Consumo de leite de vaca e anemia na infância no Município de São Paulo

Abstract

ObjectiveTo evaluate the influence of the consumption of cow's milk on the risk of anemia during childhood in the city of São Paulo. MethodsWe have studied a probabilistic sample (n=584) of underfive children living in the city of São Paulo, southeastern Brazil, between 1995 and 1996. Anemia (hemoglobin <11g/dl) was diagnosed using capillary blood obtained by fingertip puncture. The cow's milk content and the density of heme and nonheme iron in the child's diet were obtained using 24-hour recall questionnaires. Multiple linear and logistic regression models were used to study the association between cow's milk content in the diet and hemoglobin concentration or risk of anemia, and included statistical control for potential confounders (age, sex, birthweight, presence of intestinal parasites, family income, and mother's schooling). ResultsThe prevalence of anemia was 45.2% and the mean contribution of milk to the total caloric content of the children's diets was 22.0%. The association between milk consumption and risk of anemia remained significant, even after considering the dilutive effect of milk consumption on the density of iron in the diet, thus indicating a possible inhibitor effect of milk on the absorption of the iron present in the other foods ingested by the child. ConclusionsThe relative participation of cow's milk in the child's diet showed a significant positive association with risk of anemia in children between ages six and 60 months, regardless of the density of iron in the diet.

Fatores associados à ocorrência de anemia em crianças menores de seis anos: uma revisão sistemática dos estudos populacionais

“…Em doze estudos, 14,15,[17][18][19][20][21]23,25,27,29,30 foi utilizado o ponto de corte indicado pela Organização Mundial da Saúde 1,2 para o diagnóstico da anemia (Hb<11g/dL, para crianças de 6-59 meses), entretanto, um dos estudos internacionais 26 utilizou o ponto de corte da hemoglobina <10g/dL. Em relação à deficiência de ferro, nenhum estudo brasileiro avaliou esta deficiência e os estudos estrangeiros que o fizeram, utilizaram dois ou mais parâmetros associados, como ferritina, saturação da transferrina, protoporfirina eritrocitária livre, zincoprotoporfirina e volume corpuscular médio.…”

“…Dos artigos incluídos nesta revisão, sete [14][15][16][17][18][19][20] são estudos realizados no Brasil e dez 21-30 em outros países. As principais características dos estudos (autores, ano de publicação e local do estudo, desenho do estudo e amostragem, amostra, diagnós-tico de anemia e/ou de deficiência de ferro, variáveis analisadas e fatores associados) podem ser observadas nas Tabelas 1 e 2. leitura dos artigos correspondentes a estas 58 referências foi realizada uma segunda seleção, de acordo com os critérios de inclusão, restando 9 artigos.…”

“…Nestes casos, [14][15][16][17]22,24,28 os estudos foram incluídos na revisão por se entender que as análises possuíam objetivos, amostras e métodos de análise estatística diferentes. Contudo, os fatores associados e/ou determinantes da anemia e/ou deficiência de ferro, constantes em diferentes estudos resultantes de um mesmo banco de dados foram computados na análise uma única vez.…”

Magnitude, tendência temporal e fatores associados à anemia em crianças do Estado da Paraíba

“…This process occurs simultaneously with the organism's greater requirement of an increased consumption of Studies have verifi ed the benefi cial effect of exclusive breastfeeding in the fi rst six months of life, as it increases the hemoglobin levels. 11,15,16 In addition, the association of breastfeeding with the use of cow's milk has caused a decline in children's hemoglobin levels due to occurrences of intestinal microhemorrhages. 11,15,16 As a preventive measure, combined with other interventions, it is necessary to implement actions to promote exclusive breastfeeding up to the sixth month of life and nutritional guidance about adequate complementation to breast milk up to two years, aiming to reduce the consumption of cow's milk and to stimulate the ingestion of foods with high density of heme iron.…”

“…11,15,16 In addition, the association of breastfeeding with the use of cow's milk has caused a decline in children's hemoglobin levels due to occurrences of intestinal microhemorrhages. 11,15,16 As a preventive measure, combined with other interventions, it is necessary to implement actions to promote exclusive breastfeeding up to the sixth month of life and nutritional guidance about adequate complementation to breast milk up to two years, aiming to reduce the consumption of cow's milk and to stimulate the ingestion of foods with high density of heme iron. 16 The greater risk of anemia in children with unfavorable housing conditions (number of co-inhabitants and number of rooms in the house) might be explained by the reduction in these families' economic accessibility, which leads to a per capita reduction in foods and to the consequent reduction in iron intake.…”