Disponibilidade do ferro da alimentação escolar dos centros municipais de educação infantil de Maceió-AL

Abstract

Iron deficiency anemia remains a public health problem in children under the age of five, women of childbearing age and pregnant women, whose consequences can reverberate over the years. Thus, this dissertation aimed to carry out a narrative review of the algorithms and qualitative models available in the literature to estimate the availability of dietary iron, that is, the amount of absorbable iron, and to assess the availability of iron in school meals at the Municipal Centers for Child Education-MCCE, from Maceió-AL. This dissertation consisted of three stages, namely: 1) narrative review of the algorithms and qualitative models available in the literature to estimate available iron; 2) selection of algorithms to be used in the second stage of the dissertation; 3) evaluation of the availability of iron in the school meals of the CMEI in Maceió-AL. Eighteen algorithms and 2 qualitative models were found to estimate iron availability, over 39 years, between 1978 and 2017. The selected algorithms were: Monsen and Balintfy (1982), Singer et al. (1982), Du et al. (2000) and Rickard et al. (2009). Estimates of the availability of iron in school meals, obtained in each of the four algorithms, were expressed as mean and mean standard error. Correlation analysis was performed between the estimates, followed by the analysis test with repeated measures (ANOVA) to compare the estimates, and the Bland-Altman test to verify the agreement of the results. Correlation analysis between diet constituents was also performed to evaluate the proposed menu. Absorbable iron estimates ranged from 0.23 to 0.44 mg/day, and the estimated absorption efficiency ranged from 4.8% to 9.7%. When comparing the estimates with the nutritional recommendations, it was found that, although the amount of total iron apparently met the iron recommendations of the children assisted by the MCCE, on the vast majority of the days analyzed, the amount of absorbable iron did not meet the nutritional recommendations adopted by the National School Feeding Program (NSFP). Based on the Bland-Altman test, it was found that the pair of algorithms by Monsen and Balinfty (1982) and Rickard et al. (2009) showed the greatest agreement with each other. The results of the present study, associated with the ease of its application, allow us to recommend the algorithm of Monsen and Balinfty (1982) as the one of choice, in the context investigated here. The correlation analysis between the constituents of the meals showed that animal tissue (AT) and non-heme iron (NHI) showed a moderate positive correlation (r = 0.42; p < 0.05), while AT and calcium (r = -0.54) and calcium and phytic acid (r = -0.46) showed a moderate negative correlation (p<0.05). It is concluded that the amount of iron available in school meals estimated in this study does not meet, on most days, the nutritional recommendations adopted by the NSFP. In addition, the analysis of the menu's constituents confirmed the need to adopt strategies to increase the availability of iron in school meals, such as associating the consumption of NHI and ascorbic acid and reducing the presence of inhibitory factors, especially in meals with higher amounts of iron.