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Maternal vitamin A (VA) supplementation in risk areas for Vitamin A deficiency (VAD) was launched to improve the level of this nutrient in nursing mothers and in their breast milk. This longitudinal and randomized study aimed to evaluate the levels of retinol in breast milk after supplementation with VA in varying amounts (200,000 IU or 400,000 IU) and different postpartum intervals. Women were distributed into four intervention groups and given a single 200,000 IU postnatal dosage of VA at time 0 h (postnatal morning) (G200 0H); a single 200,000 IU dosage of VA in week four (G200 4W); 200,000 IU of VA at time 0 h + 200,000 IU of VA 24 h after the first supplementation (G400 24H); and 200,000 IU of VA at time 0 h + 200,000 IU of VA one week after the first supplementation (G400 1W). Breast milk samples were collected over a 12-week period (0 h, 24 h and 1, 4, 12 weeks post-natal). Retinol levels were determined by high-performance liquid chromatography. The Generalized Estimated Equation (GEE) assessed the different retinol levels. The G200 (0H), G400 (24H), and G400 (1W) groups presented higher retinol levels at 24 h than the G200 (4W) group (p < 0.001). The retinol levels of all groups were similar at times 1, 4 and 12 weeks after delivery (p > 0.05). Maternal VA supplementation increased retinol levels in the colostrum. Different supplementation dosages or postpartum administration times did not result in added benefit to retinol levels in mature breast milk.

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Background: Assessing food consumption in adolescents is essential for the determination of an appropriate nutritional status. This study intended to assess dietary patterns and its associated factors in rural Mozambican adolescents. Methods: This was a cross-sectional study of 323 adolescents. A food frequency questionnaire was used and food was grouped into nine groups. An exploratory factorial analysis identified the food patterns. A principal component analysis provided food consumption scores in each factor, split into three groups. An adjustment of multinomial regression models was made. Results: Two diet patterns were identified: pattern 1 (fats, beans, meats and eggs, cereals and sugars) and pattern 2 (vegetables, roots and tubers, fruits, chestnuts and walnuts). The proportional model for pattern 1 indicated highest consumption for adolescents with per capita family income equal to or greater than 78.13 meticais (Mozambique's currency) and for adolescents whose parents had a formal job. For pattern 2, consumption was lower for adolescents whose guardians had high school education or more. The consumption in the first three quartiles was lower for individuals with an income between 1 and 78.12 meticais. Conclusions: For Mozambican adolescents, higher income, education and parents' jobs were predictive variables for consumption of fats, beans, meats and eggs, cereals, and sugars, while higher education and higher income implies lower consumption of vegetables, roots and tubers, fruits, chestnuts, and walnuts.

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Malnutrition can lead to possible irreversible consequences in the development of muscle function and some of them are yet poorly characterized. The present study evaluated the mechanical properties of the triceps surae and motor performance in stunted (S) and eutrophic (E) prepubertal children (9 years ± 6 months). Height-for-age ratio was used as indicator of stunting due to early malnutrition, according to the World Health Organization. Torque was determined by maximal voluntary contractions (MVC) and musculotendinous (MT) stiffness was achieved through quick-release tests to obtain MT stiffness index (SI(MT)) and passive stiffness (K (p)) from linear MT stiffness-torque relationships. Percutaneous supramaximal electrically elicited contractions determined twitch torque (Pt) and electromechanical delay (EMD). Motor performance was evaluated by balance test. S group presented significantly lower MVC and a trend of lower Pt values indicating lower capacities to develop force under voluntary or induced conditions. Significantly higher SI(MT) and EMD values were observed, while K (p) and motor performance in balance were significantly lower. Higher SI(MT) values have been reported previously in youngest prepubertal children, indicating that immature activation capacities can mask MT stiffness assessment during voluntary contractions, taking into consideration the higher EMD values as a measure of muscle stiffness contribution. Lower K (p) may indicate a delay in the maturation of tendinous tissue in S group, influencing motor performance in balance. The present study shows that malnutrition leads to adaptation of intrinsic MT elastic properties, but depends on the level of the observed structure.

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OBJECTIVE: to analyse the opinions of men and women on the father's participation in breast feeding. DESIGN: a qualitative and exploratory study, using the content analysis method, on its thematic modality. Data were collected at discussion groups that answered the following questions: which meanings and feelings are related to father's involvement in breast feeding? Which factors help or obstruct the act of breast feeding? How do fathers participate in breast feeding? SETTING: three discussion groups took place during the event 'The man as an ally in breast feeding process: is that the question?', supported by the Federal University of Pernambuco, Brazil. PARTICIPANTS: 11 men and nine women attended the event. Of the men, two had more than one child and five had babies who were being breast fed. Among the women, all were mothers and three were breast feeding. FINDINGS: four thematic nuclei emerged from the performed analysis, which was also based in the historical, social and cultural process of fatherhood: involvement in the pregnancy-puerperal cycle; feelings and meanings of breast feeding; meanings of breast feeding in public; and ways to include father in the breast-feeding process. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: fathers participating in breast feeding considered it to be a brief period in the process of fatherhood. Behaviours of ambivalence, conflict, exclusion, insecurity and concern towards breast feeding were revealed. There was a perception of the nursing mother as a sexless being. However, the participants also suggested ways of including fathers in the process of breast feeding. According to the participants, they could (1) provide a favourable environment for the mother and baby; (2) participate more during pregnancy and birth; (3) help with domestic chores; (4) develop parenthood; and (5) be present during breast feeding. These suggestions may function as foundations for health staff to develop programmes, in order to involve fathers in breast feeding. This could result in a contribution to improve the practice and duration of that process.

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OBJECTIVE: To identify the experiences, knowledge, behaviors and emotions of fathers with relation to the process of breastfeeding. METHODS: This is a descriptive, explorative and qualitative study involving 17 couples resident in a favela in the city of Recife, PE, in the Northeast of Brazil, whose most recent child was aged between 6 and 8 months. A semi-structured interview employing leading questions was used for data collection. These data were analyzed in the light of theoretical references, the historical, social and cultural construction of fatherhood, by means of thematic content analysis. RESULTS: Four themes emerged from this analysis: faint/ambiguous memories of breastfeeding during childhood; knowledge about breastfeeding is focused on the child's health, mother's responsibility and savings for father; breastfeeding-related behavior of father during his participation in the pregnancy-child care cycle; and interconnected feelings of fragility when breastfeeding. CONCLUSIONS: The knowledge and emotions involved in fathers' participation in breastfeeding are the products of socialization of both men and women, centered on the biological body and reinforcing the belief that breastfeeding is the preserve of women.

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OBJETIVO: Identificar vivências, conhecimentos, comportamentos e sentimentos do pai no processo da amamentação. MÉTODOS: Trata-se de um estudo descritivo, exploratório e qualitativo, realizado com 17 casais moradores de uma favela da cidade de Recife (PE), Nordeste do Brasil, em relação ao aleitamento materno do último filho, com idade entre 6 e 8 meses. A entrevista semi-estruturada, conduzida por questões norteadoras, foi utilizada para coletar as informações. Estas foram investigadas à luz do referencial teórico, da construção histórica, social e cultural da paternidade, através da análise de conteúdo, na modalidade temática. RESULTADOS: Desta análise, emergiram quatro temas: recordações ambíguas/esmaecidas sobre amamentação durante a infância; conhecimento sobre amamentação centrado na saúde da criança, responsabilidade da mulher e economia para o pai; comportamentos apresentados pelo pai durante a sua participação no ciclo grávido-puerperal direcionados à amamentação; e sentimentos entrelaçados de fragilidades ao amamentar. CONCLUSÕES: Os conhecimentos e sentimentos presentes na participação do pai na amamentação são produtos da socialização do homem/mulher, centrada no corpo biológico, reforçando que o amamentar pertence apenas à mulher.

OBJECTIVE: To identify the experiences, knowledge, behaviors and emotions of fathers with relation to the process of breastfeeding. METHODS: This is a descriptive, explorative and qualitative study involving 17 couples resident in a favela in the city of Recife, PE, in the Northeast of Brazil, whose most recent child was aged between 6 and 8 months. A semi-structured interview employing leading questions was used for data collection. These data were analyzed in the light of theoretical references, the historical, social and cultural construction of fatherhood, by means of thematic content analysis. RESULTS: Four themes emerged from this analysis: faint/ambiguous memories of breastfeeding during childhood; knowledge about breastfeeding is focused on the child's health, mother's responsibility and savings for father; breastfeeding-related behavior of father during his participation in the pregnancy-childcare cycle; and interconnected feelings of fragility when breastfeeding. CONCLUSIONS: The knowledge and emotions involved in fathers' participation in breastfeeding are the products of socialization of both men and women, centered on the biological body and reinforcing the belief that breastfeeding is the preserve of women.

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OBJECTIVE: The objective of this study was to use statistical modeling to identify risk factors for anemia in children aged 6 to 59 months in the state of Pernambuco, covering socioeconomic and dietary aspects. METHODS: The sample comprised 746 children aged between 6 and 59 months from the state of Pernambuco. Their hemoglobin was assayed and a 24-hour dietary recall performed. Risk of anemia was analyzed with relation to socioeconomic variables and to dietary intakes, using multivariate analysis models. RESULTS: The risk factors for anemia were: a high proportion of calories from cow's milk, low density of nonheme iron, low age and low maternal educational level; age was the most prominent factor, with children under 24 months exhibiting 3.61 times greater risk of being anemic than the older children. CONCLUSIONS: This study confirms the need for a clear picture of the dietary intake of children in Brazil, in order that associations with anemia can be better understood. Our results revealed that the dietary factors which were most responsible for risk of anemia were a greater proportion of calories from cow's milk and lower density of nonheme iron, in addition to age below 24 months and low maternal educational level.

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OBJETIVO: Este estudo tem como objetivo identificar, utilizando modelagem estatística, os fatores de risco da anemia em crianças de 6 a 59 meses de idade no estado de Pernambuco, contemplando aspectos socioeconômicos e da dieta. MÉTODOS: A amostra constou de 746 crianças de 6 a 59 meses do estado de Pernambuco, nas quais foram realizados dosagem de hemoglobina e inquérito dietético recordatório de 24 horas. Foi analisado o risco de anemia em relação às variáveis socioeconômicas e de consumo alimentar, utilizando modelos de análise multivariada. RESULTADOS: Os fatores de risco para a anemia foram: alta proporção de calorias do leite de vaca, baixa densidade de ferro não-heme, baixa idade e baixa escolaridade materna, destacando-se que as crianças com menos de 24 meses apresentaram risco 3,61 vezes maior de serem anêmicas em relação às demais. CONCLUSÕES: O presente estudo reforça a importância de se conhecer o consumo alimentar das crianças no país para melhor estabelecer a sua associação com a ocorrência da anemia. Os resultados revelaram que os fatores que mais explicaram o risco de anemia foram, com relação à dieta, a maior proporção de calorias do leite de vaca e menor densidade de ferro não-heme, além de idade menor de 24 meses e baixa escolaridade materna.

OBJECTIVE: The objective of this study was to use statistical modeling to identify risk factors for anemia in children aged 6 to 59 months in the state of Pernambuco, covering socioeconomic and dietary aspects. METHODS: The sample comprised 746 children aged between 6 and 59 months from the state of Pernambuco. Their hemoglobin was assayed and a 24-hour dietary recall performed. Risk of anemia was analyzed with relation to socioeconomic variables and to dietary intakes, using multivariate analysis models. RESULTS: The risk factors for anemia were: a high proportion of calories from cow's milk, low density of nonheme iron, low age and low maternal educational level; age was the most prominent factor, with children under 24 months exhibiting 3.61 times greater risk of being anemic than the older children. CONCLUSIONS: This study confirms the need for a clear picture of the dietary intake of children in Brazil, in order that associations with anemia can be better understood. Our results revealed that the dietary factors which were most responsible for risk of anemia were a greater proportion of calories from cow's milk and lower density of nonheme iron, in addition to age below 24 months and low maternal educational level.

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OBJECTIVES: to compare the validity and reproducibility of clinical signs with the World Health Organization hemoglobin color scale. METHODS: Two hundred six children in the age range of 6-23 months, at the Instituto Materno Infantil Prof. Fernando Figueira, IMIP, were assessed. Two examiners evaluated the clinical signs and the hemoglobin color scale of each child at the different times. The hemoglobin value was used as a standard for validation. RESULTS: in more than 90 percent of cases the agreement between the values of the color scale and the laboratorial hemoglobin was <2 g/dL. Between the clinical signs the highest sensitivity level for diagnosing Hb<11 g/dL was presented by the hemoglobin color scale (75.7 percent). For moderate/severe anemia Hb<9g/dL the highest sensitivity was shown by combined palmar or conjunctival pallor (74.3 percent) and by the color scale (52.5 percent), according to the first and second observer, respectively. The highest specificity level for Hb<11 g/dL was presented by palmar pallor in comparison with the mother's palm and conjunctival pallor (100 percent). For Hb<9 g/dL the highest specificity was presented by the hemoglobin color scale (91.9 percent). CONCLUSIONS: this study suggests that moderate/severe anemia can be diagnosed either by clinical signs or by the color scale, while, in cases of mild anemia, the better diagnosis tool appears to be the color scale.

OBJETIVOS: comparar a validade e reprodutibilidade dos sinais clínicos (palidez palmar e conjuntival) com a escala de cores da hemoglobina da Organização Mundial de Saúde. MÉTODOS: pesquisa realizada em 206 crianças de 6-23 meses, atendidas nos ambulatórios de puericultura e pediatria do Instituto Materno Infantil Prof. Fernando Figueira, IMIP. Os sinais clínicos e a escala de cores da hemoglobina foram avaliados por dois observadores em diferentes momentos. A validação foi realizada utilizando-se a hemoglobina como padrão. RESULTADOS: em mais de 90 por cento dos casos, a concordância entre os valores da escala de cores e da hemoglobina laboratorial encontravam-se em <2 g/dL. Entre os sinais clínicos e a escala de cores, a maior sensibilidade para diagnosticar anemia (Hb<11 g/dL) foi apresentada pela escala de cores da hemoglobina (75,7 por cento) e na anemia moderada/grave (Hb<9 g/dL), pela palidez palmar ou de conjuntiva ocular combinadas (74,3 por cento) e pela escala de cores (52,5 por cento), para o primeiro e segundo examinadores, respectivamente. A maior especificidade foi apresentada na palidez palmar comparada à palma da mãe e palidez de conjuntiva (100 por cento) para Hb<11 g/dL e a escala de cores da hemoglobina (91,9 por cento) para a Hb<9 g/dL. CONCLUSÕES: o presente estudo sugere que o diagnóstico da anemia moderada/grave seja possível através dos sinais clínicos e da escala de cores e, no caso da anemia leve, o melhor instrumento parece ser a escala de cores.

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OBJECTIVE: To thoroughly investigate the association between the consumption of cow's milk and anemia in childhood. SOURCES OF DATA: The information was gathered from papers catalogued in Lilacs and MEDLINE and published during the last two decades, and also from textbooks and publications by international organizations. SUMMARY OF THE FINDINGS: Iron deficiency anemia is a severe public health problem in developing countries. Breast milk contains adequate iron for full term babies in the first 6 months. Thereafter, an additional iron-rich diet becomes essential. In recognition of the importance of the diet in triggering anemia, this paper discusses the relationship in children between a high intake of cow's milk and iron deficiency anemia. Gastrointestinal and allergic problems may be caused by early introduction of cow's milk or by its substitution for breast milk. Furthermore, cow's milk has decreased iron density and bioavailability, excess protein and minerals, notably calcium, and thus interferes in the absorption of iron from other foods, and is also linked to small intestinal hemorrhage in young children. CONCLUSIONS: The use of cow's milk in lieu of other foods rich in bioavailable iron was shown to be a risk factor for anemia. Exclusive breastfeeding during the first 6 months of life, discretionary weaning only after the 24th month, and a complementary diet rich in iron are highly important to avoid anemia and its consequences.

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