Association between quality of the diet and cardiometabolic risk factors in postmenopausal women.

BACKGROUND: Climateric is a phase of women's life marked by the transition from the reproductive to the non-reproductive period. In addition to overall weight gain, the menopause is also associated with the increase of abdominal fat. We used The Healthy Eating Index as a summary measure to evaluate the major components and the quality of women's diet after the onset of the menopause. This study aims at examining the association between the quality of the diet and cardiometabolic risk factors in postmenopausal women. METHODS: Cross-sectional study including 215 postmenopausal women attending a public outpatient clinic. The 24-hour dietary recall method was used to assess the food intake and to establish the Healthy Eating Index. Diets were then classified as appropriate diet (>80 points), diet "requiring improvement" (80-51 points), and poor diet (<51 points). Cardiometabolic risk factors included abdominal obesity, dyslipidemia, diabetes mellitus, and hypertension. The Fisher's exact test was utilized for the Statistical analysis. RESULTS: The analysis of the food intake showed that the average daily intake of lipids (36.7%) and sodium (2829.9 mg) were above the recommended. Only 8.8% of the women performed moderate or intense physical exercises on a regular basis. The diet was considered poor in 16.3%, "requiring improvement" in 82.8%, and appropriate for only 0.9% of the women. The study detected increased waist circumference in 92.1% of the participants. The mean concentration of triglycerides was of 183.3 mg/dl, and 130.7 mg/dl for cholesterol (Low Density Lipoprotein). CONCLUSION: Women consume a low quality diet, possibly due to the low intake of vegetables and fruits and excessive consumption of sodium. These inappropriate eating habits are associated with and, have a negative impact on the cardiometabolic risk factors such as abdominal obesity.

Factors associated with exclusive breastfeeding in " Near Miss " neonates in Brazil.

Objective: To assess the association between sociodemographic and perinatal factors and hospital practices to encourage exclusive breastfeeding in near miss neonates in maternity hospitals. Methods: This is a prospective cohort of live births from the survey "To be born in Brazil" conducted between 2011 and 2012. The weighted number of newborns who met the neonatal near miss criteria was 832. Exclusive breastfeeding at hospital discharge and 45 days after delivery were dependent variables of the study. The sociodemographic and perinatal factors of the puerperal women and hospital practices to encourage breastfeeding were independent variables. The data were analyzed with Poisson regression and set with p value<0.05. Is exclusive breastfeeding in neonatal near misses associated with factors related to sociodemographic conditions, maternal characteristics and the organization of health services? Results: Data from 498 women and their children were analyzed. Mothers with incomplete primary education were more likely (36%) to have exclusive breastfeeding (RR: 1.36; 95% CI: 1.06-1.74) at discharge. Women who did not offer the breast to the newborn in the joint accommodation (65%) were less likely to be breastfeeding exclusively (RR: 0.65; 95% CI: 0.56-0.75) at discharge. Variables that increased the probability of exclusive breastfeeding after 45 days of delivery were primiparity (RR: 1.36; 95% CI: 1.08-1.69) and having the newborn in the delivery room (RR: 1.90; 95% CI: 1.12-3.24). Conclusion: Exclusive breastfeeding in neonatal near misses was associated with maternal characteristics and important hospital practices, such as being breastfed in the joint accommodation and the newborn being in the mother's lap in the delivery room.

Tobacco use by sexual and gender minorities: findings from a Brazilian national survey.

OBJECTIVE: The study aims to identify the prevalence of use of tobacco products by sexual and gender minorities (SGM) in Brazil, the users' profile and associations between tobacco use and social and behavioural variables. METHODOLOGY: The study used data from a representative nationwide household survey of the Brazilian population aged 12-65 years-the first one to address the issue of sexual orientation/gender identity. The study sample consisted of 15 801 individuals. Social and behavioural characteristics and the use of tobacco products were compared according to sexual orientation/gender identity. A multivariate logistic model was constructed to assess the association between tobacco use and sexual orientation/gender identity, as well as models stratified by SGM and non-SGM. RESULTS: Prevalence of any tobacco product use was 44.7% among SGM and 17.0% among non-SGM. Water pipe use was ~8 times higher for SGM than for non-SGM (13.5% vs 1.6%). SGM tobacco users were younger and had more schooling than non-SGM tobacco users. After adjusting for social and behavioural variables, the multivariate model showed that SGM were 150% more likely to use tobacco products than non-SGM (adjusted OR 2.52; 95% CI 1.61 to 3.95). In the model for SGM, schooling, alcohol consumption, illicit drug consumption, violence and anxiety/depression were significantly associated with tobacco use. CONCLUSION: Prevalence of tobacco use among SGM was higher than among non-SGM, and the profile of tobacco users differed between them. It is urgent to monitor health issues in SGM in Brazil and to adopt tobacco control strategies for this group.

Factors associated with the adequacy of gestational weight gain among Brazilian teenagers. / Fatores associados à adequação do ganho de peso gestacional de adolescentes brasileiras.

The scope of this article is to evaluate the adequacy of total gestational weight gain (GWG) according to maternal characteristics of Brazilian adolescents. It involved a cross-sectional, hospital-based study. A total of 3,904 teenagers with a single fetus gestation and gestational age (GA) at birth ≥ 37 weeks were included. A hierarchical model was built to analyze the dependent and independent variables adequacy of GWG: sociodemographic, care, obstetric and behavioral characteristics. The chances of insufficient GWG were higher for adolescents from the North (OR = 1.50, 95%CI: 1.07-2.10) and Northeast (OR = 1.68, 95%CI: 1.27-2.21). Paid work increased the chances of insufficient (95%CI: 1.15-2.39) and excessive (95%CI: 1.01-1.86) GWG. The pre-pregnancy body mass index of overweight or obese adolescents was associated with excessive GWG (OR = 1.86, 95%CI: 1.19-2.92 and OR = 3.06, 95%CI: 2.10-4.45, respectively), as well as GA ≥ 42 weeks (OR = 2.23, 95%CI: 1.03-4.81). Living in the North and Northeast regions increases the chances of adolescents having insufficient GWG. Having paid work was associated with a greater chance of excessive and insufficient GWG. Furthermore, pre-pregnancy excess weight or obesity and GA ≥ 42 weeks increased the chances of excessive GWG.

O objetivo deste artigo é avaliar a adequação do ganho de peso gestacional total (GPT) segundo características maternas de adolescentes brasileiras. Estudo transversal e de base hospitalar. Foram incluídos 3.904 adolescentes com gestação de feto único e idade gestacional (IG) ao nascimento ≥ 37 semanas. Foi construído um modelo hierarquizado para analisar as variáveis dependentes e a adequação do GPT e das independentes: características sociodemográficas, assistenciais, obstétricas e comportamentais. As chances de GPT insuficiente foram maiores para as adolescentes do Norte (OR = 1,50; IC95%: 1,07-2,10) e Nordeste (OR = 1,68; IC95%: 1,27-2,21). O trabalho remunerado elevou as chances de GPT insuficiente (IC95%: 1,15-2,39) e excessivo (IC95%: 1,01-1,86). O índice de massa corporal pré-gestacional de sobrepeso ou obesidade associou-se ao GPT excessivo (OR = 1,86; IC95%: 1,19-2,92 e OR = 3,06; IC95%: 2,10-4,45, respectivamente), bem como a IG ≥ 42 semanas (OR = 2,23; IC95%: 1,03-4,81). Residir nas regiões Norte e Nordeste aumentou as chances de as adolescentes apresentarem GPT insuficiente. Exercer trabalho remunerado esteve associado a maior chance de GPT excessivo e insuficiente. Além disso, o sobrepeso ou obesidade pré-gestacional e IG ≥ 42 semanas ampliaram as chances de GPT excessivo.

Factors associated with infant formula supplementation in Brazilian hospitals: a cross-sectional study.

OBJECTIVE: To analyze the factors associated with infant formula supplementation in newborns referred to rooming-in in Brazilian hospitals. METHOD: Cross-sectional study with data from 14,531 postpartum women and newborns obtained from the "Birth in Brazil" survey, conducted in 2011-2012. The analysis used a logistic regression model with a hierarchical approach. RESULTS: In total, 21.2% newborns received infant formula during hospital stay. After adjustment, the following factors were associated with the use of infant formula: maternal age ≥ 35 years (OR = 1.51; IC95%:1.30-1.75), prenatal care in a private service (OR = 2,22; IC:1.72-2.85)/public and private service (OR = 1.67; IC:1.24-2.23), cesarean delivery (OR = 1.83; IC:1.41-2.38), multiple pregnancy (OR = 3.786; IC:2.02-7.06), non-breastfeeding in the delivery room (OR = 1.780; IC:1.43-2.21), birth in a private hospital (OR = 1.695; IC:1.02-2.79), prematurity (OR = 1.656; IC:1.32-2.06) and extremes of birth weight (< 2.500 g: OR = 2.084; IC: 1.585-2.741/ ≥4,000g: OR = 1.672; IC:1.31-2.11). Teenage age (OR = 0.651; IC:0.55-0.76), low maternal education (OR = 0.579; IC:0.43-0.77), multiparity (OR = 0.588; IC:0.510-0.678), and lower economic class (OR = 0.565; IC:0.41-0.76) significantly reduced the probability of using infant formula. CONCLUSIONS: Of the associated factors, the authors highlight cesarean delivery and non-breastfeeding in the delivery room, showing that it is necessary to strengthen policies that encourage good practices during childbirth care in order to promote exclusive breastfeeding and protect mothers and newborns from all social classes against the misuse of infant formula.

External evaluation and self-monitoring of the Baby-friendly Hospital Initiative's maternity hospitals in Brazil.

Background: In Brazil, the Baby-Friendly Hospital Initiative (BFHI) proposes following the criteria, the "Ten Steps to Successful Breastfeeding", International Code of Marketing of Breast-milk Substitutes and Good birth and delivery practices. Brazilian Baby-Friendly Hospitals are reassessed triennially by external evaluators and annually by self-monitoring. This study aimed to verify if the self-monitoring system fulfills its role of enabling accredited hospitals to assess and improve their compliance with the BFHI criteria. In this sense, we will analyze the self-monitoring evaluation results and compare them with those of the external reassessment. Methods: This descriptive evaluation study of the compliance with the BFHI criteria by the Brazilian Baby-Friendly Hospitals by self-monitoring evaluators from 2010 to 2015 and by external evaluators in 2015. Results: Self-monitoring was performed in all years from 2010 to 2015 by 143 BFHI accredited hospitals. The trend of the levels of compliance with BFHI's criteria according to self-monitoring evaluations was stable over the assessed period. Most criteria presented compliance above 70%, except Step 4 (skin-to-skin contact and breastfeeding in the first hour of life), with mean compliance of 67%. Steps 1 (written policy), 7 (rooming-in) and 9 (give no artificial teats) showed mean compliance above 90%. Regarding the external evaluation carried out in 2015, the criteria with lowest compliance were Step 4 and Woman-Friendly care, both below 50%. Steps 9 and 10 (refer mothers to breastfeeding support groups) reached levels of compliance above 90%. For 2015, self-monitoring provided significant higher compliance levels than those from external evaluations in most criteria, except Step 3 (prenatal information on breastfeeding) and Step 10. There was a difference of more than 30% points between evaluations of Steps 1 (written policy), 2 (training), 5 (show mothers how to breastfeed), Woman-Friendly Care and father or mother stay with their newborn. Conclusions: The self-monitoring system fulfilled partially its role of allowing accredited hospitals to self-assess and improve rates of compliance with BFHI criteria. Future trainings of hospital managers need to address difficulties and identify solutions to improve implementation of Steps 4 and 6.

Nutritional profile of newborns with microcephaly and factors associated with worse outcomes.

OBJECTIVE: To describe the nutritional profile of newborns with microcephaly and factors associated with worse outcomes during the first 14 days of life. METHODS: This investigation is a longitudinal, descriptive study carried out in 21 full-term neonates exposed vertically to the Zika virus and hospitalized in a neonatal intensive care unit from February to September 2016. Patients receiving parenteral nutrition were excluded. Data analysis was performed using a generalized estimating equation model and Student's t-test to evaluate the association between worsening weight-for-age z-scores and independent clinical, sociodemographic and nutritional variables during hospitalization, with p<0.05 indicating significance. RESULTS: During hospitalization, there was a decrease in the mean values of the weight-for-age z-scores. The factors associated with worse nutritional outcomes were symptomatic exposure to the Zika virus, low maternal schooling, absence of maternal income and consumption of infant formula (p<0.05). Calcification and severe microcephaly were also associated with poor nutritional outcomes. Energy and macronutrient consumption remained below the recommendations and had an upward trend during hospitalization. CONCLUSION: The presence of cerebral calcification, the severity of microcephaly and symptomatic maternal exposure to Zika virus affected the nutritional status of newborns. In terms of nutritional factors, human milk intake had a positive impact, reducing weight loss in the first days of life. Other known factors, such as income and maternal schooling, were still associated with a poor nutritional status.

Prevalence of bone mineral disease among adolescents with cystic fibrosis.

OBJECTIVE: To evaluate the prevalence of bone mineral disease among adolescents with cystic fibrosis and to relate the findings with the variables studied. METHODS: The study enrolled 37 adolescents who were assessed for: nutritional status according to height/age and body mass/age ratios; bone mineral density of the lumbar spine and entire body by densitometry with dual emission X-ray; daily dietary intake according to a 3-day dietary recall; and pulmonary function by the forced expiratory volume in one second test. RESULTS: Mean age was 13.2 (+/-2.8) years. Nutritional status was adequate in 70.3 and 75.7% of patients according to the height/age and body mass/age indices, respectively; 54.1% of the patients exhibited reduced lumbar spine bone mineral density and 32.5% for the whole body. There was a positive correlation between bone mineral density and body mass index (p = 0.04). Lung disease and pancreatic insufficiency exhibited a correlation with altered bone mineral density. The dietary recall revealed adequate percentages of calcium, phosphorous and calories, according to the nutritional recommendations laid out in the European Cystic Fibrosis Consensus. The multivariate analysis indicated that these variables were not statistically significant. CONCLUSIONS: There is a high prevalence of bone mineral disease among adolescents. Good nutritional status, pancreatic enzyme replacement and control of lung disease may have a protective effect on bone mass.

Sponsorship of the LGBT parade by the tobacco industry and promotion of its heated tobacco product from the perspective of critical discourse analysis / Patrocínio da parada LGBT pela indústria tabagista e promoção de seu produto de tabaco aquecido sob a ótica da análise crítica do discurso

Abstract Brazil has advanced in tobacco control actions, with a significant decline in the prevalence of tobacco use. However, it is essential to identify more vulnerable populations, such as LGBT persons. This study aimed to analyze the discursive production sustaining the search for support and penetration of the tobacco industry among the LGBT population, taking the sponsorship of Philip Morris Brasil to the LGBT parade in São Paulo in 2019. We employed the critical discourse analysis of a report published on a blog. The analysis of the piece points to the use of vocabularies such as diversity, inclusion, modernity, and innovation, which concern the LGBT cause and the launch of its new product. The text conveys a high commitment and a courteous tone, using discursive resources that associate the company with technical and behavioral innovation ideas. It communicates intertextually with regulatory bodies about introducing its new product in the Brazilian market (prohibited in Brazil). It uses different ideological operators, such as the euphemism of the smokeless or smoke-free future. The work shows a tobacco industry strategy to promote its heated product while supporting LGBT cause and promoting a positive corporate image.

Resumo O Brasil tem avançado em ações de controle do tabaco, resultando em grande declínio da prevalência de tabagismo. Entretanto, é fundamental identificar populações mais vulneráveis, como as pessoas LGBT. Este estudo teve como objetivo analisar a produção discursiva que sustenta a busca de apoio e penetração da indústria tabageira junto à população LGBT, tomando o caso do patrocínio da Philip Morris Brasil à parada LGBT em São Paulo em 2019. A metodologia utilizada foi análise de discurso Crítica de notícia publicada em um blog. A análise da peça aponta para utilização de vocabulários como diversidade, inclusão, modernidade e inovação, que dizem respeito à causa LGBT e ao lançamento de novo produto. O texto traz alto grau de comprometimento e tom cortês, fazendo uso de recursos discursivos que associam a empresa às ideias de inovação técnica e comportamental. Comunica intertextualmente com órgãos regulatórios acerca da entrada no mercado brasileiro de seu novo produto (proibido no Brasil). Faz uso de diferentes operadores ideológicos, como o eufemismo do futuro sem fumaça ou futuro livre de fumaça. O trabalho apresenta uma estratégia da indústria do tabaco para promover seu produto de tabaco aquecido enquanto apoia a causa LGBT e promove imagem corporativa positiva.

Dietary intake of pregnant adolescents cared for in primary health care units of a Brazilian urban municipality.

OBJECTIVE: to evaluate the adequacy of dietary intake and the anthropometric nutritional status of pregnant adolescents in the city of Niterói, Rio de Janeiro, Brazil. METERIALS AND METHODS: forty-two adolescents (13-19 years of age), with single-fetus gestation, assisted in the public prenatal health care units between 2008-2014, participated in the study. Body mass index (BMI) was used to assess the nutritional status. Dietary intake was assessed by 24h dietary recalls on two days during a week and one during weekend. Basal metabolic rate was measured by indirect calorimetry and used to determine the energy requirements. Mixed effects models were used to assess dietary intake over the gestational weeks (random effect) and BMI. RESULTS: mean age (SD) of the pregnant women was 16.5 (1.5) years and the majority received allowance from a cash transfer federal program. Overall, 30.3% were overweight/obese pre-pregnancy and 16.7%, during pregnancy. Energy and protein intake adequacies decreased with increasing BMI and gestational week. There was adequate dietary intake of energy, protein, vitamin A and zinc and insufficient intakes of iron and calcium. There was excessive intake of sodium. CONCLUSION: pregnant adolescents living in underprivileged socio-economic environments assisted for prenatal care in primary health care units have adequate intakes of energy, protein, vitamin A and zinc. Pre-pregnancy overweight and high sodium intake are causes of concern due to the future implications for their health. The official Brazilian recommended criterion for anthropometric assessment in pregnancy of adolescents proved to be inadequate.

Factors associated with infant formula supplementation in Brazilian hospitals: a cross-sectional study

Abstract Objective To analyze the factors associated with infant formula supplementation in newborns referred to rooming-in in Brazilian hospitals. Method Cross-sectional study with data from 14,531 postpartum women and newborns obtained from the "Birth in Brazil" survey, conducted in 2011-2012. The analysis used a logistic regression model with a hierarchical approach. Results In total, 21.2% newborns received infant formula during hospital stay. After adjustment, the following factors were associated with the use of infant formula: maternal age ≥ 35 years (OR = 1.51; IC95%:1.30-1.75), prenatal care in a private service (OR = 2,22; IC:1.72-2.85)/public and private service (OR = 1.67; IC:1.24-2.23), cesarean delivery (OR = 1.83; IC:1.41-2.38), multiple pregnancy (OR = 3.786; IC:2.02-7.06), non-breastfeeding in the delivery room (OR = 1.780; IC:1.43-2.21), birth in a private hospital (OR = 1.695; IC:1.02-2.79), prematurity (OR = 1.656; IC:1.32-2.06) and extremes of birth weight (< 2.500 g: OR = 2.084; IC: 1.585-2.741/ ≥4,000g: OR = 1.672; IC:1.31-2.11). Teenage age (OR = 0.651; IC:0.55-0.76), low maternal education (OR = 0.579; IC:0.43-0.77), multiparity (OR = 0.588; IC:0.510-0.678), and lower economic class (OR = 0.565; IC:0.41-0.76) significantly reduced the probability of using infant formula. Conclusions Of the associated factors, the authors highlight cesarean delivery and non-breastfeeding in the delivery room, showing that it is necessary to strengthen policies that encourage good practices during childbirth care in order to promote exclusive breastfeeding and protect mothers and newborns from all social classes against the misuse of infant formula.

Fatores associados à adequação do ganho de peso gestacional de adolescentes brasileiras / Factors associated with the adequacy of gestational weight gain among Brazilian teenagers

Resumo O objetivo deste artigo é avaliar a adequação do ganho de peso gestacional total (GPT) segundo características maternas de adolescentes brasileiras. Estudo transversal e de base hospitalar. Foram incluídos 3.904 adolescentes com gestação de feto único e idade gestacional (IG) ao nascimento ≥ 37 semanas. Foi construído um modelo hierarquizado para analisar as variáveis dependentes e a adequação do GPT e das independentes: características sociodemográficas, assistenciais, obstétricas e comportamentais. As chances de GPT insuficiente foram maiores para as adolescentes do Norte (OR = 1,50; IC95%: 1,07-2,10) e Nordeste (OR = 1,68; IC95%: 1,27-2,21). O trabalho remunerado elevou as chances de GPT insuficiente (IC95%: 1,15-2,39) e excessivo (IC95%: 1,01-1,86). O índice de massa corporal pré-gestacional de sobrepeso ou obesidade associou-se ao GPT excessivo (OR = 1,86; IC95%: 1,19-2,92 e OR = 3,06; IC95%: 2,10-4,45, respectivamente), bem como a IG ≥ 42 semanas (OR = 2,23; IC95%: 1,03-4,81). Residir nas regiões Norte e Nordeste aumentou as chances de as adolescentes apresentarem GPT insuficiente. Exercer trabalho remunerado esteve associado a maior chance de GPT excessivo e insuficiente. Além disso, o sobrepeso ou obesidade pré-gestacional e IG ≥ 42 semanas ampliaram as chances de GPT excessivo.

Abstract The scope of this article is to evaluate the adequacy of total gestational weight gain (GWG) according to maternal characteristics of Brazilian adolescents. It involved a cross-sectional, hospital-based study. A total of 3,904 teenagers with a single fetus gestation and gestational age (GA) at birth ≥ 37 weeks were included. A hierarchical model was built to analyze the dependent and independent variables adequacy of GWG: sociodemographic, care, obstetric and behavioral characteristics. The chances of insufficient GWG were higher for adolescents from the North (OR = 1.50, 95%CI: 1.07-2.10) and Northeast (OR = 1.68, 95%CI: 1.27-2.21). Paid work increased the chances of insufficient (95%CI: 1.15-2.39) and excessive (95%CI: 1.01-1.86) GWG. The pre-pregnancy body mass index of overweight or obese adolescents was associated with excessive GWG (OR = 1.86, 95%CI: 1.19-2.92 and OR = 3.06, 95%CI: 2.10-4.45, respectively), as well as GA ≥ 42 weeks (OR = 2.23, 95%CI: 1.03-4.81). Living in the North and Northeast regions increases the chances of adolescents having insufficient GWG. Having paid work was associated with a greater chance of excessive and insufficient GWG. Furthermore, pre-pregnancy excess weight or obesity and GA ≥ 42 weeks increased the chances of excessive GWG.

Nutritional profile of newborns with microcephaly and factors associated with worse outcomes

OBJECTIVE: To describe the nutritional profile of newborns with microcephaly and factors associated with worse outcomes during the first 14 days of life. METHODS: This investigation is a longitudinal, descriptive study carried out in 21 full-term neonates exposed vertically to the Zika virus and hospitalized in a neonatal intensive care unit from February to September 2016. Patients receiving parenteral nutrition were excluded. Data analysis was performed using a generalized estimating equation model and Student's t-test to evaluate the association between worsening weight-for-age z-scores and independent clinical, sociodemographic and nutritional variables during hospitalization, with p<0.05 indicating significance. RESULTS: During hospitalization, there was a decrease in the mean values of the weight-for-age z-scores. The factors associated with worse nutritional outcomes were symptomatic exposure to the Zika virus, low maternal schooling, absence of maternal income and consumption of infant formula (p<0.05). Calcification and severe microcephaly were also associated with poor nutritional outcomes. Energy and macronutrient consumption remained below the recommendations and had an upward trend during hospitalization. CONCLUSION: The presence of cerebral calcification, the severity of microcephaly and symptomatic maternal exposure to Zika virus affected the nutritional status of newborns. In terms of nutritional factors, human milk intake had a positive impact, reducing weight loss in the first days of life. Other known factors, such as income and maternal schooling, were still associated with a poor nutritional status.

Assessment of factors that interfere on breastfeeding within the first hour of life.

OBJECTIVE: To investigate how the 4thStep of the Baby-Friendly Hospital Initiative was applied, assess the prevalence of breastfeeding (BF) within the first hour after birth and analyze factors associated with non-BF in this period of life. METHODS: Cross-sectional study conducted in a high-risk maternity-hospital in Rio de Janeiro City, Brazil, with interview to a sample of 403 rooming-in mothers. The prevalence ratio with its respective 95% confidence interval was estimated by the use of SPSS 15® from a model with complementary log log link function. RESULTS: The prevalence of BF in the first hour of life was 43.9%. Multivariate analysis showed that were protected against non-BF in the first hour after birth non-black women (PR = 0.62, 95% CI: 0.42-0.90), multiparous women (PR = 0.66, 95% CI: 0.47-0.93), prenatal care (PR = 0.23, 95% CI: 0.08-0.67), vaginal delivery (PR =0 .41, 95% CI: 0.28-0.60), newborn with birthweight ≥ 2,500g (PR = 0.31, 95% CI: 0.11-0.86) and women who received help from the health team to BF in the delivery room (PR = 0.51, 95% CI: 0.36-0.72). CONCLUSION: Help provided by the health team to breastfeeding at birth, Step 4 of the Baby-Friendly Hospital Initiative, as well as non black women, multiparous women, receiving pre-natal care, vaginal delivery and appropriate birthweight contributed to breastfeeding in the first hour of life.

Dietary intake of pregnant adolescents cared for in primary health care units of a brazilian urban municipality / Consumo dietético de adolescentes embarazadas atendidas en unidades de atención primaria de salud de un municipio urbano brasileño

Objective: to evaluate the adequacy of dietary intake and the anthropometric nutritional status of pregnant adolescents in the city of Niterói, Rio de Janeiro, Brazil. Materials and methods: forty-two adolescents (13-19 years of age), with single-fetus gestation, assisted in the public prenatal health care units between 2008-2014, participated in the study. Body mass index (BMI) was used to assess the nutritional status. Dietary intake was assessed by 24h dietary recalls on two days during a week and one during weekend. Basal metabolic rate was measured by indirect calorimetry and used to determine the energy requirements. Mixed effects models were used to assess dietary intake over the gestational weeks (random effect) and BMI. Results: mean age (SD) of the pregnant women was 16.5 (1.5) years and the majority received allowance from a cash transfer federal program. Overall, 30.3% were overweight/obese pre-pregnancy and 16.7%, during pregnancy. Energy and protein intake adequacies decreased with increasing BMI and gestational week. There was adequate dietary intake of energy, protein, vitamin A and zinc and insufficient intakes of iron and calcium. There was excessive intake of sodium. Conclusions: pregnant adolescents living in underprivileged socio-economic environments assisted for prenatal care in primary health care units have adequate intakes of energy, protein, vitamin A and zinc. Pre-pregnancy overweight and high sodium intake are causes of concern due to the future implications for their health. The official Brazilian recommended criterion for anthropometric assessment in pregnancy of adolescents proved to be inadequate

Objetivo: evaluar la adecuación de la ingesta dietética y el estado nutricional antropométrico de adolescentes embarazadas en Niterói, Río de Janeiro, Brasil. Materiales y métodos: participaron en el estudio 42 adolescentes de 13-19 años, con gestación de feto único, asistidas en las unidades públicas de atención prenatal entre 2008 y 2014. El índice de masa corporal (IMC) se utilizó para evaluar el estado nutricional. La ingesta dietética fue evaluada por recuerdos diarios de 24h dos días durante una semana y uno durante el fin de semana. La tasa metabólica basal se midió mediante calorimetría indirecta y se utilizó para determinar los requerimientos energéticos. Se emplearon modelos de efectos mixtos para evaluar la ingesta alimentaria durante las semanas de gestación (SG, efecto aleatorio) y el IMC. Resultados: la mayoría de las mujeres embarazadas recibían subsidios de un programa federal de Transferencia de efectivo. En general, el 30,3% tenía sobrepeso/obesidad antes del embarazo y el 16,7%, durante el embarazo. La cantidad de energía y la ingesta de proteínas disminuyeron con el aumento del IMC y la SG. Había una ingesta dietética adecuada de energía, proteínas, vitamina A y una ingesta insuficiente de hierro y calcio. Conclusiones: las adolescentes embarazadas tienen un consumo adecuado de energía, proteínas y vitamina A. El sobrepeso previo y el alto consumo de sodio son causas de preocupación debido a las implicaciones futuras para su salud. El criterio oficial brasileño recomendado para la evaluación antropométrica en el embarazo de los adolescentes demostró ser inadecuado

[Justifications for formula supplementation in low-risk newborns at a Baby-Friendly Hospital]. / Justificativas para uso de suplemento em recém-nascidos de baixo risco de um Hospital Amigo da Criança.

The Baby-Friendly Hospital Initiative recommends not giving newborn infants any food or drink other than breast milk unless medically indicated. This study investigated the prevalence and alleged reasons for giving formula supplementation to rooming-in newborns at a Baby-Friendly Hospital. Participants were 300 formula-supplemented, exclusively rooming-in newborns at a Baby-Friendly Hospital in Rio de Janeiro, Brazil. Reasons for formula supplementation were classified as acceptable or unacceptable in accordance with the WHO/UNICEF Baby-Friendly Hospital Initiative guidelines. A supplementation prevalence of 33.3% was found. The main allegations were: hypogalactia/ agalactia (36.8%), conditions involving risk of hypoglicemia (21.1%), cesarean section (7.9%), stomatognathic system-related conditions (7.4%), maternal conditions (6.3%), and absence of maternal HIV serology (4.5%). Cesarean section was associated with a higher risk of supplementation (RP = 2.1; 95%CI: 1.77-2.55) as compared to vaginal delivery. Supplementation prevalence was high, and only 9% of the allegations were justified.

Avaliacao de fatores que interferem na amamentacao na primeira hora de vida / Assessment of factors that interfere on breastfeeding within the first hour of life

Objetivo: Investigar como o passo 4 da Iniciativa Hospital Amigo da Criança foi aplicado, avaliar a prevalência da amamentação na primeira hora após o nascimento e analisar os fatores associados à não amamentação neste período de vida. Métodos: Estudo transversal conduzido em alojamento conjunto de maternidade de alto risco na cidade do Rio de Janeiro, com entrevista com amostra de 403 puérperas. A Razão de Prevalência, com seu respectivo intervalo de confiança de 95%, foi estimada a partir de modelo com função de ligação complementar log log, através do programa SPSS15® . Resultados: A prevalência de amamentação na primeira hora após o nascimento foi de 43,9%. A análise multivariada evidenciou que foram protegidas contra a não amamentação na primeira hora de vida as mulheres de cor não preta (RP = 0,62; IC 95%: 0,42-0,90), multíparas (RP = 0,66; IC 95%: 0,47-0,93), que fizeram pré-natal (RP = 0,23; IC 95%: 0,08-0,67), com parto normal (RP = 0,41; IC 95%: 0,28-0,60), cujos bebês tiveram peso ao nascer igual ou superior a 2.500g (RP = 0,31; IC 95%: 0,11-0,86) e que receberam ajuda da equipe de saúde para amamentar na sala de parto (RP = 0,51; IC 95%: 0,36-0,72). Conclusão: A ajuda prestada pela equipe de saúde à amamentação ao nascimento, que se constitui no “Passo 4 da Iniciativa Hospital Amigo da Criança”, bem como a cor materna não preta, a multiparidade, a realização de pré-natal, o parto normal e o peso adequado ao nascer contribuíram para o inicio do aleitamento materno na primeira hora de vida. .

Objective: To investigate how the 4thStep of the Baby-Friendly Hospital Initiative was applied, assess the prevalence of breastfeeding (BF) within the first hour after birth and analyze factors associated with non-BF in this period of life. Methods: Cross-sectional study conducted in a high-risk maternity-hospital in Rio de Janeiro City, Brazil, with interview to a sample of 403 rooming-in mothers. The prevalence ratio with its respective 95% confidence interval was estimated by the use of SPSS 15® from a model with complementary log log link function. Results: The prevalence of BF in the first hour of life was 43.9%. Multivariate analysis showed that were protected against non-BF in the first hour after birth non-black women (PR = 0.62, 95% CI: 0.42-0.90), multiparous women (PR = 0.66, 95% CI: 0.47-0.93), prenatal care (PR = 0.23, 95% CI: 0.08-0.67), vaginal delivery (PR =0 .41, 95% CI: 0.28-0.60), newborn with birthweight ≥ 2,500g (PR = 0.31, 95% CI: 0.11-0.86) and women who received help from the health team to BF in the delivery room (PR = 0.51, 95% CI: 0.36-0.72). Conclusion: Help provided by the health team to breastfeeding at birth, Step 4 of the Baby-Friendly Hospital Initiative, as well as non black women, multiparous women, receiving pre-natal care, vaginal delivery and appropriate birthweight contributed to breastfeeding in the first hour of life. .

Body mass index and waist circumference as markers of arterial hypertension in adolescents.

OBJECTIVE: To evaluate the sensitivity and specificity of anthropometric measurements of body fat in a sample of Brazilian adolescents for the prediction of hypertension. METHODS: The arterial blood pressure was measured on two visits in a sample of 456 students aged 12 to 17 years, from public and private schools of the Fonseca neighborhood, in Niterói, between 2003 and 2004. A subject was defined as hypertensive if he/she had systolic and diastolic pressures above the 95th percentile for sex, age and height. A questionnaire was applied and Body Mass Index (BMI) and waist circumference (WC) measurements were made. RESULTS: A statistically significant correlation was observed between hypertension and the cutoff points considered unfavorable, both for BMI and WC. The greatest association was with the cutoff point proposed for the Brazilian population. As to the BMI sensitivity used for American Black or White populations or for the Brazilian population, we found 52.4% to 57.1% and 52.4%, respectively. And BMI specificity was 69.3%, 70.0% and 80.88%, respectively. The sensitivity found in our sample, relative to the cutoff points for WC proposed for all American ethnic groups, was also low (45.0%) and specificity was a little higher (77.6% and 74.5%, respectively). CONCLUSION: Existing American WC measurements showed low sensitivity and specificity for hypertension in our population. As to BMI, the available cutoff points also showed a low level of sensitivity. There is a need to establish body fat cutoff points that can provide a better prediction of cardiovascular risk.