Retardo do crescimento e condições sociais em escolares de Osasco, São Paulo, Brasil

Abstract

Cases and controls were selected for this retrospective investigation of the social determinants of growth retardation, from a Height Census carried out in the 1989 school year,involving children attending the first grade of all public and private schools in Osasco (in the Greater Metropolitan Area of São Paulo, Brazil). The cases, totalling 125 children entering school aged 7-8 years old, were characterized by a height-for-age index below -2 z score of the NCHS/WHO reference. The controls, totalling 139 children entering school at the same age, were characterized by a height-for-age index above -1 z score. Socioeconomíc variables such as family income, head-of-family's level of schooling, mother's schooling, environmental sanitation, and housing conditions were significant factors associated with the stunting process. Risk of linear growth retardation tended to be higher with lower social class (odds ratio = 7.3 for sub-proletariat vs. petit bourgeois; p < 0,001 for overall trend), suggesting the biological impact of Brazil's economic slowdown during the 1980s.

Risk of linear growth retardation during the first two years of life: a new approach

“…Small body size does have biological implications: adult work capacity and productivity are thereby limited, and children are more vulnerable to infections, and have poor cognitive development (Gopalan, 1988;Beaton, 1989;Martorell, 1989;Waterlow, 1991). Classroom performance of stunted school children was two times lower than that of normal non-stunted students (Lei et al, 1997).…”

“…Household location was expected to be related tò stunted families', as an external unfavourable environmental factor in stunting. Lei et al (1997) found a sig-ni®cant association between the lack of fresh water and sewer and the stunting during the ®rst two years of children's life (OR 4.5), when studying retrospectively Osasco City school children and the social determinants of stunting.…”

Ecology of Children’s Growth: An Example from Transitional Populations of the Brazilian Amazon

“…Engstron and Anjos [10], examining childhood stunting and their mother's nutritional status in a general sample of the Brazilian population, observed 14.4% of stunting (15.9% boys and 12.9% girls), and a strong association between mothers' educational [25] identified strong associations of mother's level of schooling, environmental sanitation, and family income with stunting. No direct relationships between education or income and nutritional status were observed among the three study groups [44].…”

Nanismo nutricional em escolares no Brasil

“…No entanto, nessa interação "potencial genético versus meio ambiente", os fatores ambientais assumem importância primordial sobre a estatura final de um indivíduo, especialmente nos países em desenvolvimento, onde as diferenças genéticas parecem ser menos importantes do que diferenças do meio ambiente. 10,12,[42][43][44][45][46][47] Dependendo da capacidade de adaptação biológi-ca do indivíduo às agressões ambientais e à intensidade e freqüência com que essas se apresentem, é possível que não apareçam alterações severas no crescimento ou, ao contrário, as agressões possam deixar como conseqüência efeitos que vão se refletir em grande perda de peso e sério retardo de estatura. Essa última situação é mais freqüente em um grande número de "crianças sobreviventes" na maioria dos países em desenvolvimento, que tenham conseguido superar condições adversas de nutrição ocorridas durante a vida intra-uterina e primeiros anos de vida.…”

“…43 Ao contrário a relação entre baixa estatura e variáveis socioeconômicas está bem documentada. Lei et al, 47 encontraram riscos elevados entre escolares de Osasco, cujas famílias moravam em precárias condições, eram chefiadas por analfabetos e possuíam renda per capita inferior a 0,5 salário mínimo. Outras investigações apontam a baixa escolaridade dos pais, baixos níveis de renda e precárias condições de habitação e saneamento.…”