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- 474 - Texto Contexto Enferm, Florianópolis, 2008 Jul-Set; 17(3): 474-81. PREVALÊNCIA DE ANEMIA EM GESTANTES E A FORTIFICAÇÃO DE FARINHAS COM FERRO1 PREVALENCE OF ANEMIA IN PREGNANT AND IRON FORTIFICATION OF FLOURS PREVALENCIA DE ANEMIA EN EMBARAZADAS Y LA FORTIFICACIÓN DE HARINAS CON HIERRO Ana Paula Sayuri Sato2, Elizabeth Fujimori3, Sophia Cornbluth Szarfarc4, João Ricardo Sato5, Isabel Cristina Bonadio6 1�3URMHWR�GH�SHVTXLVD�ÀQDQFLDGR�SHOR�&RQVHOKR�1DFLRQDO�GH�'HVHQYROYLPHQWR�&LHQWtÀFR�H�7HFQROyJLFR��&13T�3URFHVVR�1� 402295/2005-6). 2�$OXQD�GH�*UDGXDomR�GD�(VFROD�GH�(QIHUPDJHP�GD�8QLYHUVLGDGH�GH�6mR�3DXOR��((863���6mR�3DXOR��%UDVLO� 3�'RXWRUD�HP�6D~GH�3~EOLFD��3URIHVVRU�$VVRFLDGR�GR�'HSDUWDPHQWR�GH�(QIHUPDJHP�HP�6D~GH�&ROHWLYD�GD�((863��6mR�3DXOR�� %UDVLO� 4�'RXWRUD�HP�6D~GH�3~EOLFD��3URIHVVRU�$VVRFLDGR�GR�'HSDUWDPHQWR�GH�1XWULomR�GD�)DFXOGDGH�GH�6D~GH�3~EOLFD�GD�863��6mR� 3DXOR��%UDVLO� 5�'RXWRU�HP�(VWDWtVWLFD�SHOR�,QVWLWXWR�GH�0DWHPiWLFD�H�(VWDWtVWLFD�GD�863��3HVTXLVDGRU�GD�)DFXOGDGH�GH�0HGLFLQD�GD�863��6mR� 3DXOR��%UDVLO� 6�'RXWRUD�HP�(QIHUPDJHP��3URIHVVRUD�GR�'HSDUWDPHQWR�GH�(QIHUPDJHP�0DWHUQR�,QIDQWLO�H�3VLTXLiWULFD�GD�((863��6mR�3DXOR�� %UDVLO�� RESUMO:�$YDOLRX�VH�R�LPSDFWR�GD�IRUWLÀFDomR�GDV�IDULQKDV�FRP�IHUUR��QD�SUHYDOrQFLD�GH�DQHPLD�H� FRQFHQWUDomR�GH�KHPRJORELQD�GH�JHVWDQWHV��(VWH�HVWXGR�WUDQVYHUVDO�UHWURVSHFWLYR�IRL�GHVHQYROYLGR�HP� XP�&HQWUR�GH�6D~GH�(VFROD�GR�PXQLFtSLR�GH�6mR�3DXOR���63��2V�GDGRV��FROKLGRV�GH�VHWHPEUR�D�GH]HPEUR� GH�������IRUDP�REWLGRV�GH�����SURQWXiULRV�GH�JHVWDQWHV�GLVWULEXtGDV�HP�GRLV�JUXSRV��QmR�IRUWLÀFDGR�H� IRUWLÀFDGR���DQWHV�H�DSyV�D�IRUWLÀFDomR��*HVWDQWHV�FRP�QtYHO�GH�KHPRJORELQD�LQIHULRU�D���J�GO�IRUDP� FRQVLGHUDGDV�DQrPLFDV��5HDOL]RX�VH�DQiOLVH�GH�UHJUHVVmR�OLQHDU�P~OWLSOD��$�DQHPLD�DIHWDYD������H������ GDV�JHVWDQWHV��DQWHV�H�DSyV�D�LPSODQWDomR�GR�SURJUDPD��UHVSHFWLYDPHQWH��S!�������$�DQiOLVH�P~OWLSOD� QmR�HYLGHQFLRX�GLIHUHQoD�HVWDWtVWLFD�QD�PpGLD�GH�KHPRJORELQD�HQWUH�RV�JUXSRV��S ��������2V�UHVXOWDGRV� LQGLFDUDP�XPD�EDL[D�SUHYDOrQFLD�GH�DQHPLD�H�PpGLDV�GH�KHPRJORELQD�VLPLODUHV�HQWUH�RV�JUXSRV��IDWR� TXH�SURYDYHOPHQWH�QmR�SHUPLWLX�FRQVWDWDU�R�HIHLWR�GD�IRUWLÀFDomR�GDV�IDULQKDV� ABSTRACT: 7KLV�VWXG\�HYDOXDWHG�WKH�LPSDFW�RI�LURQ�IRUWLÀHG�ÁRXUV�LQ�WKH�SUHYDOHQFH�RI�DQHPLD�DQG� KHPRJORELQ� OHYHOV�RI�SUHJQDQW�ZRPHQ��7KLV� WUDQVYHUVDO� FURVV�VHFWLRQDO� VWXG\�ZDV�GHYHORSHG�DW� D� +HDOWK�&HQWHU�6FKRRO�LQ�6mR�3DXOR���63��%UD]LO��'DWD��FROOHFWHG�IURP�6HSWHPEHU�WR�'HFHPEHU�RI������� ZHUH�REWDLQHG�IURP�����SUHJQDQW�ZRPHQ·V�PHGLFDO�UHFRUGV�DQG�GLVFULPLQDWHG�LQWR�WZR�JURXSV��EHIRUH� DQG�DIWHU�IRUWLÀFDWLRQ��QRQ�IRUWLÀHG�DQG�IRUWLÀHG��3UHJQDQW�ZRPHQ�ZLWK�KHPRJORELQ�OHYHOV�ORZHU�WKDQ� ��J�GO�ZHUH�FRQVLGHUHG�DQHPLF��'DWD�ZHUH�VXEPLWWHG�WR�PXOWLSOH�UHJUHVVLRQ�DQDO\VLV��$QHPLD�DIIHFWHG� �����DQG������RI�SUHJQDQW�ZRPHQ��EHIRUH�DQG�DIWHU�WKH�IRUWLÀFDWLRQ��UHVSHFWLYHO\��S!�������0XOWLSOH� DQDO\VLV LQGLFDWHV�QR�VWDWLVWLFDO�GLIIHUHQFH�LQ�WKH�PHDQ�KHPRJORELQ�OHYHOV�EHWZHHQ�WKH�JURXSV��S �������� 7KH�UHVXOWV�LQGLFDWHG�D�ORZ�SUHYDOHQFH�RI�DQHPLD�DQG�VLPLODU�KHPRJORELQ�OHYHOV�EHWZHHQ�WKH�JURXSV�� ZKLFK�SUREDEO\�GLG�QRW�DOORZ�IRU�GHPRQVWUDWLQJ�WKH�HIIHFW�RI�ÁRXU�IRUWLÀFDWLRQ�� RESUMEN:�6H�HYDOXy�HO�LPSDFWR�GH�OD�IRUWLÀFDFLyQ�GH�KDULQDV�FRQ�KLHUUR�HQ�OD�SUHYDOHQFLD�GH�DQHPLD�\� FRQFHQWUDFLyQ�GH�KHPRJORELQD�GH�JHVWDQWHV��(VWH�HVWXGLR�WUDQVYHUVDO�UHWURVSHFWLYR�IXH�GHVDUUROODGR�HQ�XQ� &HQWUR�GH�6DOXG�(VFXHOD��GH�OD�FLXGDG�GH�6mR�3DXOR���63��/RV�GDWRV��UHFRJLGRV�GH�VHSWLHPEUH�D�GLFLHPEUH� GH�������IXHURQ�REWHQLGRV�GH�����PDQXDOHV�GH�JHVWDQWHV��GLVWULEXLGDV�HQ�GRV�JUXSRV��DQWHV�\�GHVSXpV� GHO�LQLFLR�GH�OD�IRUWLÀFDFLyQ��QR�IRUWLÀFDGR�\�IRUWLÀFDGR��/DV�JHVWDQWHV�FRQ�QLYHO�GH�KHPRJORELQD�LQIHULRU� ��J�GO�IXHURQ�FRQVLGHUDGDV�DQpPLFDV��6H�UHDOL]y�HO�DQiOLVLV�GH�OD�UHJUHVLyQ�P~OWLSOH��/D�DQHPLD�DIHFWy�� �����\������GH�ODV�JHVWDQWHV��DQWHV�\�GHVSXpV�GH�OD�LPSODQWDFLyQ�GHO�SURJUDPD��UHVSHFWLYDPHQWH��S!������� (O�DQiOLVLV�GH�OD�UHJUHVLyQ�P~OWLSOH�QR�HYLGHQFLy�GLIHUHQFLD�HVWDGtVWLFD�HQ�HO�SURPHGLR�GH�KHPRJORELQD� HQWUH�ORV�JUXSRV��S ��������/RV�UHVXOWDGRV�LQGLFDURQ�EDMD�SUHYDOHQFLD�GH�DQHPLD�\�SURPHGLRV�VLPLODUHV� GH�KHPRJORELQD�HQWUH�ORV�JUXSRV�HVWXGLDGRV��KHFKR�TXH�SUREDEOHPHQWH�QR�SHUPLWLy�GHPRVWUDU�HO�HIHFWR� GH�OD�IRUWLÀFDFLyQ�GH�ODV�KDULQDV� PALAVRAS-CHAVE: Ane- PLD� IHUURSULYD��'HILFLrQFLD� GH�IHUUR��*UDYLGH]��&XLGDGR� SUp�QDWDO� K E Y W O R D S : A n e m i a . ,URQ�GHÀFLHQF\�� 3UHJQDQF\�� 3UHQDWDO�FDUH� PALABRAS CLAVE: Ane- PLD� IHUURSpQLFD��'HÀFLHQFLD� GH�KLHUUR��(PEDUD]R��$WHQ- FLyQ�SUHQDWDO� 6DWR�$36��)XMLPRUL�(��6]DUIDUF�6&��6DWR�-5��%RQDGLR�,& (OL]DEHWK�)XMLPRUL (VFROD�GH�(QIHUPDJHP�GD�8QLYHUVLGDGH�GH�6mR�3DXOR (QGHUHoR��$YHQLGD�'U��(QpDV�&DUYDOKR�$JXLDU����� ������������6mR�3DXOR��63��%UDVLO (�PDLO��HIXMLPRU#XVS�EU $UWLJR�RULJLQDO��3HVTXLVD 5HFHELGR�HP�����GH�GH]HPEUR�GH����� $SURYDomR�ÀQDO�����GH�MXOKR�GH����� - 475 - Texto Contexto Enferm, Florianópolis, 2008 Jul-Set; 17(3): 474-81. 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PpGLDV�GH�SHVR�H�DOWXUD�VLPLODUHV�H�SHVR�DGHTXDGR� SDUD�D�LGDGH�JHVWDFLRQDO�� $�7DEHOD���PRVWUD�TXH������GDV�JHVWDQWHV� GR�JUXSR�QmR� IRUWLÀFDGR H������GR�JUXSR� IRU- WLÀFDGR� HUDP� DQrPLFDV� �S!�������1R�SULPHLUR� WULPHVWUH��PDLV� GH� ����GDV�PXOKHUHV� WLQKDP� +E�����J�G/� Tabela 1 - Médias de Hb e proporção de gestantes anêmicas (Hb<11,0g/dL) segundo trimestres ges- WDFLRQDLV�H�JUXSRV�QmR�IRUWLÀFDGR�H�IRUWLÀFDGR��6mR�3DXOR���63������� Hemoglobina Trimestre 1mR�IRUWL¿FDGR )RUWL¿FDGR p* n x ± DP %<11,0g/dL n x ± DP %<11,0g/dL I† 254 12,62± 0,9 2,0 231 12,68±0,9 3,0 0,627 II 108 11,94±1,2 21,3 105 11,87±1,0 16,2 III 28 11,28±1,2 28,6 24 11,28±1,4 29,2 Total 390 12,35±1,0 9,2 360 12,39±1,1 8,6 �2�YDORU�GH�S�UHIHUH�VH�DR�WHVWH�4XL�TXDGUDGR�SDUD�GLIHUHQoD�GD�GLVWULEXLomR�GH�PXOKHUHV�FRP�+E�����J�G/�HQWUH�RV�JUXSRV� QmR�IRUWLÀFDGR�H�IRUWLÀFDGR� †�1R�SULPHLUR�WULPHVWUH��D�SURSRUomR�GH�JHVWDQWHV�FRP�+E�����J�G/�HUD�GH�������H�������QR�JUXSR�QmR�IRUWLÀFDGR�H�IRUWLÀFDGR�� UHVSHFWLYDPHQWH� $�7DEHOD���PRVWUD�TXH�D�GLVWULEXLomR�GDV� JHVWDQWHV� DQrPLFDV� VHJXQGR� YDULiYHLV� VyFLR� HFRQ{PLFR�GHPRJUiILFDV� IRL� VLPLODU� HQWUH� RV� *UXSRV� �S!������� FRQVWDWDQGR�VH�� SRUpP�TXH� D� DQHPLD� HUD�PDLV� IUHTHQWH� QDV� JHVWDQWHV� VHP� FRPSDQKHLUR�� 6DWR�$36��)XMLPRUL�(��6]DUIDUF�6&��6DWR�-5��%RQDGLR�,& - 477 - Texto Contexto Enferm, Florianópolis, 2008 Jul-Set; 17(3): 474-81. 7DEHOD�����'LVWULEXLomR�GD�DQHPLD�VHJXQGR�YDULiYHLV�VyFLR�HFRQ{PLFR�GHPRJUiÀFDV�H�JUXSRV�QmR� IRUWLÀFDGR�H�IRUWLÀFDGR��6mR�3DXOR���63������� Variáveis 1mR�IRUWL¿FDGR )RUWL¿FDGR p* N Hb<11,0g/dL (%) N Hb<11,0g/dL (%) ,GDGH�DQRV� <20 69 9 (13,0) 65 5 (7,7) 0,395 20 |– 30 262 24 (17,1) 220 19 (16,3) !ҏ�� 59 3 (5,1) 75 7 (9,3) 6LWXDomR�FRQMXJDO Com companheiro 276 24 (8,7) 223 14 (6,3) 0,127 Sem companheiro 114 12 (10,5) 137 17 (12,4) (VFRODULGDGH��DQRV� 0 |– 4 43 5 (11,6) 21 1 (4,7) 0,080 4 |– 8 152 15 (9,8) 101 7 (6,9) 8 |– 11 98 11 (11,2) 106 14 (13,2) > 11 97 5 (5,1) 132 9 (6,8) 5HQGD�IDPLOLDU��HP�VDOiULRV�PtQLPRV�† <2 65 7 (10,7) 66 5 (7,5) 0,298 �ҏ�±_�� 115 13 (11,3) 108 13 (12,0) �ҏ�±_�� 36 3 (8,3) 21 4 (19,0) �� 25 1 (4,0) 8 1 (12,5) �2�YDORU�GH�S�UHIHUH�VH�DR�WHVWH�4XL�TXDGUDGR� †�1HP�WRGRV�RV�SURQWXiULRV�FRQWLQKDP�HVWD�LQIRUPDomR� 'D�PHVPD� IRUPD�� FRQVWDWD�VH�QD�7DEHOD� �� TXH�D�GLVWULEXLomR�GDV�JHVWDQWHV�DQrPLFDV�VHJXQGR� HVWDGR�QXWULFLRQDO��LGDGH�JHVWDFLRQDO�QD���FRQVXOWD� SUp�QDWDO� H�Q~PHUR�GH� FRQVXOWDV�SUp�QDWDLV�QmR� GLIHULX�HQWUH�RV�*UXSRV��S!������ 7DEHOD�����'LVWULEXLomR�GD�DQHPLD�VHJXQGR�DGHTXDomR�GH�SHVR�H�YDULiYHLV�SUp�QDWDLV�VHJXQGR�JUXSRV� QmR�IRUWLÀFDGR�H�IRUWLÀFDGR��6mR�3DXOR���63������� Variáveis* 1mR�IRUWL¿FDGR )RUWL¿FDGR p† N Hb<11,0g/dL (%) N Hb<11,0g/dL (%) (VWDGR�QXWULFLRQDO� Baixo peso 61 7 (11,5) 65 5 (7,7) 0,788 Peso adequado 211 24 (11,4) 178 22 (12,3) Sobrepeso 82 4 (4,8) 67 2 (2,9) Obesidade 18 1 (5,5) 34 2 (5,9) 1~PHUR�GH�FRQVXOWDV�SUp�QDWDO <6 177 26 (14,7) 216 22 (10,2) 0,872 t 6 213 10 (4,7) 144 9 (6,2) 7ULPHVWUH�JHVWDFLRQDO�QD���FRQVXOWD I 275 12 (4,3) 231 7 (3,03) 0,111 II 98 22 (22,4) 105 17 (16,1) III 17 2 (11,7) 24 7 (29,1) Total 390 36 (9,2) 360 31 (8,6) �1HP�WRGRV�RV�SURQWXiULRV�FRQWLQKDP�DV�LQIRUPDo}HV� †�2�YDORU�GH�S�UHIHUH�VH�DR�WHVWH�4XL�TXDGUDGR� 3UHYDOrQFLD�GH�DQHPLD�HP�JHVWDQWHV�H�D�IRUWLÀFDomR�GH�IDULQKDV��� - 478 - Texto Contexto Enferm, Florianópolis, 2008 Jul-Set; 17(3): 474-81. 2V�UHVXOWDGRV�GD�DQiOLVH�P~OWLSOD�PRVWUDUDP� TXH�QmR�KRXYH�GLIHUHQoD�HVWDWLVWLFDPHQWH�VLJQLÀ- FDWLYD�QD�PpGLD�GH�+E�HQWUH�RV�JUXSRV�HVWXGDGRV� �7DEHOD�����$V�YDULiYHLV�TXH�DSUHVHQWDUDP�DOJXP� HIHLWR� VREUH�RV�QtYHLV�GH�+E� IRUDP�� ,0&�� LGDGH� JHVWDFLRQDO�QD�SULPHLUD�FRQVXOWD�SUp�QDWDO�H�QR�PR- PHQWR�GR�H[DPH�GH�VDQJXH��Q~PHUR�GH�FRQVXOWDV� SUp�QDWDLV�H�VLWXDomR�FRQMXJDO��7DEHODV���H����� 2V� UHVXOWDGRV� FRQWURODGRV�SHODV�SRWHQFLDLV� YDULiYHLV� GH� FRQIXVmR� LQGLFDUDP� TXH� �7DEHOD� ���� D��TXDQWR�PDLRU�R� ,0&�QD�SULPHLUD�FRQVXOWD� SUp�QDWDO��PDLRU�HUD�D�FRQFHQWUDomR�PpGLD�GH�+E�� FRQVWDWDQGR�VH�DXPHQWR�GH������J�GO�SDUD�FDGD� XQLGDGH�D�PDLV�GH�,0&��E��TXDQWR�PDLRU�D�LGDGH� JHVWDFLRQDO�QD�SULPHLUD�FRQVXOWD�SUp�QDWDO��PHQRU� HUD�D�FRQFHQWUDomR�PpGLD�GH�+E��TXH�GHFOLQRX�HP� �����J�GO�SDUD� FDGD�PrV�D�PDLV�GH�JHVWDomR�� F�� TXDQWR�PDLRU�D�LGDGH�JHVWDFLRQDO�QR�PRPHQWR�GR� H[DPH�GH�VDQJXH��PHQRU�D�FRQFHQWUDomR�PpGLD�GH� +E��TXH�DSUHVHQWRX�VH������J�GO�PHQRU�D�FDGD�PrV� D�PDLV�GH�JHVWDomR��G��TXDQWR�PDLRU�R�Q~PHUR�GH� FRQVXOWDV�SUp�QDWDLV��PDLRU�HUD�D�FRQFHQWUDomR�Pp- GLD�GH�+E��GH�IRUPD�TXH�VH�FRQVWDWRX�XP�DXPHQWR� GH������J�GO�D�FDGD�FRQVXOWD�D�PDLV�GH�SUp�QDWDO� 7DEHOD�����3DUkPHWURV�GD�UHJUHVVmR�OLQHDU�P~OWLSOD�SDUD�QtYHLV�PpGLRV�GH�KHPRJORELQD�H�DV�YDULiYHLV� HVWXGDGDV��6mR�3DXOR���63������� Variáveis E 'HVYLR�SDGUmR W�VWXGHQW S�YDORU *UXSR�IRUWL¿FDGR�H�QmR�IRUWL¿FDGR* 0,117 IMC na primeira consulta pré-natal 0,024 0,008 3,207 0,001 Idade gestacional na primeira consulta pré-natal -0,016 0,008 -1,972 0,049 Idade gestacional no momento do exame de sangue -0,247 0,030 -8,204 <0,001 Número de consultas pré-natais 0,048 0,021 2,212 0,027 6LWXDomR�FRQMXJDO† 0,005 �9DULiYHO�QmR�VLJQLÀFDWLYD� †�9DULiYHO�FDWHJyULFD� +E�GR���PrV��GH�DPERV�RV�JUXSRV��IRL�H[FOXtGD�D�ÀP�GH�SURSRUFLRQDU�PDLRU�ÀGHGLJQLGDGH�j�DQiOLVH��SRLV�RV�YDORUHV�HQFRQWUDGRV� QDTXHOH�PrV�WLQKDP�SDGUmR�GLIHUHQWH�GRV�RXWURV�PHVHV� (P�UHODomR�j�VLWXDomR�FRQMXJDO�DSUHVHQWDGD� HP�GHWDOKH�QD�7DEHOD����YHULÀFRX�VH�TXH�RV�QtYHLV� GH�+E�VH�DSUHVHQWDUDP�PDLV�HOHYDGRV�HP�PXOKH- UHV�FDVDGDV�HP�UHODomR�jV�DPDVLDGDV��VROWHLUDV�H� SULQFLSDOPHQWH� VHSDUDGDV�� DV�JHVWDQWHV� FDVDGDV� DSUHVHQWDYDP�PpGLDV�GH�KHPRJORELQD������J�GO� PDLRU�TXH�DV�DPDVLDGDV��S �������������J�GO�PDLRU� TXH�DV�VROWHLUDV��S ��������H������J�GO�PDLRU�TXH� DV�VHSDUDGDV��S ��������� Tabela 5 - Parâmetros da regressão linear múlti- SOD�SDUD�QtYHLV�PpGLRV�GH�KHPRJORELQD�H�VLWXDomR� FRQMXJDO�GDV�JHVWDQWHV��6mR�3DXOR���63������� 6LWXDomR�FRQMXJDO Diferença em relação às FDVDGDV S�YDORU Amasiadas -0,278 0,012 Solteiras -0,322 0,007 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