Continuous epileptiform discharges are associated with worse neurodevelopmental findings in a congenital Zika syndrome prospective cohort.

PURPOSE: This study aimed to identify continuous epileptiform discharges (CEDs) on electroencephalograms (EEG) and to determine their clinical significance in children with congenital Zika syndrome (CZS). METHODS: This prospective cohort study included 75 children diagnosed with CZS born from March 2015 and followed up until September 2018 (age up to 36 months). EEG was performed to detect CEDs up to 24 months old. Data on obstetric, demographic, and clinical signs; cranial computed tomography (CT); ophthalmology examination; anti-seizure medication; growth; and motor development were collected. Fisher's exact test was used to verify the associations between categorical variables, and the T- test was used to compare the mean z-scores of anthropometric measurements between the groups with and without CED. RESULTS: CEDs were identified in 41 (54.67 %) children. The mean age of CEDs identification was 12.24 ± 6.86 months. Bilateral CEDs were shown in 62.89 % of EEGs. CEDs were associated with severe congenital microcephaly, defined by z-score >3 standard deviation of head circumference (HC) below the mean for sex and age (p = 0.025), and worse outcomes, including first seizure before 6 months (p = 0.004), drug-resistant epilepsy (p < 0.001), chorioretinal scarring or mottling (p = 0.002), and severe CT findings (p = 0.002). The CED group had lower mean z-scores of HC up to 24 months of age. CONCLUSION: This is the first description of the prevalence and significance of CEDs that also remains during wakefulness in patients with CZS. New investigations may suggest that it is more appropriate to classify the EEG not as a CED, but as a periodic pattern. Anyway, CEDs may be a marker of neurological severity in children with CSZ.

Dietary Patterns, Nutritional Status and Inflammatory Biomarkers in Adolescents from the RPS Birth Cohort Consortium.

This study aimed to identify the dietary patterns (DPs) of adolescents and assess indicators of subclinical inflammation. It was a cross-sectional study aligned with the RPS cohort with data from São Luís, Maranhão, Brazil. We evaluated 511 adolescents between 18-19 years old. DPs were identified with a factor analysis of the principal components. Nutritional status was assessed with body mass index and body fat percentages. Hierarchical modeling was performed using a linear regression to estimate the beta coefficient (ß) of the independent variables with the dependent variables interleukin-6 and high-sensitivity C-reactive protein (hs-CRP). Five DPs were identified: energy-dense, sugar-sweetened beverages and breakfast cereals, prudent, traditional Brazilian and alcoholic and energy beverages. Greater adherence to the prudent DP was associated with a lower concentration of interleukin-6 (ß = -0.11; p value = 0.040). Greater adherence to the DP "traditional Brazilian" and "alcoholic and energy beverages" were associated with increased IL-6, mediated by the nutritional status. A higher BMI (ß = 0.36; p value = <0.001) and %BF (ß = 0.02; p value = 0.014) were associated with higher hs-CRP concentrations. The nutritional status and "prudent" pattern were associated with inflammatory biomarkers. These findings show that a higher consumption of fresh and minimally processed foods and the adequacy of the nutritional status are protective factors for the inflammatory process.

Modifiable behavioral risk factors for NCDs and sleep in Brazilian adolescents.

OBJECTIVE: To analyze the association between modifiable behavioral risk factors for non-communicable diseases and sleep parameters in Brazilian adolescents. METHODS: This was a cross-sectional study that used data from the RPS Cohort Consortium, São Luís, Brazil for the follow-up of adolescents aged 18-19 years (n = 2,515). The outcomes were excessive daytime sleepiness (Epworth Sleepiness Scale - ESS) and sleep quality (Pittsburgh Sleep Quality Index - PSQI). The exposures of interest were the behavioral risk factors for non-communicable diseases (NCDs): screen time, physical inactivity, alcohol, smoking, illicit drugs, caffeine intake, and consumption of sugar-sweetened beverages. Excess weight was considered a possible mediator of this association between the exposures of interest and the outcomes. The models were analyzed by modeling with structural equations. RESULTS: Physical inactivity (standardized coefficient, SC = 0.112; p = 0.001), higher consumption of alcohol (SC = 0.168; p = 0.019) and of sugar-sweetened beverages (SC = 0.128; p < 0.001) were associated with excessive daytime sleepiness in adolescents; better socioeconomic status was also associated with this outcome (SC = 0.128; p < 0.001). Physical inactivity (SC = 0.147; p < 0.001) and higher consumption of sugar-sweetened beverages (SC = 0.089; p = 0.003) were also associated with poor sleep quality. Overweight was neither a mediator nor associated with sleep quality or excessive daytime sleepiness. CONCLUSIONS: The main modifiable behavioral risk factors for NCDs are associated with worse sleep parameters already in adolescence, which serves as a warning toward the accumulation of risks for sleep disorders in the future.

Do childhood depressive symptoms interfere with intelligence in adulthood?

OBJECTIVE: To investigate the effects of depressive symptoms in childhood on the intellectual development of young adults. METHODS: Study conducted with a birth cohort of São Luís, Maranhão, Brazil, composed of 339 participants evaluated between 7 and 9 years and between 18 and 19 years. Structural equation modeling (young adult education, sex, race/color) and childhood variables (nutritional status, depressive symptoms, cognitive function, head of household's and mother's education, family income) were used. In addition, head of household's occupation, mother's age, and presence of partner were tested as determinants of adults' intelligence quotient (IQ). RESULTS: Presence of depressive symptoms in childhood triggered a reduction of 0.342 in standard deviation (SD) and -3.83 points in the average IQ of adults (p-value < 0.001). Cognitive function in childhood had a total and direct positive effect (standardized coefficient [SC] = 0.701; p-value < 0.001) on IQ, increasing 7.84 points with each increase in level. A positive indirect effect of child nutritional status (SC = 0.194; p-value = 0.045), head of household's (SC = 0.162; p-value = 0.036), and mother's education was identified, the latter mediated by cognitive function in childhood (SC = 0.215; p-value = 0.012) on the IQ of young people. CONCLUSION: Presence of depressive symptoms in childhood triggered a long-term negative effect on intelligence, reducing the IQ score in adulthood.

Association between the Consumption of Ultra-Processed Foods and Asthma in Adults from Ribeirão Preto, São Paulo, Brazil.

BACKGROUND: Ultra-processed Food (UPF) consumption can play a role in the pathogenesis and progression of asthma. The aim of this study was to evaluate the association between the consumption of UPF and asthma. METHODS: This cross-sectional study included 1857 adults aged 23-25 years from the Ribeirão Preto-SP birth cohort (1978/1979). The exposure variable was the consumption of UPF (expressed as their percentage contribution to energy intake-% total caloric value [%TCV] and their percentage contribution to the amount of food ingested-%grams), which was assessed with a food frequency questionnaire. Asthma was the outcome and was defined based on a positive methacholine challenge test and the presence of wheezing, chest tightness, or shortness of breath over the last 12 months. Poisson regression with robust variance was used to estimate the association between these variables. Unadjusted analyses and analyses adjusted for sex, age, household income, smoking, and physical activity level were performed. RESULTS: The prevalence of asthma in the sample was 13.2%. The mean total consumption of UPF was 37.9 ± 11.2% TCV (corresponding to 35.1 ± 15.1% grams). There was no association between the consumption of UPF and asthma in adults. CONCLUSION: This study provides no evidence for an association between the consumption of UPF and asthma in young adults.

Is There an Association between Food Consumption According to the Degree of Processing and Body Image (Dis)satisfaction in Adolescents?

(1) Background: Adolescence is characterized by changes in eating habits, with increased consumption of ultra-processed foods and reduced intake of unprocessed or minimally processed foods, which can affect body image satisfaction. Thus, this study aims to verify the association of food consumption according to the degree of processing with body image (dis)satisfaction in adolescents from the 1997/1998 birth cohort of São Luís, Maranhão. (2) Methods: A cross-sectional study was conducted with 2515 adolescents aged between 18 and 19. Food consumption was stratified based on the NOVA classification in culinary preparations, processed foods, and ultra-processed foods, categorized into tertiles. Body image (dis)satisfaction was evaluated based on the Stunkard Body Scale and was classified as satisfaction, dissatisfaction with thinness, and dissatisfaction with excess weight. Multinomial logistic regression was used for associations. (3) Results: Among the adolescents, 77% considered themselves dissatisfied with their body image, with 42.8% dissatisfied with being thin and 34.2% dissatisfied with excess weight. However, food consumption, according to the degree of processing, was not associated with body image (dis)satisfaction. (4) Conclusion: This work highlighted the prevalence of body image dissatisfaction among adolescents but found no association between body (dis)satisfaction and food consumption according to the degree of processing.

Performance of Body Fat Percentage, Fat Mass Index and Body Mass Index for Detecting Cardiometabolic Outcomes in Brazilian Adults.

Obesity is a recognized risk factor for the development of cardiometabolic outcomes. Therefore, it is essential to evaluate anthropometric and body composition indicators used for its diagnosis. This study aimed to assess the diagnostic performance of body fat percentage (BF%), fat mass index (FMI) and body mass index (BMI) for detecting cardiometabolic outcomes in adults. A cross-sectional study was conducted involving adults at 30 years of age from Pelotas, RS (n = 3517) and at 37-39 years from Ribeirão Preto, SP (n = 1696). Receiver operating characteristic (ROC) curves were used to determine the cut-off points for predicting cardiometabolic risk factors, including altered blood pressure, blood glucose, triglycerides, total cholesterol, low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDDL-c), C-reactive protein and glycated hemoglobin. The cut-off points of BF% ranged from 25.2 to 27.8 in men and from 37.4 to 39.7 in women at 30 years, and from 26.1 to 27.8 in men and from 38.5 to 42.2 in women at 37-39 years. For FMI (kg/m2), the cut-off points ranged from 6.3 to 7.5 in men and from 9.5 to 10.8 in women at 30 years, and from 7.3 to 7.8 in men and from 10.2 to 12.2 in women at 37-39 years. The BMI cut-off points (kg/m2) ranged from 26.3 to 27.3 in men and from 25.4 to 27.2 in women at 30 years, and from 28.3 to 29.0 in men and from 27.2 to 29.6 in women at 37-39 years. The areas under the curve were similar for the three indicators, ranging from 0.523 to 0.746. BMI showed a performance similar to that of the body fat-based indicators in identifying cardiometabolic outcomes. The cut-off points of the three indicators showed acceptable discriminatory power in subjects with cardiometabolic risk factors.

Temporal trends and projections of caesarean sections in Brazil, its administrative macro-regions, and federative units. / Tendências temporais e projeções de cesariana no Brasil, macrorregiões administrativas e unidades federativas.

Trend studies on the model of birth in Brazil show a scenario of successive linear increases in cesarean rates. However, they ignore possible changes in the temporal evolution of this delivery modality. Thus, this study aimed to evaluate possible inflection points in cesarean rates in Brazil, its macro-regions, and federated units, as well as to estimate projections for 2030. A time series with information on cesarean sections from 1994 to 2019 from the SUS Department of Informatics was used. Autoregressive integrated moving average and joinpoint regression models were used to obtain cesarean rate projections and trends, respectively. Caesarean rates showed a significant upward trend over the 26 study years at all levels of aggregation. On the other hand, when considering the formation of segments, a stabilization trend was observed both in the country and in the South and Midwest regions, starting in 2012. Rates tended to increase in North and Northeast and significantly decrease in Southeast. Projections show that in 2030, 57.4% of births in Brazil will be cesarean, with rates higher than 70% in Southeast and South regions.

Os estudos de tendência sobre a via de nascimento no Brasil têm revelado um cenário de sucessivos aumentos lineares nas proporções de cesariana. Entretanto, a possibilidade de mudanças na evolução temporal da via cirúrgica não tem sido considerada. Dessa forma, objetivou-se verificar possíveis pontos de inflexão na proporção de cesarianas no Brasil, macrorregiões e unidades federativas, bem como estimar suas projeções para o ano de 2030. Utilizou-se a série temporal com as cesarianas notificadas no Departamento de Informática do SUS no período de 1994 a 2019. Foram utilizados modelos autorregressivos integrados de médias móveis e de regressão joinpoint para obtenção de projeções e de tendências das proporções de cesariana, respectivamente. As proporções de cesarianas apresentaram tendência significativa de aumento ao longo dos 26 anos de estudo em todos os níveis de agregação. Por outro lado, quando se considera a formação de segmentos, observa-se tendência de estabilização no país e nas regiões Sul e Centro-Oeste, a partir de 2012. Norte e Nordeste apresentaram tendência de aumento e o Sudeste, de queda significativa. Projeções indicam que no ano de 2030, 57,4% dos nascimentos no país ocorrerão por via cirúrgica e que nas regiões Sudeste e Sul, serão observadas proporções superiores a 70%.

Tendências temporais e projeções de cesariana no Brasil, macrorregiões administrativas e unidades federativas / Temporal trends and projections of caesarean sections in Brazil, its administrative macro-regions, and federative units

Resumo Os estudos de tendência sobre a via de nascimento no Brasil têm revelado um cenário de sucessivos aumentos lineares nas proporções de cesariana. Entretanto, a possibilidade de mudanças na evolução temporal da via cirúrgica não tem sido considerada. Dessa forma, objetivou-se verificar possíveis pontos de inflexão na proporção de cesarianas no Brasil, macrorregiões e unidades federativas, bem como estimar suas projeções para o ano de 2030. Utilizou-se a série temporal com as cesarianas notificadas no Departamento de Informática do SUS no período de 1994 a 2019. Foram utilizados modelos autorregressivos integrados de médias móveis e de regressão joinpoint para obtenção de projeções e de tendências das proporções de cesariana, respectivamente. As proporções de cesarianas apresentaram tendência significativa de aumento ao longo dos 26 anos de estudo em todos os níveis de agregação. Por outro lado, quando se considera a formação de segmentos, observa-se tendência de estabilização no país e nas regiões Sul e Centro-Oeste, a partir de 2012. Norte e Nordeste apresentaram tendência de aumento e o Sudeste, de queda significativa. Projeções indicam que no ano de 2030, 57,4% dos nascimentos no país ocorrerão por via cirúrgica e que nas regiões Sudeste e Sul, serão observadas proporções superiores a 70%.

Abstract Trend studies on the model of birth in Brazil show a scenario of successive linear increases in cesarean rates. However, they ignore possible changes in the temporal evolution of this delivery modality. Thus, this study aimed to evaluate possible inflection points in cesarean rates in Brazil, its macro-regions, and federated units, as well as to estimate projections for 2030. A time series with information on cesarean sections from 1994 to 2019 from the SUS Department of Informatics was used. Autoregressive integrated moving average and joinpoint regression models were used to obtain cesarean rate projections and trends, respectively. Caesarean rates showed a significant upward trend over the 26 study years at all levels of aggregation. On the other hand, when considering the formation of segments, a stabilization trend was observed both in the country and in the South and Midwest regions, starting in 2012. Rates tended to increase in North and Northeast and significantly decrease in Southeast. Projections show that in 2030, 57.4% of births in Brazil will be cesarean, with rates higher than 70% in Southeast and South regions.

Sleep characteristics and excessive daytime sleepiness in adolescents and adults: results from the birth cohorts of three Brazilian cities - RPS Consortium.

OBJECTIVE: To describe the prevalence of insufficient sleep duration, long sleep latency, terminal or maintenance insomnia, subjective sleep quality, and excessive daytime sleepiness among participants of birth cohorts conducted in three Brazilian cities, and to evaluate differences in prevalence rates within cohorts according to sociodemographic characteristics. METHODS: Cross-sectional analyses involving adolescents and adults participating in four birth cohorts conducted in Ribeirão Preto (RP78 and RP94), Pelotas (PEL93) and São Luís (SL97/98). Sleep duration, latency, terminal or maintenance insomnia, and subjective sleep quality were obtained through the Pittsburgh Sleep Quality Index; and excessive daytime sleepiness was assessed using the Epworth Sleepiness Scale. Differences in the prevalence of the outcomes were analyzed in each cohort according to sociodemographic characteristics (skin color, marital status, socioeconomic status, study and working at the time of the interview) stratified by sex. RESULTS: Insufficient sleep duration was the most common outcome at the four cohorts, with higher frequency among men. Long latency was more frequently reported by young adult women in RP94 and PEL93 cohorts, and insomnia by women of the four cohorts, when compared to men of the same age. Women generally suffered more from excessive daytime sleepiness and evaluated the quality of their sleep more negatively than men. In addition to sex, being a student and working were associated with the largest number of outcomes in both sexes. CONCLUSION: Sleep disorders are more prevalent in women, reinforcing the need for greater investment in sleep health in Brazil, without disregarding gender and socioeconomic determinants.

High prevalence of hepatitis B virus and low vaccine response in children and adolescents in Northeastern Brazil.

Children have an increased likelihood of becoming carriers of the chronic hepatitis B virus. A total of 1,381 children and adolescents were assessed in five municipalities of Maranhao State, Brazil, for detection of anti-HBc, HBsAg and anti-HBs serologic markers and sociodemographic and behavioral features. Among those who were HBsAg negative and anti-HBc negative, the proportion of anti-HBs positives was calculated after the individuals had completed the vaccination schedule. The robust variance of the Poisson's regression model was used in order to have adjusted tables and calculate the prevalence ratio. Multivariate analysis was performed to identify the factors associated with the prevalence of anti-HBc with or without HBsAg and the vaccine response. It was observed that 163 children were anti-HBc positive and nine individuals were HBsAg positive. The factors associated with the infection were: municipality of residence (residing in Morros municipality or Humberto de Campos municipality), residence in a rural area, aged between 13 and 15 years old, and illicit drug use. The percentage of individuals who were anti-HBc negative and received all three doses of the vaccine was 48.5%. Among these, only 276 (38.9%) had antibodies at protective concentrations. In an adjusted analysis, Morros municipality presented an increased positivity of vaccine response (p < 0.001), and the age ranging between 6 and 10 years old presented a reduced frequency of response. This study reveals a high prevalence of current and past HBV infection within the targeted age group which, in addition to the low vaccination coverage and serological responses, raises concerns about the management of prevention measures, especially the quality of vaccination in these locations.

Influence of mode of delivery on satisfaction with hospitalization for childbirth in the study Birth in Brazil.

Controversial results have been reported on the association between mode of delivery and patient satisfaction. This study investigates which mode of delivery leads to greater satisfaction with hospital admission for childbirth. A cohort study was conducted with data from the Birth in Brazil study, which began in 2011. A total of 23,046 postpartum women were included from a random sample of hospitals, selected by conglomerates with a three level stratification. At the first follow-up, 15,582 women were re-interviewed. Mode of delivery, dichotomized into vaginal or cesarean section, and confounders were collected before hospital discharge. The outcome maternal satisfaction, investigated as a 10-item unidimensional construct, was measured by the Hospital Birth Satisfaction Scale up to six months after discharge. We used a directed acyclic graph to define minimal adjustment variables for confounding. The effect of mode of delivery on satisfaction was estimated using a structural equation model with weighting by the inverse of the probability of selection, considering the complex sampling design. The weight was estimated considering the different sample selection probabilities, the losses to follow-up, and the propensity score, which was estimated in a logistic regression model. The analysis revealed no significant difference in satisfaction with hospitalization for childbirth between respondents who had vaginal delivery and cesarean section in the adjusted analysis (standardized coefficient = 0.089; p-value = 0.056). Therefore, women who had vaginal delivery and cesarean section were equally satisfied with their hospitalization for childbirth.

Óbitos, crimes e violências não tipificadas como crimes contra crianças e adolescentes no Maranhão, Brasil, 2014 a 2020 / Deaths, crimes and violence not classified as a crime among children and adolescents in Maranhão, Brazil (2014 to 2020)

Resumo O presente estudo compara tendências temporais de óbitos por violências contra crianças e adolescentes e analisa diferenças em ocorrências tipificadas ou não como crimes. Foram analisados dados do Sistema de Informação sobre Mortalidade e da Secretaria de Segurança Pública do Estado do Maranhão, Brasil, de 2014-2020. Crianças e adolescentes foram definidos respectivamente como pessoas com 0-11 e 12-17 anos. Tipos de violências foram organizados segundo grupos, subgrupos e tipos penais do Código Penal Brasileiro. Foram contabilizados 1.326 óbitos e 8.187 ocorrências, mais frequentes na adolescência. Subtração de incapazes (p < 0,001), abandono de incapaz (p = 0,045) e estupro de vulnerável (p = 0,003) predominaram na infância. Homicídios (p < 0,001), crimes contra a liberdade individual (p = 0,004), crimes contra a liberdade sexual (p < 0,001) e violência psicológica (p = 0,034) foram mais frequentes na adolescência. Violência doméstica com lesão corporal predominou no sexo feminino (p < 0,001). Lesões corporais graves (p = 0,002), homicídios (p < 0,001) e constrangimento ilegal (p < 0,001) vitimizaram mais adolescentes do sexo masculino. Houve diferenças temporais em óbitos e ocorrências de violências contra crianças e adolescentes, assim como em características de violências tipificadas ou não como crimes.

Abstract This study compares temporal trends in violent deaths of children and adolescents and analyzes differences in incidents of violence classified and not classified as a crime. We analyzed data from the Mortality Information System and State of Maranhão Public Security Department for the period 2014 to 2020. Child and adolescent were defined as aged 0-11 and 12-17 years old, respectively. Types of violence were organized according to the groups, subgroups, and types of crimes set out in Brazil's penal code. A total of 1,326 deaths and 8,187 incidents of violence were reported, both of which were more frequent in adolescents. The most frequent types of violence in children and adolescentes, respectively, were: abduction of incapable persons (p < 0.001), abandonment of incapable persons (p = 0.045), rape of vulnerable persons (p = 0.003); homicides (p < 0.001), crimes against individual freedom (p = 0.004), crimes against sexual freedom (p < 0.001), psychological violence (p = 0.034). Domestic violence with bodily harm was more frequent in girls (p < 0.001), while severe bodily harm (p=0.002), homicide (p < 0.001), and harassment (p < 0.001) were more frequent in boys. The findings reveal differences over time in deaths and incidents of violence classified and not classified as crime among both children and adolescents.

Deaths, crimes and violence not classified as a crime among children and adolescents in Maranhão, Brazil (2014 to 2020). / Óbitos, crimes e violências não tipificadas como crimes contra crianças e adolescentes no Maranhão, Brasil, 2014 a 2020.

This study compares temporal trends in violent deaths of children and adolescents and analyzes differences in incidents of violence classified and not classified as a crime. We analyzed data from the Mortality Information System and State of Maranhão Public Security Department for the period 2014 to 2020. Child and adolescent were defined as aged 0-11 and 12-17 years old, respectively. Types of violence were organized according to the groups, subgroups, and types of crimes set out in Brazil's penal code. A total of 1,326 deaths and 8,187 incidents of violence were reported, both of which were more frequent in adolescents. The most frequent types of violence in children and adolescentes, respectively, were: abduction of incapable persons (p < 0.001), abandonment of incapable persons (p = 0.045), rape of vulnerable persons (p = 0.003); homicides (p < 0.001), crimes against individual freedom (p = 0.004), crimes against sexual freedom (p < 0.001), psychological violence (p = 0.034). Domestic violence with bodily harm was more frequent in girls (p < 0.001), while severe bodily harm (p=0.002), homicide (p < 0.001), and harassment (p < 0.001) were more frequent in boys. The findings reveal differences over time in deaths and incidents of violence classified and not classified as crime among both children and adolescents.

O presente estudo compara tendências temporais de óbitos por violências contra crianças e adolescentes e analisa diferenças em ocorrências tipificadas ou não como crimes. Foram analisados dados do Sistema de Informação sobre Mortalidade e da Secretaria de Segurança Pública do Estado do Maranhão, Brasil, de 2014-2020. Crianças e adolescentes foram definidos respectivamente como pessoas com 0-11 e 12-17 anos. Tipos de violências foram organizados segundo grupos, subgrupos e tipos penais do Código Penal Brasileiro. Foram contabilizados 1.326 óbitos e 8.187 ocorrências, mais frequentes na adolescência. Subtração de incapazes (p < 0,001), abandono de incapaz (p = 0,045) e estupro de vulnerável (p = 0,003) predominaram na infância. Homicídios (p < 0,001), crimes contra a liberdade individual (p = 0,004), crimes contra a liberdade sexual (p < 0,001) e violência psicológica (p = 0,034) foram mais frequentes na adolescência. Violência doméstica com lesão corporal predominou no sexo feminino (p < 0,001). Lesões corporais graves (p = 0,002), homicídios (p < 0,001) e constrangimento ilegal (p < 0,001) vitimizaram mais adolescentes do sexo masculino. Houve diferenças temporais em óbitos e ocorrências de violências contra crianças e adolescentes, assim como em características de violências tipificadas ou não como crimes.

Validation of a food frequency questionnaire for assessing the intake of food groups and nutrients in adults / Validação de um questionário de frequência alimentar para avaliação do consumo de grupos de alimentos e nutrientes em adultos

ABSTRACT Objective: To validate a food frequency questionnaire used to assess food consumption among adults in a Brazilian cohort. Methods: Cross-sectional study conducted on 100 adults. Food intake was assessed by the food frequency questionnaire and by two 24-hour recalls. Validation was performed for nutrients (n=19) and food groups (n=21). Results: Moderate deattenuated Pearson's correlation coefficients (>0.4) were observed for the consumption of dairy products, breads and crackers, rice, pasta and tubers, leafy vegetables, other vegetables, fats, sweetened drinks, sandwiches and savory snacks, and nuts, and for the following nutrients (deattenuated and adjusted for energy intake): fiber, calcium, and vitamins A, B2, and C. Based on almost all food groups and nutrients assessed, ≥70% of the individuals were classified into the same or adjacent quartile for both methods, except for red and pork meat, snacks, nuts, phosphorus, potassium, and vitamin B3. The food groups and nutrients with fair kappa agreement (>0.2) were: dairy products, other vegetables, sweetened drinks, breakfast cereals, energy, carbohydrate, iron, and vitamin A. Conclusion: The food frequency questionnaire has proven useful for estimating the intake of some nutrients and food groups of the subjects evaluated. Only the intake of red and pork meat, snacks, nuts, vitamin B3, phosphorus and potassium were estimated with less accuracy.

RESUMO Objetivo: Validar um questionário de frequência alimentar para avaliar o consumo alimentar de adultos em uma coorte brasileira. Métodos: Estudo transversal realizado com 100 adultos. A ingestão alimentar foi avaliada pelo questionário de frequência alimentar e por dois recordatórios de 24 horas. A validação foi realizada para nutrientes (n=19) e grupos de alimentos (n=21). Resultados: Coeficientes de correlação de Pearson deatenuados moderados (>0,4) foram observados para o consumo de laticínios, pães e biscoitos, arroz, macarrão e tubérculos, vegetais folhosos, outros vegetais, gorduras, bebidas adoçadas, sanduíches e salgadinhos, e nozes, e para os seguintes nutrientes (deatenuados e ajustados para ingestão de energia): fibra, cálcio e vitaminas A, B2 e C. Com base em quase todos os grupos de alimentos e nutrientes avaliados, ≥70% dos indivíduos foram classificados no mesmo quartil ou quartil adjacente para ambos os métodos, exceto para carnes vermelhas e suínas, salgadinhos, nozes, fósforo, potássio e vitamina B3. Os grupos de alimentos e nutrientes com concordância kappa justa (>0,2) foram: laticínios, outras verduras, bebidas açucaradas, cereais matinais, energia, carboidratos, ferro e vitamina A. Conclusão: O questionário de frequência alimentar mostrou-se útil para estimar a ingestão de alguns nutrientes e grupos de alimentos dos sujeitos avaliados. Apenas o consumo de carnes vermelhas e suínas, salgadinhos, nozes, vitamina B3, fósforo e potássio foi estimado com menor precisão.

Modifiable behavioral risk factors for NCDs and sleep in Brazilian adolescents / Fatores de risco comportamentais modificáveis para DNT e sono em adolescentes brasileiros

ABSTRACT OBJECTIVE To analyze the association between modifiable behavioral risk factors for non-communicable diseases and sleep parameters in Brazilian adolescents. METHODS This was a cross-sectional study that used data from the RPS Cohort Consortium, São Luís, Brazil for the follow-up of adolescents aged 18-19 years (n = 2,515). The outcomes were excessive daytime sleepiness (Epworth Sleepiness Scale - ESS) and sleep quality (Pittsburgh Sleep Quality Index - PSQI). The exposures of interest were the behavioral risk factors for non-communicable diseases (NCDs): screen time, physical inactivity, alcohol, smoking, illicit drugs, caffeine intake, and consumption of sugar-sweetened beverages. Excess weight was considered a possible mediator of this association between the exposures of interest and the outcomes. The models were analyzed by modeling with structural equations. RESULTS Physical inactivity (standardized coefficient, SC = 0.112; p = 0.001), higher consumption of alcohol (SC = 0.168; p = 0.019) and of sugar-sweetened beverages (SC = 0.128; p < 0.001) were associated with excessive daytime sleepiness in adolescents; better socioeconomic status was also associated with this outcome (SC = 0.128; p < 0.001). Physical inactivity (SC = 0.147; p < 0.001) and higher consumption of sugar-sweetened beverages (SC = 0.089; p = 0.003) were also associated with poor sleep quality. Overweight was neither a mediator nor associated with sleep quality or excessive daytime sleepiness. CONCLUSIONS The main modifiable behavioral risk factors for NCDs are associated with worse sleep parameters already in adolescence, which serves as a warning toward the accumulation of risks for sleep disorders in the future.

RESUMO OBJETIVO Analisar a associação entre fatores de risco comportamentais modificáveis para doenças não transmissíveis e parâmetros do sono em adolescentes brasileiros. MÉTODOS Estudo transversal que utilizou dados do Consórcio de Coortes RPS, São Luís, Brasil para o seguimento de adolescentes de 18-19 anos (n = 2.515). Os desfechos foram a sonolência diurna excessiva (Escala de Sonolência de Epworth - ESE) e a qualidade do sono (Índice de Qualidade do Sono de Pittsburgh - IQSP). As exposições de interesse foram os fatores de risco comportamentais para doenças não transmissíveis (DNT): tempo de tela, inatividade física, álcool, cigarro, drogas ilícitas, consumo de cafeína, consumo de bebidas adoçadas com açúcar. O excesso de peso foi considerado um possível mediador dessa associação entre as exposições de interesse e os desfechos. Os modelos foram analisados por modelagem com equações estruturais. RESULTADOS A inatividade física (Coeficiente padronizado, CP = 0,112; p = 0,001), maior consumo de álcool (CP = 0,168; p = 0,019) e de bebidas adoçadas com açúcar (CP = 0,128; p < 0,001) foram associados a sonolência diurna excessiva nos adolescentes; a melhor situação socioeconômica também foi associada a este desfecho (CP = 0,128; p < 0,001). A inatividade física (CP = 0,147; p < 0,001) e o maior consumo de bebidas adoçadas com açúcar (CP = 0,089; p = 0,003) também se associaram com a qualidade do sono ruim. O excesso de peso não foi mediador e nem associado à qualidade do sono ou à sonolência diurna excessiva. CONCLUSÕES Os principais fatores de risco comportamentais modificáveis para DNT estão associados a piores parâmetros do sono já na adolescência; alertando para um quadro de acúmulos de riscos para distúrbios de sono no futuro.