O artigo descreve a experiência do governo brasileiro na organização das ações de Alimentação e Nutrição ao que cabe à Atenção Básica. As ações são desenvolvidas por meio da Vigilância Alimentar e Nutricional, com o uso do Sistema de Vigilância Alimentar e Nutricional como principal ferramenta; Ações de Promoção à Saúde e da Alimentação Saudável, com a implementação do Guia Alimentar para a População Brasileira, da Estratégia Nacional para a Alimentação Complementar Saudável, do Programa Saúde na Escola e Ações de controle e prevenção da Obesidade, Doenças Crônicas e deficiências de micronutrientes, com foco na anemia ferropriva e hipovitaminose A. As ações de Alimentação e Nutrição na Atenção Básica foram fortalecidas com a inserção do nutricionista nas equipes dos Núcleos de Apoio à Saúde da Família - equipes multidisciplinares que garantem o matriciamento das ações de Alimentação e Nutrição às equipes de Atenção Básica. A intersetorialidade é uma das vertentes das ações de Alimentação e Nutrição na Atenção Básica, tanto com atendimento as famílias beneficiárias do Programa Bolsa Família como com a integração das ações dos diferentes setores (Saúde, Educação, Assistência Social e Trabalho) no território. Configura-se como desafio a consolidação, expansão e universalização das ações propostas para a atenção básica no Brasil.

ResumoObjetivo: Examinar fatores socioeconômicos e outras condições de vida familiar associadas a excesso de peso, baixa estatura e baixo peso para a estatura em menores de 5 anos.Métodos: Estudo transversal avaliou 3.957 crianças entre 1 mês e 5 anos de idade durante campanha nacional de imunização no município de São Leopoldo (RS) em 2002. As condições socioeconômicas e de saneamento das áreas de abrangência das unidades de saúde foram agrupadas por análise de cluster dos setores do censo populacional de 2001.Resultados: Déficit de peso para estatura ocorreu em 2,6% das crianças, baixa estatura em 9,1% e excesso de peso em 9,8%. A regressão logística multivariada sugere que os fatores associados à chance de excesso de peso foram: área de condições socioeconômicas alta (RC = 1,47; IC95% 1,09-1,96), filhos únicos (RC = 1,44; IC95% 1,00-2,07) e peso ao nascer ≥ 2.500 g (RC = 2,21; IC95%1,27-3,83). A chance de déficit de peso associou-se ao baixo peso ao nascer (RC = 3,46; IC95% 2,06-5,80) e idade da mãe < 20 anos (RC = 1,99; IC95% 1,09-3,62). A baixa estatura associou-se à área de condições socioeconômicas baixas (RC = 2,36; IC95% 1,51-3,69), três ou mais irmãos (RC = 3,12; IC95% 2,18-4,47), peso ao nascer < 2.500 g (RC = 3,49; IC95% 2,53-4,80), idade < 36 meses (RC = 1,77; IC95% 1,37-2,29) e idade materna < 20 anos (RC = 1,60; IC95%1,09-2,35).Conclusões: Excesso de peso e baixa estatura foram os principais desvios antropométricos observados neste estudo, constituindo prioridades que devem ser consideradas nas políticas públicas atuais.J Pediatr (Rio J). 2008;84(3):251-257: Estado nutricional, criança, fatores de risco, antropometria, excesso de peso e insuficiência de crescimento. AbstractObjective: To explore whether socioeconomic and sanitary conditions, maternal and child factors are associated with overweight, stunting, and wasting in children under five year old in the city of São Leopoldo, southern Brazil. Methods:Cross-sectional study of 3,957 children aged 1 month to 5 years conducted in all primary care services of the city during the National Children's Vaccination Day in 2002. Maternal and child factors were assessed by a questionnaire. Children's height and weight were measured. Cluster analysis was used to group the areas served by the primary care services according to socioeconomic and sanitary conditions of the census tracts assessed by the 2001 National Census.Results: Wasting was observed in 2.6% of children, stunting in 9.1% and overweight in 9.8%. The multivariable logistic regression model suggests that overweight was associated with higher socioeconomic status and better sanitation of the area (OR = 1.47; 95%CI 1.09-1.96), single child (OR = 1.44; 95%CI 1.00-2.07) and birth weight ≥ 2,500 g (OR = 2.21; 95%CI 1.27-3.83). Wasting was associated with low birth weight (OR = 3.46; 95%CI 2.06-5.80) and mother's age < 20 years (OR = 1.99; 95%CI 1.09-3.62). Stunting was associated with low socioeconomic status and poor sanitation of the area (OR = 2.36; 95%CI 1.51-3.69), three or more siblings (OR ...

This study assesses the impact of an intervention known as the Ten Steps to Healthy Feeding: A Nutritional Guide for Children under Two on nutritional conditions and infant health in low-income families. Two hundred newborns were randomized to the intervention group and three hundred to the control group. Parents of the intervention group received nutritional orientation during the child's first year of life. Both groups received visits at 6 and 12 months and routine follow-up by their pediatricians. The results (n = 397) showed that the intervention was associated with a higher proportion of exclusive breastfeeding at 4 months (RR = 1.58; 95%CI: 1.21-2.06) and 6 months (RR = 2.34; 95%CI: 1.37-3.99) and breastfeeding at 12 months (RR = 1.26; 95%CI: 1.02-1.55) and a lower proportion of children with diarrhea (RR = 0.68; 95%CI: 0.51-0.90), respiratory problems (RR = 0.63; 95%CI: 0.46-0.85), use of medication (RR = 0.56; 95%CI: 0.34-0.91), and dental caries (RR = 0.56; 95%CI: 0.32-0.96) in the 12-16 month bracket. The intervention had no effect on the occurrence of anemia, hospitalization, or nutritional status. The results suggest that the nutritional orientation program led to positive changes in infant feeding practices and health conditions, but that it was insufficient to prevent iron deficiency anemia.

The aim of this study was to assess food consumption in Brazilian children 6 to 59 months of age by region of the country and area of residence. This was a descriptive cross-sectional study of 4,322 children in the National Demographic and Health Survey (2006Survey ( -2007

Objective: To identify the association of household food insecurity (HFI) with anthropometric status, the risk of vitamin A deficiency and anaemia, morbidities such as cough and fever, and hospitalizations for diarrhoea and pneumonia in children under 5 years old. Design: Cross-sectional study using data from the 2006 Brazilian Demographic and Health Survey. HFI was measured with the Brazilian Food Insecurity Measurement Scale (EBIA). Vitamin A deficiency and anaemia were assessed in blood samples. Child morbidities were reported by the child's mother and included cough, fever, and hospitalizations for diarrhoea and pneumonia. Regression results were expressed as unadjusted and adjusted OR and corresponding 95 % CI for severe food insecurity, with statistical significance set at P < 0·05. Setting: Nationally representative survey. Subjects: Children (n 4064) under 5 years old. Results: There was no association between HFI and vitamin A deficiency, pneumonia, wasting or overweight. The prevalence of cough, fever, hospitalization for diarrhoea and stunting were associated with degree of HFI severity. There was a significant association of morbidities and stunting with severe food insecurity (v. food secure). After controlling for confounders, the association between severe food insecurity (v. food secure/rest of food insecurity categories) and the prevalence of common morbidities remained strong, showing that severely food-insecure children had a greater likelihood of experiencing cough (adjusted OR = 1·79) and of being hospitalized for diarrhoea (adjusted OR = 2·55). Conclusions: Severe HFI was associated with cough and severe diarrhoea among Brazilian children. Household food insecurity (HFI) happens when people do not have, at all times, physical, social and economic access to sufficient, safe and nutritious food which meets their dietary needs and food preferences for an active and healthy life (1) . HFI is a global epidemic that can lead to hunger and malnutrition. The FAO estimates that 795 million people are undernourished globally (2) . In Brazil, only 62·5 % of households are considered food secure and 4·8 % are severely food insecure, a percentage that reaches 5·8 % in households with minors under the age of 18 years (3) . HFI is known to be associated with insufficient or inadequate food intake (4) and this low intake of healthy foods and micronutrients is associated with worse health status (5) , both in developed and developing countries. Children are negatively affected by HFI (6,7) as it has been associated with a higher prevalence of hospitalization, respiratory infection, fever, diarrhoea, and nutritional deficiencies such as Fe deficiency and other forms of malnutrition compared with children living in food-secure households (8)(9)(10) . Food deprivation and poor dietary quality in childhood influence children's growth, psycho-emotional, social and cognitive development, and overall health (11,12) . According to the 2006 Brazilian Demographic and Health Survey (DHS), only 57 % of 12-to 18...

RESUMO No Brasil, o Sistema Único de Saúde (SUS), público e universal, oferece ações de promoção, proteção e recuperação da saúde. A atenção primária à saúde (APS) é a porta preferencial de acesso dos indivíduos ao SUS e tem como papel coordenar e ordenar as ações e os serviços de saúde disponibilizados na rede. No âmbito da APS, as ações de alimentação e nutrição devem estar alinhadas às diretrizes da Política Nacional de Alimentação e Nutrição (PNAN) e podem ser potencializadas a partir de ações de vigilância alimentar e nutricional. Dados de sistemas de informação disponíveis em todas as unidades básicas de saúde e em inquéritos populacionais indicam que mais da metade da população adulta no Brasil apresenta excesso de peso e que o consumo de alimentos ultraprocessados vem aumentando. Essa situação exige que as equipes de saúde se organizem de forma a priorizar ações para indivíduos com agravos crônicos com base em estratificação de risco, estabilização da condição e potencialização do autocuidado apoiado, com foco em alimentação e atividade física. Ao mesmo tempo, dependendo do perfil epidemiológico, as equipes devem empreender ações de combate à desnutrição, prevenção da anemia e hipovitaminose A, considerando a múltipla carga da má nutrição no país. O presente artigo tem como objetivo apresentar o panorama atual das ações de alimentação e nutrição implementadas no âmbito da APS no SUS.

BackgroundMultiple micronutrients in powder (MNP) are recommended by WHO to prevent anemia in young children. However, evidences for its effectiveness in different populations and improvements in other outcomes (e.g. linear growth and vitamin A deficiency) are scarce.MethodsA multicentre pragmatic controlled trial was carried out in primary health centres. At study baseline, a control group (CG) of children aged 10- to 14 months (n = 521) was recruited in the routine healthcare for assessing anemia, anthropometric and micronutrient status. At the same time, an intervention group (IG) of infants aged 6- to 8 months (n = 462) was recruited to receive MNP daily in complementary feeding over a period of 60 days. Both study groups were compared when the IG infants reached the age of the CG children at enrolment.ResultsIn CG, the prevalence of anemia [hemoglobin (Hb) < 110 g/L], iron deficiency (ID, plasma ferritin < 12 μg/L or TfR > 8.3 mg/L), and vitamin A deficiency (VAD, serum retinol < 0.70μmol/L) were 23.1%, 37.4%, and 17.4%, respectively. Four to six months after enrolment, when the IG participants had the same age of the controls at the time of testing, the prevalence of anemia, ID and VAD in IG were 14.3%, 30.1% and 7.9%, respectively. Adjusting for city, health centre, maternal education, and age, IG children had a lower likelihood of anemia and VAD [Prevalence Ratio (95% CI) = 0.63 (0.45, 0.88) and 0.45 (0.29, 0.69), respectively] when compared with CG children. The adjusted mean distributions of Hb and length-for-age Z-scores improved by 2 SE in the IG compared to CG children.ConclusionsMNP effectively reduced anemia and improved growth and micronutrient status among young Brazilian children.Trial RegistrationRegistro Brasileiro de Ensaios Clinicos RBR-5ktv6b

Background: Breastfeeding and adequate complementary feeding are associated with healthy eating habits, prevention of nutritional deficiencies, obesity and non-communicable diseases. Our aim was to identify feeding practices and to evaluate the association between breastmilk intake and complementary feeding, focusing on ultraprocessed foods (UPF) and sweetened beverages, among children under 2 years old. Methods: We conducted a cross-sectional study including 847 children from 20 Primary Health Units. We evaluated children's food consumption using a food intake markers questionnaire. We conducted a logistic regression to evaluate the effect of breastmilk intake on feeding practices. Results: The breastmilk intake was associated with lower odds of consuming non-recommended foods, such as cookies or crackers (OR: 0.29; IC 95%: 0.20-0.41) for children under 6 months, yogurt (OR: 0.33; CI 95%: 0.12-0.88) for children between 6 and 12 months and soft drinks (OR: 0.36; CI 95%: 0.17-0.75) for children between 12 and 24 months. Moreover, the breastmilk intake was associated with lower odds of consuming UPF (OR: 0.26; CI 95%: 0.09-0.74) and sweetened beverages (OR: 0.13; CI 95%: 0.05-0.33) for children under 6 months. For children between 12 and 24 months, breastmilk intake was associated with lower odds of consuming sweetened beverages (OR: 0.40; CI 95%: 0.24-0.65). Conclusion: Breastmilk intake was associated with a reduced consumption of UPF and sweetened beverages. Investment in actions to scale up breastfeeding can generate benefits, besides those of breastmilk itself, translating into better feeding habits and preventing health problems in childhood.