Feeding during the first three months of life

Universidade Federal de São Paulo (UNIFESP) Departamento de PediatriaUniversidade Federal de São Paulo (UNIFESP)UNIFESP, Depto. de PediatriaUNIFESPSciEL

Efectos del peso extremadamente bajo al nacimiento sobre la familia: revisión bibliográfica

Objective: The present study is a literature review to identify the effects of a very low birth weight newborn on family. This is an important instrument to clarify epidemiological issues and to suggest the directions for health policy efforts.Method: A three-step review was carried out using databases of journals indexed for Medline/Lilacs/Scielo/Cochrane published between 1966 and 2005 using specific criteria of inclusion. The first step selected 12 articles from 2,889 when searching for the keyword very low birth weight infant; the second step used the crossing of keyword premature infant with other pertinent keywords and terms resulting in 191 articles generating 7 more articles matching the criteria of inclusion. The third step was to analyze the references of articles in steps 1 and 2 (12 + 7 = 19), selecting 3 additional ones totalizing 22 selected articles.Result: Evidences in literature state that the families of very low birth weight newborns suffer potential negative effects on their operational dynamics, which is associated to the clinical seriousness, the age and the neuropsycomotor development of such children. It seems that the mother is the most affected member due to the situation imposed to the family, and the one who needs psychosocial support more frequently.Conclusion: The number of existing studies is still insufficient to clarify whether the effects on the family considering all their aspects are preponderantly positive or negative.Univ Fed Sao Paulo, Dept Pediat, Disciplina Nutrol, BR-04040032 Sao Paulo, BrazilUniv Fed Sao Paulo, Dept Pediat, Disciplina Nutrol, BR-04040032 Sao Paulo, BrazilWeb of Scienc

Evaluation of the hygienic-sanitary conditions of kitchens in public and philanthropic daycare centers

This paper aims to evaluate the hygienic-sanitary conditions of kitchens in philanthropic and public daycare centers in the city of São Paulo using a tool of easy application. Information on the hygienic-sanitary conditions was gathered observing the operational conditions of five public and philanthropic daycare centers in the city of São Paulo. A score was developed for classifying the risks of food contamination. The operational conditions in the kitchens of the studied philanthropic and public daycare centers in the city of São Paulo can result in contamination of the prepared food. Among the most important risk factors for food contamination is the behavior of the workers who handle the food. Training and continuous supervision of the involved personnel are the best and easiest alternatives for assuring the appropriate hygienic-sanitary conditions and quality of the food offered to the children in these daycare centers.Este trabalho objetiva avaliar as condições higiênico-sanitárias das cozinhas de creches públicas e filantrópicas do município de São Paulo, através da utilização de um instrumento de fácil aplicação. As informações sobre as condições higiênico-sanitárias foram coletadas através da observação das condições de funcionamento da cozinha de cinco creches públicas e filantrópicas do município de São Paulo. Para a classificação do risco de contaminação da alimentação, foi criado um escore. As cozinhas observadas de creches públicas e filantrópicas do município de São Paulo encontram-se em condições de funcionamento que oferecem riscos de contaminação à alimentação produzida pela instituição. Dentre os maiores fatores de risco de contaminação dos alimentos encontram-se as ações dos manipuladores. O investimento em treinamento e supervisão continuada da mão-de-obra envolvida na manipulação de alimentos é a melhor e mais fácil alternativa a ser realizada como forma de garantia das adequadas condições higiênico-sanitárias e da qualidade da alimentação servida às crianças em creches.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de PediatriaUNIFESP, EPM, Depto. de PediatriaSciEL

Multivariate hierarchical model for physical inactivity among public school children

OBJECTIVE: To identify biological and sociodemographic factors associated with physical inactivity in public school children. METHODS: Parents of 2,519 children (49.3% of whom were girls), aged 7 to 10 years (mean = 7.6±0.9 years), from eight public schools in São Paulo, Brazil, completed a self-administered questionnaire. We used multiple correspondence analysis to identify groups of responses related to levels of physical activity and inactivity and to obtain an optimal scale. The cluster analysis identified groups of active and inactive children. The analysis of the receiver operator characteristic (ROC) curve, for the study of diagnostic properties of a simplified scale for physical inactivity derived from the optimal scale, revealed that a cutoff point of 3 had the best sensitivity and specificity, being therefore used as outcome variable in the regression model. A multivariate hierarchical model was built, including distal and proximal categorical variables, with a p < 0.05. RESULTS: Physical inactivity was positively associated with biological factors such as being overweight, being older than 7.5 years, being a female, and having a good appetite, and with socioeconomic factors such as having garbage collected less than twice a week and having mothers who work outside the home. CONCLUSION: The results are consistent with published data about determinant factors of physical activity and inactivity among children, showing that questionnaires answered by parents and submitted to a sophisticated statistical analysis can be used in population-based studies involving children younger than 10 years old.OBJETIVO: Identificar fatores biológicos e sociodemográficos atribuíveis à inatividade física em crianças de escolas públicas. MÉTODOS: Foram estudadas, através de questionário auto-relatado pelos pais, 2.519 crianças (49,3% meninas), de 7 a 10 anos (média = 7,6±0,9 anos), de oito escolas públicas da cidade de São Paulo. Aplicamos a análise de correspondência múltipla para identificar grupos de respostas relacionadas com padrões de atividade e inatividade física e a geração de uma escala ótima. A análise de agrupamento identificou os grupos de crianças ativas e inativas. A análise de curva ROC (receiver operator characteristic), para o estudo das propriedades diagnósticas de uma escala simplificada de inatividade física derivada da escala ótima, mostrou o ponto de corte = 3 como o de melhor sensibilidade e especificidade, sendo utilizado como a variável de resposta no modelo de regressão. Um modelo hierárquico multivariado foi construído, assumindo variáveis categóricas como distais e proximais, adotando-se p < 0,05. RESULTADOS: A inatividade física foi positivamente associada aos fatores determinantes biológicos como sobrepeso, idade maior do que 7,5 anos, sexo feminino e bom apetite, e aos determinantes socioeconômicos como freqüência de coleta de lixo menor do que duas vezes por semana e mães que trabalham fora de casa. CONCLUSÃO: Os resultados são coerentes com os dados publicados sobre fatores determinantes de atividade e inatividade física na infância, indicando que questionários respondidos pelos pais, submetidos a uma análise estatística sofisticada, podem ser viáveis em estudos populacionais envolvendo crianças menores de 10 anos.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaCenter for Physical Activity and Health PromotionCenters for Disease Control and Prevention Division of Nutrition and Physical ActivityUNIFESP-EPM Departamento de PediatriaUNIFESP, EPM, Depto. de PediatriaSciEL

Diagnosis of complementary feeding practices for creating a matrix model for action in primary health care

Timely and appropriate complementary feeding is essential for the healthy growth and development of children, and Primary Health Care, especially the Family Health Support Nuclei, are the ideal location for developing relevant actions during this period. A cross-sectional study that applied a questionnaire to mothers and anthropometric evaluation for 324 children sought to develop an index of complementary feeding inadequacies and to study its association with social, economic, clinical, epidemiological and nutritional variables. For quantification of feeding inadequacies, an index using the Delphi method was created. High frequencies were observed for all inadequacies, especially for late introduction of solids (80.2%), early introduction of sugar/thickeners (78.1%) and liquids (73.5%). The most significant results of these associations were early weaning of exclusive (p = 0.000) and total (p = 0.005) breastfeeding, absence of partner (p = 0.001) and the mother supporting the family financially (p = 0.025). The use of this index identifies higher-risk situations for developing a nutritional assistance action plan, especially when it comes to promoting matrix model work.A alimentação complementar adequada e oportuna é essencial para o crescimento e o desenvolvimento saudáveis da criança, sendo a Atenção Primária à Saúde, em especial os Núcleos de Apoio à Saúde da Família, o lócus ideal para o desenvolvimento de ações pertinentes a esta prática. Estudo transversal com aplicação de questionário para mães e avaliação antropométrica de 324 crianças visou desenvolver um escore de inadequações na alimentação complementar e estudar suas relações com variáveis socioeconômicas, clínico-epidemiológicas e nutricionais. Para quantificação das inadequações alimentares foi criado um escore por meio do Método Delphi. Foram observadas altas frequências para todas as inadequações, especialmente na introdução tardia de sólidos (80,2%), precoce de açúcares/engrossantes (78,1%) e precoce de líquidos (73,5%). Entre as variáveis mais significantemente associadas com o escore estão desmame precoce do aleitamento materno exclusivo (p = 0,000) e total (p = 0,005), ausência de companheiro (p = 0,001) e a mãe ser chefe da família (p = 0,025). A utilização do escore identifica situações de maior risco para subsidiar as ações prioritárias da assistência nutricional, especialmente para promover o trabalho matricial.Universidade Federal de São Paulo (UNIFESP) Departamento de PediatriaUniversidade Federal de São Paulo (UNIFESP) Instituto Saude e Sociedade Departamento de Politicas Publicas e Saude ColetivaUNIFESP, Depto. de PediatriaUNIFESP, Instituto Saude e Sociedade Depto. de Politicas Publicas e Saude ColetivaSciEL

The effect of participation in school-based nutrition education interventions on body mass index: A meta-analysis of randomized controlled community trials

Objective. the aim of this study was to evaluate the effectiveness of school-based nutrition education interventions in reducing or preventing overweight and obesity among children and adolescents.Methods. We conducted a systematic search of 14 databases until May 2010 and cross-reference check in 8 systematic reviews (SRs) for studies published that described randomized controlled trials conducted in schools to reduce or prevent overweight in children and adolescents. An additional search was carried out using PubMed for papers published through May 2012, and no further papers were identified. Body mass index (BMI) was the primary outcome. the title and abstract review and the quality assessment were performed independently by two researchers. the software EPPI-Reviewer3 was used to store, manage and analyze all data. This SR is registered at ClinicalTrials.gov (NCT00985972).Results. From the 4888 references initially retrieved, only 8 met the eligibility criteria for a random-effects meta-analysis. the total population consisted of 8722 children and adolescents. Across the studies, there was an average treatment effect of -0.33 kg/m(2) (-0.55, 0.11 95% CI) on BMI, with 84% of this effect explained by the highest quality studies.Conclusion. This systematic review provides evidence that school-based nutrition education interventions are effective in reducing the BMI of children and adolescents. (c) 2013 Elsevier Inc. All rights reserved.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Universidade Federal de São Paulo, Dept Pediat, Disciplina Nutrol, BR-04040032 São Paulo, BrazilUniv São Paulo, Fac Med, Inst Coracao,Hosp Clin, Programa Posgaduacao Cardiol,Unidade Epidemiol Cl, BR-05403900 São Paulo, BrazilUniv São Paulo, Unidade Epidemiol Clin, Inst Coracao, BR-05403900 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Pediat, Disciplina Nutrol, BR-04040032 São Paulo, BrazilFAPESP: 09/12438-5Web of Scienc