Anaemia and iron deficiency associate with polymorphism TMPRSS6 rs855791 in Brazilian children attending day care centres.

Fe-deficiency anaemia is a major public health concern in children under 5 years of age. TMPRSS6 gene, encoding matriptase-2 protein, is implicated in Fe homoeostasis and has been associated with anaemia and Fe status in various populations. The aim of this cross-sectional study was to investigate the associations between the single nucleotide polymorphism (SNP) TMPRSS6 rs855791 and biomarkers of anaemia and Fe deficiency in Brazilian children attending day care centres. A total of 163 children aged 6-42 months were evaluated. Socio-economic, demographic, biochemical, haematological, immunological and genotype data were collected. Multiple logistic and linear regressions with hierarchical selection were used to assess the effects of independent variables on categorised outcomes and blood marker concentrations. Minor allele (T) frequency of rs855791 was 0·399. Each copy of the T allele was associated with a 4·49-fold increased risk of developing anaemia (P = 0·005) and a 4·23-fold increased risk of Fe deficiency assessed by serum soluble transferrin receptor (sTfR) (P < 0·001). The dose of the T allele was associated with an increase of 0·18 mg/l in sTfR concentrations and reductions of 1·41 fl and 0·52 pg in mean corpuscular volume (MCV) and mean corpuscular haemoglobin (MCH), respectively. In conclusion, the T allele of SNP TMPRSS6 rs855791 was significantly associated with anaemia and Fe deficiency assessed by sTfR in Brazilian children attending day care centres. The effect was dose dependent, with each copy of the T allele being associated with lower MCV and MCH and higher concentrations of sTfR.

Characterization of micronutrient supplements use by Brazilian children 6-59 months of age: Brazilian National Survey on Child Nutrition (ENANI-2019) / Caracterização do uso de suplementos de micronutrientes por crianças brasileiras de 6-59 meses de idade: Estudo Nacional de Alimentação e Nutrição Infantil (ENANI-2019) / Caracterización del uso de suplementos de micronutrientes por niños brasileños de 6-59 meses de edad: Estudio Nacional de Alimentación y Nutrición Infantil (ENANI-2019)

This study aimed to characterize micronutrient supplements use among Brazilian children 6-59 months of age included in the Brazilian National Survey on Child Nutrition (ENANI-2019; n = 12,598). Micronutrient supplements use at the time of the interview and the 6 months prior to it was evaluated using a structured questionnaire. The following indicators were included: micronutrient supplement use; supplements containing a single micronutrient; supplements of the Brazilian National Iron Supplementation Program (PNSF); multivitamin supplements with or without minerals; multivitamin supplements with minerals; multivitamin supplements without minerals. The estimates and their respective 95% confidence intervals (95%CI) were calculated for Brazil and according to macroregion, educational level of the mother or caregiver, and type of health care service used, considering the sampling plan, weights, and calibration. In Brazil, the prevalence of micronutrient supplements use was 54.2% (95%CI: 50.5; 57.8), with the highest prevalence in the North Region (80.2%; 95%CI: 74.9; 85.6) and among children 6-23 months of age (69.5%; 95%CI: 65.7; 73.3). The prevalence of the use of supplements containing exclusively iron and exclusively vitamin A in Brazil was 14.6% (95%CI: 13.1; 16.1) and 23.3% (95%CI: 19.4; 27.1), respectively. The prevalence of the use of multivitamin with or without minerals in Brazilian children 6-59 months of age was 24.3% (95%CI: 21.4; 27.2). These results may help to understand the practice of supplements use among Brazilian children and support the proposal of national public policies for the prevention and control of micronutrient deficiencies.

O objetivo deste estudo foi caracterizar o uso de suplementos de micronutrientes entre crianças brasileiras de 6-59 meses de idade incluídas no Estudo Nacional de Alimentação e Nutrição Infantil (ENANI-2019; n = 12.598). O uso de suplementos de micronutrientes no momento da entrevista e nos seis meses anteriores foi avaliado por meio de um questionário estruturado. Foram incluídos os seguintes indicadores: uso de suplemento de micronutrientes; suplementos contendo um único micronutriente; suplemento do Programa Nacional de Suplementação de Ferro (PNSF); suplementos multivitamínicos com ou sem minerais; suplementos multivitamínicos com minerais; suplementos multivitamínicos sem minerais. As estimativas pontuais e seus respectivos intervalos de 95% de confiança (IC95%) foram calculados para o Brasil e de acordo com a macrorregião, a escolaridade da mãe ou cuidadora e o tipo de serviço de saúde utilizado, considerando o plano, os pesos e a calibração amostral. No Brasil, a prevalência de uso de suplemento de micronutrientes foi de 54,2% (IC95%: 50,5; 57,8), com maior prevalência na Região Norte (80,2%; IC95%: 74,9; 85,6) e entre crianças de 6-23 meses de idade (69,5%; IC95%: 65,7; 73,3). A prevalência do uso de suplementos contendo apenas ferro e apenas vitamina A no Brasil foi de 14,6% (IC95%: 13,1; 16,1) e 23,3% (IC95%: 19,4; 27,1), respectivamente. A prevalência de uso de multivitamínicos com ou sem minerais em crianças brasileiras de 6-59 meses de idade foi de 24,3% (IC95%: 21,4; 27,2). Esses resultados podem auxiliar na compreensão da prática do uso de suplementos entre crianças brasileiras e apoiar a proposta de políticas públicas nacionais de prevenção e controle de deficiências de micronutrientes.

El objetivo de este estudio fue caracterizar el uso de suplementos de micronutrientes entre niños brasileños con edades entre 6-59 meses incluidos en el Estudio Nacional de Alimentación y Nutrición Infantil (ENANI-2019; n = 12.598). El uso de suplementos de micronutrientes en el momento de la entrevista y en los seis meses anteriores se evaluó mediante un cuestionario estructurado. Se incluyeron los siguientes indicadores: uso de suplementos de micronutrientes; suplementos que contienen un solo micronutriente; suplemento del Programa Nacional de Suplementación con Hierro (PNSF); suplementos multivitamínicos con o sin minerales; suplementos multivitamínicos con minerales; suplementos multivitamínicos libres de minerales. Se calcularon las estimaciones puntuales para Brasil y sus respectivos intervalos del 95% de confianza (IC95%) de acuerdo con la macrorregión, el nivel educativo de la madre/cuidador y el tipo de servicio de salud utilizado, considerando el plan, los pesos y la calibración de la muestra. En Brasil, la prevalencia del uso de suplementos de micronutrientes fue del 54,2% (IC95%: 50,5; 57,8), con mayor prevalencia en la Región Norte (80,2%; IC95%: 74,9; 85,6) y entre niños con edades entre 6-23 meses (69,5%; IC95%: 65,7; 73,3). Las prevalencias del uso de suplementos que contienen solo hierro o solo vitamina A en Brasil fueron del 14,6% (IC95%: 13,1; 16,1) y del 23,3% (IC95%: 19,4; 27,1), respectivamente. La prevalencia de uso de multivitamínicos con o sin minerales en niños brasileños de 6-59 meses de edad fue del 24,3% (IC95%: 21,4; 27,2). Estos resultados pueden ayudar a comprender la práctica de uso de suplementos entre los niños brasileños y apoyar la propuesta de políticas públicas para la prevención y control de la carencia de micronutrientes.

Nutrition transition in Brazilian children under 5 years old from 2006 to 2019 / Transição nutricional em crianças brasileiras menores de 5 anos de idade entre 2006 e 2019 / Transición nutricional en niños brasileños menores de 5 años de edad entre 2006 y 2019

Abstract: This manuscript aims to report the nutrition transition in Brazilian children under 5 years old from 2006 to 2019. Microdata from the Brazilian National Survey on Demography and Health of Women and Children (PNDS 2006) and the Brazilian National Survey on Child Nutrition (ENANI-2019) were analyzed. The indicators considered were: micronutrient status (anemia and vitamin A deficiency), anthropometric status (stunting and excessive weight), and breastfeeding practice (exclusive breastfeeding among children < 6 months and continued breastfeeding among children 12-23 months). We also analyzed minimum dietary diversity (MDD), consumption of ultra-processed foods, consumption of meat or eggs, and not consuming fruits or vegetables in children 6-59 months of age only for ENANI-2019. Equiplot charts were generated according to geographic region, maternal schooling level, and maternal race/skin color. From 2006 to 2019, the prevalence rates of anemia and vitamin A deficiency decreased from 20.5% to 10.1% and 17.2% to 6%, respectively. The prevalence of stunting remained at 7%, and excessive weight rates increased from 6% to 10.1%. The prevalence of exclusive breastfeeding among children < 6 months increased from 38.6% to 45.8%, and of continued breastfeeding among children 12-23 months from 34.6% to 43.6%. In 2019, 61.5% of children achieved the MDD, 88.8% consumed ultra-processed foods, 83.1% consumed meat or egg, and 25.7% did not consume fruits or vegetables the day before the survey. Trends of decreased micronutrient deficiencies, increased breastfeeding, and excessive weight rates, as well as reductions in disparities related to geographic region, maternal schooling level, and maternal race/skin color, were observed for most of the indicators.

Resumo: Buscamos reportar a transição nutricional em crianças brasileiras menores de 5 anos de idade entre 2006 e 2019. Foram analisados microdados da Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher (PNDS 2006) e do Estudo Nacional de Alimentação e Nutrição Infantil (ENANI-2019). Foram considerados os seguintes indicadores: status de micronutrientes (anemia e deficiência de vitamina A), estado nutricional antropométrico (excesso de peso e baixa estatura) e a prática de aleitamento materno (aleitamento materno exclusivo entre crianças < 6 meses e aleitamento materno continuado entre crianças de 12-23 meses). Analisamos a diversidade alimentar mínima (DAM), o consumo de alimentos ultraprocessados, de carne ou ovos e o não consumo de frutas ou hortaliças apenas para o ENANI-2019 em crianças de 6-59 meses de idade. Equiplots foram gerados de acordo com a região geográfica, escolaridade e raça/cor da pele maternas. Entre 2006 e 2019, as prevalências de anemia e deficiência de vitamina A diminuíram de 20,5% para 10,1% e de 17,2% para 6%, respectivamente. A prevalência de déficit de estatura manteve-se em 7% e a de excesso de peso aumentou de 6% para 10,1%. A prevalência de aleitamento materno exclusivo entre crianças < 6 meses aumentou de 38,6% para 45,8% e a de aleitamento materno continuado entre crianças de 12-23 meses aumentou de 34,6% para 43,6%. Em 2019, 61,5% das crianças atingiram a DAM, 88,8% consumiram alimentos ultraprocessados, 83,1% consumiram carne ou ovos e 25,7% não consumiram frutas ou hortaliças no dia anterior à pesquisa. Observamos tendências de diminuição das deficiências de micronutrientes, aumento do aleitamento materno e excesso de peso e reduções em disparidades regional, de escolaridade e de raça/cor da pele maternas para a maioria dos indicadores.

Resumen: Buscamos informar sobre la transición nutricional en niños brasileños menores de 5 años entre 2006 y 2019. Se analizaron microdatos de la Encuesta Nacional de Demografía y Salud del Niño y de la Mujer (PNDS 2006) y del Encuesta Nacional de Alimentación Nutrición Infantil (ENANI-2019). Se consideraron los siguientes indicadores: estado de micronutrientes (anemia y deficiencia de vitamina A), estado nuricional antropométrico (sobrepeso y baja estatura) y la práctica de la lactancia materna (lactancia materna exclusiva en niños < 6 meses y lactancia materna continua entre niños de 12-23 meses) como indicadores. Analizamos la diversidad dietética mínima (DDM), el consumo de alimentos ultraprocesados, carne o huevos, y el no consumo de frutas o verduras solo para ENANI-2019 en niños de 6-59 meses de edad. Se generaron equiplots en función de la región geográfica, la educación y raza/color de la piel de la madre. Entre 2006 y 2019, las prevalencias de anemia y deficiencia de vitamina A disminuyeron del 20,5% al 10,1% y del 17,2% al 6%, respectivamente. La prevalencia del déficit de estatura se mantuvo en el 7 % y la de sobrepeso aumentó del 6% al 10,1%. La prevalencia de lactancia materna exclusiva en niños < 6 aumentó del 38,6% al 45,8% y la de lactancia materna continua entre niños de 12-23 meses aumentó del 34,6% al 43,6%. En 2019, el 61,5% de los niños alcanzaron DDM, el 88,8% consumieron alimentos utraprocesados, el 83,1% consumieron carne o huevos y el 25,7% no consumieron frutas o verduras el día anterior a la encuesta. Observamos tendencias de disminución de las deficiencias de micronutrientes, un aumento de la lactancia materna y sobrepeso y reducciones en las disparidades regionales, de escolaridad y de raza/color de la piel de la madre para la mayoría de los indicadores.

Prevalência da disfagia no doente renal crônico com diabetes em serviço de hemodiálise em um hospital público / Prevalence of dysphagia in chronic renal patients with diabetes on hemodialysis in a public hospital

A Doença Renal Crônica (DRC) é caracterizada como uma alteração estrutural e/ou funcional dos rins que leva à redução da taxa de filtração glomerular. No Brasil, a hipertensão arterial é a principal doença de base associada à DRC, seguida pelo diabetes mellitus (DM). É admitido que pacientes com DRC possam apresentar alterações nos sistemas e estruturas relacionadas à deglutição, devido a modificações provocadas pelo tratamento ou pela falta dele. Objetivo: Estimar a prevalência de disfagia em pessoas com doença renal crônica em tratamento de hemodiálise e com diabetes, além de verificar os fatores Associados. Método: Trata-se de um estudo transversal, descritivo e de caráter quantitativo, realizado através da aplicação do protocolo GUGGING SWALLOWING SCREEN (GUSS) em indivíduos com doença renal crônica e diabetes em tratamento de hemodiálise, internados no Hospital Estadual Dr. Alberto Rassi (HGG). Participaram do estudo 26 indivíduos, com uma mediana de idade de 62 anos (IQR: 57-67). Observou-se maior frequência do sexo masculino, representando 73% dos participantes. Durante os testes de deglutição, os participantes apresentaram maior dificuldade na deglutição com a consistência sólida, onde 61,54% tiveram deglutição atrasada e 34,62% apresentaram tosse involuntária durante a ingesta. A pontuação média no protocolo GUSS foi de 19 pontos (IQR: 18-20), indicando uma ligeira disfagia nos indivíduos, com baixo risco de broncoaspiração. Pacientes doentes renais crônicos com diabetes, em tratamento de hemodiálise no HGG, apresentaram baixa frequência de disfagia, com risco mínimo de broncoaspiração, de acordo com o protocolo GUSS.

Chronic Kidney Disease (CKD) is considered a structural and/or functional alteration of the kidneys that contributes to the reduction of the glomerular filtration rate. In Brazil, arterial hypertension remains the main underlying disease of CKD, followed by diabetes mellitus (DM). It is accepted that patients with CKD may present alterations in the systems and structures that are related to swallowing, due to changes caused by the treatment or the lack of it. Objective: To estimate the prevalence of dysphagia in people with chronic kidney disease on hemodialysis and with diabetes and to verify associated factors. Method: This is a cross-sectional, descriptive, quantitative study, with the result of the application of the GUGGING SWALLOWING SCREEN (GUSS) protocol in individuals with chronic kidney disease and diabetes undergoing hemodialysis treatment, admitted to Hospital Estadual Dr. Alberto Rassi (HGG). 26 individuals participated in the study. The median age observed in this sample was 62 years (IQR:57-67), with a higher frequency of males, 73%. In swallowing tests, participants had greater difficulty in swallowing with solid consistency, in which 61.54% had delayed swallowing and 34.62% had involuntary coughing during ingestion. In the GUSS protocol, the average score was 19 points (IQR: 18-20), which means slight dysphagia in individuals with a low risk of broncho-aspiration. Chronic kidney disease patients with diabetes undergoing hemodialysis treatment at HGG, who live with diabetes, had a low frequency of dysphagia, with minimal risk of broncho-aspiration, according to the GUSS protocol

Factors associated with anemia and vitamin A deficiency in Brazilian children under 5 years old: Brazilian National Survey on Child Nutrition (ENANI-2019) / Fatores associados à anemia e deficiência de vitamina A em crianças brasileiras menores de cinco anos: Estudo Nacional de Alimentação e Nutrição Infantil (ENANI-2019) / Factores asociados con la anemia y la deficiencia de vitamina A en niños brasileños menores de cinco años: Estudio Nacional de Alimentación y Nutrición Infantil (ENANI-2019)

Abstract: Factors associated with anemia and vitamin A deficiency were investigated in 7,716 children 6-59 months of age studied in the Brazilian National Survey on Child Nutrition (ENANI-2019). We adopted a hierarchical approach based on a United Nations Children's Fund (UNICEF) theoretical model with three levels, stratifying by age (6-23; 24-59 months). Prevalence ratio (PR) and 95% confidence interval (95%CI) were estimated. Enabling determinants: a higher prevalence of anemia was observed in children 6-23 months whose mothers had ≤ 7 years of schooling (PR = 1.92; 95%CI: 1.10; 3.34), < 20 years old (PR = 2.47; 95%CI: 1.34; 4.56) or 20-30 years old (PR = 1.95; 95%CI: 1.11; 3.44), mixed-race (PR = 1.57; 95%CI: 1.06; 2.23); and in children 24-59 months in the North Region (PR = 3.11; 95%CI: 1.58; 6.13). A higher prevalence for vitamin A deficiency was observed in children 6-23 months from Central-West (PR = 2.32; 95%CI: 1.33; 4.05), and in children 24-59 months living in the North (PR = 1.96; 95%CI: 1.16; 3.30), South (PR = 3.07; 95%CI: 1.89; 5.01), and Central-West (PR = 1.91; 95%CI: 1.12; 3.25) and whose mothers were 20-34 years (PR = 1.62; 95%CI: 1.11; 2.35). Underlying determinants: the presence of more than one child < 5 years old in the household was associated with a higher prevalence of anemia (PR = 1.61; 95%CI: 1.15; 2.25) and vitamin A deficiency (PR = 1.82; 95%CI: 1.09; 3.05) in children 6-23 months. Immediate determinants: consumption of 1-2 groups of ultra-processed foods in children 24-59 months (PR = 0.44; 95%CI: 0.25; 0.81) and lack of breastfeeding in the day before in children 6-23 months (PR = 0.56; 95%CI: 0.36; 0.95) were associated with lower prevalence of anemia and vitamin A deficiency. Public policies focused on geographically and socially vulnerable groups are needed to promote equity.

Resumo: Fatores associados a anemia e deficiência de vitamina A foram investigados em 7.716 crianças de 6-59 meses de idade parte da Estudo Nacional de Alimentação e Nutrição Infantil (ENANI-2019). Adotamos uma abordagem hierárquica baseada em um modelo teórico do Fundo das Nações Unidas para a Infância (UNICEF) com três níveis estratificados por idade (6-23; 24-59 meses). Foram estimadas razões de prevalência (RP) e intervalos de 95% de confiança (IC95%). Determinantes habilitadores: observamos maior prevalência de anemia em crianças de 6-23 meses de idade cujas mães tinham ≤ 7 anos de escolaridade (RP = 1,92; IC95%: 1,10; 3,34), < 20 anos de idade (RP = 2,47; IC95%: 1,34; 4,56) ou 20-30 anos de idade (RP = 1,95; IC95%: 1,11; 3,44), cor parda (RP = 1,57; IC95%: 1,06; 2,23); e em crianças de 24-59 meses de idade na Região Norte (RP = 3,11; IC95%: 1,58; 6,13). Encontramos maior prevalência de deficiência de vitamina A em crianças de 6-23 meses de idade no Centro-oeste (RP = 2,32; IC95%: 1,33; 4,05) e em crianças de 24-59 meses de idade residentes nas regiões Norte (RP = 1,96; IC95%: 1,16; 3,30), Sul (RP = 3,07; IC95%: 1,89; 5,01) e Centro-oeste (RP = 1,91; IC95%: 1,12; 3,25) cujas mães tinham entre 20-34 anos de idade (RP = 1,62; IC95%: 1,11; 2,35). Determinantes subjacentes: a presença de mais de uma criança < 5 anos de idade no domicílio se associou a maior prevalência de anemia (RP = 1,61; IC95%: 1,15; 2,25) e deficiência de vitamina A (RP = 1,82; IC95%: 1,09; 3,05) em crianças de 6-23 meses de idade. Determinantes imediatos: o consumo de 1-2 grupos de alimentos ultraprocessados em crianças de 24-59 meses de idade (RP = 0,44; IC95%: 0,25; 0,81) e o não aleitamento materno no dia anterior em crianças de 6-23 meses de idade (RP = 0,56; IC95%: 0,36; 0,95) foram associados com a menor prevalência de anemia e deficiência de vitamina A. Políticas públicas focadas em grupos geográfica e socialmente vulneráveis são necessárias para promover equidade.

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Cross-breastfeeding and milk donation in Brazil / Amamentação cruzada e a doação de leite no Brasil / Lactancia materna cruzada y donación de leche en Brasil

Abstract: The objective of this study was to describe the frequency of cross-breastfeeding, human milk donation to human milk banks and reception of human milk from human milk banks, and to investigate the intersection between cross-breastfeeding and breast milk donation practices. This study used data from the national household-based survey Brazilian National Survey on Child Nutrition (ENANI-2019), which collected information from 14,558 children < 5 years old between February 2019 and March 2020. The present study included data from 5,831 biological mothers who reported having breastfed their child < 2 years old at least once and replied questions about cross-breastfeeding, donation and recaption of human milk to human milk banks. Prevalence and 95% confidence intervals (95%CI) were estimated for each stratifier, considering the study complex sample design. Among mothers of children < 2 years old who breastfed their child at least once, 21.1% practiced cross-breastfeeding; breastfeeding another child was more frequent (15.6%) than allowing a child to be breastfed by another woman (11.2%). Among this population, 4.8% of women donated human milk to a human milk bank, and 3.6% reported that their children had received donated human milk. The donation of human milk is a practice recommended by the Brazilian Ministry of Health and has the potential to save thousands of newborns throughout Brazil. In contrast, cross-breastfeeding is contraindicated due to the potential risk of transmitting HIV. There is a need for a broad debate on these practices in Brazil and worldwide.

Resumo: O objetivo deste estudo foi descrever a frequência de amamentação cruzada, doação de leite humano para bancos de leite humano e recepção de leite humano dos bancos de leite humano, além de investigar a interseção entre práticas de amamentação cruzada e a doação de leite materno. Este estudo utilizou dados do Estudo Nacional de Alimentação e Nutrição Infantil (ENANI-2019), uma pesquisa populacional de base domiciliar que coletou informações de 14.558 crianças < 5 anos entre fevereiro de 2019 e março de 2020. Dados de 5.831 mães biológicas que relataram ter amamentado seu filho com menos de dois anos de idade pelo menos uma vez e que responderam às perguntas sobre amamentação cruzada, doação e recepção de leite humano nos bancos de leite humano foram inclusos. Foram estimados as prevalências e os intervalos de 95% de confiança (IC95%) para cada estratificador, considerando o desenho amostral complexo do estudo. Entre as mães de crianças com menos de dois anos que amamentaram o filho pelo menos uma vez, 21,1% praticaram a amamentação cruzada. Amamentar outra criança foi mais frequente (15,6%) do que permitir que a sua criança fosse amamentada por outra mulher (11,2%). Entre essas mulheres, 4,8% doaram leite humano para um bancos de leite humano e 3,6% relataram que seus filhos receberam leite humano doado. A doação de leite humano é uma prática recomendada pelo Ministério da Saúde e tem o potencial de salvar milhares de recém-nascidos em todo o Brasil. Em contraste, a amamentação cruzada é contraindicada devido ao risco potencial de transmissão do HIV. Há necessidade de um amplo debate sobre essas práticas no Brasil e no mundo.

Resumen: El objetivo de este estudio fue describir la frecuencia de lactancia materna cruzada, la donación de leche humana a los bancos de leche humana y la recepción de leche humana de los bancos de leche humana, además de investigar la intersección entre las prácticas de lactancia materna cruzada y la donación de leche materna. Este estudio utilizó datos del Estudio Nacional de Alimentación y Nutrición Infantil (ENANI-2019), una encuesta nacional de hogares que recopiló información de 14.558 niños < 5 años, en el periodo entre febrero de 2019 y marzo de 2020. Se incluyeron datos de 5.831 madres biológicas que reportaron haber amamantado a su hijo < 2 años, al menos una vez, y que respondieron preguntas sobre lactancia cruzada, donación y recepción de leche humana en los bancos de leche humana. Se estimaron prevalencias y los intervalos de 95% de confianza (IC95%) para cada estrato, considerando el diseño muestral complejo del estudio. Entre las madres de niños < 2 años que amamantaron a su hijo al menos una vez, el 21,1% practicaba la lactancia cruzada. Amamantar a otro hijo fue más frecuente (15,6%) que dejar que su hijo sea amamantado por otra mujer (11,2%). Entre estas mujeres, el 4,8% donó leche humana a un bancos de leche humana y el 3,6% informó que sus hijos recibieron leche humana donada. La donación de leche humana es una práctica recomendada por el Ministerio de Salud brasileño y puede salvar muchos recién nacidos en todo Brasil. Por el contrario, la lactancia cruzada está contraindicada debido al potencial riesgo de transmisión del VIH. Es necesario un amplio debate sobre estas prácticas en Brasil y en el mundo.

Minimum dietary diversity and consumption of ultra-processed foods among Brazilian children 6-23 months of age / Diversidade alimentar mínima e o consumo de alimentos ultraprocessados em crianças brasileiras de 6-23 meses / Diversidad alimentaria mínima y consumo de alimentos ultraprocesados en niños brasileños de 6-23 meses de edad

Abstract: The study aimed to estimate the prevalence of minimum dietary diversity (MDD) and consumption of ultra-processed foods in children 6-23 months of age according to sociodemographic variables. Three indicators of complementary feeding of 4,354 children from the Brazilian National Survey on Child Nutrition (ENANI-2019) were built based on a questionnaire about food consumption on the day before the interview: MDD, consumption of ultra-processed foods, and MDD without the consumption of ultra-processed foods. The prevalence and 95%CI were calculated, stratified by macroregion; race/skin color, education and work status of the mother or caregiver; enrollment in the Brazilian Income Transfer Program; household food security; sanitation; and child enrollment in daycare/school. The overall prevalence of MDD was 63.4%, with lower prevalences among children who lived in the North Region (54.8%), whose mothers or caregivers had 0-7 years of education (50.6%), and lived under moderate or severe food insecurity (52.6%). Ultra-processed foods were consumed by 80.5% of the children, with the highest prevalence in the North Region (84.5%). The prevalence of MDD without ultra-processed foods was 8.4% and less prevalent among children with black mothers or caregivers (3.6%) and among those whose mother or caregiver had 8-10 years of education (3.6%). The most frequently consumed food groups from the MDD indicator were grains, roots and tubers (90.2%), dairy products (81%) and those from ultra-processed food were sweet or salty cookies/crackers (51.3%) and instant flours (41.4%). The ubiquitous presence of ultra-processed foods in the diets of Brazilian children and the low frequency of diversified foods, especially among the most vulnerable populations, indicate the need to strengthen policies and programs to ensure adequate and healthy infant nutrition.

Resumo: O objetivo do estudo foi estimar a prevalência de diversidade alimentar mínima (DAM) e consumo de alimentos ultraprocessados em crianças de 6-23 meses de acordo com variáveis sociodemográficas. Três indicadores de alimentação complementar de 4.354 crianças do Estudo Nacional de Alimentação e Nutrição Infantil (ENANI-2019) foram construídos com base em um questionário sobre o consumo alimentar do dia anterior à entrevista: DAM, consumo de alimentos ultraprocessados e DAM sem consumo de alimentos ultraprocessados. Foram calculadas as prevalências e IC95%, estratificados por macrorregião; raça/cor da pele, escolaridade e situação profissional da mãe ou cuidador; inscrição no Programa Bolsa Família; segurança alimentar do domicílio; saneamento; e matrícula da criança em creche/escola. A prevalência geral de DAM foi de 63,4%, com menores prevalências entre crianças que residiam na Região Norte (54,8%), cujas maẽs ou cuidadores tinham de 0-7 anos de estudo (50,6%) e entre aquelas que viviam em situação de insegurança alimentar moderada ou grave (52,6%). Os alimentos ultraprocessados foram consumidos por 80,5% das crianças, com maior prevalência na Região Norte (84,5%). A prevalência de DAM sem alimentos ultraprocessados foi de 8,4%, sendo menos prevalente entre crianças cuja mãe ou cuidador era negro (3,6%) e entre aquelas cuja mãe ou cuidador tinha 8-10 anos de estudo (3,6%). Os grupos de alimentos do indicador DAM mais consumidos foram os cereais, raizes e tubérculos (90,2%), os derivados do leite (81%) e os dos alimentos ultraprocessados foram os biscoitos (51,3%) e os cereais instantâneos (41,4%). A onipresença de alimentos ultraprocessados na alimentação das crianças brasileiras e a baixa frequência de diversidade alimentar, especialmente entre as populações mais vulneráveis, indicam a necessidade de fortalecer políticas e programas para garantir uma nutrição infantil adequada e saudável.

Resumen: El objetivo del estudio fue estimar la prevalencia de diversidad alimentaria mínima (DDM) y consumo de alimentos ultraprocesados en niños de 6-23 meses según variables sociodemográficas. Se construyeron tres indicadores de alimentación complementaria de 4.354 niños de el Estudio Nacional de Alimentación y Nutrición Infantil (ENANI-2019) a partir de un cuestionario sobre el consumo de alimentos el día anterior a la entrevista: DDM, consumo de alimentos ultraprocesados y DDM sin consumo de alimentos ultraprocesados. Se calcularon la prevalencia y los IC95%, estratificados por macrorregión; raza/color de piel, situación educativa y laboral de la madre o cuidador; inscripción al Programa Bolsa Familia; seguridad alimentaria del hogar; saneamiento; e inscripción de niños en guarderías/escuelas. La prevalencia general de DDM fue del 63,4%, con prevalencias menores entre los niños que vivían en la Región Norte (54,8%), cuyas madres o cuidadores tenían entre 0-7 años de escolaridad (50.6%) y los que vivían en inseguridad alimentaria moderada o grave (52,6%). Los alimentos ultraprocesados fueron consumidos por el 80,5% de los niños, con mayor prevalencia en la Región Norte (84,5%). La prevalencia de DDM sin alimentos ultraprocesados fue del 8,4%, siendo menos prevalente entre niños de padres negros (3,6%) y con 8-10 años de escolaridad (3,6%). Los grupos de alimentos más consumidos del indicador DDM fueron los granos, raíces y tubérculos (90,2%), y los productos lácteos (81%) y los de alimentos ultraprocesados fueron las galletas (51,3%) y los cereales instantáneos (41,4%). La presencia ubicua de alimentos ultraprocesados en las dietas de los niños brasileños y la baja frecuencia diversidad dietética, especialmente entre las poblaciones más vulnerables, indican la necesidad de fortalecer políticas y programas para garantizar una nutrición infantil adecuada y saludable.

Baru nuts reduce abdominal adiposity in type 2 diabetic adults: a randomized, placebo-controlled, crossover trial / Amêndoa de baru reduz a adiposidade abdominal de adultos com diabetes Mellitus tipo 2: um estudo randomizado, placebo-controlado, crossover

ABSTRACT Objective: This study aimed to evaluate the effect of baru nuts supplementation on body composition and metabolic profile in adults with type 2 diabetes. Methods: This is a randomized, placebo-controlled, crossover trial with 30 adults with type 2 diabetes. The assay had two periods of 12 weeks each, with a washout period of 12 weeks between treatments. The subjects were randomized and received the two treatments in alternate periods: supplementation of 30g baru nuts or placebo. Anthropometry, body composition, blood pressure, blood sampling, food intake, and physical activity data were analyzed. Results: Baru nut intake reduced waist circumference (p=0.032), compared to placebo group. In the intra-group analysis, baru nut intake reduced total cholesterol (p=0.012) and LDL-c (p=0.017). Conclusion: The daily intake of baru nuts improved abdominal adiposity. Therefore, these nuts should be included in the diet to improve the health status of adults with type 2 diabetes.

RESUMO: Objetivo: Avaliar o efeito da suplementação com amêndoa de baru sobre a composição corporal e perfil metabólico de adultos com diabetes Mellitus tipo 2. Métodos: Este é um estudo randomizado, placebo-controlado, crossover com 30 adultos com diabetes Mellitus tipo 2. O ensaio clínico foi dividido em dois períodos de 12 semanas cada, com um washout de 12 semanas entre os tratamentos. Os sujeitos foram randomizados e receberam dois tratamentos em períodos alternativos: suplementação com 30 g de amêndoa de baru ou placebo. Foram coletados dados referentes à antropometria, composição corporal, pressão arterial, amostras de sangue, ingestão de alimentos e práticas de atividade física. Resultados: A ingestão de amêndoa de baru reduziu a circunferência da cintura (p=0,032), em comparação com o grupo placebo. Na análise intragrupo, a ingestão de amêndoa de baru também reduziu o colesterol total (p=0,012) e LDL-c (p=0,017). Conclusão: A ingestão diária de amêndoa de baru melhorou a adiposidade abdominal, portanto, deve ser incluída na dieta para a melhora do estado de saúde de adultos com diabetes Mellitus tipo 2.

Efeito de uma ação de aconselhamento nutricional, com uso de rede social, no enfrentamento à obesidade / Effect of a nutritional counseling activities, by using a social network, in coping with obesity

Estratégias inovadoras precisam ser adotadas para o combate à crescente prevalência de obesidade. Assim, o objetivo desse trabalho é avaliar o efeito de uma ação de aconselhamento nutricional com uso de rede social no enfrentamento à obesidade. Este é um estudo experimental do tipo antes e depois, incluindo 60 indivíduos com excesso de peso e adscritos a uma Unidade Básica de Saúde. Foi realizado de junho-outubro de 2020. As ações educativas (compartilhamento de informações sobre alimentação saudável e saúde e pactuação de desafios) foram realizadas pelo aplicativo WhatsApp®, semanalmente, por 16 semanas. Foram coletadas informações sociodemográficas, econômicas, clínicas, antropométricas, sobre consumo alimentar e exames bioquímicos. Os dados foram comparados por teste de Wilcoxon ou Kappa. A maioria dos participantes era do sexo feminino e 36,4% com diagnóstico de hipertensão. Após a intervenção, verificou-se redução de circunferência da cintura (antes:107,3±11,4; depois:105,6±11,5 cm, p=0,004), colesterol total (antes:205,9±48,3; depois:191,5±34,3 mg/dL, p<0,001) e LDL-c (antes:132,4±37,8; depois:120,2±29,3 mg/dL, p<0,001). A ação foi capaz de promover reduções de marcadores corporais de obesidade e de descompensações metabólicas associadas a obesidade, demonstrando a importância de intervenções inovadoras que possam somar a outras intervenções e facilitar a adesão do público.

Innovative strategies need to be adopted to combat the growing prevalence of obesity. Thus, the aim of this study is to evaluate the effect of a nutritional counseling activity using a social network in coping with obesity. This is a before-and-after experimental study, including 60 overweight individuals enrolled in a Primary Care Center. It was carried out from June to October 2020. Educational actions (sharing information about healthy eating and health and agreeing on challenges) were carried out through the WhatsApp® application, weekly, for 16 weeks. Sociodemographic, economic, clinical, anthropometric, food consumption, and biochemical data were collected. Data were compared by the Wilcoxon or Kappa test. Most participants were female and 36.4% had a diagnosis of hypertension. After the intervention, there was a reduction in waist circumference (before:107.3±11.4; after:105.6±11.5 cm, p=0.004), total cholesterol (before:205.9±48, 3; after:191.5±34.3 mg/dL, p<0.001), and LDL-c (before:132.4±37.8; after:120.2±29.3 mg/dL, p<0.001). The activity was able to promote reductions in body markers of obesity and metabolic imbalances associated with obesity, demonstrating the importance of innovative interventions that can add to other interventions and facilitate public adherence.

Diet quality index and its components have not associated with the development of breast cancer risk assessed by the diet quality index: a case-control study.

OBJECTIVE: To investigate if the diet quality and its components are associated with breast cancer risk. METHODS: A case-control study was conducted with 332 women, 114 who were diagnosed with breast cancer, and 218 control individuals. Groups were matched for age, body mass index, and menopausal status. The quality of diet was assessed using Brazilian Healthy Eating Index Revised (BHEI-R) and its components. Food consumption was measured through three 24-h dietary recalls and assessed using the NDS-R software. For statistical analyses, it was performed an adjusted logistic regression, estimation of the Odds Ratio (OR), and 95% confidence interval (95%CI), with a p-value <0.05. RESULTS: The BHEI-R score, classified into quartiles, did not differ between groups in the lowest quartile of diet quality (p=0.853). The components total cereals (p=0.038), saturated fat (p=0.039) and Gord_AA (fat, alcohol, and added sugar) (p=0.023) had higher scores among the case group. The scores for total fruits (p=0.010) and milk and dairy products (p=0.039) were higher among the control group. The BHEI-R components and the quality of diet were not associated with the outcome. CONCLUSION: Diet quality, assessed by the BHEI-R and its components, was not associated with breast cancer.

Intuitive eating in general aspects of eating behaviors in individuals with obesity: Randomized clinical trial.

BACKGROUND AND AIMS: Dysfunctional eating behaviors may be associated with weight gain and have a negative impact on obesity. Intuitive eating is a strategy that helps with changing eating behaviors. This study aimed to analyze the effects of intuitive eating alone or combined with nutritional guidelines on eating behaviors, weight, and body mass index (BMI), in individuals with obesity. METHODS: This is a randomized clinical trial of 58 individuals (84.5% females and 84.5% candidates for bariatric surgery). The mean age was 40.5 years (SD = 9.1). The mean BMI was 48.3 kg/m2 (SD = 7.4). Individuals were randomized into three groups: 1) the control group (CG; n = 18), who received an individualized meal plan, 2) the intuitive eating group (IEG; n = 23), and 3) the intuitive eating and nutritional guidelines application group (IEGDG; n = 17). The study lasted for six months. Eating behaviors were assessed using the Binge Eating Scale and Three Factor Eating Questionnaire, the 21-item version. RESULTS: Compared with the CG, the IEG and IEGDG did not differ in binge eating, cognitive restriction, emotional eating, and uncontrolled eating. Likewise, there were no significant differences in weight and BMI. CONCLUSIONS: Intuitive eating alone or in combination with nutritional guidelines did not alter the general domains of eating behaviors, weight, and BMI in individuals with obesity. We suggest further studies involving other health professionals, as well as evaluating the effects of intuitive eating using scales, in addition to eating behaviors. CLINICAL TRIAL REGISTRATION: https://ensaiosclinicos.gov.br6, Identifier: RBR-7q9nj8.

Diet quality index and its components have not associated with the development of breast cancer risk assessed by the diet quality index: a case-control study / Índice de qualidade da dieta e seus componentes não se associaram ao desenvolvimento de câncer de mama: um estudo caso-controle

ABSTRACT Objective: To investigate if the diet quality and its components are associated with breast cancer risk. Methods: A case-control study was conducted with 332 women, 114 who were diagnosed with breast cancer, and 218 control individuals. Groups were matched for age, body mass index, and menopausal status. The quality of diet was assessed using Brazilian Healthy Eating Index Revised (BHEI-R) and its components. Food consumption was measured through three 24-h dietary recalls and assessed using the NDS-R software. For statistical analyses, it was performed an adjusted logistic regression, estimation of the Odds Ratio (OR), and 95% confidence interval (95%CI), with a p-value <0.05. Results: The BHEI-R score, classified into quartiles, did not differ between groups in the lowest quartile of diet quality (p=0.853). The components total cereals (p=0.038), saturated fat (p=0.039) and Gord_AA (fat, alcohol, and added sugar) (p=0.023) had higher scores among the case group. The scores for total fruits (p=0.010) and milk and dairy products (p=0.039) were higher among the control group. The BHEI-R components and the quality of diet were not associated with the outcome. Conclusion: Diet quality, assessed by the BHEI-R and its components, was not associated with breast cancer.

RESUMO Objetivo: Avaliar se a qualidade da dieta e seus componentes estão associados ao desenvolvimento de câncer de mama. Métodos: Trata-se de estudo caso-controle com a participação de 332 mulheres, sendo 114 casos e 218 controles. Os grupos foram pareados por idade, índice de massa corporal e estado menopausal. A qualidade da dieta foi avaliada pelo Índice de Qualidade da Dieta Revisado (IQD-R) e seus componentes. O consumo alimentar foi mensurado por meio da aplicação de três recordatórios alimentares de 24 horas e analisados no software NDS-R. Foi realizada regressão logística ajustada, estimativa de odds ratio (OR) e intervalo de confiança de 95% (IC95%), com valor de p<0,05. Resultados: A pontuação do IQD-R, classificada em quartis, não diferiu entre os grupos no quartil inferior de qualidade da dieta (p=0,853). Os componentes cereais totais (p=0,038), gordura saturada (p=0,039) e Gord_AA (gordura, álcool e açúcar de adição) (p=0,023) tiveram maior pontuação no grupo caso. Já a pontuação de frutas totais (p=0,010) e leites e derivados (p=0,039) foi maior no grupo controle. Os componentes do IQD-R, assim como a qualidade da dieta, não se associaram ao desfecho investigado. Conclusão: A qualidade da dieta, avaliada pelo IQD-R e os seus componentes, não se associou ao câncer de mama.

Effect of Fortification with Multiple Micronutrient Powder on the Prevention and Treatment of Iron Deficiency and Anaemia in Brazilian Children: A Randomized Clinical Trial.

Fortification with multiple micronutrient powder has been proposed as a public health intervention able to reduce micronutrient deficiencies in children. Our objective was to compare the effectiveness of fortification with multiple micronutrient powder with drug supplementation in the prevention and treatment of iron deficiency and anaemia. This was a cluster trial with anemic and non-anaemic children between six and 42 months old, in randomization data. Non anaemic children received fortification with multiple micronutrient powder or standard drug supplementation of ferrous sulfate associated with folic acid in a prevention dose. Anaemic children who were randomized to receive multiple micronutrient powder also received the recommended iron complementation for anaemia treatment. A total of 162 children were evaluated. The prevalence of anaemia decreased from 13.58 to 1.85%. Iron deficiency decreased from 21.74% to 7.89% (by serum ferritin) and iron deficiency decreased from 66.81 to 38.27% (by soluble transferrin receptor). No difference was identified between interventions for hemoglobin (p = 0.142), serum ferritin (p = 0.288), and soluble transferrin receptor (p = 0.156). Fortification with multiple micronutrient powder was effective in preventing iron deficiency and anaemia in children aged six to 48 months. In anaemic children; it was necessary to supplement the dose of multiple micronutrient powder with ferrous sulfate.

Chemotherapy negatively impacts body composition, physical function and metabolic profile in patients with breast cancer.

BACKGROUND: Evidence suggests that chemotherapy (CT) leads to unfavorable outcomes on nutritional and metabolic profile; however, this is poorly understood. OBJECTIVE: To evaluate the impact of CT on body composition, bone mineral density (BMD), insulin resistance, lipid markers related to atherosclerotic cardiovascular diseases in women recently diagnosed with breast cancer according to menopausal status. METHODS: This is a prospective study that enrolled women newly diagnosed with stage II-III breast cancer (2014-18). Body composition were measured by dual-energy x-ray absorptiometry. Blood samples were collected to assess lipid profile, insulin resistance and sensitivity, visceral adiposity index and lipid accumulation product were calculated. Dietary intake, physical activity and function were also evaluated at the time of breast cancer diagnosis and after CT completion. RESULTS: Ninety-nine women (40.4% in the premenopausal stage) aged 51 ± 1 years took part in this study. CT duration was 197 ± 27 days and main regimen was anthracyclines with taxanes (88.9%). CT was associated with an increase in total and central adiposity, insulin resistance, and all lipid-related markers, and a decrease in appendicular lean mass index, BMD and HDL-c concentration. Premenopausal women experienced greater unfavorable outcomes on adiposity markers and BMD compared to postmenopausal women (p < 0.01). No changes were observed in dietary intake and physical activity after CT. CONCLUSIONS: Breast cancer CT negatively impacted body composition and metabolic profile. Premenopausal women experienced greater unfavorable impact on adiposity markers and BMD.

Músculo adutor do polegar e força de preensão palmar: métodos potenciais de avaliação nutricional em pacientes cirúrgicos / Adductor pollicis muscle and handgrip strength: potential methods of nutritional assessment in surgical patients

Medidas da espessura do músculo adutor do polegar (EMAP) e da força de preensão palmar (FPP) são de fácil e rápida aplicação, baixo custo e poderão detectar alterações do estado nutricional em curto prazo. A utilização dessas medidas agilizaria o diagnóstico nutricional e otimizaria a atenção aos pacientes hospitalizados. O objetivo deste estudo foi avaliar a associação entre EMAP e FPP com parâmetros antropométricos, avaliação subjetiva global (ASG) e marcadores bioquímicos de pacientes admitidos para a realização de cirurgia do aparelho digestivo e órgãos anexos. Trata-se de um estudo transversal em que foram avaliadas o índice de massa corporal (IMC), circunferência braquial (CB), dobra cutânea tricipital, circunferência muscular do braço, EMAP, FPP, ASG e variáveis bioquímicas. Participaram 56 pacientes, sendo evidenciado que o aumento de uma unidade na CB promoveu um aumento de 0,73 kgf na FPP (IC95%: 0,30;1,17, p=0,002). O aumento de uma unidade no peso habitual, CB e albumina sérica ajustado pela altura, idade e sexo foi associado a maiores valores da EMAP (peso habitual: 0,92 mm; IC95%: 0,18;1,66, p=0,017; CB: 0,69 mm; IC95%: 0,27;1,11, p=0,006; albumina sérica 1,83 mm; IC95% 0,10; 3,57, p=0,039). Por outro lado, o aumento de uma unidade da perda de peso (%) e IMC refletiu em redução de 0,85 mm (IC95%: -1,46; -0,25, p=0,008) e 2,80 mm da EMAP (IC95%: -4,73; -0,88, p=0,006), respectivamente. Há associação positiva entre FPP e CB e entre EMAP, peso habitual, CB e albumina sérica e associação inversa entre EMAP, IMC e percentual de perda de peso.

Measurements of the adductor pollicis muscle thickness (APMT) and handgrip strength (HGS) are easy and quick to apply, low cost, and may detect changes in nutritional status in the short term. The use of these measurements would speed up the nutritional diagnosis and optimize the care of hospitalized patients. The aim of this study was to evaluate the association between APMT and HGS with anthropometric parameters, subjective global assessment (SGA), and biochemical markers in patients admitted for digestive tract and adnexal organ surgery. This is a cross-sectional study in which body mass index (BMI), arm circumference (AC), triceps skinfold thickness, arm muscle circumference, APMT, HGS, SGA and biochemical variables were evaluated. A total of 56 patients participated, showing that the increase of one unit in the AC promoted an increase of 0.73 kgf in the HGS (95%CI: 0.30;1.17, p=0.002). A one-unit increase in normal weight, AC, and serum albumin adjusted for height, age, and gender was associated with higher APMT values (normal weight: 0.92 mm, 95%CI: 0.18;1.66, p=0.017; AC: 0.69 mm, 95%CI: 0.27;1.11, p=0.006; serum albumin 1.83 mm, 95%CI: 0.10;3.57, p=0.039). On the other hand, the increase of one unit in weight loss (%) and BMI resulted in a reduction of 0.85 mm (95%CI: -1.46;-0.25, p=0.008) and 2.80 mm in the APMT (95%CI: -4.73;-0.88, p=0.006), respectively. There is a positive association between HGS and AC and between APMT, normal weight, AC, and serum albumin, and an inverse association between APMT, BMI, and percentage of weight loss.

Incidentes em sessões de hemodiálise à beira leito em unidades de terapia intensiva / Incidencias en las sesiones de hemodiálisis a pie de cama en las unidades de cuidados intensivos / Incidents in bedside hemodialysis sessions in intensive care units

RESUMO Objetivo: identificar associação entre diagnósticos de enfermagem relacionados à locomoção e ao cuidado corporal com incapacidade funcional em idosos hospitalizados. Método: estudo descritivo, transversal, realizado com 100 idosos em um hospital público, da Paraíba - Brasil, no ano de 2019. Utilizou-se instrumento semiestruturado e Índice de Barthel, sendo elencados diagnósticos a partir da CIPE®. A análise de dados utilizou a estatística descritiva. Resultados: a escala é composta por 17 itens distribuídos em sete domínios: Tratamento Medicamentoso, Assistência Pré-natal, Intervenção Baseada no Senso Comum, Entendimento das Recomendações com Apoio Familiar, Estilo de Vida, Intervenção Dietética e Cuidado de Si. A consistência interna dos domínios pelo alfa de Cronbach variou de 0,527 a 0,597. Conclusão: os diagnósticos identificados fornecem subsídios para planejamento e implementação de cuidados de enfermagem visando menor tempo de hospitalização, prevenindo desfechos desfavoráveis à saúde e garantindo assistência integral e individualizada para a população.

RESUMEN Objetivo: identificar la asociación entre diagnósticos de Enfermería relacionados a la locomoción y al cuidado corporal con incapacidad funcional en adultos mayores hospitalizados. Métodos: estudio descriptivo y transversal, realizado en el año 2019 con 100 adultos mayores en un hospital público de Paraíba - Brasil. Se utilizó un instrumento semiestructurado y el Índice de Barthel, y los diagnósticos se listaron a partir de la clasificación CIPE®. Para el análisis de los dados se utilizó estadística descriptiva. Resultados: la dependencia total se mostró asociada con Capacidad perjudicada para la higiene oral, Capacidad perjudicada para la higiene y Confinado a la cama. La dependencia grave estuvo asociada con Capacidad perjudicada para la higiene oral, Capacidad perjudicada para la higiene, Capacidad perjudicada para vestirse, Movilidad perjudicada y Confinado a la cama. Conclusión: los diagnósticos identificados proporcionan apoyos para planificar e implementar medidas de atención de Enfermería con vistas a reducir los tiempos de hospitalización, previniendo así consecuencias desfavorables para la salud y garantizando asistencia integral e individualizada para la población.

ABSTRACT Objective: to analyze incidents during bedside hemodialysis sessions held in Intensive Care Units. Method: cross-sectional, retrospective study, developed in Intensive Care Units of Goiânia, Brazil. Analysis of incidents identified in bedside hemodialysis sessions was performed between March and April 2018. Descriptive analysis was performed for categorical data and for continuous data, mean and standard deviation of the mean. Results: 873 sessions were analyzed, and 563 incidents were recorded. Among those reported, 259 (46%) were inherent to the treatment. Near miss was the most frequent type of incident, generating delay in the beginning of the session, and no support from the multi-professional team (p<0.05). In 132 (56.12%) of the notifiable circumstances, the professional worked for more than 12 uninterrupted hours (p<0.05). Conclusion: the analysis of the results allows students and experts in the area to subsidize improvement strategies for the service.

Reliability and Agreement of the 10-Repetition Maximum Test in Breast Cancer Survivors.

The aim of this study was to evaluate the reliability and agreement between the test and retest of the 10-repetition maximum (10-RM) test for leg press and bench press in breast cancer survivors (BCS). Thirty-one BCS participated in this study, age 54.87 ± 5.7 years. All performed 10-RM tests and retests for the leg press 45° and the bench press. For reliability analyses, an intraclass coefficient correlation (ICC) and coefficient of variation (CV) were performed. The limits of agreement were calculated using a Bland-Altman plot with 95% CIs. For absolute and relative error of measurement, we used standard error of measurement and minimally detectable change. The result showed a high reliability for the bench press and leg press; ICC of 0.94 and 0.98, respectively. CV was <10% for both exercises. The systematic error were 1.5 kg (10%) and 6.1 (8%) for the bench press and leg press, respectively. The standard errors of measurements were 0.96 kg (6.08%) and 4.11 kg (5.27%) for the bench press and leg press, respectively. The minimally detectable changes were 2.72 kg (17.20%) and 5.62 kg (7.21%) for the bench press and leg press, respectively. In breast cancer survivors, the muscular strength measurement for the 10-RM test showed a high to very high rate of reliability and agreement, with acceptable error of measurement.

Sedentary Behavior and Alcohol Consumption Increase Breast Cancer Risk Regardless of Menopausal Status: A Case-Control Study.

Identification of modifiable risk factors for breast cancer is critical for primary prevention of the disease. The aim of this study was to evaluate how certain lifestyle variables modify the chances of developing breast cancer based on menopausal status. A case-control study was performed in a group of 542 women, 197 who were diagnosed with breast cancer and 344 control individuals. The groups were matched by age, body mass index, and menopausal status. Participants were evaluated for level of physical activity, alcohol consumption, smoking habit, weight, height, and waist circumference (WC). A multivariate logistic regression model was used to estimate odds ratios and 95% confidence intervals (95% CI). Regular consumption of alcoholic beverages (2.91, 95% CI 1.58-5.38 and 1.86, 95% CI 1.15-3.03) and sedentary behavior (2.08; 95% CI 1.12-3.85 and 1.81; 95% CI 1.12-2.94) were associated with breast cancer risk in pre- and postmenopausal women, respectively. High WC (3.31, 95% CI 1.45-7.55) was associated with an increased risk of developing breast cancer in premenopausal women. While in postmenopausal women, current smoking (2.43, 95% CI 1.01-5.83) or previous history of smoking (1.90; 95% CI 1.14-3.14) increased the chances of developing breast cancer. Sedentary behavior and current consumption of alcoholic beverages were more likely to increase the risk of developing breast cancer regardless of menopausal status.

High Bone Mineral Density of the Lumbar Spine Is Positively Associated with Breast Cancer.

OBJECTIVE: The objective of this study was to verify possible associations between bone mineral density (BMD) and breast cancer in recently diagnosed women in the Brazilian Mid-west region, considering the menopausal status of patients. METHODS: A case-control study was conducted with 142 cases of breast cancer and 234 controls matched by for age, body mass index (BMI), and menopausal status (pre- and postmenopause), performed in a university hospital in the Brazilian Mid-west. Lumbar spine (L1-L4), femoral neck, and total femur BMD were measured by the dual-energy X-ray absorptiometry (DXA) method. For association, a logistic regression analysis was used. RESULTS: Women in the highest lumbar spine BMD quartile presented had a higher chance of developing breast cancer (OR = 2.31; 1.02-5.25; p = 0.045), after adjusting for the confounding variables. Nonetheless, there were no statistically significant differences in the association between pre- and postmenopause in that quartile and breast cancer. CONCLUSIONS: High lumbar spine BMD was positively associated with breast cancer in the total sample. In evaluating the BMD of the femoral neck and total femur, such an association was not observed.