Ultra-processed food consumption and metabolic syndrome: a cross-sectional study in Quilombola communities of Alagoas, Brazil.

BACKGROUND: The processing of food can cause changes that turn them into risk factors for chronic diseases. A higher degree of food processing is associated with the development of chronic non-communicable diseases (NCDs), including the metabolic syndrome (MetS). The objective of this study was to analyze the relationship between ultra-processed food (UPF) consumption and the prevalence of MetS and its risk factors, focusing on a population group especially subjected to precarious living conditions and food insecurity. METHOD: Cross-sectional population-based study with women (19 to 59 years) from Quilombola communities of Alagoas. The socioeconomic, demographic, anthropometric, health status, lifestyle, and food intake (24-h recall) variables were analyzed. The dependent variable was the MetS, defined using the harmonization criteria of the Joint Interim Statement, and its components. The foods consumed were categorized according to the Nova Classification, assuming the highest UPF consumption as risk exposure. The measure of association was the prevalence ratio (PR) and respective 95%CI, calculated by Poisson regression with robust variance. We also analyzed the association with the Nova score of UPF consumption. RESULTS: We investigated 895 women (38.9 ± 11.0 years), of whom 48.3% had MetS. On average, 15.9% of the total energy intake came from UPF. Lower Nova scores were associated with a lower prevalence of diabetes and low HDL. Higher UPF consumption was associated with a 30% higher prevalence of hypertension (PR = 1.30; 95%CI: 1.06-1.61). CONCLUSION: The highest UPF consumption was positively associated with the prevalence of hypertension, while a lower Nova score was a protective factor against diabetes and low HDL. UPF consumption in Quilombola communities is important but lower than that observed in the Brazilian population in general. It is suggested that public health programs be implemented to promote healthy eating while valuing the existing eating habits and traditions among the remaining Brazilian Quilombola people.

RESUMO: INTRODUçãO: O processamento de alimentos pode causar alterações que os transformam em fatores de risco para doenças crônicas. Um maior grau de processamento de alimentos está associado ao desenvolvimento de doenças crônicas não transmissíveis (DCNT), incluindo a síndrome metabólica (SM). O objetivo deste estudo foi analisar a relação entre o consumo de alimentos ultraprocessados (AUP) e a prevalência de SM e seus fatores de risco, com foco em um grupo populacional especialmente submetido a precárias condições de vida e insegurança alimentar. MéTODO: Estudo transversal de base populacional com mulheres (19 a 59 anos) de comunidades Quilombolas de Alagoas. Foram analisadas as variáveis socioeconômicas, demográficas, antropométricas, estado de saúde, estilo de vida e ingestão alimentar (recordatório de 24 horas). A variável dependente foi a SM, definida a partir dos critérios de harmonização do Joint Interim Statement, e seus componentes. Os alimentos consumidos foram categorizados de acordo com a Classificação Nova, assumindo como exposição de risco o maior consumo de AUP. A medida de associação foi a razão de prevalência (RP) e respectivo IC 95%, calculado por regressão de Poisson com variância robusta. Também analisou-se a associação com o Escore Nova de consumo de AUP. RESULTADOS: Foram investigadas 895 mulheres (38,9 ± 11,0 anos), das quais 48,3% tinham SM. Em média, 15,9% da ingestão total de energia provinham de AUP. Escores Nova mais baixos foram associados a uma menor prevalência de diabetes e HDL baixo. O maior consumo de AUP se associou a uma prevalência 30% maior de hipertensão arterial (RP = 1,30; IC95%: 1,06-1,61). CONCLUSãO: O maior consumo de AUP se associou positivamente à prevalência de hipertensão, enquanto o menor escore Nova foi fator de proteção contra diabetes e baixo HDL. O consumo de AUP nas comunidades Quilombolas é relevante, mas inferior ao observado na população brasileira em geral. Sugere-se a implementação de programas de saúde pública que promovam a alimentação saudável, valorizando os hábitos e tradições alimentares existentes entre os remanescentes Quilombolas brasileiros.

Estado nutricional e fatores associados à prevalência de obesidade entre escolares das redes pública e privada de ensino fundamental de Maceió, Alagoas / Nutritional status and factors associated with the prevalence of obesity among schoolchildren from public and private elementary schools in Maceio, Alagoas / Estado nutricional y factores asociados a la prevalencia de obesidad entre escolares de enseñanza básica pública y privada de Maceió, Alagoas

Resumo Objetivou-se classificar o estado nutricional e investigar os fatores associados à prevalência de obesidade entre escolares do ensino fundamental público e privado de Maceió. Trata-se de um estudo transversal com amostra probabilística de 1.510 alunos (9,8±0,5 anos) de escolas públicas (n=931) e privadas (n=579). Obtiveram-se dados socioeconômicos, demográficos, antropométricos e dietéticos. O estado nutricional foi estabelecido por antropometria segundo os critérios da OMS. A obesidade foi definida por IMC-para-idade >2 z. A medida de associação foi a razão de prevalência (RP) e respectivo IC95%, calculados por regressão de Poisson. Apenas 1,2% dos investigados apresentaram déficit estatural. A prevalência de obesidade foi maior entre os alunos da rede privada (22,1% vs. 10,3%; RP=2,14; IC95%=1,66-2,76). Na análise bruta associaram-se à obesidade: menor número de moradores no domicílio; comprar lanche na cantina da escola; não ser usuário de programas assistenciais do governo; maior consumo de alimentos não saudáveis; e pertencer à escola privada. Na análise ajustada, apenas esta última variável manteve-se associada (p<0,05), possivelmente, pelo fato de a maioria dos demais preditores ocorrer com maior frequência no âmbito dos estabelecimentos particulares. A obesidade é o principal agravo nutricional encontrado entre os alunos do ensino fundamental de Maceió, condição que se associa, de forma independente, ao fato de pertencer à escola privada.

Abstract The objective was to classify the nutritional status and investigate the factors associated with the prevalence of obesity among students from public and private elementary schools in Maceio. This is a cross-sectional study with a probability sample of 1510 students (9.8 ± 0.5 years) from public (n=931) and private (n=579) schools. Socioeconomic, demographic, anthropometric and dietary data were obtained. Nutritional status was defined by anthropometry according to WHO criteria. Obesity was defined as BMI-for-age >2 z. The measure of association was the prevalence ratio (PR) and respective 95% CI, calculated by Poisson regression. Only 1.2% of those investigated had stunting. The prevalence of obesity was higher among students from the private network (22.1% vs. 10.3%; PR=2.14; 95%CI=1.66; 2.76). In the crude analysis, obesity was associated with lower number of residents at home, buying snacks at school canteens, not being a user of government assistance programs, greater consumption of unhealthy foods and attending a private school. In the adjusted analysis, only this last variable remained associated (p<0.05), possibly due to the fact that most of the other predictors occurred more frequently in the context of private establishments. Obesity is the main nutritional disorder found among elementary school students in Maceio, a condition that is independently associated with attending a private school.

Resumen Este estudio tuvo como objetivo clasificar el estado nutricional e investigar los factores asociados a la prevalencia de obesidad entre estudiantes de escuelas públicas y privadas de Maceió. Se trata de un estudio transversal con una muestra aleatoria de 1510 estudiantes (9,8 ± 0,5 años) que asisten a escuelas públicas (n = 931) y privadas (n = 579), del que se obtuvieron datos socioeconómicos, demográficos, antropométricos y dietéticos. El estado nutricional se definió por antropometría según los criterios de la Organización Mundial de la Salud (OMS). La obesidad se definió como IMC para la edad > 2 z. La medida de asociación fue la razón de prevalencia (PR) y su IC 95 %, calculada por regresión de Poisson. Solo el 1,2 % de los investigados presentaba baja estatura para la edad y la prevalencia de obesidad fue mayor entre estudiantes de la red privada (22,1 % vs. 10,3 %; RP = 2,14, IC 95% : 1,66; 2,76). En el análisis crudo estaban asociados con la obesidad el menor número de integrantes de la familia, comprar almuerzo en la cantina de la escuela, no ser usuarios de programas de asistencia del Gobierno, mayor consumo de alimentos no saludables y la asistencia a escuela privada. En el análisis ajustado, solo esta última variable se mantuvo asociada (p < 0,05). La obesidad es el principal problema nutricional entre los alumnos de enseñanza básica de Maceió, condición que se asocia de forma independiente al hecho de asistir a una escuela privada.

[Trend in the prevalence of anemia in children from maroon communities according to two population-based surveys in Alagoas State, Brazil (2008-2018)]. / Evolução da prevalência de anemia em crianças quilombolas, segundo dois inquéritos de base populacional em Alagoas, Brasil (2008-2018).

The study aimed to assess trends in the prevalence of anemia in children from quilombos (maroon communities) in Alagoas State, Brazil. This was a descriptive study comparing the results of two household surveys (2008; n = 950 and 2018; n = 426), involving a sample of children from 6 to 59 months of age. Anemia was diagnosed as hemoglobin < 110g/L (HemoCue). Prevalence rates between the two surveys were described by percentage and by prevalence ratio (PR) and 95% confidence interval (95%CI), calculated by Poisson regression. Prevalence rates for anemia in 2008 and 2018 were 53% (95%CI: 49.8-56.1) and 38% (95%CI: 33.4-42.6), respectively, or a decrease of 28.3% (RP = 0.72; 95%CI: 0.63-0.82). Children 6 to 24 months of age had higher anemia rates than those 25 to 59 months of age, both in 2008 (72% vs. 44%) and in 2018 (54.8% vs. 28.3%). There was a reduction in prevalence in both age brackets (23.9% and 35.7%, respectively). This sharper decline in older children meant that younger children had nearly double the prevalence rate compared to older children (PR = 1.94; 95%CI: 1.53-2.46). In conclusion, there was a major decline in prevalence of anemia during the period studied, but anemia persisted as a relevant public health problem, especially in children 6 to 24 months of age. The children in the sample are exposed to harsh social vulnerabilities, evidencing that health promotion for this population requires more than actions in the public health sphere itself. Healthcare workers and administrators should be alert to the data presented here, aimed at implementation of measures to confront the social and health iniquities that contribute to greater vulnerability in this ethnic-racial group.

Objetivou-se avaliar a evolução da prevalência de anemia em crianças quilombolas de Alagoas, Brasil. Trata-se de uma análise descritiva comparando resultados de dois inquéritos domiciliares (2008; n = 950 e 2018; n = 426), envolvendo amostra das crianças de 6 a 59 meses. A anemia foi diagnosticada com hemoglobina < 110g/L (HemoCue). As prevalências entre os dois inquéritos foram descritas percentualmente e pela razão de prevalência (RP) e intervalo de 95% de confiança (IC95%), calculados por regressão de Poisson. As prevalências de anemia em 2008 e 2018 foram, respectivamente, 53% (IC95%: 49,8-56,1) e 38% (IC95%: 33,4-42,6), configurando um declínio de 28,3% (RP = 0,72; IC95%: 0,63-0,82). Crianças de 6 a 24 meses foram mais acometidas do que aquelas de 25 a 59 meses, tanto em 2008 (72% vs. 44%) como em 2018 (54,8% vs. 28,3%). Houve redução de prevalência em ambas as faixas etárias (23,9% e 35,7%, respectivamente). Essa redução mais pronunciada nas crianças mais velhas fez que as mais jovens passassem a ter quase o dobro da prevalência vista nas de maior idade (RP = 1,94; IC95%: 1,53-2,46). Conclui-se que houve declínio expressivo da prevalência de anemia durante o período avaliado, persistindo, porém, como relevante problema de saúde pública, sobretudo entre as crianças de 6 a 24 meses. As crianças avaliadas sobrevivem em grande vulnerabilidade social, evidenciando-se que, para promover a saúde dessa população, não são suficientes ações no âmbito da saúde pública. Gestores e profissionais de saúde devem estar atentos aos dados aqui apresentados, visando à implementação de medidas para enfrentamento das iniquidades sociais e de saúde que contribuem para maior vulnerabilidade desse grupo étnico-racial.

El objetivo fue evaluar la evolución de la prevalencia de anemia en niños quilombolas de Alagoas, Brasil. Se trata de un análisis descriptivo, comparando resultados de dos encuestas domiciliarias (2008; n = 950 y 2018; n = 426), implicando en la muestra a niños de 6 a 59 meses. La anemia se diagnosticó con hemoglobina < 110g/L (HemoCue). Las prevalencias entre los dos cuestionarios fueron descritas porcentualmente y por la razón de prevalencia (RP) e intervalo de 95% de confianza (IC95%), calculados por regresión de Poisson. Las prevalencias de anemia en 2008 y 2018 fueron, respectivamente, 53% (IC95%: 49,8-56,1) y 38% (IC95%: 33,4-42,6), configurando un declive de un 28,3% (RP = 0,72; IC95%: 0,63-0,82). Los niños de 6 a 24 meses estuvieron más afectados que aquellos de 25 a 59 meses, tanto en 2008 (72% vs. 44%), como en 2018 (54,8% vs. 28,3%). Hubo una reducción de prevalencia en ambas franjas etarias (23,9% y 35,7%, respectivamente). Esta reducción más pronunciada en niños mayores provocó que los más jóvenes pasasen a tener casi el doble de la prevalencia, vista en aquellos de mayor edad (RP = 1,94; IC95%: 1,53-2,46). Se concluye que hubo un declive expresivo de la prevalencia de anemia durante el período evaluado, persistiendo, no obstante, como un relevante problema de salud pública, sobre todo entre los niños de 6 a 24 meses. Los niños evaluados sobreviven bajo una gran vulnerabilidad social, evidenciándose que para la promoción de la salud de esa población no son suficientes acciones en el ámbito de la salud pública. Gestores y profesionales de salud deben estar atentos a los datos aquí presentados, con el fin de implementar medidas para enfrentar las inequidades sociales y de salud que contribuyen a una mayor vulnerabilidad de ese grupo étnico-racial.

Methodological aspects of the anthropometric assessment in the Brazilian National Survey on Child Nutrition (ENANI-2019): a population-based household survey.

The article presents methodological aspects of anthropometric assessment of nutritional status in children under five years of age and their biological mothers. It discusses the strategies used for training and data collection in the Brazilian National Survey on Child Nutrition (ENANI-2019). ENANI-2019 is a population-based household survey conducted in 123 municipalities in Brazil's 26 states and the Federal District. The anthropometric measurements were body mass and length/stature. The equipment was purchased according to its measurement capacity and precision, portability, and cost-benefit ratio after an extensive market search. The study used internationally established procedures described in manuals, videos, and support material developed for the study by a group of experts. The interviewers were trained to perform the anthropometric measurements and were assessed according to technical measurement error, which was considered adequate (0.30cm) for the children's length/stature measurements. Measurement errors were identified, and the interviewers were retrained when necessary. Of the 14,558 children in the sample, body mass and length/stature measurements were taken in duplicate in 13,835 and 13,693 children, respectively. The standardized methodological aspects will be helpful in future population studies and were essential for obtaining greater reliability in the data for generating current evidence on the anthropometric assessment of the nutritional status of Brazilian children under five years of age, allowing new perspectives for public policy development.

Accuracy of the Simplified Version of the Global Risk Score in Detecting Cardiovascular Risk in Women from Quilombola Communities in the State of Alagoas, Brazil

Abstract Background: Cardiovascular risk (CVR) monitoring is important for defining preventive actions against cardiovascular disease; this condition prevails more intensely in scenarios with less infrastructure such as African descent communities. The Framingham Risk Score (FRS) and the Global Risk Score (GRS) have been used in Brazil for CVR monitoring based on scales of points for certain risk factors. Among these, hypercholesterolemia and low high-density lipoprotein cholesterol require tests not always available in primary care. An alternative would be the simplified GRS (sGRS), in which these tests are replaced by the body mass index (kg/m2). Objective: To determine the accuracy of the sGRS in estimating CVR in African descent women (quilombolas) from Alagoas. Method: This is a cross-sectional study with a representative sample (n=1015) of women from African descent communities in Alagoas. GRS, sGRS, and FRS consisted in the sum of points obtained according to their respective scales. Receiver operating characteristic curves were used to compare the accuracy of these instruments as CVR predictors, assuming the GRS as reference. Statistical significance was assumed when p<0.05. Results: The prevalence of high CVR assessed with the GRS or sGRS was similar (20.1% vs. 20.7%; p>0.05) and higher than that found with the FRS (4.5%; p<0.001). Considering the area under the curve (AUC), the sGRS had a higher discriminatory power (AUC=0.98; 95%CI: 0.98-0.99) than the FRS (AUC=0.91; 95%CI: 0.90-0.93). Conclusion: Among black women living in regions with less infrastructure, the sGRS produced similar results to the GRS, with greater operational simplicity.

Common Mental Disorder and early interruption of exclusive maternal breastfeeding in Quilombola women: a population-based study / Transtorno mental comum e interrupção precoce do aleitamento materno exclusivo em mulheres quilombolas: estudo de base populacional

Abstract Objectives: to investigate the prevalence of exclusive maternal breastfeeding (EMBF) and evaluate whether common mental disorder (CMD) and other predictors promote its early interruption (EI-EMBF4). Methods: a cross-sectional study involving all children <24 months (n=252) residing in 50% (n=34) of the Quilombola communities in Alagoas. The EI-EMBF4 was established when EMBF was ≤4 months. The Self-Reporting Questionnaire was used to identify the occurrence of CMD. Other predictors were obtained through interviews. The measure of association was the prevalence ratio calculated by the Poisson regression, following a hierarchical theoretical model. The prevalence of EMBF for 4 and 6 months, and its median duration (survival analysis) were calculated. Results: the prevalence of EI-EMBF4 and CMD was 57.6% and 42.9%, respectively. The risk factors independently associated with EI-EMBF4 were: living in a mud house, maternal age ≤18 years, low birth weight and the use of a pacifier or baby bottle. There was no association with CMD. The prevalence of EMBF for four and six months was 42.4% and 25.4%, respectively, and the median duration was 106 days. Conclusion: EMBF indicators are below the established recommendations, justifying the implementation of measures that prioritize women subjected to risk factors identified here. CMD is not configured among these.

Resumo Objetivos: investigar a prevalência do aleitamento materno exclusivo (AME) e se o transtorno mental comum (TMC) e outros preditores promovem sua interrupção precoce (IP- AME4). Métodos: estudo transversal envolvendo todas as crianças <24 meses (n=252) residentes em 50% (n=34) das comunidades quilombolas de Alagoas. A IP-AME4 foi definida quando o AME foi ≤ 4 meses. Utilizou-se o Self-Reporting Questionnaire para identificar o TMC. Outros preditores foram obtidos por meio de entrevista. A medida de associação foi a razão de prevalência calculada por regressão de Poisson, seguindo modelo teórico hierárquico. Foram calculadas as prevalências de AME por 4 e 6 meses e sua duração mediana (análise de sobrevivência). Resultados: as prevalências de IP-AME4 e do TMC foram 57,6% e 42,9%, respectivamente. Os fatores de risco independentemente associados à IP-AME4 foram: residir em casa de taipa, idade materna ≤18 anos, baixo peso ao nascer e uso de chupeta ou de mamadeira. Não houve associação com TMC. As prevalências do AME por quatro e por seis meses foram 42,4% e 25,4%, nessa ordem, e a duração mediana foi de 106 dias. Conclusão: os indicadores de AME estão aquém das metas estabelecidas, justificando a implementação de medidas que atuem sobre os fatores de risco aqui identificados, sendo que o TMC não se configura entre esses.

Prevalence of IGFBP3, NOS3 and TCF7L2 polymorphisms and their association with hypertension: a population-based study with Brazilian women of African descent.

OBJECTIVE: African ancestry seems to be a risk factor for hypertension; however, few genetic studies have addressed this issue. This study aimed to investigate the prevalence of polymorphisms NOS3; rs1799983, IGFBP3; rs11977526 and TCF7L2; rs7903146 in Brazilian women of African descent and their association with hypertension. RESULTS: The prevalences of the less frequent genotypes were 26.5% TT genotype of NOS3; rs1799983, 16.7% AA genotype of IGFBP3; rs11977526, and 18.3% TT genotype of TCF7L2; rs7903146. For these conditions, the prevalence of hypertension and PR (adjusted) relatively to the ancestral genotype were, respectively: 52.0% vs 24.5% (PR = 1.54; p < 0.001), 62.0% vs 24.1% (PR = 1.59; p < 0.001), and 38.9% vs 27.9% (PR = 0.86; p = 0.166). Associations with hypertension were statistically significant, except for the TCF7L2; rs7903146 polymorphism, after adjusted analysis. Brazilian Afro-descendant women with the TT genotype for the NOS3 gene and the AA genotype for the IGFBP3 gene are more susceptible to hypertension. The understanding of underlying mechanisms involving the pathogenesis of hypertension can motivate research for the development of new therapeutic targets related to nitric oxide metabolism and the management of oxidative stress.

Factors associated with childhood anaemia in Afro-descendant communities in Alagoas, Brazil.

OBJECTIVE: To investigate factors associated with anaemia in preschool children. DESIGN: A home survey was conducted in 2018. Anaemia in children (capillary blood Hb level < 110 g/l) was the outcome, and socio-economic, demographic and health factors of the mother and child were the independent variables. The measure of association was the prevalence ratio, and its 95 % CI was calculated using Poisson's regression with robust variance and hierarchical selection of independent variables. SETTING: Afro-descendants communities living in the state of Alagoas, northeast Brazil. PARTICIPANTS: Children aged 6-59 months and their mothers (n 428 pairs). RESULTS: The prevalence of child anaemia was 38·1 % (95 % CI 33·5, 42·7). The associated factors with child anaemia were male sex, age < 24 months, larger number of residents at home (> 4), relatively taller mothers (highest tertile) and higher z-score of BMI for age, after further adjustment for wealth index, vitamin A supplementation in the past 6 months and clinical visit in the last 30 d. CONCLUSIONS: The high prevalence of anaemia observed reveals a relevant public health problem amongst children under five from the quilombola communities of Alagoas. Considering the damage caused to health and multiplicity of risk factors associated with anaemia, the adoption of intersectoral strategies that act on modifiable risk factors and increase vigilance concerning those that are not modifiable becomes urgent.

Evolução da prevalência de anemia em crianças quilombolas, segundo dois inquéritos de base populacional em Alagoas, Brasil (2008-2018) / Trend in the prevalence of anemia in children from maroon communities according to two population-based surveys in Alagoas State, Brazil (2008-2018) / Evolución de la prevalencia de anemia en niños quilombolas, según dos encuestas de base poblacional en Alagoas, Brasil (2008-2018)

Objetivou-se avaliar a evolução da prevalência de anemia em crianças quilombolas de Alagoas, Brasil. Trata-se de uma análise descritiva comparando resultados de dois inquéritos domiciliares (2008; n = 950 e 2018; n = 426), envolvendo amostra das crianças de 6 a 59 meses. A anemia foi diagnosticada com hemoglobina < 110g/L (HemoCue). As prevalências entre os dois inquéritos foram descritas percentualmente e pela razão de prevalência (RP) e intervalo de 95% de confiança (IC95%), calculados por regressão de Poisson. As prevalências de anemia em 2008 e 2018 foram, respectivamente, 53% (IC95%: 49,8-56,1) e 38% (IC95%: 33,4-42,6), configurando um declínio de 28,3% (RP = 0,72; IC95%: 0,63-0,82). Crianças de 6 a 24 meses foram mais acometidas do que aquelas de 25 a 59 meses, tanto em 2008 (72% vs. 44%) como em 2018 (54,8% vs. 28,3%). Houve redução de prevalência em ambas as faixas etárias (23,9% e 35,7%, respectivamente). Essa redução mais pronunciada nas crianças mais velhas fez que as mais jovens passassem a ter quase o dobro da prevalência vista nas de maior idade (RP = 1,94; IC95%: 1,53-2,46). Conclui-se que houve declínio expressivo da prevalência de anemia durante o período avaliado, persistindo, porém, como relevante problema de saúde pública, sobretudo entre as crianças de 6 a 24 meses. As crianças avaliadas sobrevivem em grande vulnerabilidade social, evidenciando-se que, para promover a saúde dessa população, não são suficientes ações no âmbito da saúde pública. Gestores e profissionais de saúde devem estar atentos aos dados aqui apresentados, visando à implementação de medidas para enfrentamento das iniquidades sociais e de saúde que contribuem para maior vulnerabilidade desse grupo étnico-racial.

The study aimed to assess trends in the prevalence of anemia in children from quilombos (maroon communities) in Alagoas State, Brazil. This was a descriptive study comparing the results of two household surveys (2008; n = 950 and 2018; n = 426), involving a sample of children from 6 to 59 months of age. Anemia was diagnosed as hemoglobin < 110g/L (HemoCue). Prevalence rates between the two surveys were described by percentage and by prevalence ratio (PR) and 95% confidence interval (95%CI), calculated by Poisson regression. Prevalence rates for anemia in 2008 and 2018 were 53% (95%CI: 49.8-56.1) and 38% (95%CI: 33.4-42.6), respectively, or a decrease of 28.3% (RP = 0.72; 95%CI: 0.63-0.82). Children 6 to 24 months of age had higher anemia rates than those 25 to 59 months of age, both in 2008 (72% vs. 44%) and in 2018 (54.8% vs. 28.3%). There was a reduction in prevalence in both age brackets (23.9% and 35.7%, respectively). This sharper decline in older children meant that younger children had nearly double the prevalence rate compared to older children (PR = 1.94; 95%CI: 1.53-2.46). In conclusion, there was a major decline in prevalence of anemia during the period studied, but anemia persisted as a relevant public health problem, especially in children 6 to 24 months of age. The children in the sample are exposed to harsh social vulnerabilities, evidencing that health promotion for this population requires more than actions in the public health sphere itself. Healthcare workers and administrators should be alert to the data presented here, aimed at implementation of measures to confront the social and health iniquities that contribute to greater vulnerability in this ethnic-racial group.

El objetivo fue evaluar la evolución de la prevalencia de anemia en niños quilombolas de Alagoas, Brasil. Se trata de un análisis descriptivo, comparando resultados de dos encuestas domiciliarias (2008; n = 950 y 2018; n = 426), implicando en la muestra a niños de 6 a 59 meses. La anemia se diagnosticó con hemoglobina < 110g/L (HemoCue). Las prevalencias entre los dos cuestionarios fueron descritas porcentualmente y por la razón de prevalencia (RP) e intervalo de 95% de confianza (IC95%), calculados por regresión de Poisson. Las prevalencias de anemia en 2008 y 2018 fueron, respectivamente, 53% (IC95%: 49,8-56,1) y 38% (IC95%: 33,4-42,6), configurando un declive de un 28,3% (RP = 0,72; IC95%: 0,63-0,82). Los niños de 6 a 24 meses estuvieron más afectados que aquellos de 25 a 59 meses, tanto en 2008 (72% vs. 44%), como en 2018 (54,8% vs. 28,3%). Hubo una reducción de prevalencia en ambas franjas etarias (23,9% y 35,7%, respectivamente). Esta reducción más pronunciada en niños mayores provocó que los más jóvenes pasasen a tener casi el doble de la prevalencia, vista en aquellos de mayor edad (RP = 1,94; IC95%: 1,53-2,46). Se concluye que hubo un declive expresivo de la prevalencia de anemia durante el período evaluado, persistiendo, no obstante, como un relevante problema de salud pública, sobre todo entre los niños de 6 a 24 meses. Los niños evaluados sobreviven bajo una gran vulnerabilidad social, evidenciándose que para la promoción de la salud de esa población no son suficientes acciones en el ámbito de la salud pública. Gestores y profesionales de salud deben estar atentos a los datos aquí presentados, con el fin de implementar medidas para enfrentar las inequidades sociales y de salud que contribuyen a una mayor vulnerabilidad de ese grupo étnico-racial.

Stunting and overweight among children in Northeast Brazil: prevalence, trends (1992-2005-2015) and associated risk factors from repeated cross-sectional surveys.

BACKGROUND: A study involving children from Alagoas (Northeast Brazil) revealed that, as a consequence of a drastic reduction in the prevalence of stunting between 1992 to 2005, (22.5 to 11.4%) combined with an increase in overweight prevalence (6.7 to 9.3%), the prevalence of these two conditions in 2005 was very close. If these trends were maintained, it is very likely that, at this time, the childhood overweight prevalence has already exceeded that of the stunting. However, no study is available to confirm this hypothesis. The identification of these changes is relevant to the planning and evaluation of public policies. This study aimed to investigate the prevalence, time trends and associated factors with stunting and overweight in children from Alagoas. METHODS: Independent cross-sectional household surveys were conducted in 1992 (n = 1231), 2005 (n = 1381) and 2015 (n = 988). Data were collected from probabilistic samples of children aged 0-60 months. Stunting was defined by stature-for-age < - 2 sd and overweight by weight-for-stature > 2 sd. RESULTS: Between 1992, 2005 and 2015, the stunting prevalence was 22.6, 11.2 and 3.2% (reduction of 85.8%), while the overweight prevalence was 6.9, 7.5 and 14.9% (increase of 115.9%), respectively. After multivariate analysis, the following positive associations with stunting were observed in 1992: age group > 24 months (28.3% vs 14.5%), mother with ≥2 children (28.8% vs 12.8%), low birth weight (28.3% vs 15.7%) and mother with low schooling (29.3% vs 7.2%). In 2015 there was a higher prevalence of stunting in males (4.2% vs 2.2%), in children < 24 months (4.6% vs 2.2%), with low birth weight (8.6% vs 3.0%) and in those who had mothers with low schooling (7.0% vs 2.6%). Regarding overweight, in 1992 there was higher prevalence for male (9.1% vs 4.7%) and in children whose mothers had ≤2 children (8.9% vs 5.8%), while in 2015 only birth weight >  4 kg was associated to overweight (27.3% vs 14.2%). CONCLUSIONS: During the analyzed period, there was a significant decrease in stunting prevalence. At the same time, a substantial increase was observed in the overweight prevalence. Currently, stunting is a problem of low magnitude, while overweight has become a worrying public health problem.

Anthropometric assessment of children's nutritional status: a new approach based on an adaptation of Waterlow's classification.

BACKGROUND: The methodology currently used for nutritional assessment of populations classifies children according to four conditions: eutrophy, wasting, stunting, and overweight. However, children can be stunted and wasted concomitantly. Similarly, they can be stunted and overweight. These conditions are associated with greater susceptibility to mortality or chronic diseases, respectively. This work presents an adaptation of Waterlow's classification (AWC), which discriminates six nutritional conditions. Additionally, it provides a command routine in Stata, which processes the z-scores of the anthropometric indices height-for-age and weight-for-height and presents the respective prevalence of the nutritional conditions. METHODS: Data from two household surveys were used to demonstrate the application of AWC, which were conducted in 1992 (n = 1229) and 2015 (n = 987), with probabilistic samples of children (< 5 years) in Alagoas, Northeast Brazil. AWC is based on a cross-classification scheme, involving the categories obtained with height-for-age (z < - 2; z ≥ - 2) and weight-for-height (z < - 2; - 2 to 2; z > 2). RESULTS: The prevalence obtained with AWC in 1992 and 2015 was, respectively: eutrophy (71.0/80.2), stunting (20.8/2.7), wasting (0.8/2.1), concurrent stunting and wasting (0.5/0.0), overweight (4.8/14.4) and short stature with overweight (2.0/0.5). The prevalence of wasting, concurrent wasting and stunting, and for short stature with overweight was never higher than 2.3%. Possibly these values should be much higher in countries where there is a high prevalence of undernutrition. In total, 472 children had low height-for-age. By the usual anthropometric classification, they would be classified as chronic undernourished. However, 39 (8.3%) of them were also overweight and seven (1.5%) had concurrent stunting and wasting, a condition at extreme risk of mortality, which is perhaps the explanation for its low prevalence in cross-sectional studies. CONCLUSION: In addition to identifying wasted, stunted and overweight children, AWC also identified children with two other conditions, which are generally neglected in most nutritional surveys. Each of these nutritional conditions have different characteristics (aetiology, preventive, and therapeutic approach, damage to the patient's health, and priority level in public policy). Such aspects justify their identification in the distinct scenarios where nutritional surveys are developed.

Developmental origins of health and disease: a new approach for the identification of adults who suffered undernutrition in early life.

BACKGROUND: Undernutrition in early life (UELife) is a condition associated with greater occurrence of chronic diseases in adulthood. Some studies on this relationship have used short stature as indicator of UELife. However, other non-nutritional factors can also determine short stature. Depending on the severity of UELife, the human body reacts primarily compromising weight and length gain, but prioritizing brain growth, resulting in disproportionate individuals. Based on this premise, this study aimed to validate a new anthropometric indicator of UELife. DESIGN: Using stature and head circumference data from a probabilistic sample of 3,109 women, the Head-to-Height Index was calculated: HHI = (head × 2.898)/height. A HHI >1.028 (75th percentile) was the best cutoff for predicting obesity (best balance between sensitivity/ specificity, largest area under the receiver operating characteristic curve, and highest correlation coefficient) and was used to define the condition of body disproportionality. The strength of associations with several outcomes was tested for both disproportionality and short stature (height ≤25th percentile: 153.1 cm). RESULTS: In adjusted analysis for confounding factors (age, smoking, and education level), the strength of the associations between body disproportionality and the analyzed outcomes was greater than that observed when short stature was used. Respectively, the observed prevalence ratios (95% CI) were (P<0.05 for all comparisons): obesity: 2.61 (2.17-3.15) vs 1.09 (0.92-1.28); abdominal obesity: 2.11 (1.86-2.40) vs 1.42 (1.27- 1.59); high blood pressure: 1.24 (1.02-1.50) vs 0.90 (0.75-1.08); hypercholesterolemia: 2.98 (1.47-6.05) vs 1.65 (0.91-2.99); and hypertriglyceridemia: 1.47 (1.07-2.03) vs 0.91 (0.69-1.21). CONCLUSION: Body disproportionality is a more accurate indicator of UELife than short stature. While short stature may be genetically determined, a high HHI is due to metabolic adaptations to undernutrition in early life.

Prevalence, temporal trend and associated factors with excess body weight in mothers of children under five years / Prevalência, tendência temporal e fatores associados ao excesso de peso em mães de crianças menores de cinco anos

ABSTRACT Objective This study aims to evaluate the prevalence, temporal trends and associated factors with excess weight in mothers of children under five years of age. Methods This is a time-series study using data from two household surveys conducted in 2005 and 2015. A total of 1,436 mothers were evaluated in 2005, and 690 were evaluated in 2015. The dependent variables were excess body weight (Body Mass Index [BMI] ≥25.0kg/m2), high percentage of Body Fat (%BF ≥33%) and abdominal obesity (waist circumference >80cm). The independent variables were the socioeconomic and demographic factors. The changes that occurred between the two surveys were expressed in percentages, and the measure of association was the Prevalence Ratio, calculated by Poisson regression, in both the crude and multivariate analyses. Results There were increases of 33.2%, 59.2% and 31.0%, respectively, for the prevalence of excess weight (PR=1.33, 95% Confidence Interval [CI]:1.21-1.46), abdominal obesity (PR=1.59, 95% CI:1.43-1.77) and high %BF (PR=1.31, 95% CI:1.07-1.60). The factors independently associated with excess weight and abdominal obesity were the highest age group (>30 years), menarche ≤12 years and higher parity (>2 children). The same was observed for high %BF, except for the loss of significance in the adjusted analysis for the variable menarche ≤12 years. Conclusion The prevalence of high body adiposity is a problem of relevant importance in the studied population and has presented an upward trend in the last 10 years. Women over 30 years and with more than two children should be given priority in prevention and control.

RESUMO Objetivo Este estudo teve como objetivo avaliar a prevalência, a tendência temporal e os fatores associados ao excesso de peso em mães de crianças menores de cinco anos. Métodos Trata-se de um estudo de série temporal que se utilizou de dados de dois inquéritos domiciliares realizados em 2005 e 2015, respectivamente. Em 2005 foram avaliadas 1.436 mães, e em 2015 avaliaram-se 690. As variáveis dependentes foram o excesso de peso (IMC ≥25,0kg/m2), o percentual de gordura corporal elevado (%GC ≥33%) e a obesidade abdominal (perímetro da cintura >80cm). As variáveis independentes foram os fatores socioeconômicos e demográficos. As modificações ocorridas entre os dois inquéritos foram expressas percentualmente, e a medida de associação foi a razão de prevalência, calculada por regressão de Poisson, tanto na análise bruta quanto na multivariável. Resultados Verificaram-se incrementos de 33,2%, 59,2% e 31,0%, respectivamente, para as prevalências de excesso de peso (RP=1,33; IC95%: 1,21-1,46), obesidade abdominal (RP=1,59; IC95%: 1,43-1,77) e percentual de gordura corporal elevado (RP=1,31; IC95%: 1,07-1,60). Os fatores independentemente associados ao excesso de peso e à obesidade abdominal foram a maior faixa etária (>30 anos), menarca (<12 anos) e maior paridade (>2 filhos). O mesmo se observou para o percentual de gordura corporal elevado, exceto pela perda da significância na análise ajustada para a variável menarca <12 anos. Conclusão A prevalência de excesso de adiposidade corporal se apresenta em alta magnitude na população estudada e vem apresentando tendência ascendente nos últimos dez anos. Mulheres com mais de trinta anos e com mais de dois filhos devem receber prioridade nas ações de prevenção e controle.

Prevalence and temporal trend (2005-2015) of anaemia among children in Northeast Brazil.

OBJECTIVE: Anaemia is the main nutritional deficiency in Brazil, and a prevention and control programme (National Program for Iron Supplementation) has been developed since 2005. Studies on the temporal evolution of anaemia prevalence contribute to assessment of the effectiveness of the actions undertaken. The present study aimed to identify the prevalence and temporal trend of anaemia in children. DESIGN: Study based on two cross-sectional household surveys carried out in 2005 and 2015. Anaemia was defined as Hb<11 g/dl (HemoCue®). Trend analysis was performed using the prevalence ratio (PR), calculated by Poisson regression with a robust adjustment of the variance. Differences were significant when P<0·05 in both crude analyses and those adjusted for possible confounding factors (e.g. socio-economic, demographic and health variables). SETTING: Alagoas, Brazil. SUBJECTS: In total, 666 and 782 children in the first and second Alagoas State Health and Nutrition Survey, respectively (probabilistic samples). RESULTS: In 2005 and 2015, anaemia prevalence was 45·1 and 27·4 %, respectively (-39·1 %; PR=0·61; 95 % CI 0·52, 0·70). In both surveys, children aged ≤24 months were more affected (P24 months (67·2 v. 40·7 %; 27·0 v. 19·3 %, respectively). CONCLUSIONS: The prevalence of anaemia reduced significantly in the evaluated period. Thus, it may no longer be a severe public health problem but can instead be considered a problem of moderate magnitude. It remains, however, above the level considered acceptable according to WHO criteria. These results justify the implementation of prevention and control actions.

Preditores antropométricos de hipertensão arterial sistêmica em mulheres afrodescendentes / Anthropometric predictors of hypertension in afro-descendant women

OBJETIVOS: Investigar a associação entre parâmetros antropométricos e hipertensão arterial sistêmica e identificar os melhores preditores antropométricos dessa condição em mulheres afrodescendentes, de comunidades remanescentes de quilombos. MÉTODOS: Estudo transversal realizado com mulheres quilombolas do Estado de Alagoas. Foram investigados pressão arterial, parâmetros antropométricos (índice de massa corporal, circunferência da cintura, razão cintura-quadril, razão cintura-estatura, índice de conicidade, gordura corporal), variáveis sociodemográficas, tabagismo e paridade. As associações entre parâmetros antropométricos e hipertensão arterial sistêmica foram averiguadas por meio da regressão de Poisson com ajuste robusto da variância. A capacidade desses parâmetros em predizer a presença de hipertensão arterial sistêmica foi analisada por meio de curvas ROC (Receiver Operating Characteristic). RESULTADOS: Foram avaliadas 1.553 mulheres, com idades entre 20 e 59 anos. A prevalência de hipertensão arterial sistêmica foi 35,8% e a de excesso de peso foi 48,5%. A presença de hipertensão arterial sistêmica associou-se a índice de massa corporal, circunferência da cintura, razão cintura-quadril, razão cintura-estatura e gordura corporal, mesmo após o ajuste para idade, classe socioeconômica e tabagismo. A partir das curvas ROC, foram encontrados os seguintes pontos de corte: índice de massa corporal ≥26,2 kg/m², circunferência da cintura ≥81,6 cm, razão cintura-quadril ≥0,84, razão cintura-estatura ≥0,54, índice de conicidade ≥1,20 e gordura corporal ≥35,4%. Gordura corporal, razão cintura-quadril e razão cintura-estatura apresentaram igual capacidade em predizer a hipertensão arterial sistêmica. CONCLUSÕES: Todos os indicadores de obesidade global e os de obesidade central, excetuando-se o índice de conicidade, associaram-se à hipertensão arterial sistêmica nessa amostra de mulheres afrodescendentes quilombolas. Os melhores preditores antropométricos de hipertensão arterial sistêmica foram porcentagem de gordura corporal, razão cintura-quadril e razão cintura-estatura. Essas medidas tiveram igual, embora baixo, poder discriminatório para a presença de hipertensão arterial sistêmica nessa população.

AIMS: To determine the association between anthropometric parameters and systemic arterial hypertension and to identify the best anthropometrics predictors of this disease in afro-descendant women from remaining quilombo communities. METHODS: A cross-sectional study was conducted with quilombola women from Alagoas State. Blood pressure, anthropometric parameters (body mass index, waist circumference, waist-to-hip ratio, waist-to-height ratio, conicity index, body fat), sociodemographic variables, smoking and parity were investigated. The associations between anthropometric parameters and systemic arterial hypertension were investigated using Poisson regression with robust variance adjustment. The ability of these parameters to predict the presence of systemic arterial hypertension was analyzed using Receiver Operating Characteristic (ROC) curves. RESULTS: A total of 1,553 women, aged between 20 and 59 years, were evaluated. The prevalence of systemic arterial hypertension was 35.8% and that of overweight was 48.5%. The presence of systemic arterial hypertension was associated with body mass index, waist circumference, waist-to-hip ratio, waist-to-height ratio, and body fat, even after adjusting for age, socioeconomic class, and smoking status. From the ROC curves, the following cutoff points were found: body mass index ≥26.2 kg/m², waist circumference ≥81.6 cm, waist-to-hip ratio ≥0.84, waistto-height ratio ≥0.54, conicity index ≥1.20 and body fat ≥35.4%. Body fat, waist-to-hip ratio and waist-to-waist ratio were equally able to predict systemic arterial hypertension. CONCLUSIONS: All indicators of global obesity and those of central obesity, except for the conicity index, were associated with systemic arterial hypertension in this sample of Afro-descendant quilombola women. Percentage of body fat, waist-to-hip ratio and waist-to-height ratio were the best anthropometric predictors of systemic arterial hypertension. These measures had equal, albeit low, discriminatory power for the presence of systemic arterial hypertension in this population.

Short Stature Is Associated With Overweight but Not With High Energy Intake in Low-Income Quilombola Women.

BACKGROUND: Population exposed to chronic undernutrition in early life seems to be more susceptible to obesity in adulthood due to the development of mechanisms that improve the efficiency of energy use. Therefore, these individuals have relatively reduced energy requirements (thrifty phenotype). OBJECTIVE: To investigate, among women living on severe socioeconomic vulnerability, whether short stature, a marker for undernutrition in early life, is associated with excess body weight but not with a high energy intake. METHODS: This cross-sectional study, carried out between July and November 2008, evaluated 1308 women from all (N = 39) Quilombola communities of Alagoas. Adequacy of energy intake was estimated by the ratio between energetic ingestion and the estimated energy requirement (EER). RESULTS: The prevalence of short stature (≤ 154.8 cm) was 43.0% and 52.4% had excess body weight (body mass index ≥ 25 kg/m2), being that 33.1% were overweight and 19.3% obese. Excess body weight was higher among women with short stature (56.6% vs 49.2%; P = .008), even after adjusting for age, energy intake, and per capita income (prevalence ratio = 1.16; 95% confidence interval = 1.04; 1.28). The ratio of energy intake/EER was independent of women's stature. CONCLUSION: Excess body weight among Quilombola women represents a serious health problem. Short stature was significantly associated with excess body weight but not with a high energy intake. "Thrifty phenotype" may be one of the plausible explanations for this finding.

Comunidade quilombola na Região Nordeste do Brasil: saúde de mulheres e crianças antes e após sua certificação / A quilombola community in the Northeast region of Brazil: the health of women and children before and after certification

Caracterizar a situação de saúde de mulheres e crianças em uma comunidade quilombola no Nordeste do Brasil, antes e após sua certificação. Métodos: os dados procedem de dois inquéritos com metodologias similares, realizados em 2008 e 2009, no universo de mulheres e crianças residentes. As características socioeconômicas e de saúde das populações nos dois períodos foram comparadas pelo cálculo da Razão de Prevalência (RP), utilizando regressão de Poisson. Resultados: foram estudadas 143 mulheres e 194 crianças e 172 mulheres e 67 crianças nos anos de 2008 e 2012, respectivamente. As prevalências de excesso de peso (59,1 por cento vs. 62,8 por cento) e circunferência da cintura ≥80cm (59,5 por cento vs. 57,4 por cento) foram semelhantes entre os períodos (p>0,05). As características que apresentaram mudanças significantes (p<0,05) foram: renda familiar per capita >2 dólares/dia (23,2 por cento vs. 67,4 por cento; RP=2,90; IC95 por cento: 2,11-4,01), prevalência de diarreia nas crianças (10,3 por cento vs. 26,9 por cento; RP=2,61; IC95 por cento: 1,46-4,62), calendário vacinal atualizado (80,4 por cento vs. 95,3 por cento; RP=1,18; IC95 por cento: 1,08-1,30), frequência de suplementação de vitamina A (70,3 por cento vs. 100,0 por cento; RP=1,42; IC95 por cento: 1,29-1,56), período de amamentação exclusiva ≥6 meses (8,7 por cento vs. 44,6 por cento; RP=5,13; IC95 por cento: 2,95-8,92) e prevalência de anemia em crianças (41,6 por cento vs. 20,0 por cento; RP=0,48; IC95 por cento: 0,27-0,87). Conclusões: ocorreram melhorias na situação de saúde, todavia ainda são necessários investimentos visando o incremento do padrão de saúde na comunidade...

To characterize the health status of women and children in a quilombola community in the Northeast region of Brazil before and after certification. Methods: the data are taken from two investigations using similar methodologies carried out in 2008 and 2009, among women and children residing in the community. The socio-economic and health characteristics of these populations in the two periods were compared by calculating the Prevalence Ratio (PR), using Poisson regression. Results: the studies covered 143 women and 194 children in 2008 and 172 women and 67 children in 2012. The prevalence of overweight (59.1 percent vs. 62.8 percent) and waist circumference ≥80cm (59.5 percent vs. 57.4 percent ) were similar in the two periods (p>0.05). The characteristics that exhibited significant changes (p<0.05) were: per capita family income > 2 US dollars/day (23.2 percent vs. 67.4 percent ; PR=2.90; CI95 percent: 2.11-4.01), prevalence of diarrhea in children (10.3 percent vs. 26.9 percent; PR=2.61; CI95 percent: 1.46-4.62), up-to-date vaccination record (80.4 percent vs. 95.3 percent ; PR=1.18; CI95 percent : 1.08-1.30), frequency of receipt of vitamin A supplements (70.3 percent vs. 100.0 percent ; PR=1.42; CI95 percent : 1.29-1.56), duration of exclusive breastfeeding ≥6 months (8.7 percent vs. 44.6 percent; PR=5.13; CI95 percent : 2.95-8.92) and prevalence of anemia among children (41.6 percent vs. 20.0 percent ; PR=0.48; CI95 percent : 0.27-0.87). Conclusions: there have been improvements in the health status of the population, but investment still needs to be made to ensure that health standards in the community continue to rise...

Sanitary status of public school food services in Maceió (Alagoas, Brazil), 2013

The risk of foodborne illnesses is related to incorrect food handling practices and food service infrastructure and equipment. This study aimed to assess the sanitary status of the food services of public schools in Maceió. The services of 40 of 121 schools were chosen by simple random sampling. The assessment used a good-practices checklist containing all of the rules in Resolution 216/04 of the National Sanitary Surveillance Agency. The possible answers were "in compliance" and "not in compliance," which were then considered to determine the compliance of the service with the above-mentioned Resolution. The services were classified as: critical (≤ 30%), unsatisfactory (31 to 49%), regular (50 to 69%), satisfactory (70 to 89%), and excellent (≥ 90%). Not one service achieved regular, satisfactory, or excellent compliance; 23 (57.5%) and 17 (42.5%) presented with unsatisfactory and critical compliance, respectively. The main problems were bad infrastructure and poor food-handling practices. The services do not comply with the norms for safe food production. This situation demands urgent action from the professionals and managers.

Objetivou-se avaliar os aspectos higiênico-sanitários dos serviços de alimentação dos estabelecimentos públicos de ensino fundamental de Maceió, Estado de Alagoas, Brasil. De um total de 121 escolas, 40 foram selecionadas por sorteio simples e tiveram seus serviços avaliados. Para isso, utilizou-se um checklist de boas práticas baseado na Resolução 216/04 da Agência Nacional de Vigilância Sanitária, constando 83 questões referentes aos aspectos higiênico-sanitários, cujas respostas, "conforme" ou "não conforme", determinam o percentual de adequação do serviço. De acordo com este percentual, os serviços foram classificados nas seguintes categorias: crítico (≤ 30%), insatisfatório (31 a 49%), regular (50 a 69%), satisfatório (70 a 89%) e excelente (≥ 90%). Nenhum serviço atingiu a condição de regular, satisfatório ou excelente, sendo que 23 (57,5%) serviços apresentaram nível insatisfatório e 17 (42,5%) nível crítico. As principais inconformidades relacionaram-se às condições de infraestrutura e à baixa qualificação dos funcionários no que se refere às boas práticas de manipulação de alimentos. Os serviços estudados não atendem às normas de produção de alimento seguro, situação que constitui uma violação ao direito humano à alimentação adequada e demanda providências urgentes por parte dos profissionais e gestores envolvidos com a alimentação, nutrição e com a saúde dos escolares da capital alagoana.

[Prevalence and factors associated with food and nutrition insecurity in families in municipalities of the north of the State of Alagoas, Brazil, 2010]. / Prevalência e fatores associados à Insegurança Alimentar e Nutricional em famílias dos municípios do norte de Alagoas, Brasil, 2010.

The scope of this study was to identify the prevalence and factors associated with food insecurity (INSEC) in families of northern Alagoas. A cross-sectional study was conducted with a random sample of 1444 households classified in accordance with the Brazilian INSEC scale into the following categories: mild, moderate or severe. The prevalence ratio calculated by Poisson regression was used to investigate the association of moderate + severe INSEC with the independent variables in both crude and adjusted analysis. The variables that in the crude analysis reached p < 0.2 were included. INSEC was detected in 919 families, of which, 23.3% and 14.2% were in the moderate or severe form, respectively. There was a higher proportion of food insecurity in the families with subjects < 18 years. The variables that remained independently associated to moderate + severe food insecurity were: rooms in the household ≤ 4, schooling of the household head ≤ 4 years, drinking water other than mineral, beneficiary of the Bolsa Família Program, number of residents in the household > 4, head of household is female and schooling of the housewife ≤ 4 years. The conclusion was that the families studied showed a high prevalence of INSEC, especially those with individuals < 18 years.

Prevalence and factors associated with overweight and obesity in children under five in Alagoas, Northeast of Brazil; a population-based study / Prevalencia y factores asociados con sobrepeso y obesidad en los niños menores de cinco años en alagoas, noroeste de Brasil; un estudio basado en la población

Objective: To investigate the prevalence and associated factors with overweight and obesity among children under five in the Alagoas state, Northeast of Brazil. Design: Cross-sectional population-based study. The study was based on 1115 children with an average age of 24.7 months (SD ± 16.8), and 51.7% were female. Nutritional status was classified according to BMI / age. The z score > + 1 and ≤ +2 z identified children with overweight and > + 2 z score identified those with obesity, according to the standard reference of World Health Organization. To identify the variables associated with overweight and obesity was performed Poisson regression analysis. Results: The prevalence of overweight and obesity was 23.9% and 7.8%, respectively, 33.8% for girls and 29.4% in boys. After adjustment, the per capita income equal to or greater than 2.5 times the minimum wage, age 6 to 23 months and mother overweight and obesity remained positively associated with overweight/obesity. On the other hand, it was observed negative association between low and insufficient birth weight with child overweight/ obesity. Conclusions: The results show a similar prevalence of overweight and obesity to other studies in the country for children under five years, warning for possible impairment of adequate child growth and development (AU)

Objetivo: Investigar la prevalencia y los factores asociados con el sobrepeso y la obesidad en niños menores de 5 años en el estado de Alagoas, al noreste de Brasil. Diseño: Estudio poblacional transversal. El estudio se basó en 1.115 niños con una edad promedio de 24,7 meses (DE ± 16,8), de los que el 51,7% eran niñas. El estado nutricional se clasificó según el IMC / edad. El score > + 1 and ≤ +2 z identificaba a los niños con sobrepeso y aquellos con un score > + 2 z a aquellos con obesidad, en función de la referencia estándar de la Organización Mundial de la Salud. Para identificar las variables asociadas con el sobrepeso y la obesidad se realizó un análisis de regresión de Poisson. Resultados: La prevalencia de sobrepeso y obesidad fue del 23,9% y del 7,8%, respectivamente, del 33,8% en las niñas y del 29,4% en los niños. Tras el ajuste, la renta per cápita igual o superior a 2,5 veces el salario mínimo, la edad de 6 a 23 meses y el sobrepeso y la obesidad maternos seguían asociándose positivamente con el sobrepeso/obesidad. Por otro lado, se observó una asociación negativa entre el peso al nacimiento bajo o insuficiente con el sobrepeso/ obesidad infantil. Conclusiones: Los resultados muestran una prevalencia similar de sobrepeso y obesidad a la de otros estudios en este país para los niños menores de 5 años, alertando de una posible alteración del crecimiento y desarrollo del niño (AU)