From: Subject: CONSUMO ALIMENTAR APARENTE DE FE Date: Sat, 23 Jul 2011 22:56:44 -0300 MIME-Version: 1.0 Content-Type: multipart/related; type="text/html"; boundary="----=_NextPart_000_0000_01CC498B.CB7F6F70" X-MimeOLE: Produced By Microsoft MimeOLE V6.00.2900.6090 This is a multi-part message in MIME format. ------=_NextPart_000_0000_01CC498B.CB7F6F70 Content-Type: text/html; charset="Windows-1252" Content-Transfer-Encoding: quoted-printable Content-Location: http://www.nutricao.uerj.br/revista/v2/v2n2.htm CONSUMO ALIMENTAR APARENTE DE FE

 

CONSUMO ALIMENTAR APARENTE DE FERRO

IRON APPARENT FOOD INTAKE

 

 

 Hayd=E9e Serr=E3o=20 Lanzillotti1*

Concei=E7=E3o de Maria=20 Sintz1

Regina = Serr=E3o=20 Lanzillotti2

Eduardo = Pereira=20 Alcantara da Silva3

Rute = Ramos da Silva=20 Costa3

 

 

Resumo=20

Objetivo: = Estimar o=20 consumo alimentar aparente de ferro considerando seus modificadores de = absor=E7=E3o.=20 M=E9todo: O estudo utilizou a hist=F3ria alimentar descrita nos = prontu=E1rios de=20 Nutri=E7=E3o para avaliar o consumo habitual e verificar se as = recomenda=E7=F5es=20 diet=E9ticas para ferro, c=E1lcio e vitamina C est=E3o sendo cumpridas. = A estimativa=20 de absor=E7=E3o de ferro foi calculada utilizando-se os algoritmos = criados por=20 Hallberg e Hulth=E9n. A correla=E7=E3o de Spearman avaliou a = associa=E7=E3o entre condi=E7=E3o=20 socioecon=F4mica e ingest=E3o de ferro e c=E1lcio. Resultados: Somente = foi poss=EDvel=20 avaliar o consumo alimentar de 15 crian=E7as porque o desvio padr=E3o = intrapessoal=20 para ferro, c=E1lcio e vitamina C est=E3o dispon=EDveis a partir de 4 = anos. O consumo=20 declarado destas crian=E7as apresentou inadequa=E7=E3o (p ≥ 0,70) = para ferro (100%),=20 c=E1lcio (80%) e vitamina C (3,33%). A m=E9dia da estimativa de = absor=E7=E3o de ferro,=20 considerando os fatores estimuladores e inibidores, foi de 2,21=B1 0,94, = o que=20 representa 57,63% da ingest=E3o de ferro total. A = associa=E7=E3o entre a=20 condi=E7=E3o socioecon=F4mica e a ingest=E3o de nutrientes apresentou-se = fraca tanto=20 para ferro quanto para c=E1lcio. Conclus=E3o: A dieta avaliada das = crian=E7as est=E1=20 inadequada em ferro, c=E1lcio e vitamina C.

Palavras-chave: consume = alimentar,=20 crian=E7a, ferro.

 

Abstract

Objective: To estimate the iron apparent = food intake by=20 considering their modifiers of absorption. Method: The study used the = food=20 history described in the nutrition register to evaluate the usual food = intake=20 and to verify if the Recommended Dietary Allowances for iron, calcium = and=20 vitamin C are being followed. Iron absorption was calculated using the = algorithm=20 of Hallberg and Hulth=E9n. Spearman=92s correlation evaluated the = association=20 between socio-economic conditions and the iron and calcium intakes. = Results: It=20 was only possible to evaluate the food intake of 15 children because the = intrapersonal standard deviation of iron, calcium and vitamin C are = available=20 from 4 years old on. The declared food intake of these children = presented=20 inadequacies (p ≥0, 70) in iron (100%), calcium (80%) and vitamin = C (93,33%).=20 The mean of the iron absorption estimate, considering the inhibitors and = enhancing factors, was 2.21 =B1 0.94. This represents 57.63% of the = whole iron=20 ingestion. The association between socio-economic conditions and = nutrient=20 ingestion were weak both for iron and calcium. Conclusion: The valued = diet of=20 children is inadequate for iron, calcium and vitamin C. =

Key words:=20 food intake, child, iron

 

Introdu=E7=E3o

O = Departamento de=20 Nutri=E7=E3o Social da Universidade do Estado do Rio de Janeiro vem = desenvolvendo,=20 desde 1998, o projeto de extens=E3o =93Educa=E7=E3o Nutricional em = Puericultura: uma=20 parceria UERJ/INU/DNS/PPC=94, integrado ao Programa de Aten=E7=E3o = Integral da Sa=FAde=20 da Mulher, da Crian=E7a e do Adolescente (PAISMCA). O projeto atende a = crian=E7as na=20 faixa et=E1ria de 0 a 8 anos em sua maioria, das classes sociais C, D e = E, segundo=20 o crit=E9rio ABA/ABIPEME (Associa=E7=E3o Brasileira de = Anunciantes/Associa=E7=E3o=20 Brasileira dos Institutos de Mercado). O atendimento se inicia por uma = avalia=E7=E3o=20 nutricional, segundo as orienta=E7=F5es do Sistema de Vigil=E2ncia = Alimentar e=20 Nutricional -SISVAN/MS (Facundes et al., 2004), seguida de = orienta=E7=E3o diet=E9tica,=20 al=E9m das a=E7=F5es educativas dirigidas =E0s crian=E7as e seus = acompanhantes. Sua=20 relev=E2ncia social =E9 mostrar ao aluno e =E0 comunidade a = responsabilidade da=20 Universidade com os anseios da sociedade.

Por = raz=F5es de=20 n=E3o-acesso ao alimento ou escolha incorreta para compor uma dieta, as = crian=E7as=20 podem deixar de incluir em sua alimenta=E7=E3o fontes de nutrientes = essenciais ao=20 organismo e, por conseq=FC=EAncia, cair em situa=E7=E3o de risco = nutricional. Existe uma=20 intera=E7=E3o entre os alimentos que deve ser explorada e explicada para = a=20 popula=E7=E3o, se o desejo =E9 melhorar a qualidade de vida das = comunidades, sobretudo=20 aquelas de condi=E7=F5es educacionais menos = privilegiadas.

O = panorama=20 nutricional do setor de Puericultura da Policl=EDnica Piquet Carneiro, = onde o=20 projeto se desenvolve, apresenta tr=EAs grandes preocupa=E7=F5es: a = desnutri=E7=E3o, a=20 obesidade e a anemia ferropriva.

A = obesidade tem no=20 h=E1bito alimentar, talvez o principal componente etiol=F3gico. A = obesidade est=E1 em=20 crescimento, tanto em adultos quanto em crian=E7as. A aten=E7=E3o = nutricional =E0=20 inf=E2ncia tem-se deparado com casos de desnutri=E7=E3o e obesidade. De = uma maneira=20 geral, tanto uma quanto a outra, por via de conseq=FC=EAncia, = desencadeia a anemia=20 ferropriva. No Brasil, embora n=E3o se tenha preval=EAncia global, o = artigo de=20 revis=E3o realizado por Coutinho, Goloni-Bertollo e Bertelli (2005) = mostrou que no=20 Estado de S=E3o Paulo quase 3.000 crian=E7as menores de dois anos = apresentam=20 defici=EAncia de ferro. No Estado de Pernambuco, a cifra alcan=E7ou 777 = crian=E7as na=20 idade entre seis e 59 meses. Em Porto Alegre, a preval=EAncia de anemia = foi de=20 65,6% entre crian=E7as de 12 a 23 meses. Os autores ainda relatam que em = outras=20 regi=F5es do Brasil a preval=EAncia de anemia ferropriva varia entre = 13,3 % e 60,5%.=20

A = transi=E7=E3o na=20 alimenta=E7=E3o ocorrida a partir da Terceira Revolu=E7=E3o Industrial = conduziu a uma=20 alimenta=E7=E3o mais rica em gorduras hidrogenadas e alimentos = refinados, em=20 detrimento dos carboidratos complexos e fibras. A obesidade tornou-se um = problema de Sa=FAde P=FAblica, devido ao crescimento r=E1pido de sua = preval=EAncia em=20 muitos pa=EDses em todo o mundo (Tomkins, 2006). O desmame precoce = (antes dos seis=20 meses de idade) tamb=E9m vem contribuindo para agravar este quadro = (Armstrong=20 & Reilly, 2002).

Neste cen=E1rio,=20 onde coexistem desnutri=E7=E3o, obesidade e anemia na popula=E7=E3o = infantil, elegeu-se=20 como objetivo estimar a adequa=E7=E3o alimentar aparente de ferro, = considerando seus=20 modificadores de absor=E7=E3o.

 

Metodologia

O estudo faz parte do Projeto Nutri-Fuzzy-Orix=E1s: = biodisponibilidade de=20 nutrientes sob a =F3tica dos sistemas baseados em conhecimento Orix=E1s = e Sistemas=20 L=F3gicos Fuzzy, aprovado pelo Comit=EA de =C9tica em Pesquisa do = Hospital=20 Universit=E1rio Pedro Ernesto, sob o protocolo n=BA 794 = CEP/HUPE.

O ambulat=F3rio de Nutri=E7=E3o da Policl=EDnica Piquet = Carneiro atende a=20 crian=E7as encaminhadas pelo Servi=E7o de Pediatria, Servi=E7o de = Enfermagem ou por=20 livre demanda. As crian=E7as podem vir com diagn=F3stico conclusivo de = anemia=20 ferropriva ou com suspeita. Em ambos os casos, o diagn=F3stico = conclusivo =E9=20 realizado atrav=E9s de hemograma, o qual =E9 apresentado ou requerido.=20 Indiferentemente de as crian=E7as apresentarem ou n=E3o diagn=F3stico de = anemia por=20 defici=EAncia de ferro, os pais s=E3o orientados a combinar os = alimentos, a fim de=20 biodisponibilizar o ferro da dieta. Em se tratando de aten=E7=E3o = prim=E1ria, a medida=20 =E9 de car=E1ter preventivo. O diagn=F3stico nutricional =E9 realizado = atrav=E9s da=20 antropometria (peso e estatura) e de inqu=E9rito alimentar, = privilegiando a=20 hist=F3ria alimentar.

O estudo = utilizou a=20 hist=F3ria alimentar (Fisberg; Martini, Slater, 2005) descrita nos = prontu=E1rios de=20 Nutri=E7=E3o para avaliar o consumo habitual na primeira consulta. Este = =E9 realizado=20 por acad=EAmicos de Nutri=E7=E3o devidamente treinados, com dura=E7=E3o = de aproximadamente=20 uma hora na primeira consulta, ou seja, quando n=E3o se fez qualquer = interven=E7=E3o=20 diet=E9tica. Utilizou-se a tabela de Avalia=E7=E3o de Consumo Alimentar = em Medidas=20 Caseiras (Pinheiro et al., 2000), para transformar medidas caseiras = registradas=20 nos prontu=E1rios em massa (g) e volume (ml). O teor de nutrientes foi = calculado=20 com aux=EDlio da Tabela de Composi=E7=E3o de Alimentos (Philippi, 2002), = a tabela=20 citada anteriormente e a rotulagem nutricional.

Para o = c=E1lculo da=20 adequa=E7=E3o aparente, foram utilizadas as estimativas da ingest=E3o e = da=20 variabilidade do consumo do nutriente, da necessidade m=E9dia (EAR) e da = varia=E7=E3o=20 da necessidade (coeficiente de varia=E7=E3o - CV) deste. A estimativa do = grau de=20 confian=E7a com que a ingest=E3o do nutriente alcan=E7a a necessidade do = indiv=EDduo foi=20 obtida atrav=E9s do c=E1lculo do escore Z. Esta abordagem compara a = diferen=E7a entre=20 a ingest=E3o relatada (a melhor estimativa da ingest=E3o habitual) e a = EAR, levando=20 em conta a variabilidade da necessidade e a varia=E7=E3o intrapessoal, = relativa ao=20 consumo do dia-adia. A EAR =E9 calculada a partir da Ingest=E3o = Diet=E9tica=20 Recomendada (RDA), que corresponde ao n=EDvel de ingest=E3o di=E1ria = suficiente para=20 atender =E0 necessidade do nutriente para 97% dos indiv=EDduos de uma = popula=E7=E3o de=20 refer=EAncia em determinado est=E1gio de vida e g=EAnero. A RDA = corresponde a EAR +=20 2DPnecessidade.

As = tabelas de=20 refer=EAncia que fornecem os valores da RDA e a estimativa da EAR = consideram um CV=20 te=F3rico de 10% para a maioria dos nutrientes. Logo, a EAR =E9 = calculada pela=20 divis=E3o da RDA por 1,2. Alguns nutrientes n=E3o t=EAm a RDA = estabelecida, neste caso=20 se adota a Ingest=E3o Adequada (AI) para calcular a probabilidade de = adequa=E7=E3o do=20 nutriente. A AI =E9 estabelecida com base em n=EDveis de ingest=E3o = derivados=20 experimentalmente ou por aproxima=E7=F5es da m=E9dia de consumo do = nutriente por um=20 grupo de indiv=EDduos aparentemente saud=E1veis. Este =E9 o caso do = nutriente c=E1lcio.=20 Calculado o escore Z, determina-se a probabilidade de a dieta estar=20 adequada (Marchioni, Slater, Fisberg, = 2004).

A = estimativa do n=EDvel=20 de absor=E7=E3o de ferro da dieta, levando-se considera=E7=E3o seus = modificadores, foi=20 realizado utilizando-se o modelo de Hallberg e Hulth=E9n (2000), = considerando-se=20 os algoritmos descritos na Tabela 1.

 

Tabela 1: = Algoritmos=20 para a predi=E7=E3o da absor=E7=E3o de ferro 

Vitamina=20 C

[1+0,01AA+log(P-phitate+1) ]0,01(100,8875log=20 AA+1)=20

r2=3D0,995 = (3)=20

Sujeitos: n=3D240 =

Testado para = refei=E7=F5es com e sem=20 c=E1lcio e para refei=E7=F5es com e sem carne =

C=E1lcio

0,4081+ {0,6059/1 = 10=96[2,022=96log=20 (Ca+1)] 2,919]}

r2=3D0,998=20

Sujeitos: n=3D7 =

Refei=E7=E3o < 50mg = de Ca , nenhum=20 efeito sobre a absor=E7=E3o do ferro

Intervalo de = inibi=E7=E3o m=E1xima:=20 [300mg, 600mg]

Carne, Aves; Peixe, = Frutos do mar=20

1+0,00628carne(g)[1+0,006(P-fitato)]

r2=3D0,877=20

Sujeitos: = n=3D135

Testado para = refei=E7=F5es contendo=20 fitato

Ovos

1-0,27 = ovos

r2 =3D=20 (...)

Sujeitos n=3D50 =

A equa=E7=E3o =E9 = v=E1lida para 3 ovos na=20 refei=E7=E3o

 

Fonte: Hallberg e Hulth=E9n = (2000)=20

Nutrientes em (mg) =  

Foi = calculado o ferro=20 heme da ingest=E3o de carnes como 40% do ferro total, considerando-se um = estoque=20 de ferro adequado de 500mg. O ferro n=E3o-eme dos outros alimentos foi = calculado=20 pela diferen=E7a entre o ferro total e o ferro heme. Embora Hallberg e = Hulth=E9n=20 tenham constru=EDdo os algoritmos em experimentos com refei=E7=F5es, = neste estudo=20 utilizou-se o valor de ferro da dieta.

Cook = & Reddy=20 (2001) mostraram que o efeito facilitador da vitamina C sobre a = absor=E7=E3o do=20 ferro de uma dieta completa =E9 menos pronunciado do que de uma = refei=E7=E3o, talvez=20 devido =E0 variabilidade das subst=E2ncias alimentares da = dieta.

A = avalia=E7=E3o das=20 condi=E7=F5es socioecon=F4micas a partir de itens de conforto foi = realizada atrav=E9s do=20 m=E9todo ABA/ABIPEME. Este m=E9todo emprega vari=E1veis que podem = garantir uma=20 estimativa da renda dom=E9stica, sendo selecionados oito indicadores=20 discriminantes da renda: n=FAmero de r=E1dios, TV em cores, = autom=F3veis, aspirador de=20 p=F3, m=E1quina de lavar roupa, geladeira, empregada mensalista, = banheiros e n=EDvel=20 educacional do chefe de fam=EDlia. Em seguida, atribu=EDram-se pontos = =E0 posse desses=20 itens. Conforme a pontua=E7=E3o de corte das classes, o indiv=EDduo =E9 = classificado nas=20 classes: A =96 alta (35 ou mais pontos), B - m=E9dia (21-34), C =96 = m=E9dia baixa=20 (10-20), D =96 pobre (5-9), E - muito pobre (0-4) (Metodologia...., = 2007).=20

Sabendo-se que os=20 alimentos mais ricos nos nutrientes ferro e c=E1lcio s=E3o os de maior = custo,=20 calculou-se o coeficiente de correla=E7=E3o, utilizando-se os pontos = atribu=EDdos a=20 cada sujeito para a classifica=E7=E3o dos estratos sociais, a fim de = avaliar a=20 associa=E7=E3o entre os pontos obtidos pelos respons=E1veis da crian=E7a = na=20 classifica=E7=E3o socioecon=F4mica segundo o crit=E9rio ABA/ABIPEME e o = valor=20 nutricional de consumo. 

An=E1lise = estat=EDstica

Para a = an=E1lise dos=20 dados coletados foram usados a planilha Excel e o Graph Pad PRISM = vers=E3o 4.0. As=20 vari=E1veis cont=EDnuas foram expressas atrav=E9s da m=E9dia e intervalo = de confian=E7a=20 com 95% de confiabilidade. Prova de Kolmogorov-Smirnov (p =3D0,10) = testou a=20 normalidade da matriz de valores do consumo de ferro e c=E1lcio e dos = pontos do=20 crit=E9rio ABA/ABIPEME obtidos pelos participantes. Coeficiente de = correla=E7=E3o de=20 Spearman foi usado como medida de associa=E7=E3o entre vari=E1veis. O = escore Z=20 calculou a probabilidade de adequa=E7=E3o aparente do consumo habitual = dos=20 nutrientes. Teste t comparou as m=E9dias de consumo da amostra com as = DRIs.=20 Adotou-se o n=EDvel de signific=E2ncia p<0,05.

 

Resultados e=20 discuss=E3o

Foram = selecionados 45=20 prontu=E1rios referentes ao per=EDodo de atendimento de fevereiro a = agosto de 2006,=20 cujo registro da hist=F3ria alimentar apresentava consist=EAncia de = informa=E7=E3o=20 necess=E1ria ao c=E1lculo da probabilidade de adequa=E7=E3o dos = nutrientes eleitos. O=20 perfil de consumo est=E1 consolidado na tabela 2.

 

Tabela 2: Perfil de consumo do = nutriente=20 ferro e de seus modificadores de absor=E7=E3o c=E1lcio e vitamina C em = crian=E7as=20 atendidas no ambulat=F3rio de Nutri=E7=E3o na Policl=EDnica Piquet=20 Carneiro 

 

Faixa = Et=E1ria

 

n

Consumo

Ferro=20 (mg)

C=E1lcio=20 (mg)

Vitamina C=20 (mg)

m=E9dia

IC=20

EAR

AI

m=E9dia

IC

AI

m=E9dia

IC

EAR

AI

0-6 = meses

5

4,48*

=B11,47

na

0,3

627,05

=B1339,29

210

118,31

=B164,82

na

40

7-12 = meses

6

5,73

=B12,40

9,16

na

830,33*

=B1351,29

270

112,93*

=B135,06

na

50

1-3 = anos

18

7,75*

=B11,43

5,83

na

881,74*

=B1309,85

500

118,52*

=B165,51

12,5

na

4 =968 = anos

14

9,22

=B12,15

8,3

na

738,04

=B1268,39

800

48,19*

=B117,63

20,8

na

Valor=20 individual

 

9 = anos

1

11,3

 

 

 

117,45

 

 

54,88

 

 

 

                                 

* m=E9dias = significativamente=20 diferentes

=93p=94 = <0,05

(na) n=E3o se = aplica

 (IC) = intervalo de=20 confian=E7a p<0,05 

 Em rela=E7=E3o=20 ao ferro, as crian=E7as cuja dieta mais se afasta da RDA s=E3o as que = est=E3o na faixa=20 et=E1ria de 7 a 12 meses, possivelmente porque a alimenta=E7=E3o = complementar n=E3o est=E1=20 sendo introduzida de forma adequada =96 ou seja, n=E3o se est=E1 = privilegiando os=20 alimentos ricos em ferro, tais como as e hortali=E7as de cor verde = escura e a=20 carne. Para que este ferro seja mais bem aproveitado pelo organismo, = duas=20 recomenda=E7=F5es devem ser atendidas: fornecer a papa de hortali=E7as = acompanhada de=20 suco ou papa de fruta rica em vitamina C e n=E3o servir alimentos que = contenham=20 quantidades de leite apreci=E1veis na mesma refei=E7=E3o, uma vez que o = c=E1lcio =E9 um=20 inibidor da absor=E7=E3o do ferro (Ybarra, Costa, Ferreira, 2001). = Registra-se um=20 consumo expressivo de vitamina C (tabela 2) em todas as faixas = et=E1rias, dado=20 positivo para favorecer a absor=E7=E3o do ferro n=E3o-heme, considerando = que n=E3o=20 atingiu os n=EDveis de UL (n=EDvel superior toler=E1vel de=20 ingest=E3o).

A = quest=E3o n=E3o =E9 a=20 quantidade dos nutrientes, mas a forma como estes interagem na = combina=E7=E3o entre=20 alimentos. O consumo de c=E1lcio supera as recomenda=E7=F5es, =E0 = exce=E7=E3o da faixa=20 et=E1ria de 4 a 8 anos, que se encontra ligeiramente inferior. A = crian=E7a nessa=20 idade tem maior liberdade para escolher seus alimentos e o leite, na = maioria das=20 vezes, =E9 o primeiro que vai ser substitu=EDdo por refrigerantes, = guaran=E1 natural e=20 mate, todos ricos em cafe=EDna, outro competidor do ferro. =C9 = importante mostrar =E0=20 crian=E7a e aos respons=E1veis por sua alimenta=E7=E3o o valor do leite = e seus derivados=20 e a necessidade de consumo moderado desses alimentos.

Interessante notar=20 a diferen=E7a significativa entre as m=E9dias de consumo de ferro nas = diferentes=20 faixas et=E1rias identificadas atrav=E9s do Teste t. Este achado permite = inferir,=20 particularmente na faixa et=E1ria de 0 a 6 meses, onde os valores foram = superiores=20 a AI, que isto tenha ocorrido devido =E0 introdu=E7=E3o de f=F3rmulas = l=E1cteas infantis=20 industrializadas, que, dada sua fortifica=E7=E3o, apresentam teores do = mineral acima=20 da composi=E7=E3o do leite materno, o qual serve de orienta=E7=E3o para = a proposta da=20 AI.

No = caso da faixa=20 et=E1ria de 7 a 12 meses, a diferen=E7a =E9 significativa para o consumo = de c=E1lcio e=20 vitamina C. Crian=E7as nesta idade consomem leite em p=F3 integral ou = f=F3rmula de=20 seguimento, geralmente com concentra=E7=E3o superior =E0 dilui=E7=E3o = correta e ainda=20 acrescentam ao leite farinhas de cereais enriquecidas. Esta pode ser uma = das=20 explica=E7=F5es para estes achados. Analogamente, o fen=F4meno acontece = at=E9 os tr=EAs=20 anos. Na =FAltima faixa et=E1ria, apenas o consumo de vitamina C = encontra-se=20 levemente superior a EAR, o que =E9 peculiar =E0 dieta do brasileiro que = n=E3o=20 apresenta defici=EAncia desta vitamina.

Castro et al.=20 (2005), estudando a alimenta=E7=E3o de crian=E7as de 24 a 72 meses de = idade=20 matriculadas em creches municipais de Vi=E7osa, encontraram consumo = mediano para=20 ferro de 4,5mg , vitamina C, 13,1mg e c=E1lcio 285,0 mg. Outro estudo, = realizado=20 por Cavalcante et al. (2006), tamb=E9m = realizado=20 em Vi=E7osa mas com crian=E7as na faixa et=E1ria entre 12 e 35 meses, = encontrou=20 consumo de 5,47=B1 2,62 mg e=20 2,36=B1 14,27mg para ferro e vitamina C, = respectivamente.=20 Spinelli et al. (2003), avaliando o = consumo=20 alimentar de crian=E7as em creches do Munic=EDpio de S=E3o Paulo, = encontraram m=E9dia de=20 consumo de ferro de 3,84=B1 0,81 mg; 4,59=B1 1,40 mg e=20 5,22=B1 1,41mg para as faixas et=E1rias de 6 a 9 , = 9 a 12 e 12=20 a 18 meses, respectivamente. Analogamente, o consumo de c=E1lcio atingiu = 249,49=B1 35,05mg; 309,21=B1 94,81mg;=20 369,01=B1 66,16mg e vitamina C , 41,35=B1 17,05mg;=20 39,91=B1 11,51mg; 44,72=B1 15,84mg.

Embora n=E3o exista=20 semelhan=E7a nos pontos de corte das faixas et=E1rias deste estudo com = os demais=20 citados, podem-se dividir os dados para confronto em dois grupos: = crian=E7as=20 menores e maiores de dois anos. No primeiro grupo, existe certa = semelhan=E7a no=20 consumo de ferro e c=E1lcio e diferen=E7a em rela=E7=E3o =E0 vitamina C, = mais alto no=20 presente estudo. An=E1lise an=E1loga para o segundo grupo, este = apresenta valor de=20 consumo superior para ferro, assemelhado para c=E1lcio e inferior para = vitamina=20 C.

Dos = 45 registros=20 da hist=F3ria alimentar das crian=E7as, foi poss=EDvel calcular a = adequa=E7=E3o aparente=20 da dieta de apenas 15 crian=E7as, uma vez que a estimativa de desvio = padr=E3o=20 intrapessoal para os nutrientes ferro, c=E1lcio e vitamina C, calculadas = pelo=20 Institute of Medicine (IOM, 2000) est=E3o dispon=EDveis para = indiv=EDduos a partir de=20 quatro anos de idade (tabela 3).

 

Tabela 3: Classifica=E7=E3o = da ingest=E3o=20 habitual das crian=E7as atendidas no ambulat=F3rio de Nutri=E7=E3o na = Policl=EDnica Piquet=20 Carneiro

 

 

Faixa=20 et=E1ria

Ferro=20 (mg)

C=E1lcio=20 (mg)

Vitamina=20 C(mg)

Adequado

P = ≥=20 0,70

Inadequado

p<=20 0,70

Adequado

P = ≥=20 0,70

Inadequado

p<=20 0,70

Adequado P ≥=20 0,70

 

Inadequado

p< = 0,70

4 = a 8=20 anos

0%

93,33%

20.00%

73.33%

6.67%

86.66%

9 = anos

0%

6.67%

0%

6.67%

0%

6.67%

 n=3D15=20

 O consumo=20 alimentar declarado das 15 crian=E7as cuja dieta foi avaliada est=E1 = inadequado para=20 ferro (100%), c=E1lcio (80%) e vitamina C (93,33%), quando considerado o = grau de=20 confiabilidade =93p≥ 0,70=94 sugerido por Fisberg et al. (2005). =

Em = rela=E7=E3o =E0=20 adequa=E7=E3o, Castro et al. (2005) encontraram preval=EAncia de = inadequa=E7=E3o de 21,4%=20 e 72,8% para ferro e vitamina C, respectivamente. Os resultados da = predi=E7=E3o da=20 absor=E7=E3o de ferro est=E3o consolidados na tabela = 4.

 

 

Tabela 4. Absor=E7=E3o = estimada de ferro=20 atrav=E9s dos algoritmos (Hallberg & Hulth=E9n)

 

Sujeito

Ferro da dieta =

estimuladores

inibidores

Ferro

Total

Heme

 N=E3o heme =

Vit.. = C

Carnes

C=E1lcio

Ovo

 Estimativa de=20 absor=E7=E3o

mg

mg

mg

mg

g

mg

ud

mg

1

18,94

2,66

16,28

20,75

429,00

613,31

 

1,67

2

5,43

0,44

4,99

140,71

71,50

925,00

 

2,28

3

6,75

0,00

6,75

133,67

0,00

997,66

 

1,97

4

2,25

0,00

2,25

13,50

0,00

174,00

 

0,04

5

11,22

0,59

10,63

126,75

95,81

268,91

 

4,60

6

2,50

0,00

2,50

13,50

0,00

587,64

 

0,04

7

4,27

0,53

3,74

73,24

85,80

73,89

 

0,73

8

9,93

0,62

9,31

24,07

100,10

538,05

 

0,50

9

6,95

0,00

6,95

105,10

0,00

365,02

 

1,44

10

4,91

0,49

4,42

5,41

78,65

758,87

 

0,04

11

5,91

0,44

5,47

41,10

71,50

316,54

 

0,48

12

8,89

0,35

8,54

9,43

57,20

186,86

 

0,14

13

9,89

0,93

8,96

26,80

150,15

394,55

 

0,64

14

6,57

0,44

6,13

199,81

71,50

764,30

 

4,76

15

6,20

0,53

5,67

28,16

85,80

679,64

 

0,34

16

11,75

1,24

10,51

129,08

200,20

1115,86

 

6,58

17

5,64

0,53

5,11

50,98

85,80

919,74

 

0,62

18

4,28

1,24

3,04

35,50

200,20

1130,06

 

0,35

19

4,05

0,89

3,16

64,05

143,00

896,35

 

0,64

20

4,53

0,00

4,53

78,45

0,00

714,92

 

0,63

21

4,89

0,18

4,71

107,33

28,60

549,95

 

1,18

22

4,36

0,35

4,01

601,89

57,20

390,47

 

18,25

23

5,92

0,00

5,92

285,92

0,00

544,34

 

5,63

24

5,05

0,53

4,52

15,98

85,80

479,15

 

0,15

25

11,23

0,71

10,52

70,55

114,40

2524,92

 

2,17

26

7,90

0,27

7,63

83,39

42,90

689,16

 

1,46

27

14,40

0,00

14,40

0,00

0,00

3164,40

 

n=E3o = calculado

28

4,14

0,00

4,14

115,87

0,00

589,72

1,00

0,72

29

4,29

0,00

4,29

60,81

0,00

701,08

 

0,43

30

4,57

0,00

4,57

220,12

0,00

1146,40

 

2,85

31

12,95

0,44

12,51

118,52

71,50

1900,83

 

4,44

32

12,55

1,77

10,78

144,96

286,00

911,02

 

9,92

33

7,24

0,53

6,71

17,74

85,80

675,82

 

0,24

34

8,66

0,89

7,77

28,72

143,00

1009,26

 

0,59

35

6,32

0,98

5,34

40,87

157,30

496,69

 

0,64

36

4,51

0,44

4,07

136,95

71,50

860,10

 

1,78

37

7,68

0,44

7,24

192,87

71,50

718,20

 

5,32

38

11,30

1,15

10,15

54,88

185,90

117,45

 

1,91

39

7,13

0,00

7,13

98,65

0,00

1412,46

 

1,35

40

13,13

0,89

12,24

77,37

143,00

672,79

 

3,16

41

9,18

0,31

8,87

37,05

50,05

726,81

 

0,63

42

12,50

0,53

11,97

97,00

85,80

595,80

 

3,40

43

13,23

1,06

12,17

75,11

171,60

540,89

 

3,30

44

10,51

0,18

10,33

42,58

28,60

1158,22

 

0,78

45

6,89

0,44

6,45

159,36

71,50

1021,50

 

3,54

 A = m=E9dia da=20 estimativa de absor=E7=E3o de ferro, considerando os fatores = estimuladores e=20 inibidores, foi de 2,21=B1 0,94, o que representa 57,63% = da = ingest=E3o de ferro=20 total. Este resultado pode ter sido devido ao efeito vitamina C e carne. = O=20 consumo m=E9dio da carne (crua) foi de 86,18 =B1 24,74 g, que representa = aproximadamente 60g de carne cozida declarada consumida ao dia. Esta = quantidade=20 se aproxima da sugerida nos dez passos para uma alimenta=E7=E3o = saud=E1vel =96 duas=20 por=E7=F5es de 30 a 50g (Vitolo, 2002).

Este = cen=E1rio, onde se=20 calculam a adequa=E7=E3o aparente de ferro e sua absor=E7=E3o, traz = inquieta=E7=E3o em=20 rela=E7=E3o ao cumprimento das recomenda=E7=F5es nutricionais, uma vez = que n=E3o as=20 satisfaz. Ainda deve ser destacado que os fatores estimuladores, quando=20 considerados na dieta completa, s=E3o menos pronunciados do que nas = refei=E7=F5es em=20 separado (Cook & Reddy, 2001).

Os = coeficientes de=20 correla=E7=E3o de Spearman (r) (tabela 5) apresentaram valores discretos = tanto para=20 ferro quanto para c=E1lcio, o que denota fraca associa=E7=E3o. No = entanto, seria=20 necess=E1rio aumentar o tamanho da amostra, uma vez que o valor de r = n=E3o foi=20 significativo. A partir dos coeficientes de determina=E7=E3o, pode-se = inferir que 4%=20 e 1%=20 da vari=E2ncia do ferro e do c=E1lcio, respectivamente, s=E3o = atribu=EDdas =E0=20 condi=E7=E3o socioecon=F4mica.

A = op=E7=E3o pelo=20 coeficiente de correla=E7=E3o de Spearman prendeu-se a que as matrizes = relativas ao=20 consumo alimentar, ferro (dist=E2ncia KS =3D 0,1396; p=3D 0,0278) e = c=E1lcio (dist=E2ncia=20 KS=3D 0,1763; p=3D 0,0012) n=E3o apresentaram distribui=E7=E3o normal; = diferentemente da=20 vari=E1vel ponto obtido pelo crit=E9rio ABA/ABIPEME (dist=E2ncia KS =3D = 0,126; p=3D=20 0,0706).  

 

Tabela 5: Associa=E7=E3o = entre pontos do=20 ABIPEME para classifica=E7=E3o da situa=E7=E3o socioecon=F4mica e = consumo alimentar de=20 ferro e c=E1lcio das crian=E7as atendidas no ambulat=F3rio de = Nutri=E7=E3o na Policl=EDnica=20 Piquet Carneiro

 

Consumo=20 Alimentar

Pearson

 (r)

Intervalo de=20 confian=E7a

(IC)

Coeficiente de=20 determina=E7=E3o

 (r2)

Ferro=20 (mg)

0,20*

-0.11 para=20 0.47

0,04

C=E1lcio=20 (mg)

0,11*

-0.20 para=20 0.40

0,01

 

n=3D45

(*) n=E3o significativo (p = <0,05)=20

 

Os = resultados levaram=20 a considerar duas quest=F5es. A primeira, referente =E0 = biodisponibilidade do ferro=20 na dieta, torna imperativo, durante a consulta de Nutri=E7=E3o, explicar = as formas=20 de se combinar os alimentos, a fim de favorecer a absor=E7=E3o de ferro = da dieta. A=20 segunda leva a acreditar que outros fatores, al=E9m dos = socioecon=F4micos=20 =96comportamentais, cognitivos, emocionais e comunicativos =96, podem = estar=20 influenciando na escolha dos alimentos.

 

Conclus=E3o

O = perfil de=20 adequa=E7=E3o aparente da ingest=E3o habitual da dieta das crian=E7as = =E9 de inadequa=E7=E3o=20 para ferro, c=E1lcio e vitamina C, ao n=EDvel de confiabilidade de 70%. = Os achados=20 mostram que =E9 imperativo o monitoramento do consumo alimentar e das = a=E7=F5es=20 educativas na orienta=E7=E3o nutricional. A n=E3o-exist=EAncia de = associa=E7=E3o=20 significativa entre os pontos da ABA/ABIPEME e o consumo de c=E1lcio e = ferro=20 permite, mesmo que com reservas, refor=E7ar a id=E9ia de que a = educa=E7=E3o nutricional=20 =E9 a ferramenta de interven=E7=E3o mais apropriada, independentemente = da situa=E7=E3o=20 socioecon=F4mica da crian=E7a.

A = contribui=E7=E3o do=20 estudo est=E1 em monitorar o consumo alimentar de um grupo vulner=E1vel = =96 crian=E7as=20 do desmame =E0 entrada na adolesc=EAncia =96, ensinando aos = respons=E1veis por sua=20 alimenta=E7=E3o a maneira mais adequada de combinar os alimentos, a fim = de=20 biodisponibilizar o ferro n=E3o-heme, ou seja, aquele que est=E1 = presente=20 principalmente em leguminosas e hortali=E7as verde = escuras.

 

Refer=EAncias=20

ARMSTRONG, J.; = REILLY, J.J.=20 Child Health Information Team. Breastfeeding and lowering the risk of = childhood=20 obesity. Lancet; v. 359, p. 2003-04,=20 2002.

CASTRO T.G. et al. = Caracteriza=E7=E3o do=20 consumo alimentar, ambiente socioecon=F4mico e estado nutricional de = pr=E9-escolares=20 de creches municipais. Revista Nutri=E7=E3o. Campinas, v. 18, n. 3, p. = 321-330,=20 2005.

CAVALCANTE et al. Consumo = alimentar e=20 estado nutricional de crian=E7as atendidas em servi=E7os p=FAblicos de = sa=FAde do=20 munic=EDpio de Vi=E7osa, Revista Nutri=E7=E3o. Campinas, v. = 19, n. 3, p.=20 321-330, 2006.

COOK, J.D.; = REDDY, M.B.=20 Effect of ascorbic acid intake on nonheme-iron absorption from a = complete diet.=20 American Journal of Clinical Nutrition. Bethesda, v. 73, p. 93-8, 2001.=20

COUTINHO, = G.G.P.L.;=20 GOLONI-BERTOLLO, E.M.; BERTELLI, E.C.P. Iron deficiency anemia in = chidren: a=20 challenge for public health and for society. Sao Paulo Medical = Journal. S=E3o Paulo, v. 1233, n. = 2, mar. 2005.=20 Dispon=EDvel em: <http://www.scielo.br>. Acesso em: 10 out.=20 2007.

FACUNDES, A.A. et = al.=20 Vigil=E2ncia Alimentar=20 e Nutricional =96 SISVAN: orienta=E7=F5es b=E1sicas para a coleta, processamento, = an=E1lise de dados e=20 informa=E7=E3o em servi=E7os de sa=FAde. Bras=EDlia: Minist=E9rio da = Sa=FAde, 2004.=20 120p.

FISBERG M.R.; MARTINI, L.A., = SLATER, B.=20 M=E9todos de Inqu=E9ritos alimentares. In: ___. (Orgs.). = Inqu=E9ritos=20 Alimentares: m=E9todos e bases cient=EDficos. Barueri: Manole, 2005.=20

HALLBERG L., = HULTH=C9N L.=20 Prediction of dietary iron absorption an algorithm for calculating = absorption=20 and bioavailability of dietary iron, American Journal of Clinical = Nutrition.=20 Bethesda, v. 71, p. 1147-60, 2000.

INSTITUTE OF = MEDICINE.=20 Dietary Reference Intakes: applications in dietary assessment.=20 Washington, DC.:=20 National Academic Press, 2000.

MARCHIONI D.M.L.; SLATER B.; = FISBERG=20 R.M. Aplica=E7=E3o das Dietary Reference Intakes na avalia=E7=E3o da = ingest=E3o de=20 nutrientes para indiv=EDduos. Revista de Nutri=E7=E3o. Campinas, v. 17, = n. 2, p.=20 207-216, 2004.

METODOLOGIA E CRIT=C9RIOS = Empregados no=20 Brasil para Classificar os Estratos Sociais. Dispon=EDvel em: www.maxwell.lambda.ele.puc-rio.br/cgi-bin/PRG_0599.EXE/5253_3.PDF?= NrOcoSis=3D13795&CdLinPrg=3Dpt.=20 Acesso em: 22 nov. 2007

PHILIPPI, S.T. Tabela de = Composi=E7=E3o de=20 alimentos: suporte para decis=E3o nutricional. S=E3o Paulo: Coron=E1rio; = 2002. 135p.=20

PINHEIRO A.B.V et al. Tabela = para=20 avalia=E7=E3o de consumo em medidas caseiras. S=E3o Paulo: Atheneu, = 2000.=20 63p.

SPINELLI et al. Consumo = alimentar de=20 crian=E7as de 6 a 18 meses em creche. Revista=20 Nutri=E7=E3o. Campinas, = v. 16, n. 4, p.=20 409-414, 2003.

TOMKINS, A. = Measuring obesity=20 in children: what standards to use? Jornal de Pediatria, v. 82, n. 4, p. 246-8,=20 2006.

VITOLO, M.R. Dez passos para = uma=20 alimenta=E7=E3o saud=E1vel: guia alimentar para crian=E7as menores de = dois anos.=20 Bras=EDlia: Minist=E9rio da Sa=FAde, 2002. 45p.

YBARRA, M.; COSTA, N.M.B.; = FERREIRA,=20 C.L.F. Intera=E7=E3o c=E1lcio e ferro: uma revis=E3o. Nutrire: Revista = Sociedade=20 Brasileira Alimenta=E7=E3o Nutri=E7=E3o. S=E3o Paulo, v. 22, p.85-107,=20 2001. 

Fonte de aux=EDlio: = Sub-Reitoria de=20 Extens=E3o Universit=E1ria da Universidade do Estado do Rio de Janeiro. = Concess=E3o de=20 uma bolsa para o aluno participante do Projeto n. 411-2006 SR3/UERJ - = Educa=E7=E3o=20 Nutricional em Puericultura: uma parceria INU/DNS/PPC/UERJ. =C1rea = tem=E1tica:=20 Sa=FAde

 

1*Professoras no Departamento = de Nutri=E7=E3o=20 Social / Instituto de Nutri=E7=E3o / Universidade do Estado do Rio de = Janeiro=20

2Professora no Instituto de = Matem=E1tica e=20 Estat=EDstica / Universidade do Estado do Rio de

3Alunos do Curso de = Gradua=E7=E3o em Nutri=E7=E3o=20 / Universidade do Estado do Rio de Janeiro

 

*Correspond=EAncia=20 para :=20 Hayd=E9e = Serr=E3o=20 Lanzillotti

Avenida Jambeiro n. 910 apto = 101. Vila=20 Valqueire, Rio de Janeiro. RJ

CEP = 21330-300

E-mail:=20 haydeelan@uol.com.br

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