Undernutrition is one of the most important public health problems, affecting more than 900 million individuals around the World. It is responsible for the highest mortality rate in children and has long-lasting physiologic effects, including an increased susceptibility to fat accumulation mostly in the central region of the body, lower fat oxidation, lower resting and postprandial energy expenditure, insulin resistance in adulthood, hypertension, dyslipidaemia and a reduced capacity for manual work, among other impairments. Marked changes in the function of the autonomic nervous system have been described in undernourished experimental animals. Some of these effects seem to be epigenetic, passing on to the next generation. Undernutrition in children has been linked to poor mental development and school achievement as well as behavioural abnormalities. However, there is still a debate in the literature regarding whether some of these effects are permanent or reversible. Stunted children who had experienced catch-up growth had verbal vocabulary and quantitative test scores that did not differ from children who were not stunted. Children treated before 6 years of age in day-hospitals and who recovered in weight and height have normal body compositions, bone mineral densities and insulin production and sensitivity.

It is estimated that over 51 million people in Brazil live in slums, areas where a high prevalence of malnutrition is also found. In general, the population of 'slum dwellers' is growing at a faster rate than urban populations. This condition is associated with poor sanitation, unhealthy food habits, low birthweight, and stunting. Stunting is of particular concern as longitudinal and cross-sectional studies of stunted adolescents have shown a high susceptibility to gain central fat, lower fat oxidation, and lower resting and postprandial energy expenditure. In addition, higher blood pressure, higher plasma uric acid and impaired flow-mediated vascular dilation were all associated with a higher level of hypertension in low birthweight and stunted children. In particular, stunted boys and girls also showed lower insulin production by pancreatic beta cells. All these factors are linked with a higher risk of chronic diseases later in life. Among stunted adults, alterations in plasma lipids, glucose and insulin have also been reported. However, adequate nutritional recovery with linear catch-up growth, after treatment in nutritional rehabilitation centers, can moderate the alterations in body composition, bone density and insulin production.

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

The nutritional programming hypothesis, which has been studied since the 1970s, proposes that intrauterine undernutrition continuing during the first years of life causes permanent metabolic disorders. These alterations are amplified with time, depending on the quality of the diet and on environmental factors. The aim of this cross-sectional study was to detect blood pressure alterations in teenagers with nutritional deficit. The study sample consisted of 53 adolescents living in shantytowns of São Paulo City, Brazil; 27 boys and 26 girls ranging in age from 11 to 16 years were studied. Weight, height, skinfold thickness, and blood pressure were measured during a medical visit. Anthropometric data were compared with the reference values of the National Center for Health Statistics and Frisancho, and arterial pressure data were compared with the reference values of the 1996 Task Force. The adolescents studied are among the 10% poorest stratum of the Brazilian population, with a per capita income of U.S. $45/month. The anthropometric results revealed nutritional deficiencies for the entire sample. The major marker of malnutrition was height, with a mean height deficit of 7 cm among boys and of 5 cm among girls. The overall prevalence of arterial (diastolic) hypertension for the sample was 21% (95% confidence interval 10%-32%). No significant difference was observed between sexes. The prevalence of cases with a systolic or diastolic arterial pressure above the 90th percentile, adjusted for height, was 51% (n=27) (95% confi-dence interval 37%-65%); 6% (n=3) of these individuals had simultaneous systolic and diastolic arterial hypertension. In conclusion, the prevalence of arterial hypertension was elevated among malnourished adolescents. The mechanisms involved in the genesis of hypertension seem to be related to malnutrition during an early phase of life, supporting the programming hypothesis.

The food environment has a great impact on the nutritional health of the population. Food environment interventions have become a popular strategy to address the obesity epidemic. However, there are still significant gaps in our understanding of the most effective strategies to modify the food environment to improve health. In this review, we examine key gaps in the food environment intervention literature, including the need for: developing appropriate formative research plans when addressing the food environment; methods for selecting intervention domains and components; incorporating food producers and distributors in intervention strategies; strengthening evaluation of environmental interventions; building the evidence base for food environment interventions in diverse settings; engaging policy makers in the process of modifying the food environment; and creating systems science models to examine the costs and benefits of a potential program or policy on the food environment prior to implementation. In addition, we outline the need for strategies for addressing these issues including conducting additional pilot interventions, developing additional methodologies, and embracing the use of simulation models.

OBJETIVO: Estudar um Instrumento para Classificação do Nível de Dependência de Pacientes Psiquiátricos aos Cuidados de Enfermagem, foi o objetivo deste estudo. MÉTODOS: Os indicadores críticos do cuidado (aparência e higiene, expressão do pensamento, humor e afeto, interação social, atividades, alimentação e hidratação, sono, medicação, eliminações, sinais vitais e outros controles, problemas e queixas somáticas). RESULTADOS: com gradação de 1 a 3 pontos permitiram identificar os níveis de dependência. Foi aplicada a técnica Delphi e, os avaliadores concordaram pela manutenção dos 11 indicadores críticos. CONCLUSÃO: Os resultados deste estudo mostram que o instrumento é válido e pode contribuir para o avanço tecnológico e científico da Especialidade no Brasil.

Demetra; 2017; 12(2); 349-360 350 discussão com transparência e equidade, a fim de manter o interesse da população brasileira em primeiro lugar. Palavras AbstractNoncommunicable chronic diseases in 2010, accounted for over 18 million deaths worldwide; in 2014, the prevalence of overweight represented 2.1 billion. In Brazil, overweight affects 51% of the population. Ultra-processed foods as sandwich cookies, pack snacks, soft drinks and fast food, collaborate to this epidemic by presenting combinations of ingredients that make them highly palatable (sugar, salt, fat and chemical additives) and damage mechanisms of control of appetite. The main factors that contributed to the increase in the consumption of these foods were the strengthening of the economy, the increase in purchasing power, marketing campaigns, as well as the comfort, convenience and its lower cost. The food industry has used opinion formation strategies, such as exposure in the media with massive campaigns to promote these products and initiatives focused on health professionals through sponsorship of scientific events and non-governmental organizations. Conflicts of interest in scientific production are increasing and analysis of studies funded by industry has shown that the outcomes are favorable to the study sponsor. This trial aimed to discuss the influence of the food industry in the increased consumption of ultra-processed food and the effects on health of the Brazilian population. Thus, ther may be a contribution to the process in the transformation of practices and principles, as well as an extension of this discussion with transparent and fair discussion, keeping the interest of the Brazilian population first.

Objective:To identify the association of dietary, socioeconomic factors, sedentary behaviors and maternal nutritional status with abdominal obesity in children.Methods:A cross-sectional study with household-based survey, in 36 randomly selected census tracts in the city of Santos, SP. 357 families were interviewed and questionnaires and anthropometric measurements were applied in mothers and their 3-10 years-old children. Assessment of abdominal obesity was made by maternal and child's waist circumference measurement; for classification used cut-off points proposed by World Health Organization (1998) and Taylor et al. (2000) were applied. The association between variables was performed by multiple logistic regression analysis.Results:30.5% of children had abdominal obesity. Associations with children's and maternal nutritional status and high socioeconomic status were shown in the univariate analysis. In the regression model, children's body mass index for age (OR=93.7; 95%CI 39.3-223.3), female gender (OR=4.1; 95%CI 1.8-9.3) and maternal abdominal obesity (OR=2.7; 95%CI 1.2-6.0) were significantly associated with children's abdominal obesity, regardless of the socioeconomic status.Conclusions:Abdominal obesity in children seems to be associated with maternal nutritional status, other indicators of their own nutritional status and female gender. Intervention programs for control of childhood obesity and prevention of metabolic syndrome should consider the interaction of the nutritional status of mothers and their children.