CONTEXT AND OBJECTIVE: Malnutrition in cancer patients has many causes. Nutritional status is usually assessed from weight/height indices. These present limitations for the nutritional assessment of cancer patients: their weights include tumor mass, and lean mass changes are not reflected in weight/height indices. The objective was to evaluate differences between two anthropometric methods and compare deficits, in non-hematological tumor patients and hematological disease patients. DESIGN AND SETTING: Cross-sectional study at Instituto de Oncologia Pediátrica, Universidade Federal de São Paulo. METHODS: Children and adolescents were evaluated between March 1998 and January 2000. Traditional anthropometric measurements were obtained in the first month of treatment (induction therapy), by weight-for-height (W/H) using z-scores index for children and body mass index (BMI) for adolescents. Body composition evaluations consisted of specific anthropometric measurements: triceps skinfold thickness (TSFT), mid-upper arm circumference (MUAC) and arm muscle circumference (AMC). Data were analyzed to compare nutritional assessment methods for diagnosing malnutrition prevalence. The chi-squared test was used for comparative analyses between tumor patients and hematological disease patients. RESULTS: Analysis was done on 127 patients with complete data. Higher percentages of deficits were found among tumor patients, by W/H z-scores or BMI and by MUAC and AMC. Higher percentages of deficits were shown by TSFT (40.2%) and MUAC (35.4%) than by W/H z-scores or BMI (18.9%). CONCLUSION: Non-hematological tumor patients presented higher malnutrition prevalence than did hematological disease patients. Body composition measurements by TSFT and MUAC detected more patients with malnutrition than did W/H or BMI.

Objective: To evaluate the growth of exclusively breastfed infants from birth to 6 months of life.Methods: This was a longitudinal study of 184 children who received primary care at a public institution (Exclusive Breastfeeding Stimulation Program, PROAME) in Belém, state of Pará, Brazil, between February 2000 and January 2001. A total of 102 children completed the study. All were born at full term with a birth weight greater than or equal to 2,500 g. No events were recorded during the neonatal period and the infants were exclusively breastfed, on demand, since their birth. The infants were followed up monthly, and the weight and length measured at birth and at the end of the first, fourth and sixth months of life were compared to the 50th percentile line of the NCHS growth charts and to other previous studies of Brazilian children who were exclusively breastfed.Results: Growth was adequate for all the children, who doubled their weight before the fourth month of life. Despite a slow-down in weight and height gain after the fourth month, the weight averages at 6 months were greater than the standards used for comparison. Conclusions:The average weight of these exclusively breastfed children was above the 50th percentile of the NCHS curve at 6 months, thus confirming the nutritional advantages of breast milk, especially when the mothers receive guidance regarding the appropriate techniques for breastfeeding.

A B S T R A C T ObjectiveThe objective of this article was to analyze the development, implementation and impact of a nutrition education program on the knowledge and attitudes associated with healthy eating habits. MethodsControlled randomized trial comprising teachers and children of eight public schools; three of them were submitted to educational activities and the remaining ones were kept as controls. Effects of nutrition education were measured in terms of knowledge and attitudes. ResultsThe results revealed an improvement in the food choice among students and a reduction in the intake of foods with high energy density. An improvement in the knowledge and attitudes of the teachers towards the prevention of obesity was also observed.

Conflict of interest: noneObjective: The objective was to determine the prevalence of iron deficiency and iron deficiency anemia among exclusively breastfed infants from one to six months of life and to identify associated risk factors. Methods: This is a cohort study of the hemoglobin and serum ferritin levels of 102 healthy full-term infants, weighing more than 2500 grams (5.5 pounds) at birth, evaluated for growth development and supported to promote exclusive breastfeeding. Hemoglobin and ferritin levels were measured in the first, fourth, and sixth months of life. The hemoglobin and ferritin levels of the mothers were also measured in the first month postpartum. Results: At four months, 5.7% presented iron deficiency and 3.4% had iron deficiency anemia. At six months, the percentage of children with iron deficiency increased more than four times, reaching 26.1%, while iron deficiency anemia was present in 23.9% of the infants studied. Iron deficiency at six months of age was significantly correlated to growth velocity. Conclusion: According to the results of this study, exclusive breastfeeding protects infants from iron deficiency and iron deficiency anemia for the first four months of life. After this age, in accordance with the literature, the findings of this study demonstrated an increase in anemia and iron deficiency rates, adding to evidence that supports the monitoring of iron levels in exclusively breastfed children presenting higher weight gains beginning at four months of age.

OBJETIVO: Avaliar os fatores de risco no processo de desmame de lactentes matriculados em creches. MÉTODOS: Estudo analítico transversal com 56 crianças de nove a 18 meses de idade matriculadas em cinco creches de São Paulo. As mães das crinaças responderam ao questionário pré-testado que abordava questões demográficas, socioeconômicas, de gestação e nascimento, morbidade, aleitamento materno, alimentação complementar (quando/como foram introduzidos novos alimentos) e atividades da criança na creche. Os fatores associados ao desmame precoce e menor período de desmame (variável definida pela diferença entre tempo de aleitamento exclusivo e tempo de aleitamento total) foram avaliados em análises bivariadas. As variáveis com p<0,10 foram ajustadas em modelo conceitual hierárquico de regressão logística. RESULTADOS: Na análise multivariada, foram determinados os seguintes fatores de risco independentes para desmame precoce: renda familiar <3 salários mínimos (OR 3,73; IC95% 1,23-11,34); idade da mãe >25 anos (OR 4,91; IC95% 1,35-17,95); mãe morar sem companheiro (OR 6,42; IC95% 1,28-32,20) e uso de chupeta antes dos 30 dias de vida (OR 8,75; IC95% 1,90-40,23). Os fatores de risco para tempo insuficiente de desmame foram: frequentar creche pública (OR 3,20; IC95% 0,77-14,29) e início tardio do pré-natal (OR 4,13; IC95% 0,70-31,29). CONCLUSÕES: Características relacionadas à família e à instituição creche são fatores de risco para o desmame de crianças institucionalizadas. A abordagem desses determinantes para definir ações de saúde e nutrição é estratégica para favorecer a prática do aleitamento e qualificar o papel da creche como promotora de saúde e nutrição infantil.