Crescimento físico e perfil nutricional da população indígena Xavánte de Sangradouro-Volta Grande, Mato Grosso, Brasil

The impact of urbanisation on the cardiometabolic health of Indigenous Brazilian peoples: a systematic review and meta-analysis, and data from the Brazilian Health registry

BACKGROUND

Indigenous Brazilian peoples have faced an unparalleled increase in the rate of cardiovascular diseases following rapid nutritional transition to more urban diets. We aimed to conduct a systematic review and meta-analysis to evaluate the association between urbanisation (including data from Amazon rainforest deforestation) and cardiometabolic risk factors and outcomes.

METHODS

In this systematic review and meta-analysis, we searched Pubmed, Embase, Web of Science, and Scopus for articles published in any language between the year 1950 and March 10, 2022. Studies conducted in Indigenous Brazilian adults that evaluated metabolic health were included. Data for deforestation was obtained by the Amazon Deforestation Monitoring Project. Cardiovascular mortality was obtained from the Brazilian Health registry. Two independent reviewers evaluated studies for risk of bias, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. The main outcomes assessed were the prevalence of obesity and related cardiometabolic risk factors among Indigenous Brazilian peoples and its association with urbanisation. Summary data were extracted from published reports for the meta-analyses. We calculated pooled estimates of the prevalence of each cardiometabolic outcome by using a random-effects model (DerSimonian-Laird method). This study is registered with the International Prospective Register of Systematic Reviews, CRD42021285480.

FINDINGS

46 studies were identified, including a total of 20 574 adults from at least 33 Indigenous Brazilian ethnicities. Meta-analyses of the prevalence of obesity showed that there were higher rates of obesity (midwest region: 23% [95% CI 17-29]; and south region 23% [13-34]) and hypertension (south region: 30% [10-50]) in Indigenous peoples living in urban regions of Brazil, while the lowest rates of obesity (11% [95% CI 8-15]) and hypertension (1% [1-2]) were observed in those in the less urbanised (north) regions of Brazil. The prevalence of obesity was 3·5 times higher in participants living in urbanised Indigenous territories (28%) than in those living in lands with >80% native Amazon rainforest (8%). In meta-analyses that evaluated blood pressure level, there was no incremental change in blood pressure with ageing in Indigenous peoples who lived according to traditional lifestyle, in contrast to those living in urbanised regions. For Indigenous men with traditional lifestyles, systolic blood pressure changed from 109·8 mm Hg to 104·4 mm Hg between the youngest (<30 years) and the oldest (>60 years) age groups, and diastolic blood pressure changed from 69·8 mm Hg to 66·1 mm Hg. For Indigenous women with traditional lifestyles, systolic blood pressure was 100·0 mm Hg for the youngest age group with no changes for older age groups, and diastolic blood pressure was 62 mm Hg for the youngest age group with no changes for older age groups. For Indigenous men with urbanised lifestyles, systolic blood pressure changed from 117·3 mm Hg to 124·9 mm Hg between the youngest and the oldest age groups, and diastolic blood pressure changed from 72·7 mm Hg to 76·4 mm Hg. For Indigenous women with urbanised lifestyles, systolic blood pressure changed from 110·0 mm Hg to 116·0 mm Hg between the youngest and the oldest age groups, and diastolic blood pressure changed from 68·3 mm Hg to 74·0 mm Hg. For the years 1997 and 2019, the cardiovascular mortality rate in individuals living in the southeast region (the most urbanised) was 2·5 times greater than that observed in the north. Conversely, the incremental rise in cardiovascular mortality in the past two decades among Indigenous Brazilians living in the north or northeast (2·7 times increase) stands in stark contrast to the stable rates in those living in already urbanised regions.

INTERPRETATION

The macrosocial changes of Indigenous peoples' traditional ways of living consequent to urbanisation are associated with an increased prevalence of adverse cardiometabolic outcomes. These data highlight the urgent need for environmental policies to ensure the conservation of the natural ecosystem within Indigenous territories, as well as the development of socio-health policies to improve the cardiovascular health of Indigenous Brazilians peoples living in urban areas.

FUNDING

None.

Prevalence of overweight and obesity in the adult indigenous population in Brazil: A systematic review with meta-analysis

To carry out a systematic review to identify the prevalence of overweight and obesity in the adult indigenous population in Brazil. The databases used were PubMed, Scopus, Virtual Health Library (VHL), and Science Direct, with the following search strategy: "overweight" OR "obesity" AND "indigenous" OR "tribe" AND "Brazil". For the meta-analysis, RStudio^® software was used. Were 22 articles included. The combined effect of the meta-analysis studies showed a global prevalence of overweight and obesity of 45%. Approximately half (45%) of indigenous Brazilian adults have excess weight. These findings highlight the need to implement public policies for the prevention and treatment of these morbidities.

[The nutritional status of Kaingang and Guarani indigenous peoples in the State of Paraná, Brazil]

This study arose from the need to comprehend epidemiological aspects to establish a policy for physical activity for indigenous peoples. Although infectious diseases are still the main causes of suffering in these ethnic groups, chronic diseases have emerged due to the process of epidemiological/nutritional change in indigenous peoples subject to the policy of life on reservations. The scope of this study was to evaluate the nutritional status of indigenous peoples belonging to two ethnic groups in the State of Paraná. Anthropometric data were collected on 178 adults belonging to the Kaingang (n = 117) and Guarani (n = 61) indigenous ethnic groups. The prevalence of being overweight in Guarani and Kaingang adults was 32.3% and 41%, respectively, detecting a prevalence of obesity in the order of 3.2% among the Guarani indigenous people and 12.8% among the Kaingang ethnic group. Anthropometric changes observed among the Guarani and Kaingang indigenous peoples of Paraná are of increasing concern according to some studies. Thus, the results of this study reinforce the need for integrated actions such as nutritional guidance and physical activity during leisure time for the promotion of the health of these populations.

Indicadores nutricionais combinados e fatores associados em população Quilombola no Sudoeste da Bahia, Brasil

Este estudo estimou a prevalência de duas combinações de indicadores nutricionais: Índice de Massa Corporal (IMC) + Circunferência da Cintura (CC) e IMC + Razão Cintura Estatura (RCE), e investigou os fatores associados em adultos Quilombolas. Amostra aleatória em dois estágios de 739 adultos ≥ 20 anos, residentes em Comunidades Quilombolas em Vitória da Conquista (BA), em 2011. Risco combinado IMC + RCE incluiu os indivíduos que simultaneamente apresentaram IMC ≥ 25,0Kg/m2 ou ≥ 27,0Kg/m2, se idade ≥ 60 anos e RCE ≥ 0,5. O risco IMC + RCE incluiu indivíduos com IMC elevado que também apresentavam CC ≥ 80cm, se mulher, ou ≥ 94cm, se homem. As prevalências dos indicadores nutricionais combinados foram de 35,3% (IMC + RCE) e 26,8% (IMC + CC). Sexo feminino e hipertensão aumentaram a chance para os dois indicadores enquanto que o estado civil não casado diminuiu esta chance. O indicador IMC + RCE foi maior na faixa etária de 40 a 59 anos e o indicador IMC + CC foi mais frequente na faixa de 40 a 49 anos. A baixa escolaridade elevou o indicador IMC + RCE, enquanto assistir televisão por mais de duas horas por dia, o indicador IMC + CC. A elevada prevalência de risco nutricional para DCNT, especialmente de obesidade central, confirmou a necessidade de ações de promoção de dieta saudável e saúde.

Epidemiology of high blood pressure among the Kaingang people on the Xapecó Indigenous Land in Santa Catarina State, Brazil, 2013

This cross-sectional study describes the prevalence of high blood pressure (HBP; measured at one setting, and suggestive of a clinical diagnosis of arterial hypertension) and mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) and their associations with socio-demographic and anthropometric variables among 355 Kaingang adults (≥ 20 years) on the Xapecó Indigenous Land in Brazil. Weight, height, waist circumference (WC), SBP, and DBP were measured and socio-demographic data were collected. Prevalence of HBP was 53.2% (95%CI: 45.3; 61.1) in men and 40.7% (95%CI: 33.8; 47.6) in women. In women, age and WC were directly associated with HBP; age was associated with SBP and schooling with DBP. In men, HBP was statistically associated with high body mass index (BMI) and tile floor in the home (as a socioeconomic proxy); BMI and WC were associated with SBP; BMI and WC were associated with DBP. The study highlights the need for measures to control risk factors for HBP, especially due to its relevance for cardiovascular diseases and their consequences.

Prevalence of metabolic syndrome in the Brazilian Xavante indigenous population

BACKGROUND

The raising prevalence of weight excess and of non-communicable diseases in indigenous populations, as well as changes in food consumption and reduction in the frequency and intensity of physical activity, suggest that the prevalence of metabolic syndrome (MS) is also elevated. The objective of this study was to evaluate the prevalence of MS and the frequency of its components in the Xavante adult population living in the Indian reservations of São Marcos and Sangradouro/Volta Grande, in the state of Mato Grosso, Brazil. A cross-sectional study was carried out among 932 Xavante Indians aged 20 years or more, in the 2008-2012 period. The variables analysed were gender, age, weight, height, waist circumference, blood pressure, initial and 2-h capillary glycemia in a 75 g OGTT, levels of triglycerides and HDL-cholesterol. The diagnostic criteria for MS proposed by the IDF and AHA/NHLBI were used.

RESULTS

The prevalence of MS was 66.1 % (95 % CI 63.0-69.2), being 76.2 % (95 % CI 72.4-80.0) in women and 55.6 % (95 % CI 51.0-60.2) in men. Women had higher prevalence of MS in all age groups. Elevated waist circumference and lower levels of HDL-cholesterol were the more frequent components in those with MS, and elevated blood pressure was the less frequent.

CONCLUSIONS

The high prevalence of MS in the Xavante Indians is mainly due to the increased prevalence of weight excess that resulted from an intense change in their life-style, in a short period of time in a population with a genetic predisposition. These findings highlight the magnitude of this health problem and make an alert about the necessity to implement specific preventive interventions.

[Management, operations, and menus in Kaingáng indigenous schools participating in the National School Nutrition Program in Rio Grande do Sul State, Brazil.]

Few studies have focused on the National School Nutrition Program (PNAE) in indigenous schools in Brazil. The current study describes the program's operations, management, and menus in 35 Kaingáng indigenous schools in Rio Grande do Sul State, Brazil. A cross-sectional study design was used to obtain information on the program through questionnaires submitted to the Regional Educational Offices (CRE) and to the schools. The menus suggested to the schools by the regional offices were obtained. There were no Centers for Indigenous Education in the regional offices. All the assistant principals were indigenous, 26 schools (74.6%) practiced local management of the meal program, and 34 (97.1%) reported purchasing food from local markets. Most cooks (63.9%) had temporary work contracts with the schools and 65.7% were indigenous. Low offerings of veges, milk and dairy products were observed in around 60% of the menus, and legumes and fruits low in around 80%. It points out the need for more studies about the indigenous PNAE and intends to support public policies in health, food and nutrition for the national indigenous school .

Incidence of metabolic syndrome and related diseases in the Khisêdjê indigenous people of the Xingu, Central Brazil, from 1999-2000 to 2010-2011

The aim of this study was to identify the incidence of metabolic syndrome and related diseases in the Khisêdjê population living in the Xingu Indigenous Park, Mato Grosso State, Brazil, from 1999‐2000 to 2010‐2011. The study included 78 individuals aged ≥20 years. Data were analyzed using Student t test, linear regression, and Poisson regression. In 10 years of follow-up, cumulative incidence rates were 37.5% for metabolic syndrome, 47.4% for hypetriglyceridemia, 38.9% for arterial hypertension, 32% for central obesity, 30.4% for excess weight, 29.1% for hypercholesterolemia, 25% for low HDLc, 10.4% for high LDLc, and 2.9% for diabetes mellitus. Age proved to be a risk factor for incidence of hypertension, diabetes, and elevated LDLc, regardless of gender; male gender was a protective factor against incidence of central obesity, independently of age. The study showed deterioration of most target health indicators and exposure of the Khisêdjê to high cardiometabolic risk. These results may be related to changes in traditional lifestyle.

Brazilian indigenous children: Review of studies about nutritional status

Objective: To systematize studies on the anthropometric nutritional status of Brazilian indigenous children in order to examine the ability to address the totality of biological, anthropological, and ecological aspects, as well as to characterize the main analytical results of the determinants of nutritional status of Brazilian indigenous children. Methods: MedLine and Lilacs were searched using the intersection of "South American Indians" and "nutritional status" descriptors (the search in MedLine also included the descriptor "Brazil"). Results: Overall, 65 studies were identified, and 23 were considered relevant to this study. The systematization of these studies highlights the concentration of studies in the midwestern and northern regions of Brazil, as well as the lack of cultural, biochemical, and food consumption approaches. Regarding nutritional status, we found: 1) greater vulnerability of younger children, especially in relation to stunting; 2) absence of differences in nutritional status according to sex; 3) socioeconomic determination of nutritional status; 4) differences in nutritional status between children from different villages. Conclusion: The nutritional status of Brazilian indigenous children is associated with age, socioeconomic status, and ethnic characteristics. Efforts are needed to understand the ethnic and cultural influence on nutritional status and on its causal network, as well as of various factors minimally discussed.

Overweight in Goiás'quilombola students and food insecurity in their families

Objective: To characterize the nutritional status of quilombola students and determine the food security status of their households. Methods: This is a cross-sectional study with students aged six to nineteen years from quilombola communities in twelve municipalities of Goiás categorized by age, gender, school location (urban/rural), and nutritional status based on the World Health Organization's height-for-age and body mass index for-age charts. The Brazilian Food Insecurity Scale was used for measuring food (in)security in their families. Descriptive and association analyses were conducted using the Chi-square test at a significance level of 5% (p<0.05). Results: In a sample of 226 students, overweight (17.2%) was more common than malnutrition (1.3%), especially in students attending urban schools (28.2%) (p<0.05). Most (75.2%) quilombola families experienced food insecurity, especially mild. Conclusion: The apparent contradiction of excess weight and food insecurity occurring simultaneously indicates the need of revising the study instruments and the causal network that identify poverty.

Processo de gestar e parir entre as mulheres Kaingang

Este estudo teve por objetivo identificar o processo de gestação e nascimento entre as mulheres Kaingang. Pesquisa qualitativa de abordagem etnográfica, realizada com 30 mulheres Kaingang, na Terra Indígena de Faxinal de Catanduvas-PR. A coleta de dados ocorreu por meio de observação participante, entrevistas e grupo focal, no período de janeiro a abril de 2011 e foram analisados à luz da Teoria Transcultural do Cuidado. A população estudada tinha entre 14 e 100 anos. A concepção de parto tem mudado com o passar das gerações, sendo que as mais velhas acreditam ser melhor parir acocorada em casa, já as mulheres mais novas demonstram insegurança de ter os filhos fora do hospital. Foi identificada insatisfação na assistência durante o parto. É necessária a adequação das práticas de forma a preservar a cultura da etnia sem a exposição de mulheres e recém-nascidos ao risco de complicações ou mortalidade.

Prevalence of anemia and associated factors among indigenous children in Brazil: results from the First National Survey of Indigenous People's Health and Nutrition

BACKGROUND

Anemia is the most prevalent nutritional deficiency globally, affecting about a quarter of the world population. In Brazil, about one-fifth of children under five years of age are anemic. Previous case studies indicate prevalence rates much higher among indigenous peoples in the country. The First National Survey of Indigenous People's Health and Nutrition in Brazil, conducted in 2008-2009, was the first survey based on a nationwide representative sample to study the prevalence of anemia and associated factors among indigenous children in Brazil.

METHODS

The survey assessed the health and nutritional status of indigenous children < 5 years of age based on a representative sample of major Brazilian geopolitical regions. A stratified probabilistic sampling was carried out for indigenous villages. Within villages, children < 5 years of age in sampled households were included in the study. Prevalence rates of anemia were calculated for independent variables and hierarchical multivariate analysis were conducted to assess associations.

RESULTS

Evaluation of hemoglobin levels was conducted for 5,397 children (88.1% of the total sample). The overall prevalence of anemia was 51.2%. Higher risk of presenting anemia was documented for boys, lower maternal schooling, lower household socioeconomic status, poorer sanitary conditions, presence of maternal anemia, and anthropometric deficits. Regional differences were observed, with the highest rate being observed in the North.

CONCLUSIONS

The prevalence rates of anemia in indigenous children were approximately double than those reported for non-indigenous Brazilian children in the same age group. Similarly notable differences in the occurrence of anemia in indigenous and non-indigenous children have been reported for other countries. Deeper knowledge about the etiology of anemia in indigenous children in Brazil is essential to its proper treatment and prevention.

Perfil nutricional dos indígenas Xukuru-Kariri, Minas Gerais, de acordo com diferentes indicadores antropométricos e de composição corporal

O objetivo deste artigo foi avaliar o perfil nutricional dos indígenas Xukuru-Kariri entre 7 anos e 78 anos aldeados em Minas Gerais de acordo com os diferentes indicadores antropométricos e de composição corporal . As medidas aferidas foram: peso, estatura, circunferência da cintura (CC) e percentual de gordura corporal (%GC). Foram calculadas a sensibilidade e a especificidade para os índices antropométricos com intervalo de confiança de 95% e o valor preditivo positivo (VPP) e negativo (VPN). A população foi constituída por 58 indivíduos, sendo 56,9% (n = 33) do sexo masculino e 43,1% (n = 25) do sexo feminino. A especificidade foi superior à sensibilidade em relação a todos os índices. Observou-se que 29% dos indivíduos foram classificados com excesso de adiposidade corporal quando avaliados pelo IMC e pela bioimpedância mão a mão e 50% dos indivíduos apresentaram alta adiposidade corporal em relação ao IMC e a CC. É necessário que sejam realizados estudos com diferentes etnias a fim de se construir indicadores nutricionais específicos para orientação de serviços de saúde indígenas.

Waist circumference and waist circumference to height ratios of Kaingáng indigenous adolescents from the State of Rio Grande do Sul, Brazil

The aim of this study was to describe the distribution of waist circumference (WC) and WC to height (WCTH) values among Kaingáng indigenous adolescents in order to estimate the prevalence of high WCTH values and evaluate the correlation between WC and WCTH and body mass index (BMI)-for-age. A total of 1,803 indigenous adolescents were evaluated using a school-based cross-sectional study. WCTH values > 0.5 were considered high. Higher mean WC and WCTH values were observed for girls in all age categories. WCTH values > 0.5 were observed in 25.68% of the overall sample of adolescents. Mean WC and WCTH values were significantly higher for adolescents with BMI/age z-scores > 2 than for those with normal z-scores. The correlation coefficients of WC and WCTH for BMI/age were r = 0.68 and 0.76, respectively, for boys, and r = 0.79 and 0.80, respectively, for girls. This study highlights elevated mean WC and WCTH values and high prevalence of abdominal obesity among Kaingáng indigenous adolescents.

High prevalence of acute respiratory tract infections among Warao Amerindian children in Venezuela in relation to low immunization coverage and chronic malnutrition

BACKGROUND

Higher prevalence rates of acute respiratory tract infections (ARTIs) have been described in Australian and Canadian indigenous populations than in nonindigenous age-matched counterparts. Few studies on ARTIs in South American indigenous populations have been published. We performed a cross-sectional survey to describe the prevalence of upper respiratory tract infections and acute lower respiratory tract infections (ALRTIs) and associations with malnutrition and immunization status.

METHODS

From December 1, 2009 to May 31, 2010, 487 Warao Amerindian children 0 to 59 months of age living in the Delta Amacuro in Venezuela were included in a cross-sectional survey. Data were obtained through parent questionnaires, vaccination cards, and physical examinations including anthropometric measurements.

RESULTS

Of the 487 children, 47% presented with an ARTI. Of these, 60% had upper respiratory tract infections and 40% were ALRTI. Immunization coverage was low, with only 27% of all children presenting a vaccination card being fully immunized. The prevalence of malnutrition was high (52%), with stunting (height-for-age <-2 standard deviations) being the most frequent presentation affecting 45% of children. ARTI and ALRTI prevalence diminished with increasing age (odds ratio for ALRTI in children 25-59 months of age vs. children younger than 12 months, 0.49; 95% confidence interval, 0.26-0.93). Furthermore, significant differences in ARTI prevalence were seen between villages. No significant associations between immunization status or malnutrition and ARTI or ALRTI prevalence were identified.

CONCLUSIONS

A high prevalence of ARTIs and chronic malnutrition in combination with a low immunization status highlights the need for an integrated approach to improve the health status of indigenous Venezuelan children.

Nutritional status and growth of indigenous Xavante children, Central Brazil

BACKGROUND

The aim of this study was to characterize the nutritional status of Xavante Indian children less than 10 years of age in Central Brazil and to evaluate the hypothesis of an association between child nutrition and socioeconomic differentiation in this population.

METHODS

A cross-sectional study was conducted in July 2006 that included all children under the age of 10 from the Xavante village Pimentel Barbosa in Mato Grosso, Brazil. The data collected included weight, height, and sociodemographic information. Sociodemographic data were used to generate two indices ("income" and "wealth") and to determine the proportion of adults in each household. Descriptive analyses were performed for weight-for-age (W/A), height-for-age (H/A), and weight-for-height (W/H) using the NCHS and the WHO growth references. Univariate and multivariate analyses were conducted using H/A and W/A as a response variables.

RESULTS

Of a total of 246 children under the age of ten residing in the village, 232 (94.3%) were evaluated. Following the NCHS reference, 5.6% of children under the age of ten presented low W/A and 14.7% presented low H/A. Among children under the age of five, deficit percentages for weight and height were 4.5% and 29.9%, respectively, following the WHO curves. Among children < 2 years of age, H/A index variability was found to be directly related to child's age and inversely related to the proportion of adults in the household. Maternal BMI was positively associated with growth for children from 2 to 4 years of age, explaining 11.5% of the z-score variability for the H/A index. For children 5 years of age and older, the wealth index and maternal height were positively associated with H/A. No significant associations were found using W/A as the dependent variable.

CONCLUSION

This study demonstrated that undernutrition, in particular linear growth deficit, is a notable health issue for Xavante children. These findings contrast with the nutritional profile observed among Brazilian children nationally, which is characterized by a sharp decline in child undernutrition in recent decades, even in the poorest regions of the country. This discrepancy calls attention to the persistent health disparities that exist between indigenous and non-indigenous people in Brazil.

Nutritional vulnerability in Mbyá-Guaraní adolescents and adults from Misiones, Argentina

OBJECTIVES

The aim of this study was to evaluate the nutritional status and body composition in Mbyá-Guaraní adolescents and adults from three communities in the Province of Misiones, in northern Argentina.

METHODS

Anthropometric parameters were analyzed in 45 individuals (aged 14-60). Data were transformed to z-scores using NHANES I and II.

RESULTS

Ninety-three percent of the sample showed some kind of malnutrition (undernutrition and/or excess of weight). Stunting and overweight reached the highest prevalences (85.0 and 10.0%, respectively). The most Mbyá people were found to have low arm muscle and fat areas. They also tended to have shorter than normal lower limbs. Centralized obesity was evident in both sexes and in all the age intervals.

CONCLUSIONS

Extreme poverty, together with changes in life habits and diet composition, resulted in decrease of body size and changes in body proportions and composition. Although these changes could be considered as an adaptive response to the chronic exposure of these populations to adverse environmental conditions, they would favor the co-occurrence of malnutrition and overweight in a single scenario, and consequently increase the risk of infectious and nontransmissible diseases.

Socioeconomic status and body size among women in Honduran Miskito communities

BACKGROUND

This study investigates evidence of the nutrition transition among women in Miskito communities on the northeastern coast of Honduras.

AIM

The hypothesis that socioeconomic status (SES) is positively associated with body size and fatness is tested; and dietary and physical activity patterns are examined among SES groups.

SUBJECTS AND METHODS

An anthropometric survey was conducted with 200 non-pregnant women following standard procedures. Dietary intake and physical activity data were collected using 24-hour recall methods. Women were categorized into three SES groups (high, medium and low) based on economic and social attributes. Differences in anthropometric measures, diet and physical activity among SES groups were analysed.

RESULTS

More than 70% (n = 142) of women in the sample were overweight or obese. Mean height, weight, skin-fold thicknesses, arm and calf circumferences, percentage body fat and upper-arm fat area were significantly greater among high SES women than low SES women. Women with high SES had lower rates of physical activity and higher rates of obesity, perceived food sufficiency, meat consumption, milk/dairy intake and general dietary diversity.

CONCLUSION

High SES women were significantly fatter than low SES women; and variation observed among groups is likely related to different patterns of dietary intake and physical activity.

Estado nutricional dos indígenas Kaingáng matriculados em escolas indígenas do Estado do Rio Grande do Sul, Brasil

Caracterizar o estado nutricional de 3.254 Kaingáng de escolas indígenas de 12 terras indígenas do Rio Grande do Sul, Brasil. Transversal de base escolar. Obtidas medidas de peso (P), estatura (E) e circunferência da cintura (CC) conforme Organização Mundial da Saúde - OMS (1995). Classificação do estado nutricional: crianças: índices E/I, P/I e P/E, de acordo com o National Center for Health Statistics (WHO, 1995) e E/I, P/I e índice de massa corporal/idade (IMC/I) de acordo com OMS (2006); adolescentes: IMC/I (OMS, 1995 e 2006) e E/I (OMS, 2006); adultos: IMC (OMS, 1995) e CC (OMS, 2003). Adolescentes representaram 56% dos avaliados, crianças 42,5%, adultos 1,4% e idosos 0,1%. Deficit estatural de 15,1% (OMS, 1995) e 15,5% (OMS, 2006) entre as crianças e de 19,9% entre adolescentes. Freqüências de excesso de peso foram: crianças: 11% (OMS, 1995) e 5,7% (OMS, 2006); adolescentes: 6,7%; adultos: 79,2%. Entre adultos, 45,3% estavam em risco aumentado para doenças metabólicas. Observada a transição nutricional no segmento, caracterizada por prevalências importantes de baixa estatura na infância e adolescência e sobrepeso proeminente em todas as faixas etárias.

População indígena: uma reflexão sobre a influência da civilização urbana no estado nutricional e na saúde bucal

Embora ainda existam sociedades indígenas que mantêm um modo tradicional de viver, nas quais uma alimentação adequada em quantidade e qualidade provém da caça e da prática de agricultura, a maioria dos índios vem sofrendo um processo de aculturação oriundo do contato com a civilização urbana, pois eles não mais dispõem de terra suficiente que garanta a subsistência. Desse modo, acabam tornando-se dependentes do comércio local e consumindo alimentos industrializados que podem ser prejudiciais à saúde bucal e ao estado nutricional. A presente comunicação tem como objetivo identificar a influência da transição alimentar, devido ao contato com a civilização urbana, no estado nutricional e na condição bucal da população indígena brasileira. Os dados relacionados nessa investigação foram obtidos na base de dados do SciELO e do MedLine, PubMed, pesquisando-se os termos de indexação: "índios sul-americanos", "comportamento alimentar", "estado nutricional", "saúde bucal". Estudos revelaram a prevalência de desnutrição infantil, sobrepeso e obesidade em adultos, índice de cárie elevado e doença periodontal nas comunidades indígenas que vêm passando por mudanças de hábitos culturais. Conclui-se que a transição alimentar pode levar a desordens nutricionais e ao desenvolvimento de doenças bucais, sugerindo a necessidade de uma intervenção e/ou monitoramento por meio de programas dirigidos à assistência à saúde, ao saneamento básico, ao acesso à terra e à educação.

Perfil metabólico e antropométrico dos Suyá: Parque Indígena do Xingu, Brasil Central

OBJETIVO: Descrever o perfil metabólico e antropométrico de índios Suyá que vivem no Parque Indígena do Xingu (Mato Grosso). MÉTODO: Neste estudo transversal foram avaliados 86 índios Suyá com idade de > 20 anos, de ambos os sexos. Durante o exame físico foram obtidos os valores de pressão arterial, peso, altura, perímetros corporais e dobras cutâneas. Amostras de sangue foram coletadas para dosagem de lipoproteínas, glicemia e ácido úrico. Na análise dos dados foram utilizados os testes estatísticos qui-quadrado (para proporções) ou t de Student (para valores médios) nas comparações das distribuições das variáveis relativas ao estado nutricional e perfil metabólico, segundo sexo e faixa etária dos sujeitos. RESULTADOS: As mulheres, quando comparadas aos homens, apresentaram valores médios estatisticamente menores das variáveis antropométricas (peso, índice de massa corporal, perímetro de cintura, do braço e dobras cutâneas), de pressão arterial, triglicérides, VLDL e ácido úrico. Foram encontrados, entre os Suyá, 46,5%, com excesso de peso, 12,8% com obesidade generalizada, 38,4% com obesidade central, 26,7%, apresentaram alterações pressóricas, 4% glicemia de jejum alterada, 63,9% dislipidemia e 21,9% síndrome metabólica. CONCLUSÃO: Foram observadas alterações metabólicas e antropométricas entre os índios Suyá. Intervenções educativas devem ser implementadas para resgatar hábitos e estilo de vida tradicionais a fim de conter o avanço deste quadro.

Caries, gender and socio-economic change in the Xavante Indians from Central Brazil

BACKGROUND

The oral health conditions of indigenous peoples in Amazonia are closely associated with ecological and dietary changes related to interaction with non-Indians.

AIM

The study investigated the incidence of caries in an indigenous community from Central Brazil focusing on gender differences.

SUBJECTS AND METHODS

The research was conducted among the Xavante Indians and was based on longitudinal data collected in two surveys (1999 and 2004). The study included 128 individuals, 63 (49.2%) males and 65 (50.8%) females, divided in four age brackets (6-12, 13-19, 20-34, 35-60 years of age). The DMFT (decayed, missing and filled teeth) index and incidences (difference between 1999 and 2004) were calculated for each individual. The proportion of incidence was also calculated. Differences in caries risk between gender and age brackets were compared by parametric and non-parametric tests.

RESULTS

There were statistically significant differences in relation to caries incidence between age brackets and gender. The greatest incidence was observed in the 20-34 age bracket, which presented 3.30 new decayed teeth, twice the risk of the 6-12 age bracket (p<0.01), chosen as reference. While females in most age groups did not show higher risk for caries when compared to males, there was a 4.04-fold risk in the 20-34 age bracket (p<0.01).

CONCLUSION

It is concluded that factors related to the social functions of each sex (gender issues) and differential access to information, health services, and education may help to understand the differences observed in the incidence of caries.

Perfil nutricional e fatores associados à ocorrência de desnutrição entre crianças indígenas Kaingáng da Terra Indígena de Mangueirinha, Paraná, Brasil

Este estudo objetivou avaliar o estado nutricional de crianças indígenas e verificar os fatores associados à ocorrência de agravos nutricionais. Foram avaliadas 141 crianças Kaingáng de 0 a 60 meses de idade da Terra Indígena de Mangueirinha, Paraná, Brasil, por meio das medidas de peso e altura ou comprimento. Realizaram-se entrevistas com a aplicação de um questionário sobre condições materno-infantis e sócioeconômicas. Segundo os parâmetros da Organização Mundial da Saúde (2006), 24,8% das crianças apresentavam déficit de altura para idade (AI), 9,2% baixo peso para idade (PI), 2,1% baixo peso para altura (PA) e 2,1% baixo peso segundo o índice de massa corporal para idade (IMCI). De acordo com o NCHS (1977), 19,9% das crianças apresentaram baixa AI, 9,2% baixo PI e 1,4% baixo PA. O sobrepeso chegou a 6,4%, segundo o IMCI. O baixo peso ao nascer e os materiais utilizados na construção das paredes das casas estiveram estatisticamente associados com déficits antropométricos. Este estudo mostra que as crianças Kaingáng estão inseridas em um contexto marcado por precárias condições de vida, que estão associadas com indicadores desfavoráveis do estado nutricional.

Morbidade hospitalar de indígenas Xavante, Mato Grosso, Brasil (2000-2002)

OBJETIVO: Analisar as causas de hospitalização de indígenas Xavante, Estado de Mato Grosso, Brasil, no período 2000-2002. MÉTODOS: As causas de hospitalização foram pesquisadas nos prontuários de oito hospitais que atendem aos Xavante das reservas Areões, Pimentel Barbosa, Sangradouro e São Marcos. Os dados coletados incluíram: nome, idade, sexo, terra indígena, data de admissão, data de alta, diagnóstico no momento da internação. Os diagnósticos foram classificados segundo a CID-10. RESULTADOS: Foram analisados 1.698 prontuários. As idades variaram entre 0-93 anos. Mais da metade dos pacientes eram crianças < 5 anos (65,8%). As cinco principais causas de hospitalização foram: doenças do aparelho respiratório (41,5%); doenças infecciosas e parasitárias (17,4%); gravidez, parto e puerpério (12,7%); doenças endócrinas, nutricionais e metabólicas (9,7%); e lesões, envenenamentos e conseqüências de causas externas (3,7%). Se excluídas as causas relacionadas à gravidez, parto e puerpério, a distribuição passa a ser a seguinte: doenças do aparelho respiratório (47,7%); doenças infecciosas e parasitárias (19,9%); doenças endócrinas, nutricionais e metabólicas (11,2%); e lesões, envenenamentos e conseqüências de causas externas (4,3%). As crianças Xavante foram proporcionalmente mais hospitalizadas por doenças infecciosas e parasitárias, respiratórias e desnutrição que as não-indígenas de Mato Grosso. CONCLUSÕES: O perfil de morbidade hospitalar Xavante é coerente com a reconhecida precariedade do perfil sanitário e nutricional predominante nas aldeias. Destacam-se as seguintes conclusões: crianças < 5 anos constituem mais de 50% das hospitalizações; as principais causas de internação na população são devido a doenças respiratórias, nutricionais e infecciosas e parasitárias. Frisa-se a relevância dos achados para a discussão do modelo de assistência à saúde indígena no Brasil.

CEA. Sazonalidade e estado nutricional de populações indígenas: o caso Wari', Rondônia, Brasil

A despeito da relevância do tema, as condições de alimentação e nutrição das populações indígenas no Brasil permanecem largamente desconhecidas. O presente estudo examina o caso de uma comunidade Wari', povo indígena localizado em Rondônia, no sudoeste amazônico. Foram realizados dois inquéritos antropométricos de modo a investigar a situação nutricional da população e analisar variações sazonais. Nos inquéritos, seis meses aparte, foram examinados 279 e 266 indivíduos com idades entre zero e 87 anos. As prevalências de baixa estatura (61,7%) e peso (51,7%) entre as crianças menores de cinco anos estão entre as mais elevadas já registradas na literatura sobre populações indígenas no Brasil. Sobrepeso e obesidade não são expressivos na população, seja qual for a faixa etária considerada. Os perfis antropométricos indicam condições mais desfavoráveis durante os meses de chuva, quando as prevalências de desnutrição em crianças aumentam e adultos de ambos os sexos apresentam menores médias de peso corporal. Aponta-se para a necessidade de se considerar a sazonalidade na definição de rotinas de vigilância nutricional e na discussão dos perfis de nutrição de povos indígenas.

Padrões de adoecimento e de morte da população brasileira: os renovados desafios para o Sistema Único de Saúde

No século XX, o Brasil passou por intensas transformações na sua estrutura populacional e no padrão de morbi-mortalidade. Este estudo tem o objetivo de apresentar uma reflexão sobre os grandes problemas de saúde enfrentados pela população brasileira neste momento contemporâneo. Dentre as principais causas de óbito e internações estão as doenças crônico-degenerativas, os acidentes e as diversas formas de violência. Entretanto, as doenças infecciosas ainda se apresentam como problemas importantes de morbidade. A falta de solução para problemas estruturais e básicos, a manutenção de condições e modo de vida inadequados, a insuficiência dos mecanismos que regulam os danos ao meio ambiente ocasionam riscos à saúde que se superpõem, em vez de se sucederem. Essa superposição implica na manutenção de uma alta carga de morbidade e mortalidade na população que se mantém ao longo dos anos. A redução desta carga representa um desafio para a definição de políticas de saúde. Portanto, é importante enfatizar a necessidade de ações multissetoriais para a prevenção e controle das doenças e do sofrimento humano e para dar a cada indivíduo a garantia de atingir a sua plenitude física e mental. Estas ações devem integrar não só o setor saúde, como também políticas econômicas e sociais.