Anemia e desnutrição maternas e sua relação com o peso ao nascer

With a view to evaluating the effect of anemia and maternal undernourishment on birth weight, a sample of 691 pregnant women, from an assistential maternity hospital, in S.Paulo, Brazil, were studied at delivery. Anemia was found in 29.1 % and undernourishment in 17.2% of the women, though no association was detected between these nutritional deficiences. Neither was any association detected between institutional ante-natal care and anemia or undernourishment. Among single newborns the incidence of low birth weight (LBW) was of 12.9%. LBW was observed in 23.6% of children born to women who came to the end of their pregnancy with a low weight for height ratios while among adequate weight for height women the percentage was 10.8. Children of women who remained undernourished throughout their pregnancy had a relative risk of being born with LBW 2.8 times grater than the children of those who recovered normal weight by the end of their pregnancy. Our results emphasize the need for implementation of nutritional status control activities in programs of ante-natal care.Com o objetivo de avaliar a influência da anemia e desnutrição materna sobre o peso ao nascer, estudou-se uma amostra de 691 gestantes atendidas em maternidade exclusivamente assistencial do Município de São Paulo, SP (Brasil). Encontrou-se, no final da gestação, 29,2% de gestantes anêmicas e 17,2% de desnutridas, não tendo sido verificada associação entre essas duas deficiências nutricionais. O papel favorável do serviço de assistência pré-natal no controle do estado nutricional da mulher não foi verificado, tendo sido observado que a anemia e desnutrição não estão associadas à assistência pré-natal. A incidência de baixo peso ao nascer (BPN) entre filhos de parturientes desnutridas foi 23,6%, valor significativamente diferente (

Evaluación del impacto nutricional del programa de alimentación complementaria de Panamá en niños menores de 5 años Assessment of the nutritional impact of the complementary feeding program of Panama in children under five years old.

RESUMEN. El objetivo fue evaluar el impacto nutricional del Programa de Alimentación Complementaria (PAC) del Ministerio de Salud de Panamá en niños menores de 5 años. Se estudió una cohorte retrospectiva de beneficiarios, comparando la evolución nutricional de ellos desde 6 meses antes hasta 9 meses después de la intervención, con relación a lo observado en niños de las misma edad no intervenidos. Cada beneficiario recibió 6 libras mensuales de un suplemento alimentario de cereales y leguminosas, fortificado con calcio, hierro y vitamina A, que aporta 350 Kcal y 12 gramos de proteínas por 100 gramos. Se analizó el cambio promedio en los indicadores antropométricos y la tasa de recuperación de niños desnutridos y en riesgo, en función de variables socioeconómicas, nutricionales y el tiempo de permanencia en el programa. Al ingreso la relación peso-edad y peso-talla promedio fue -1,5 ± 1,2 DE y -0,6 ± 0,9 DE respectivamente. Antes de la intervención hubo una disminución significativa de la relación peso-edad y talla-edad (-0,6 ± 1,2 y -0,3 ± 1,3 respectivamente, p SUMMARY. To evaluate the nutritional impact of the Complementary Feeding Program of Panama in children under 5 years old. A retrospective cohort of children beneficiaries of the program was studied and compared with others of the same age and districts not involved in this intervention. Weight for age (W-A), height for age (H-A), and weight for height (W-H) was calculated in each control and the nutritional status determined according to Ministry of Health norms. Every beneficiary received six pounds/month of a food supplement containing cereals, legumes, calcium, iron and vitamin A (350 Kcal and 12 g of protein by 100 grams). Most of the children enter into the program in their second year of life with an average W-A and W-H of -1.5 ± 1.2 and -0.6 ± 0.9 respectively; both indicators were declining before the intervention (-0.6 ± 1.2 y -0.3 ± 1.3 respectively, p < 0.01). In 9 months of intervention an average change in W-A of 0.0 ± 1.1 and H-A of - 0.1 ± 1.1 was observed (NS). Weight gain was higher in children with lower W-A, in families with less children or mother with better education level (p < 0.05). In 35% of malnourished children and 24% of children at risk nutritional status improved during the intervention. Children with higher nutritional deficit at the beginning of the program have significantly better nutritional improvement (p < 0.001), encouraging the importance on focusing this program in malnourished children

Anemia e desnutrição maternas e sua relação com o peso ao nascer Maternal anemia and undernowrishment and their relation to birth - weight

Com o objetivo de avaliar a influência da anemia e desnutrição materna sobre o peso ao nascer, estudou-se uma amostra de 691 gestantes atendidas em maternidade exclusivamente assistencial do Município de São Paulo, SP (Brasil). Encontrou-se, no final da gestação, 29,2% de gestantes anêmicas e 17,2% de desnutridas, não tendo sido verificada associação entre essas duas deficiências nutricionais. O papel favorável do serviço de assistência pré-natal no controle do estado nutricional da mulher não foi verificado, tendo sido observado que a anemia e desnutrição não estão associadas à assistência pré-natal. A incidência de baixo peso ao nascer (BPN) entre filhos de parturientes desnutridas foi 23,6%, valor significativamente diferente (p<0,005) do encontrado entre mulheres não desnutridas no final da gestação - 10,8%. Comparando mulheres que iniciaram o processo gravídico desnutridas e que não se recuperaram com aquelas que se recuperaram, verifica-se risco relativo 2,8 vezes maior de conceptos com BPN entre as primeiras. Os resultados encontrados permitem ressaltar a necessidade de implementação nos programas de atendimento à gestante, de atividades relacionadas ao controle do estado nutricional da mulher.<br>With a view to evaluating the effect of anemia and maternal undernourishment on birth weight, a sample of 691 pregnant women, from an assistential maternity hospital, in S.Paulo, Brazil, were studied at delivery. Anemia was found in 29.1 % and undernourishment in 17.2% of the women, though no association was detected between these nutritional deficiences. Neither was any association detected between institutional ante-natal care and anemia or undernourishment. Among single newborns the incidence of low birth weight (LBW) was of 12.9%. LBW was observed in 23.6% of children born to women who came to the end of their pregnancy with a low weight for height ratios while among adequate weight for height women the percentage was 10.8. Children of women who remained undernourished throughout their pregnancy had a relative risk of being born with LBW 2.8 times grater than the children of those who recovered normal weight by the end of their pregnancy. Our results emphasize the need for implementation of nutritional status control activities in programs of ante-natal care

EVALUACIÓN DEL PROGRAMA DE SUPLEMENTACIÓN CON HIERRO EN PANAMÁ

-

Consideraciones sobre la elaboración de las directrices de nutrición de la Organización Mundial de la Salud y su implementación

La Organizaci&oacute;n Mundial de la Salud (OMS) sigue un proceso complejo y riguroso para la elaboraci&oacute;n de directrices mundiales. En el caso de las directrices relacionadas con nutrici&oacute;n, la participaci&oacute;n conjunta de las autoridades de los Estados Miembros de la OMS y sus aliados, incluidos aquellos de la econom&iacute;a social y solidaria, es clave para fortalecer el proceso de elaboraci&oacute;n de directrices informadas por las pruebas cient&iacute;ficas y su posterior implementaci&oacute;n, como parte de las estrategias nacionales de salud p&uacute;blica. Para las autoridades en materia de salud y desarrollo social, la OMS desarrolla una serie de herramientas para la formulaci&oacute;n de pol&iacute;ticas informadas por las pruebas cient&iacute;ficas, considerando su pertinencia, relevancia e implementabilidad. Este proceso de adopci&oacute;n y adaptaci&oacute;n debe considerar aspectos de equidad, para evitar la ampliaci&oacute;n de brechas en salud. Las directrices mundiales de la OMS contribuyen a que las intervenciones en nutrici&oacute;n en sus Estados Miembros sean implementadas de manera adecuada. Dos experiencias de implementaci&oacute;n de intervenciones en nutrici&oacute;n, una en Panam&aacute; y otra en Per&uacute;, ejemplifican este proceso. El art&iacute;culo concluye sugiriendo profundizar en el conocimiento y aplicaci&oacute;n de la investigaci&oacute;n de la implementaci&oacute;n de programas para identificar los factores que permiten a una intervenci&oacute;n ser efectiva, tener una mejor estrategia de escalabilidad y contribuir a la equidad en salud.The World Health Organization (WHO) follows a complex and rigorous process to develop global guidelines. With regard to nutrition-related guidelines, the joint participation of national authorities from Member States and their partners, including those of the social economy, is key to strengthening the process of evidence-informed guideline development and the subsequent implementation as part of national public health strategies. WHO puts forward a series of tools that can assist national authorities on health and social development in the elaboration of evidenceinformed policies, considering their pertinence, relevance and implementability. This adoption and adaptation process must consider equity in order to avoid widening existing inequities. WHO global nutrition guidelines contribute to the effective implementation of nutrition interventions in Member States. Two experiences of implementation, one in Panama and one in Peru, exemplify this process. The paper ends by suggesting a deeper understanding and utilization of implementation research during programmes to identify what factors ensure effective interventions, appropriate scale up strategies and greater health equity

Consideraciones sobre la elaboración de las directrices de nutrición de la Organización Mundial de la Salud y su implementación

La Organización Mundial de la Salud (OMS) sigue un proceso complejo y riguroso para la elaboración de directrices mundiales. En el caso de las directrices relacionadas con nutrición, la participación conjunta de las autoridades de los Estados Miembros de la OMS y sus aliados, incluidos aquellos de la economía social y solidaria, es clave para fortalecer el proceso de elaboración de directrices informadas por las pruebas científicas y su posterior implementación, como parte de las estrategias nacionales de salud pública. Para las autoridades en materia de salud y desarrollo social, la OMS desarrolla una serie de herramientas para la formulación de políticas informadas por las pruebas científicas, considerando su pertinencia, relevancia e implementabilidad. Este proceso de adopción y adaptación debe considerar aspectos de equidad, para evitar la ampliación de brechas en salud. Las directrices mundiales de la OMS contribuyen a que las intervenciones en nutrición en sus Estados Miembros sean implementadas de manera adecuada. Dos experiencias de implementación de intervenciones en nutrición, una en Panamá y otra en Perú, ejemplifican este proceso. El artículo concluye sugiriendo profundizar en el conocimiento y aplicación de la investigación de la implementación de programas para identificar los factores que permiten a una intervención ser efectiva, tener una mejor estrategia de escalabilidad y contribuir a la equidad en salud

Multiple Infections, Nutrient Deficiencies, and Inflammation as Determinants of Anemia and Iron Status during Pregnancy: The MINDI Cohort

In pregnant women with multiple infections, nutrient deficiencies, and inflammation (MINDI), the study of anemia and iron status is limited. For this cross-sectional study (n = 213 Panamanian indigenous women), we investigated if hemoglobin, anemia (Hb < 110 g/L), ferritin, serum iron, serum transferrin receptor, and hepcidin were associated with (1) maternal nutritional status and supplementation practices, (2) biomarkers of inflammation, and (3) presence/absence of infections. Hierarchical generalized linear and logistic regression models and dominance analyses identified the relative importance of these predictors. Anemia (38%), which was likely underestimated due to low plasma volume (95%), was associated with lower ferritin, vitamin A, and weight-for-height, suggesting anemia of undernutrition. Inflammation was not associated with Hb or anemia; nevertheless, higher CRP was associated with increased odds of low serum iron and higher ferritin and hepcidin, indicating iron restriction due to inflammation. The length of iron supplementation did not enter models for anemia or iron indicators, but a multiple nutrient supplement was associated with higher ferritin and hepcidin. Moreover, iron supplementation was associated with higher odds of vaginal trichomoniasis but lower odds of caries and bacterial vaginosis. The complex pathogenesis of anemia and iron deficiency in MINDI settings may require other interventions beyond iron supplementation

Multiple Indicators of Undernutrition, Infection, and Inflammation in Lactating Women Are Associated with Maternal Iron Status and Infant Anthropometry in Panama: The MINDI Cohort

Maternal infections, nutrient deficiencies, and inflammation (MINDI) co-exist in lactating indigenous women in Panama, but their impact on maternal iron status and infant growth is unknown. For this secondary analysis of cross-sectional data of lactating mothers from our MINDI cohort, we investigated associations of MINDI variables with maternal anemia, elevated serum transferrin receptor (sTfR), low serum iron, hepcidin, ferritin, and infant weight-for-age (WAZ), length-for-age (LAZ), and head-circumference-for-age (HCAZ) Z-scores in 99 mother-infant dyads. A bootstrapping resampling procedure preselected covariates for inclusion in multivariable regressions models from chronic maternal infections and nutritional status [folate, vitamins A, D, retinol-binding protein (RBP), insulin-growth factor-1 (IGF-1)] and inflammation [C-reactive protein (CRP), cytokines, platelet indices] indicators. Anemia was prevalent (53.5%) but underestimated due to widespread low plasma volume (<2.2 L, 79.9%) and was associated with indicators of malnutrition [lower IGF-1, body mass index (BMI), vitamin D, and intake of green/leafy vegetables], but not inflammation. Higher CRP was associated with lower serum iron, and higher hepcidin and ferritin, whereas maternal platelets were associated with lower HCAZ (β = −0.22), WAZ (β = −0.17), and LAZ (β = −0.17). Higher LAZ was also associated with maternal serum vitamin D (β = 0.23), whereas maternal iron supplementation lowered LAZ (β = −0.22). Assessment of iron status in this MINDI cohort is complex and supplementation strategies must consider consequences for both the mother and the infant