Perfis nutricionais das crianças menores de quatro anos e de suas mães biológicas-Brasil, PNSN - 1989

O presente trabalho analisa a relacao entre o estado nutricional das criancas indice (filho mais novo com idade inferior a 48 meses, de familias com maes biologicas presentes) e o de suas maes, a partir de uma sub-amostra composta de 3.906 criancas extraidas do banco de dados da Pesquisa Nacional sobre Saúde e Nutricao (PNSN), pesquisa brasileira de representatividade nacional, realizada em 1989. Os dados sao analisados por regioes (Norte, Nordeste, Sudeste, Sul e Centro-oeste), situacao (rural e urbana), renda domiciliar per capita (ate US$ 25, entre 25 e 50 e acima de US$ 50), total de anos de estudo da mae (ate 3 anos e 4 ou mais), idade materna (ate 24 anos e 25 ou mais) e idade da crianca indice em meses (menor que 12, entre 12 e 23 e 24 e mais). Para as criancas, considera-se a relacao de peso para idade em escore Z, e classifica como desnutrida as que apresentam valores inferiores a -2,00, eutroficas entre -2,00 e +2,00 e obesas acima de +2,00 (referencia NCHS) (WHO, 1986). Para as maes, considera-se o indice de massa corporal (Quetelet) com pontos de corte em 18,69 (desnutridas), entre 18,70 e 23,89 (eutroficas), entre 23,90 e 28,59 (sobrepeso) e igual ou superior a 28,60 (obesas), conforme recomendacao da WHO (1985). Do total de criancas indice estudadas, 5,8% eram desnutridas e destas, 21,8% tinham maes com sobrepeso ou obesidade, 60,9% tinham maes eutroficas e 17,3% tinham maes que, assim como elas, eram tambem desnutridas. Quanto as macro-regioes brasileiras, situacao urbana e rural, distribuicao da renda e escolaridade materna, a menor proporcao de criancas indice desnutridas corresponde maior proporcao de maes com sobrepeso ou obesidade. O teste que avalia a concordancia entre as condicoes nutricionais de criancas e suas respectivas maes (teste de Kappa) aponta, de modo geral, para uma concordancia muito fraca, quando nao ruim, com valores de K variando entre -0,005 e 0,045, entre os estados nutricionais das criancas e suas maes. Os resultados levam a conclusao de que, quando diminuem as proporcoes de desnutridos nos diferentes grupamentos analisados, aumentam as proporcoes de maes que apresentam obesidade e sobrepeso. Tal padrao epidemiologico seria indicativo de que, nos grupos onde a desnutricao e menos prevalente, e tambem menor a proporcao daquelas criancas que tem a falta de alimentos a nivel domiciliar como um dos principais fatores limitantes. Tal fato levaria a reforcar recomendacoes de atencao especial para acoes que visem a melhoria do nivel de informacoes das maes, associado a aumento do seu tempo disponivel para cuidar dos filhos. Buscar-se-ia, dessa forma, praticas adequadas de alimentacao infantil no que tange ao prolongamento do aleitamento materno e a oferta de dietas de desmame adequadas quanto a consistencia, composicao, volume e frequencia, associadas a praticas higienicas e de utilizacao de servicos de Saúde que previnam infeccoesThis work analyses the relations between nutritional status of index children (the younger children below 48 months from family with natural mothers present) and nutritional status of their mothers, in a sub-sample of 3,906 children extracted from a database of the National Research on Health and Nutrition (PNSN), a brazilian national survey conducted in 1989. The datas are analyzed by region (North, Northeast, Southeast and Center-west), situation (urban, rural), per-capita household income (below US$25, betwen 25 and 50 and equal or over US$50), number of mother’s school years (3 and below, 4 and more), mother’s age (24 and below, 25 or more) and index child’s age in months (below 12, between 12 and 23, 24 and over). Children below -2 Z scores of weight for age, according to the NCHS reference population, are considered undernourished, children between -2 and +2 Z are classified as normal, and the ones over + 2 Z score as obese. Following the WHO (1985) recommendations and considering the body mass index (Quetelet) mothers are classified as undernourished (below 18.70), normal (among 18.70 and 23.89), overweight (among 23.90 and 28.59), and obese (equal or over 28.60). From the totality of studied index children, 5.8% were undernourished and from these, 21.8% of the children had their mothers classified as overweight or obese, 60.9% of the children had normal mothers and 17.3% had mothers that like them were undernourished. In relation to Brazilian regions, rural and urban situation, household per-capita income and mothers’ schooling level, lower proportions of undernutrition among index children’s correspond to higher proportion of overweight and obesity among their mothers. The test that assesses agreement between nutritional status of children and their mothers (Kappa) leads, in general, to a very weak or bad agreement with K values varying between -0.005 and 0.045. The results show that, when the proportions of undernutrition among index children’s correspond to higher proportion of overweight and obesity among their mothers. The test that assesses agreement between nutritional status of children and their mothers (Kappa) leads, in general, to a very weak or bad agreement with K values varying between -0.005 and 0.045. The results show that, when the proportions of undernourished children decrease in the different groups analyzed, the proportion of obese or overweight mothers increases. This epidemiological pattern would indicate that, in the groups where undernourishment is less prevalent, the proportion of those children who have lack of food at home as a limiting factor is also smaller. These results would reinforce the recommendations of special attention to actions aimed to improve mother’s knowledge, associated with increment of mother’s time to take care of their children. The objective would be to seek for adequate practices of children feeding related to increased breastfeeding duration and offering of weaning foods which are adequate in consistency, composition, volume and frequency, along with adoption of hygienic practices and use of health services that prevent infections.BV UNIFESP: Teses e dissertaçõe