SAWAYA, ANA L, GERALD DALLAL, GISELA SOLYMOS, MARIAHDESOUSA, MARIAL-, SUSANB ROBERTSAND DIRCE M SIGULEM. Obesity andmalnutritionin a shantytown populationin the city of SIioPaulo,Brazil. Obes Res. 1995;3(supp12):107~-115~. To investigatethe prevalence of obesity and malnutrition inthe poor Brazilianpopulationweconducted asurveyon the socioeconomic and nutritional status of 535 families (comprising2 411 individuals)livinginshantytownsinthe cityofSIioPaulo. Therewas a30% prevalenceofmalnutrition in the children, with chronic malnutrition as the mostpredominantproblem. Theprevalenceofobesitywas 6.4% in boys and 8.7% in girls. Overweight and obesity associated with stunting was found in 5.8% of boys and 6.8% girls. Adolescents showed a higher prevalence of malnutrition when weight-for-age distribution was used (boys 46.4%, girls 40.2%), but a right deviation in the distributionwas observedwith anincreaseinobesity and adecreaseof malnutritionwasobsered (obesity was 21% ingirlsand8.8% inboys;malnutritionwas 15.5% inboys and 12.6% in girls) when the weight-for-height adjustmentwasmade. Stuntingwas themost predominanttype of malnutrition in both sexes. Obesity associated with stuntingwas morecommon than obesitywithout stunting, bothin younger children and adolescents. Adults had a higher prevalence of obesity than malnutrition according to both the Metropolitan Life Insurance tables (1.7% of undernutrition, 16.7% of overweight , and 14.1% of obesity) and Body Mass Index (8.5% of undernutrition, 21.9% of overweight, and 14.6% of obesity). There was an increase in the percentage of obese children when at least one adult in the family was obese and an increased percentage of malnourished children when undernour- ishedadultswerepresentinthefamily. Obesity amongthe adults of the family decreased the occurrence of malnutrition among the children. In 9% of families there was a coexistenceofobesity intheadults andmalnutritioninthe children. These results demonstrate a coexistence of malnutrition and obesity in poor urban Braziliancommunities.

and 3 Fundac Ëa Äo Seade, Brazil OBJECTIVE: This study aimed to describe the prevalence of overweight and obesity (OW O) among Brazilian adolescents and to identify risks for subpopulations de®ned according to the ®ve country macro-regions and situation (urban±rural) of the domiciles, income, years of school attendance, age and sex. DESIGN: A nationwide home-based survey representative of the Brazilian civilian noninstitutionalized population, performed in 1989. METHODS: The sampling plans followed a strati®ed, multistage, probability cluster design in The National Research of Health and Nutrition sample, which collected anthropometric data of 14,455 domiciles. In all, 13,715 adolescents ranging from 10 to 19 y of age were studied. The OW O was de®ned from a body mass index (BMI) equal or superior to the 85th percentile of the reference population of the NCHS. The prevalences in the different studied groups were compared using the adjusted odds ratio in logistic regression models. RESULTS: The prevalence of OW O was of 7.7%, reaching 10.6% within the female group and 4.8% within the male group. A direct relation could be established between the socioeconomic level and OW O. Adolescents of the most industrialized region of the country presented a risk of OW O 1.86 (95% CI 1.51 ± 2.30) times higher than that found in the least developed region. Male youngsters who lived in urban areas were more liable (OR 1.71, 95% CI 1.30 ± 2.25) to overweight than their counterparts of rural areas. The occurrence of menarche increased two and a half times (OR 2.58, 95% CI 2.11 ± 3.15) the risk of OW O within the female group of adolescents. CONCLUSIONS: The results demonstrate a low prevalence of OW O among Brazilian adolescents when compared with adolescents of more industrialized regions. The OW O is twice as high within the female group, which represents a much greater difference than the one encountered in industrialized countries, probably owing to the muscular work carried out preponderantly by male adolescents of lower socioeconomic levels. Higher prevalences in subpopulations of higher socioeconomic level and of more industrialized regions show the great need for differentiated actions to control overweight and obesity in the country.

BackgroundThe Maternal-Child Pastoral is a volunteer-based community organization of the Dominican Republic that works with families to improve child survival and development. A program that promotes key practices of maternal and child care through meetings with pregnant women and home visits to promote child growth and development was designed and implemented. This study aims to evaluate the impact of the program on nutritional status indicators of children in the first two years of age.MethodsA quasi-experimental design was used, with groups paired according to a socioeconomic index, comparing eight geographical areas of intervention with eight control areas. The intervention was carried out by lay health volunteers. Mothers in the intervention areas received home visits each month and participated in a group activity held biweekly during pregnancy and monthly after birth. The primary outcomes were length and body mass index for age. Statistical analyses were based on linear and logistic regression models.Results196 children in the intervention group and 263 in the control group were evaluated. The intervention did not show statistically significant effects on length, but point estimates found were in the desired direction: mean difference 0.21 (95%CI −0.02; 0.44) for length-for-age Z-score and OR 0.50 (95%CI 0.22; 1.10) for stunting. Significant reductions of BMI-for-age Z-score (−0.31, 95%CI −0.49; -0.12) and of BMI-for-age > 85th percentile (0.43, 95%CI 0.23; 0.77) were observed. The intervention showed positive effects in some indicators of intermediary factors such as growth monitoring, health promotion activities, micronutrient supplementation, exclusive breastfeeding and complementary feeding.ConclusionsDespite finding effect measures pointing to effects in the desired direction related to malnutrition, we could only detect a reduction in the risk of overweight attributable to the intervention. The findings related to obesity prevention may be of interest in the context of the nutritional transition. Given the size of this study, the results are encouraging and we believe a larger study is warranted.

Epidemiologistas que estudam câncer têm observado que a sua prevalência no mundo tem aumentado de maneira significativa no último século. Acredita-se que este resultado está relacionado, entre outros aspectos, com a industrialização e a urbanização ocorridas neste período. De fato, a morbi-mortalidade associada ao câncer observada em países desenvolvidos é maior do que em países em desenvolvimento. Além disso, algumas formas específicas de câncer, como o de cólon e reto, próstata e mama feminina, são mais freqüentes em países desenvolvidos, enquanto outras, como de estômago, esôfago e colo de útero têm maior incidência nos países em desenvolvimento. Padrões distintos de câncer também são observados entre indivíduos que emigram para um novo país ou região. Com base em estudos epidemiológicos, analisou-se a relação entre câncer e nutrição, e algumas modificações na alimentação que podem prevenir alguns tipos de cânceres.

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Metabolic disturbances of poorly controlled DM may account for the higher REE observed in the CRF diabetes group. The role of the apparently higher protein breakdown in this increased REE remains to be clarified.

Objetivos: verificar a prevalência de anemia, anemia ferropriva e deficiência de ferro em lactentes, de unidade pública de saúde, no município de Goiânia, Brasil, analisar e correlacionar as variáveis bioquímicas e hematológicas.Métodos: realizou-se estudo transversal. De 120 mães entrevistadas, foram incluídos 110 lactentes de 6 a 12 meses de idade, a termo e não gemelares. Dados socioeconômicos e hematológicos foram obtidos. Colheu-se sangue venoso dos lactentes em jejum para realização do hemograma completo por contagem eletrônica, ferro sérico, ferritina sérica e proteína C-reativa, os quais foram utilizados na avaliação da etiologia ferropriva nos anêmicos. Crianças com hemoglobina < 11g/dl foram consideradas anêmicas.Resultados: a prevalência de anemia observada foi de 60,9%. Ao se considerar no diagnóstico da etiologia ferropriva nos lactentes sem processo inflamatório, a alteração da hemoglobina mais dois índices entre volume corpuscular médio (VCM), ou hemoglobina corpuscular média (HCM), ou ferritina, ou ferro sérico, a prevalên-cia de etiologia ferropriva foi de 87%. Porém, ao se incluir nos índices a amplitude de distribuição dos eritrócitos (RDW), a prevalência foi de 97,8%. Nos não anêmicos, considerando a ferritina e o RDW, observou-se 28% de prevalência de deficiência de ferro. As melhores correlações entre as variáveis hematológicas e bioquími-cas foram hemoglobina e hematócrito (r = 0,946), e HCM com o VCM (r = 0,950).Conclusão: a principal etiologia da anemia nos lactentes foi a ferropriva, cuja prevalência variou com os diferentes parâmetros utilizados e critérios adotados.J Pediatr (Rio J) 2002; 78 (4): 321-6: anemia ferropriva, estado nutricional, fatores epidemiológicos, ferro, lactente, proteínas da fase aguda. AbstractObjective: To verify the prevalence of anemia, iron deficiency anemia and iron deficiency in infants, at a Public Health Unit in the city of Goiânia -Brazil; to analyze and to correlate the hematologic and biochemical variables.Methods: A cross-sectional study was carried out. One hundred and ten full-term infants of the 120 mothers interviewed were included. The infants aged between six and twelve months and there were not twins. Socioeconomic and hematologic data was obtained. Venous blood was taken from fasting infants in order to carry out a complete hemogram through electronic cell counting, serum iron, serum ferritin and C-reactive protein, which were used in the evaluation of the etiology of iron deficiency in the anemic infants. Children with hemoglobin < 11g/dL were considered anemic.Results: The prevalence of anemia was 60.9%. In the diagnosis of the iron deficiency etiology in infants without an inflammation process, when considering the alteration of hemoglobin plus two more indices among mean corpuscular volume (MCV) or mean corpuscular hemoglobin (MCH) or serum ferritin or serum iron, the prevalence of the iron deficiency was 87%. Nevertheless, when red cell distribution width (RDW) was included in the indices, the prevalence was 97.8%. In the non-anemic infan...

The objective of this study was to assess the prevalence of anemia and the therapeutic and prophylactic response to ferrous sulfate and folic acid. A double-blind, randomized, controlled clinical trial was conducted with 196 children 6 to 24 months of age enrolled in municipal daycare centers in Goiânia, Goiás State, Brazil. The children were assigned to two treatment groups that received a daily dose (5 times a week) of either 4.2mg/kg/day of ferrous sulfate + folic acid (50µg) or 4.2mg/kg/day of ferrous sulfate + folic acid placebo. One of the prevention groups received 1.4mg/kg/day of ferrous sulfate + folic acid (50µg/day) and the other 1.4mg/kg/day of ferrous sulfate + folic acid placebo. Supplementation lasted approximately three months. Baseline anemia prevalence was 56.1% (95%CI: 48.9-63.1). After treatment, anemia prevalence in the folic acid group (14%) was lower than in the placebo group (34.9%) (p = 0.02). After prophylaxis in the non-anemic children, the incidence of anemia did not differ between the groups, but there was an increase in hemoglobin level in the folic acid group (p = 0.003). Iron plus folic acid was effective for the treatment of anemia and improvement of hemoglobin level in non-anemic children.