Medicina de Familia, una especialidad amenazada / Family Medicine, a threatened specialty

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Childhood stunting in Northeast Brazil: the role of Schistosoma mansoni infection and inadequate dietary intake.

OBJECTIVE: To evaluate the relationship between stunting, Schistosoma mansoni infection and dietary intake in schoolchildren. DESIGN: This is a cross-sectional study. Two stool samples were obtained from each child and examined quantitatively for the presence of S. mansoni, Ascaris lumbricoides and Trichuris trichiuria eggs. Information on dietary intake, and demographic, biologic and socioeconomic variables was elicited during the in-home survey. Logistic regression was used to evaluate the association between stunting (height for age < -2s.d.), parasitic infection and food consumption. SETTING: The study was carried out in the city of Nazaré, located in the Recôncavo region of the State of Bahia, Northeastern Brazil. SUBJECTS: The sample consisted of 461 children 7-14 y old, 228 boys and 233 girls, recruited from public schools. RESULTS: Of the children studied, 55.1% presented with S. mansoni infection and 22.1% were stunted. The median protein, lipid and carbohydrates intake were 47.8, 36.0 and 248.2 g/day, respectively. The median caloric consumption was 1527.0 kcal (6388.97 kJ/day). The analysis indicated that children heavily infected (> or = 400 eggs/g of stool) with S. mansoni had a 2.74-fold (95% CI: 1.32-5.67) higher risk of stunting than uninfected children, and those with inadequate intake of lipid (< 36 g/day) had a 1.83-fold (95% CI: 1.05-3.20) increased risk of stunting compared to those with adequate diets. CONCLUSION: Heavy S. mansoni infection and inadequate dietary intake of fat in schoolchildren play a significant and independent role in the development of stunting. This meaning that nutritional interventions in this age group in S. mansoni endemic areas must include the diagnosis and treatment of the infection associated with dietary measures. SPONSORSHIP: This study was supported by the Thrasher Foundation. Sandra Maria Conceição Pinheiro is a National Council on Technological Development Scholarship Awardee (CNPq), #302228/81-0.

Double-blind placebo-controlled study of concurrent administration of albendazole and praziquantel in schoolchildren with schistosomiasis and geohelminths.

A double-blind placebo-controlled study of the concurrent administration of albendazole and praziquantel was conducted in>1500 children with high prevalences of geohelminths and schistosomiasis. The study sites were in China and the Philippines, including 2 strains of Schistosoma japonicum, and 2 different regions of Kenya, 1 each with endemic Schistosoma mansoni or Schistosoma haematobium. Neither medication affected the cure rate of the other. There was no difference between the side effect rate from albendazole or the double placebo. Praziquantel-treated children had more nausea, abdominal pain, and headache but these side effects were statistically more common in children with schistosomiasis, suggesting a strong influence of dying parasites. The subjects were followed for 6 months for changes in infection status, growth parameters, hemoglobin, and schistosomiasis morbidity. In all 4 sites, a significant 6-month increase in serum hemoglobin was observed in children who received praziquantel, strongly supporting population-based mass treatment.

Schistosoma mansoni infection and nutritional status in schoolchildren: a randomized, double-blind trial in northeastern Brazil.

Brazilian schoolchildren with mild- to moderate-intensity schistosome infections (<400 Schistosoma mansoni eggs/g stool) were randomly allocated to a treatment (oxamniquine) or placebo group in a double-blind fashion. Anthropometric measurements were made at baseline, 6 mo, and 1 y for 353 students. At baseline, the groups were not significantly different with respect to nutritional status or selected socioeconomic and biological characteristics, including anthropometric measures. One year later, significant differences were noted only in the nutritional status of boys treated for schistosome infection. Treated boys had greater measurements for weight, triceps skinfold thickness, midarm circumference, arm muscle area, and body mass index than untreated boys. They also showed significant increases over the year in weight, height, midarm circumference, and body mass index. The rates of improvement in weight and height were more accelerated in the first 6 mo after therapy than the last. These results indicate that, at least in boys, chronic S. mansoni infection at any intensity is detrimental to short-term growth and development.

Gender differences in growth of school-aged children with schistosomiasis and geohelminth infection.

Light or moderate intensity infection with Schistosoma mansoni may contribute to growth deficits. We report on the effects of treatment for S. mansoni on growth and development in Brazilian schoolchildren. Anthropometric measurements were taken from 539 S. mansoni-infected children and their age- and sex-matched egg-negative controls between the ages of 7 and 15 years. The children as a whole exhibited chronic malnutrition, with growth retardation in height evident in 21% of the population. Infected children, however, were significantly smaller in height, weight, mid upper arm circumference (UAC), tricep skinfold (TSF), and subscapular skinfold (SSF) measurements than control children (P < 0.05). These differences were due primarily to a greater disparity between infected and egg-negative girls in height (P < 0.01), weight (P = 0.01), UAC (P = 0.O2), and TSF (P < 0.01). Nevertheless, girls demonstrated a better level of development and nutrition compared with boys. While infected boys were shorter and weighed less than controls, these differences were not significant. Growth and development in girls was negatively correlated with intensity of infection. Coinfection with S. mansoni and Trichuris appeared to act synergistically in the development of malnutrition.

The dietary adequacy of edentulous older adults.

This study tested the null hypothesis that there are no differences in dietary patterns or adequacy between edentulous patients and individuals with nearly complete dentitions. The research design involved comparing the dietary patterns and adequacies of 34 edentulous subjects who regularly wear dentures with 38 subjects who had nearly complete dentitions. The subjects were between the ages of 51 and 83 years and were sampled from patients attending Case Western Reserve University Dental Clinic. Although edentulous subjects were more likely to claim that they had trouble chewing their food, they were not more likely to select easy-to-chew foods. On the other hand, the diet of dentate subjects tended to be superior to that of edentulous subjects, as indicated by a lower fat and cholesterol consumption and a higher consumption of protein and all of the vitamins and minerals (significantly or nearly significantly for vitamin A, ascorbic acid, calcium, and riboflavin).

Feeding patterns of urban black infants.

Feeding patterns of 116 urban black infants were studied from 3 weeks to 6 months of age. Dietary data were collected using a diet history and a food frequency checklist completed by trained interviewers at each well child clinic visit at 3 weeks and at 2, 4, and 6 months of age. At 3 weeks, 20% of the infants were solely breast fed, 58% were formula fed, and 22% were partially breast fed. Twenty percent of 3-week-old infants were receiving baby foods. This increased to 48% at 2 months, and to 72% at 4 months. By 6 months of age, 98% of infants received baby foods. Nursing mothers tended to introduce baby foods later than formula-feeding mothers. This is consistent with other studies. Commercially prepared baby foods were used much more commonly than were foods prepared at home. Infant cereal was most often introduced first, followed by strained juices, strained fruits, strained vegetables, combination dinners, desserts, and plain meats, in that order. Table foods contributed very little to caloric intakes of infants less than 4 months of age. Liberal amounts of water and sugar water were given to infants in this cultural group.