;;Validação da fita "CIMDER de 3 cores" como instrumento de detecção de risco nutricional entre pré-escolares

The value of the use, by the health agents in Rondônia, Brazil, of the nutritional classification proposed by the Multidisciplinary Research Center for Rural Development (CIMDER), Colombia, known as the three color CIMDER band, is analyzed. The band, used to measure arm circumference, would be used as an instrument for the detection of nutritional risk in children under five years of age and for refering them to larger, more complex, health units. For this purpose, a sample of 1,268 children were studied. The results of the nutritional classification obtained by the band and the results of Gomez classification were compared. The application of the validations tests resulted in the following values: sensibility = 77.1%; specificity = 68.8%; positive predictive value = 59.0%; negative predictive value = 83.7%; rate of false positives = 31.2% and rate of false negatives = 22.9%. Except for the rate of false positives, the rest of the results were considered to be satisfactory, sufficiently so to recommend the use of the CIMDER band as an instrument of selection by the health agents in Rondônia. More specific indicators should be adopted at the larger, more complex health units, with a view to reducing the number of false positives in the programs for attendance to the undernourished.Analisou-se a validade da utilização da fita "CIMDER de 3 cores" pelos agentes de saúde do Estado de Rondônia, Brasil, como instrumento de detecção de risco nutricional entre crianças menores de 5 anos, para fins de encaminhamento para controle em unidades de maior complexidade que o posto de saúde. De uma amostra composta por 1.268 crianças, compararam-se os resultados da classificação nutricional obtida pela fita e da resultante da classificação de Gomez. A aplicação dos testes de validação resultou nos seguintes valores: sensibilidade = 77,1 %; especificidade = 68,8%; valor prPolonoroeste) editivo positivo = 59,0%; valor preditivo negativo = 83,7%; taxa de falsos positivos = 31,2%; taxa de falsos negativos = 22,9. Excetuando a taxa de falsos positivos, os demais resultados foram considerados suficientemente satisfatórios para que se recomende o uso da fita CIMDER como instrumento de triagem pelos agentes de saúde de Rondônia. Outros indicadores mais específicos deverão ser adotados em nível das unidades de saúde de maior complexidade para reduzir o número de falsos positivos nos programas de assistência dirigidos aos desnutridos

Dyslipidaemia and Undernutrition in Children from Impoverished Areas of Maceió, State of Alagoas, Brazil

Chronic undernutrition causes reduced growth and endocrine adaptations in order to maintain basic life processes. In the present study, the biochemical profiles of chronically undernourished children were determined in order to test the hypothesis that chronic undernutrition also causes changes in lipid profile in pre-school children. The study population comprised 80 children aged between 12 and 71 months, including 60 with moderate undernutrition [height-for-age Z (HAZ) scores ≤ −2 and > −3] and 20 with severe undernutrition (HAZ scores ≤ −3). Socioeconomic, demographic and environmental data were obtained by application of a questionnaire, and anthropometric measurements and information relating to sex, age and feeding habits were collected by a trained nutritionist. Blood samples were analysed for haemoglobin, vitamin A, insulin-like growth factor 1 (IGF-1) and serum lipids, while cortisol was assayed in the saliva. Faecal samples were submitted to parasitological investigation. Analysis of variance and χ2 methods were employed in order to select the variables that participated in the multivariate logistic regression analysis. The study population was socioeconomically homogeneous, while the lack of a treated water supply was clearly associated with the degree of malnutrition. Most children were parasitised and anaemia was significantly more prevalent among the severely undernourished. Levels of IGF-1 decreased significantly with increasing severity of undernutrition. Lipid analysis revealed that almost all of the children had dyslipidemia, while low levels of high-density lipoprotein were associated with the degree of undernutrition. It is concluded that chronic malnutrition causes endocrine changes that give rise to alterations in the metabolic profile of pre-school children

Association between malnutrition in children living in favelas, maternal nutritional status, and environmental factors

OBJECTIVE: To investigate the association of malnutrition in children living in substandard settlements (slums) of Maceió, AL, Brazil, with maternal nutritional status and environmental conditions. METHODS: Cross-sectional study involving a probability sample of 2,075 mothers (18 to 45 years) and their children (4 months to 6 years), living in the slums of the city of Maceió. First, we conducted a cluster analysis with the purpose of choosing the settlements and the administrative region of the city of Maceió with the lowest human development index. After this analysis, the 7th Administrative Region was designated for the study, including its 23 substandard settlements. Socioeconomic, demographic, anthropometric, and maternal and child health data were collected by means of household survey. The statistical analysis included the odds ratio of a child to be malnourished, and the univariate regression was used to check which maternal variables were associated with this malnutrition. RESULTS: Chronic malnutrition (-2 standard deviations/height for age) was found in 8.6% of children and was associated with mother's age and educational level, type of residence, number of rooms, flooring, water supply, and low birth weight (< 2,500 g) in children aged < 24 months. We also found an association between child malnutrition and maternal height. Such association was not observed regarding body mass index. CONCLUSIONS: The high prevalence of malnutrition observed in these settlements was related to social and environmental conditions and short maternal height, who had weight deficit or weight excess.OBJETIVO: Investigar a associação da desnutrição em crianças residentes em assentamentos subnormais (favelas) de Maceió (AL) com o estado nutricional materno e as condições socioambientais. MÉTODOS: Estudo transversal, envolvendo amostra probabilística de 2.075 mães (18 a 45 anos) e respectivos filhos (4 meses a 6 anos), moradoras nas favelas da cidade de Maceió (AL). Para escolha dos assentamentos, procedeu-se primeiramente a uma análise de clusters para eleger a região administrativa da cidade de Maceió com menor índice de desenvolvimento humano. Após essa análise, a 7ª Região Administrativa foi a designada para o estudo, com seus 23 assentamentos subnormais. Os dados socioeconômicos, demográficos, antropométricos e de saúde materno-infantil foram coletados através de inquérito domiciliar. A estatística analisou a razão de chances de uma criança ser desnutrida, e a regressão univariada foi usada para verificar quais variáveis maternas estariam associadas a essa desnutrição. RESULTADOS: A desnutrição crônica (-2 desvios padrão/altura por idade) esteve presente em 8,6% das crianças e associou-se com idade e escolaridade materna, tipo de residência, número de cômodos, revestimento de piso, origem da água e baixo peso ao nascer (< 2.500 g) em crianças com idade < 24 meses. Encontrou-se também associação entre desnutrição infantil e baixa estatura materna, que não foi observada para índice de massa corporal. CONCLUSÕES: A alta prevalência de desnutrição infantil observada nesses assentamentos esteve relacionada às condições socioambientais e à baixa estatura das mães, que apresentaram déficit ou excesso de peso.Secretaria Estadual de Saúde de AlagoasUniversidade Federal de Alagoas Faculdade de NutriçãoUniversidade Federal de São Paulo (UNIFESP) Departamento de FisiologiaUNIFESP, Depto. de FisiologiaSciEL

Protective Effect of Breastfeeding against Overweight Can Be Detected as Early as the Second Year of Life: A Study of Children from One of the Most Socially-deprived Areas of Brazil

Millions of children live in Brazil\u2019s semi-arid region, one of the most socially-deprived areas of the country, where undernutrition co-exists with obesity as a consequence of the nutrition transition. There is evidence that childhood obesity predisposes adult obesity and, thus, that obesity should be prevented as early as possible. Some studies have shown that breastfeeding is a protective factor against overweight and obesity while other studies have not found this association. There have been few studies on this association in developing countries and of children below two years of age. The present study aimed to investigate whether children exposed to exclusive breastfeeding for 656 months showed a lower prevalence of overweight in the second year of life, based on a probability sample of 2,209 children (aged 12 to 24 months). The dependent variable was overweight, defined as weight-for-length z-scores of &gt;2, based on the WHO 2006 standard while the independent variable was exclusive breastfeeding ( 656 months). The prevalence ratio (PR) and its 95% CI were estimated using Poisson regression with robust adjustment of variance. After adjusting for potential confounding factors (socioeconomic, demographic and health-related variables), children on exclusive breastfeeding for 656 months showed a lower prevalence of overweight (5.7% vs 9.1%, PR 0.62, 95% CI 0.45-0.89). It was found that exclusive breastfeeding for six months or more is a protective factor against overweight in children in the second year of life living in the Brazilian semi-arid region

Expanding tropical forest monitoring into Dry Forests: The DRYFLOR protocol for permanent plots

This is the final version. Available on open access from Wiley via the DOI in this recordSocietal Impact Statement Understanding of tropical forests has been revolutionized by monitoring in permanent plots. Data from global plot networks have transformed our knowledge of forests’ diversity, function, contribution to global biogeochemical cycles, and sensitivity to climate change. Monitoring has thus far been concentrated in rain forests. Despite increasing appreciation of their threatened status, biodiversity, and importance to the global carbon cycle, monitoring in tropical dry forests is still in its infancy. We provide a protocol for permanent monitoring plots in tropical dry forests. Expanding monitoring into dry biomes is critical for overcoming the linked challenges of climate change, land use change, and the biodiversity crisis.Newton FundNatural Environment Research Council (NERC)Fundação de Amparo à Pesquisa do Estado de São PauloCYTE