensure the reliability of data on the prevalence of micronutrient deficiency in the population. This process requires a prior knowledge about the characteristics of biochemical indicators, the metabolic interactions between micronutrientsand the influence of subclinical infectious processes on the concentrations of micronutrients. In thiscontext, this paper aims to review literature about the deficiencies of iron, zinc and vitamin A, in the context of their biochemical diagnosis, in order to support decisions related to epidemiological studies and public health analysis.

Avaliação de desempenho das concentrações capilares de zinco como método diagnóstico da deficiência de zinco: um estudo comparativo com as concentrações séricas de zinco / Performance evaluation of hair zinc levels as a diagnostic method of zinc deficiency: a comparative study with serum zinc

OBJETIVO: Examinar o poder diagnóstico de deficiência de zinco das concentrações capilares desse mineral por meio da comparação com as concentrações séricas. MÉTODOS: Estudo transversal desenvolvido com 170 crianças na faixa etária dos 12 aos 72 meses. A análise da Curva Característica de Operação do Receptor foi utilizada para identificar a sensibilidade e a especificidade do melhor ponto de corte para o diagnóstico da deficiência de zinco no cabelo. Verificou-se ainda a significância estatística da área sob a curva. RESULTADOS:O ponto de corte apontado como ótimo para o zinco no cabelo foi de 292,52ppm (sensibilidade de 55,6% e especificidade de 60,8%), com uma área sob a curva de 0,549, sem significância estatística. CONCLUSÃO: O diagnóstico da deficiência de zinco pelas concentrações capilares desse elemento, em comparação às concentrações séricas de zinco, mostra baixa sensibilidade e ponto de corte ideal superior ao sugerido. Permanece, ainda, a necessidade de novos estudos que possibilitem a obtenção de indicadores bioquímicos mais sensíveis e específicos para o diagnóstico da deficiência de zinco na população, sob tudo sem importantes limitações técnicas...

OBJECTIVE: This study examined the power of hair zinc concentration to diagnose zinc deficiency by comparing hair zinc concentration with serum zinc level. METHODS: This cross-sectional study included 170 children aged 12 to 72 months. The receiver operating characteristic curve was used for determining the sensitivity and specificity of the best cutoff point for diagnosing zinc deficiency in hair. The statistical significance of the area under the curve was also verified. RESULTS: The best cutoff for zinc concentration in hair was 292.52ppm (sensitivity of 55.6%, a specificity of 60.8%), with an area under the curve of 0.549, without statistical significance. CONCLUSION: Diagnosis of zinc deficiency based on hair zinc concentration compared with serum zinc level has low sensitivity and its ideal cutoff is higher than the suggested cutoff. New studies are needed to research more sensitive and specific biochemical indicators of zinc deficiency, especially indicators without important technical limitations...

[Micronutrient deficiencies and linear growth: a systematic review of observational studies]. / Deficiência de micronutrientes e crescimento linear: revisão sistemática de estudos observacionais.

This article seeks to evaluate the association of iron, vitamin A and zinc deficiencies with linear growth retardation. A systematic review of electronic databases in PubMed, LILACS and SciELO was conducted. Scientific papers published between January 1995 and March 2010 were selected, inserting the key words: (growth OR nutritional status) AND (child, preschool OR infant) AND (zinc AND iron AND vitamin A) OR (zinc AND iron) OR (zinc AND vitamin A) OR (iron AND vitamin A). Fourteen observational design studies were reviewed. In the cohort studies (two), one indicated a statistical association between iron levels and stunting; and the other revealed a statistical association between serum ferritin concentrations and an increase in height. Ten cross-sectional studies investigated the statistical association between micronutrient deficiencies and stunting, three of which resulted in an association with iron, two with vitamin A and none with zinc. Elucidation of the association between stunting and iron, vitamin A and zinc deficiencies involves difficulties of a biological nature and also related to the magnitude of these deficiencies, indicating the importance of a methodological standardization of the studies.

Deficiência de micronutrientes e crescimento linear: revisão sistemática de estudos observacionais / Micronutrient deficiencies and linear growth: a systematic review of observational studies

O objetivo do artigo é avaliar a associação das deficiências de ferro, vitamina A e zinco com o déficit de crescimento linear. Revisão sistemática nas bases de dados eletrônicas PubMed, LILACS e SciELO. Foram selecionados artigos publicados entre janeiro de 1995 e março de 2010, considerando os descritores: (growth OR nutritional status) AND (child, preschool OR infant) AND (zinc AND iron AND vitamin A) OR (zinc AND iron) OR (zinc AND vitamin A) OR (iron AND vitamin A). Foram revisados 14 estudos de delineamento observacional. Dos estudos tipo coorte (dois), um indicou associação estatística entre o estado nutricional de ferro e o déficit de estatura; o outro apontou associação estatística entre as concentrações de ferritina sérica e o ganho de estatura. Dez estudos transversais investigaram a associação estatística entre as deficiências de micronutrientes e o déficit de estatura, resultando três deles na associação para o ferro, dois para a vitamina A e nenhum para o zinco. O esclarecimento sobre a associação entre o déficit de estatura e as deficiências de ferro, vitamina A e zinco dificulta-se por fatores de caráter biológico e relacionados à magnitude das deficiências, o que sugere a importância da padronização metodológica dos estudos.

This article seeks to evaluate the association of iron, vitamin A and zinc deficiencies with linear growth retardation. A systematic review of electronic databases in PubMed, LILACS and SciELO was conducted. Scientific papers published between January 1995 and March 2010 were selected, inserting the key words: (growth OR nutritional status) AND (child, preschool OR infant) AND (zinc AND iron AND vitamin A) OR (zinc AND iron) OR (zinc AND vitamin A) OR (iron AND vitamin A). Fourteen observational design studies were reviewed. In the cohort studies (two), one indicated a statistical association between iron levels and stunting; and the other revealed a statistical association between serum ferritin concentrations and an increase in height. Ten cross-sectional studies investigated the statistical association between micronutrient deficiencies and stunting, three of which resulted in an association with iron, two with vitamin A and none with zinc. Elucidation of the association between stunting and iron, vitamin A and zinc deficiencies involves difficulties of a biological nature and also related to the magnitude of these deficiencies, indicating the importance of a methodological standardization of the studies.

Nutritional status of iron in children from 6 to 59 months of age and its relation to vitamin A deficiency.

OBJECTIVE: To evaluate the iron nutritional status of children from 6 to 59 months of age and its relation to vitamin A deficiency. METHOD: Cross-sectional study involving 100 children, living in nine cities in the state of Paraíba, which were selected for convenience to form two study groups: children with vitamin A deficiency (serum retinol < 0.70 µmol/L; n = 50) and children without vitamin A deficiency (serum retinol ≥ 0.70 µmol/L; n = 50). The iron nutritional status was evaluated by biochemical, haematological and hematimetric indices. The cases of subclinical infection (C-Reactive Protein ≥ 6 mg/L) were excluded. RESULTS: Children with vitamin A deficiency had serum iron values statistically lower than the corresponding values in children without deficiency. The other iron nutritional status indices showed no statistical difference according to presence/absence of vitamin A deficiency. CONCLUSION: The interaction between iron and vitamin A deficiencies was evidenced in the case of circulating iron deficiency (serum iron), suggesting failure in the transport mechanisms of the mineral in children with vitamin A deficiency.

Objetivos: Evaluar el estado nutricional de hierro en niños de 6 a 59 meses de edad y su relación con la deficiencia de vitamina A. Métodos: Estudio transversal, envolviendo 100 niños, residentes en nueve ciudades del estado de Paraíba, seleccionados por conveniencia para conformar dos grupos de estudio: niños con deficiencia de vitamina A (retinol sérico < 0,70 µmol/L; n = 50) y niños sin deficiencia de vitamina A (retinol sérico ≥ 0,70 µmol/L; n = 50). El estado nutricional de hierro fue evaluado a través de índices bioquímicos, hematológicos y hematimétricos. Los casos de infección subclínica (proteína C-reactiva ≥ 6 mg/L) fueron excluidos. Resultados: Los niños con deficiencia de vitamina A presentaron valores medios de hierro sérico estadísticamente inferiores a los valores correspondientes en niños sin deficiencia. Los otros índices del estado nutricional de hierro no mostraron diferencia estadística según la presencia/ ausencia de deficiencia de vitamina A. Conclusión: La interacción entre las carencias de hierro y de vitamina A estuvo evidenciada en los casos de deficiencia de hierro circulante (hierro sérico), sugiriendo insuficiencia en los mecanismos de transporte del mineral en niños con deficiencia de vitamina A.

Nutritional status of iron in children from 6 to 59 months of age and itsrelation to vitamin A deficiency / Estado nutricional de hierro en niños de 6 a 59 meses de edad y su relación con la deficiencia de vitamina A

OBJECTIVE: To evaluate the iron nutritional status of children from 6 to 59 months of age and its relation to vitamin A deficiency. METHOD: Cross-sectional study involving 100 children, living in nine cities in the state of Paraíba, which were selected for convenience to form two study groups: children with vitamin A deficiency (serum retinol < 0.70 μmol/L; n = 50) and children without vitamin A deficiency (serum retinol ≥ 0.70 μmol/L; n = 50). The iron nutritional status was evaluated by biochemical, haematological and hematimetric indices. The cases of subclinical infection (C-Reactive Protein ≥ 6 mg/L) were excluded. RESULTS: Children with vitamin A deficiency had serum iron values statistically lower than the corresponding values in children without deficiency. The other iron nutritional status indices showed no statistical difference according to presence/absence of vitamin A deficiency. CONCLUSION: The interaction between iron and vitamin A deficiencies was evidenced in the case of circulating iron deficiency (serum iron), suggesting failure in the transport mechanisms of the mineral in children with vitamin A deficiency (AU)

Objetivos: Evaluar el estado nutricional de hierro en niños de 6 a 59 meses de edad y su relación con la deficiencia de vitamina A. Métodos: Estudio transversal, envolviendo 100 niños, residentes en nueve ciudades del estado de Paraíba, seleccionados por conveniencia para conformar dos grupos de estudio: niños con deficiencia de vitamina A (retinol sérico < 0,70 μmol/L; n = 50) y niños sin deficiencia de vitamina A (retinol sérico ≥ 0,70 μmol/L; n = 50). El estado nutricional de hierro fue evaluado a través de índices bioquímicos, hematológicos y hematimétricos. Los casos de infección subclínica (proteína C-reactiva ≥ 6 mg/L) fueron excluidos. Resultados: Los niños con deficiencia de vitamina A presentaron valores medios de hierro sérico estadísticamente inferiores a los valores correspondientes en niños sin deficiencia. Los otros índices del estado nutricional de hierro no mostraron diferencia estadística según la presencia/ ausencia de deficiencia de vitamina A. Conclusión: La interacción entre las carencias de hierro y de vitamina A estuvo evidenciada en los casos de deficiencia de hierro circulante (hierro sérico), sugiriendo insuficiencia en los mecanismos de transporte del mineral en niños con deficiencia de vitamina A (AU)