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.

Este artigo procura mostrar alguns dados sobre as condições nutricionais e de pobreza de duas populações moradoras em favelas, nos municípios de Maceió e São Paulo. Os resultados apresentados revelam que no Brasil atual, a associação entre pobreza e estado nutricional (incluindo desnutrição energético-proteíca e obesidade) é complexa e ainda pouco conhecida. Há um número elevado de indíviduos obesos nas populações brasileiras que vivem abaixo da linha de pobreza nas zonas urbanas. A obesidade coexiste com altas prevalências de desnutrição. Esses achados estão associados com alimentação deficiente, sobretudo em qualidade, levando à alta prevalência de baixa estatura. Vários estudos mostram que a obesidade encontrada na população pobre pode ser sequela de desnutrição precoce e apontam para a necessidade de programas que: sejam focalizados nos indivíduos realmente desnutridos e consequentemente realizem avaliação do estado nutricional, cuidados de saúde caso a caso, forte atenção ao pré-natal, melhorem as condições de moradia e combatam o analfabetismo materno. O artigo recomenda ainda a criação de Centros de Educação e Recuperação Nutricional para combater a desnutrição, visando recuperação da baixa estatura, com forte enfoque de intervenção na comunidade.
This article shows the socioeconomic and nutritional conditions of two shantytown populations from the city of São Paulo and Maceió. The results reveal that in Brazil, the association between poverty and nutritional status (including undernutrition and obesity) is complex and not well known. There is a large number of obese individuals among people living below the poverty line in urban areas. Obesity coexists with undernutrition and food insecurity, specially in stunted individuals. A series of studies have shown that obesity can be a sequelae of previous undernutrition. The article describes the need for programmes that focus only the real undernurished individuals and consequently, measure nutritional status, promote health and prenatal care, improve living conditions and fight against mother illiteracy. From the results presented, the article recommend the setting up of Centers for Nutritional Rehabilitation, to fight against undernutrition, aiming the recovery of stunting, and with a strong community based intervention

A ASSISTÊNCIA em saúde tem vivido um enorme avanço tecnológico nos últimos cinqüenta anos; não obstante, a preocupação com o fator humano tem merecido espaço cada vez maior nas pesquisas e intervenções dessa área. Para lidar com o homem, porém, é preciso considerar dois fatores: a experiência vivida da pessoa e a atuação de sua liberdade no processo decisório. Em condições extremas de pobreza, como é o caso da desnutrição, a pessoa pode fazer experiências de solidão, impotência, fatalismo, velamento, não-realização de um ideal e debilidade física e psíquica. Uma intervenção em saúde junto a essa população deve considerar tais condições. Deve, ao mesmo tempo, afirmar a liberdade incondicional de cada pessoa e o fato de ela se mover por um desejo infinito de felicidade. Pesquisas recentes demonstram que a felicidade tem influência direta sobre a saúde física. Portanto, para que uma intervenção em nutrição e saúde tenha êxito, é necessário considerar que significado ela terá para a vida - e para a felicidade - das pessoas envolvidas. A consideração operativa desses fatores contribuirá para que a atuação seja efetiva e duradoura.
HEALTH care institutions have experienced a great technological advance, last 50 years. The Human Factor space has been increased in the research centers and in the public policies in this area. Managing peoples demands two important factors: lived experience and the people's freedom in the choice processes. Under extreme poverty and malnutrition condition, peoples can experience feelings of solitude, impotence, fatalism, the failure of their ideals, physical and psychological weakness, and others. Health policies have to consider these conditions and, at same time, afirm the desire of liberty and happiness in all the people. Recent scientific researches have been showed the straight link between happiness and physical health. So, successful health policies should to consider their own meaning to the life and happiness of the peoples

The prevalence of chronic malnutrition was 41.6% according to Gomez, 36.6% according to Waterlow, and 17.6% according to WHO. Risk factors for malnutrition, according to the weight-for-age index, included birthweight, presence of upper respiratory tract infections, number of pregnancies, number of births, maternal body mass index, birthplace of father, and home building material; according to the weight-for-height index, they included birthweight and maternal age at the time of birth; and according to the height-for-age index, they included the number of prenatal medical visits, birthweight, maternal height, maternal body mass index, father's employment being unregistered, and maternal birthplace. An instrument for identifying children at risk of malnutrition was devised from these major risk factors for future malnutrition, which may then be applied to newly-born children.

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