Evidências do impacto da suplementação múltipla com micronutrientes no crescimento de pré-escolares: revisão sistemática

Efect of vitamin A suplementation: a systematic review

To evaluate the effect of vitamin A supplementation in postpartum infants and women on serum retinol levels and breast milk. The databases Medline, PubMed, Lilacs and SciELO were consulted. The descriptors used were vitamin A, dietary supplement, child, postpartum period, infant and nutrition programs policies. Search found 7432 articles. After elimination of duplicity and application of eligibility criteria, 8 studies remained. All evaluated the effect of vitamin A supplementation on immediate postpartum, five studies used retinyl palmitate supplementation, one with retinyl palmitate and two did not specify the form of supplementation. Six studies evaluated colostrum and two included supplementation of children. It was found that supplementation in the puerperium increases the concentrations of serum retinol and breast milk, however, this result was in the short term and was relevant when the previous concentrations of the mother were low. When maternal serum concentrations are adequate, the retinol content in milk does not change, with little relevance for children. Further studies should be performed to evaluate the effect of megadoses supplementation on serum concentrations of children.

Brazilian studies on zinc deficiency and supplementation: emphasis on children

Abstract Objectives: to review the literature of studies developed in Brazil on zinc deficiency and the effects of supplementation. Methods: a literature review based on bibliographic research was carried out in SciELO, LILACS and MEDLINE/PUBMED databases. A total of 133 studies on zinc deficiency and 116 on the effects of supplementation were identified. Thirty-two articles, 16 of which were observational and 16 interventional, were analyzed. Results: the studies focused mainly on children (75.0% of the observational and 81.25% of the experimental studies). Biochemical deficiency of zinc in children presented great variability, from 0.0% to 74.3%, with expressive prevalence in most studies. Dietary inadequacy among children presented variability from 16.6% to 46.0%. Five from seven studies showed a positive effect of zinc supplementation on micronutrient nutritional status. Conclusions: there is evidence of zinc deficiency in children as a public health problem, preventable through micronutrient supplementation.

Linear growth of children attending public daycare centers in the municipality of Campina Grande, Paraíba, Brazil

OBJECTIVE

To identify variables predictors of linear growth in preschool children attending public child day care centers of Campina Grande, Paraíba.

METHODS

A cross-sectional study on a probabilistic sample of 335 children attending child day care centers. Were obtained information about socioeconomic, maternal and children's characteristics. The height/age (Z-score) was analyzed as continuous dependent variable. Anthropometric data were obtained in compliance with the recommendations of the World Health Organization. The Multicentre Growth Reference Study was used as the reference population. The data were subjected to multiple linear regression analysis using the hierarchical model.

RESULTS

Children who slept in rooms with at least two people, households without garbage collection, households with no refrigerator, rural zone, illiterate mothers, mothers of short stature, low birth weight and stay in child day care center at part time were the conditions associated with worse height/age of children.

CONCLUSION

There is a clear difference in linear growth with multicausal characteristic in which the low birth weight, as an expression of adverse history, and the socioeconomic conditions, as an expression of health inequities, profiling the genetic potential of growth.

Crescimento linear das crianças brasileiras: reflexões no contexto da equidade social

O artigo teve por objetivo refletir a respeito do crescimento linear das crianças no contexto da equidade social e sistematizou, primeiramente, os resultados das pesquisas que analisaram fatores associados ao declínio do deficit de estatura das crianças menores de cinco anos no Brasil. Posteriormente, os resultados foram contextualizados do ponto de vista da equidade social. Os nove artigos revisados mostraram variação temporal positiva do deficit de estatura, com valores nacionais que oscilaram de 37,1 a 7,1%; na região Nordeste a variação foi de 33,9 a 5,9%. Quatro razões principais explicaram o declínio do deficit de estatura: 1) aumento do poder aquisitivo/renda familiar nos lares de baixo poder aquisitivo; 2) melhoria da escolaridade materna; 3) expansão da rede pública de saneamento básico, e 4) expansão dos cuidados básicos de saúde. Porém, destacam-se disparidades que marcam a persistência das iniquidades sociais relacionadas ao deficit de estatura no País, as quais prejudicam populações marginalizadas. Enfoca-se a necessidade de refletir a baixa estatura na perspectiva da influência mediada pela situação da segurança alimentar, do estado nutricional de micronutrientes e dos modos de vida contemporâneos. Na perspectiva das políticas públicas, ressalta-se a importância do trabalho intersetorial. Em conclusão, sugere-se que apesar do declínio do deficit de estatura no Brasil, como reflexo do impacto das políticas públicas, ainda persistem iniquidades com vulnerabilidade marcada em grupos socioculturais desfavorecidos. Assim, o enfrentamento desta conjuntura torna imprescindível o direcionamento das pesquisas e das ações para esses segmentos populacionais.

Isolated and combined prevalence of anemia, vitamin A deficiency and zinc deficiency in preschool children 12-72 months for the government of Paraíba

OBJECTIVE: To estimate the isolated and combined prevalence of anemia, vitamin A deficiency and zinc deficiency in pre-school children, as well as the distribution of isolated deficiencies according to gender, age and prior supplementation with vitamin A. METHODS: Cross-sectional study with pre-school children in the state of Paraíba, Brazil. Analysis of the average concentrations of hemoglobin, serum retinol and serum zinc, according to gender, age and previous vitamin A supplementation of children were carried out as well as the risk of simultaneous occurrence of micronutrient deficiencies in the presence of these deficiencies. RESULTS: The prevalence of anemia, vitamin A deficiency and zinc deficiency were 15.4%, 23.3% and 13.8%, respectively. The anemia was significantly associated with age (p<0.01). Children previously supplemented by vitamin A had higher serum retinol concentrations than children without supplements, an effect that was not observed for concentrations of hemoglobin or serum zinc. The prevalence of anemia associated with vitamin A deficiency was 5.8%, with the chance of vitamin A deficiency and anemia coexist 2.21 times (95%CI=1.03-4.84) higher in the case of vitamin A deficiency or anemia rather than in the absence of these conditions. CONCLUSION: The high prevalence of micronutrient deficiencies which are important in child growth, as well as the coexistence of nutritional deficiencies, point out the need to strengthen nutrition intervention strategies that consider this issue.