Reprodução social, prática alimentar e estado nutricional de crianças (estudo populacional no município de Itupeva, SP)
Publication year: 2003
A alimentação nos primeiros anos de vida tem papel fundamental na saúde da criança, especialmente no processo de crescimento e desenvolvimento, com importantes reflexos na vida futura. Nessa fase da vida as necessidades nutricionais são muito elevadas, tornando a criança extremamente vulnerável aos agravos nutricionais, bem como as práticas alimentares inadequadas provavelmente estarão associadas às principais morbidades que acometem a criança, elevando o risco de morrer. Tendo em vista que o ato de alimentar-se ocorre em ambiente social, comumente o familiar, e que a prática alimentar infantil varia amplamente nas diferentes famílias, influenciando diretamente o estado nutricional infantil, este estudo transversal, de base populacional, teve como objetivo, caracterizar a prática alimentar e o estado nutricional de 261 crianças menores de dois anos, residentes no município de Itupeva, SP, segundo as formas de reprodução social de suas famílias. Tomando como base um modelo teórico hierarquizado, construíram-se perfis centrados na categoria da reprodução social que possibilitaram o reconhecimento de três grupos sociais homogêneos (GSH's). A prática alimentar foi caracterizada considerando o perfil de aleitamento materno, classificado segundo os critérios da OMS/OPAS e a alimentação de transição, avaliada de acordo com os grupos de alimentos. O estado nutricional, foi avaliado através da adequação dos índices altura/idade (A/I) e peso/altura (P/A), expressos em termos de escore Z e percentis. A anemia foi caracterizada através da concentração de hemoglobina (Hb) sangüínea. As crianças que compuseram o GSH1 (19,2%) pertenciam a famílias com adequadas formas de trabalhar, que possibilitaram um padrão diferenciado de consumo e um melhor uso do espaço geo-social. Já as famílias que compuseram o GSH2 (36,4%) apresentaram, apesar da precariedade da renda, uma certa qualificação para as formas de trabalhar, ) configurando um certo equilíbrio e a possibilidade de aperfeiçoamento de suas formas de viver. O mesmo não ocorreu com o GSH3 (44,4%), cujas famílias apresentaram uma precária inserção no trabalho e conseqüentemente não atingiram um padrão de consumo qualificado. Os padrões de aleitamento materno não diferiram significativamente entre os GSH's (p>0,05), porém o GSH3 apresentou os menores percentuais de AME, enquanto em relação ao AMP, equiparou-se ao GSH1. Maior proporção de crianças do GSH1 encontravam-se em AMCTO. O perfil de aleitamento materno, analisado por curva de sobrevida, mostrou que no momento da entrevista, 41% das crianças estavam sendo amamentadas, não diferindo estatisticamente entre os GSH's (p=0,31). A idade média de introdução dos alimentos distribuiu-se de forma similar nos três GSH's (p>0,05). Não se observou diferença significativa entre os GSH's, em relação à freqüência de consumo dos alimentos, analisados por grupos, exceto para o GSH3 que consumiu significativamente menos carne que os demais GSH's (p<0,05) e apresentou consumo diário de caldo de carne significativamente menor que os demais GSH's (p<0,05). As crianças do GSH2 e GSH3 consumiam mais alimentos do Grupo de Cereais e Feculentos que as do GSH1 e as do GSH3 consumiam também menos alimentos do Grupo das Hortaliças e do Grupo das Frutas, em relação aos demais GSH's. Proporção significativamente menor de mães do GSH3 (p<0,05) receberam informações sobre prática alimentar infantil durante as consultas de puericultura, reforçando a precariedade de sua inserção social. Não se verificou diferença estatisticamente significativa entre os grupos sociais (p>0,05), nem quanto à desnutrição crônica ou aguda, nem em relação à obesidade. O total de desnutridos crônicos concentrava-se no GSH2 e GSH3, da mesma forma que a proporção de crianças em risco de desnutrição crônica. As crianças com desnutrição aguda concentravam-se ) apenas no GSH2, que também apresentou maior proporção de crianças em risco de desnutrição aguda. As crianças obesas ou com risco para obesidade concentravam-se no GSH1. A prevalência de anemia foi de 41,6%, não diferindo estatisticamente entre os GSH's (p>0,05). No geral, os resultados obtidos não constataram associação significativa entre a prática alimentar e o estado nutricional das crianças estudadas com os perfis de reprodução social de suas famílias, expressos nos três GSH's. Entretanto, não há como se desconsiderar ou subestimar o papel da determinação social do processo saúde-doença. Assim, sugere-se a realização de novas investigações, com o aprimoramento das técnicas tanto para a identificação dos perfis de reprodução social, quanto para a caracterização da prática alimentar e do estado nutricional infantil.
The feeding process in the first child's years has a fundamental role in the child's health, mainly in the growing and development process with important repercussion in the furture. In this period of life, the nutrition necessities are very high, making the child extremely vulnerable to the aggravation of nutritional components, as well as badly feeding habits probably related to mainly illnesses that attack the children, increasing the risk of death. Taking into account that the act of feeding takes place in the social environment, commonly within the family and that infant feedind varies among families, directly influencing the infants nutrition status, this cross reference population study, aimed to feature the feeding practice and the nutrition status of 261 children less than two years old, residente in the town of Itupeva, SP Brazil, following social reproduction pattrens of the town's families. From a hierarchical theoretic model, focusing on the social reproduction category, which estabilish three Homogenous Social Groups (HSG's). The feeding practice considered the breastfeeding profile, categorized by WHO/PAHO standards and the transitional feeding, according to the food groups evaluation. The nutrition status was evaluated according to suitable index- Hight/age and weig/t/hight consequently expressed in terms- Z score and percents. Anemia was described through the concentration of hemoglobin blood (Hb). The children from the HSG1 (19,2%) belonged to families that had satisfactory ways of working, which made it feasible their different standard of consumption and better use of geo-social space. In comparison to the other Families from The HSG2 (36,4%) regarding lower income, presented a certain qualification to ways of working, shaping a certain balance and possibility of improvement in their way of life. On the contrary, the HSG3 (44,4%) presented a different outcome, which the families showed a unsatisfactory level of employment, therefore the standard of consumption did not reach the level needed. The breasfeeding standards did not differ signficantly among the HSG's (p>0,05) however The HSG3 presented the lower percentage of exclusive breastfeeding (EBF) meanwhile in relation to predominant breastfeeding (PBF), it leveled with HSG1. The biggest incidence of HSG1 children were located in complementary breastfeeding in opportune time. The breastfeeding profile, analysed by the lifetable technique, showed that at the moment of the interview 41% of the children were being breastfed, so there was no staitstic difference among the HSG's (p=0,31). The average age for introduction of complementary feeding practices was adminstrated in a similar way in the three HSG's (p>0,05). There were no significant difference among the HSG3, in relation to frequency of food comsumption, analized by groups, the HSG3 had a significant lower comsumption of meat from the other HSG's (p<0,05) and presented a lower daily consumption of meat broth comparing with the other HSG's (p<0,05). The children from the HSG2 and HSG3 comsumed more cereal and starch food products than the HSG1 and the HSG3 consumed less vegetables and fruts than the HSG's as well. A low proportion of mothers from the HSG3 received proper infant feeding education during childcare consultation, intensifing the precariouness of their social inclusion. There was no significant statistic difference among the social groups (p>0,05) neither in cronic or acute malnutrion nor in relation to obesity. The total amount of cronic malnourished children were in the HSG2 and HSG3, with the same proportion of children at risk of cronic malnutrion. The children with acute malnutrition were only in the HSG2, which presented a bigger proportion of children at risk of acute malnutrition. The obse children or at risk of obesity are concentreted in HSG1. Anemia predominated in 41,6%, with no significant statistic difference among the HSG's (p>0,05). In the overall result, there was no significant association between the feeding practice and the nutritional status of the children studied, within the profile of the social reproduction of their families, expressed in the three HSG's. However, It is impossible not to consider or underestimate the social role between the process of health/ilness. Thus, it is advisible to carry out new investigations, improving the techniques for identification of the social reproduction profiles as well as characterising the feeding practices of infant nutrition status.
The feeding process in the first child's years has a fundamental role in the child's health, mainly in the growing and development process with important repercussion in the furture. In this period of life, the nutrition necessities are very high, making the child extremely vulnerable to the aggravation of nutritional components, as well as badly feeding habits probably related to mainly illnesses that attack the children, increasing the risk of death. Taking into account that the act of feeding takes place in the social environment, commonly within the family and that infant feedind varies among families, directly influencing the infants nutrition status, this cross reference population study, aimed to feature the feeding practice and the nutrition status of 261 children less than two years old, residente in the town of Itupeva, SP Brazil, following social reproduction pattrens of the town's families. From a hierarchical theoretic model, focusing on the social reproduction category, which estabilish three Homogenous Social Groups (HSG's). The feeding practice considered the breastfeeding profile, categorized by WHO/PAHO standards and the transitional feeding, according to the food groups evaluation. The nutrition status was evaluated according to suitable index- Hight/age and weig/t/hight consequently expressed in terms- Z score and percents. Anemia was described through the concentration of hemoglobin blood (Hb). The children from the HSG1 (19,2%) belonged to families that had satisfactory ways of working, which made it feasible their different standard of consumption and better use of geo-social space. In comparison to the other Families from The HSG2 (36,4%) regarding lower income, presented a certain qualification to ways of working, shaping a certain balance and possibility of improvement in their way of life. On the contrary, the HSG3 (44,4%) presented a different outcome, which the families showed a unsatisfactory level of employment, therefore the standard of consumption did not reach the level needed. The breasfeeding standards did not differ signficantly among the HSG's (p>0,05) however The HSG3 presented the lower percentage of exclusive breastfeeding (EBF) meanwhile in relation to predominant breastfeeding (PBF), it leveled with HSG1. The biggest incidence of HSG1 children were located in complementary breastfeeding in opportune time. The breastfeeding profile, analysed by the lifetable technique, showed that at the moment of the interview 41% of the children were being breastfed, so there was no staitstic difference among the HSG's (p=0,31). The average age for introduction of complementary feeding practices was adminstrated in a similar way in the three HSG's (p>0,05). There were no significant difference among the HSG3, in relation to frequency of food comsumption, analized by groups, the HSG3 had a significant lower comsumption of meat from the other HSG's (p<0,05) and presented a lower daily consumption of meat broth comparing with the other HSG's (p<0,05). The children from the HSG2 and HSG3 comsumed more cereal and starch food products than the HSG1 and the HSG3 consumed less vegetables and fruts than the HSG's as well. A low proportion of mothers from the HSG3 received proper infant feeding education during childcare consultation, intensifing the precariouness of their social inclusion. There was no significant statistic difference among the social groups (p>0,05) neither in cronic or acute malnutrion nor in relation to obesity. The total amount of cronic malnourished children were in the HSG2 and HSG3, with the same proportion of children at risk of cronic malnutrion. The children with acute malnutrition were only in the HSG2, which presented a bigger proportion of children at risk of acute malnutrition. The obse children or at risk of obesity are concentreted in HSG1. Anemia predominated in 41,6%, with no significant statistic difference among the HSG's (p>0,05). In the overall result, there was no significant association between the feeding practice and the nutritional status of the children studied, within the profile of the social reproduction of their families, expressed in the three HSG's. However, It is impossible not to consider or underestimate the social role between the process of health/ilness. Thus, it is advisible to carry out new investigations, improving the techniques for identification of the social reproduction profiles as well as characterising the feeding practices of infant nutrition status.
