Prevalence of Functional Gastrointestinal Disorders in Brazilian Infants Seen in Private Pediatric Practices and Their Associated Factors.

OBJECTIVES: To assess the prevalence of the most frequent functional gastrointestinal disorders (FGIDs) in Brazilian infants seen in private pediatric clinics and their relationship with cesarean delivery, breastfeeding, and history of prematurity. METHODS: This cross-sectional study enrolled 5080 infants under 12 months old with routine visits in private pediatric clinics in Brazil. The mothers answered questions about the type of delivery, type of feeding (breast milk, infant formula, cow milk, mixed feeding), history of prematurity, and gastrointestinal symptoms. Rome IV criteria were used to diagnose FGIDs. RESULTS: The prevalence of infant regurgitation was 10.7% (487/4560); infant colic, 6.1% (131/2162); infant dyschezia, 4.0% (157/3895); functional constipation, 7.6% (341/4506); and functional diarrhea, 0.09% (2/2186). Prematurity was associated ( P < 0.05) with infant regurgitation (odds ratio [OR] = 1.41; 95% confidence interval [CI]: 1.05, 1.90), infant colic (OR = 1.97; 95% CI: 1.19, 3.24), infant dyschezia (OR = 1.64, 95% CI: 1.02, 2.64), and functional constipation (OR = 1.44; 95% CI: 1.02, 2.02). Prematurity was associated ( P < 0.001) with two or more FGIDs between 21 days and 150 days of age (OR = 3.06; 95% CI: 1.74, 5.37). CONCLUSION: FGIDs are common in infants seen in the private pediatric practice in Brazil. History of prematurity was associated with infant regurgitation, infant colic, functional dyschezia, and functional constipation.

New GJA8 variants and phenotypes highlight its critical role in a broad spectrum of eye anomalies.

GJA8 encodes connexin 50 (Cx50), a transmembrane protein involved in the formation of lens gap junctions. GJA8 mutations have been linked to early onset cataracts in humans and animal models. In mice, missense mutations and homozygous Gja8 deletions lead to smaller lenses and microphthalmia in addition to cataract, suggesting that Gja8 may play a role in both lens development and ocular growth. Following screening of GJA8 in a cohort of 426 individuals with severe congenital eye anomalies, primarily anophthalmia, microphthalmia and coloboma, we identified four known [p.(Thr39Arg), p.(Trp45Leu), p.(Asp51Asn), and p.(Gly94Arg)] and two novel [p.(Phe70Leu) and p.(Val97Gly)] likely pathogenic variants in seven families. Five of these co-segregated with cataracts and microphthalmia, whereas the variant p.(Gly94Arg) was identified in an individual with congenital aphakia, sclerocornea, microphthalmia and coloboma. Four missense variants of unknown or unlikely clinical significance were also identified. Furthermore, the screening of GJA8 structural variants in a subgroup of 188 individuals identified heterozygous 1q21 microdeletions in five families with coloboma and other ocular and/or extraocular findings. However, the exact genotype-phenotype correlation of these structural variants remains to be established. Our data expand the spectrum of GJA8 variants and associated phenotypes, confirming the importance of this gene in early eye development.

Whole-exome sequencing reveals ZNF408 as a new gene associated with autosomal recessive retinitis pigmentosa with vitreal alterations.

Retinitis pigmentosa (RP) is a group of progressive inherited retinal dystrophies that cause visual impairment as a result of photoreceptor cell death. RP is heterogeneous, both clinically and genetically making difficult to establish precise genotype-phenotype correlations. In a Spanish family with autosomal recessive RP (arRP), homozygosity mapping and whole-exome sequencing led to the identification of a homozygous mutation (c.358_359delGT; p.Ala122Leufs*2) in the ZNF408 gene. A screening performed in 217 additional unrelated families revealed another homozygous mutation (c.1621C>T; p.Arg541Cys) in an isolated RP case. ZNF408 encodes a transcription factor that harbors 10 predicted C2H2-type fingers thought to be implicated in DNA binding. To elucidate the ZNF408 role in the retina and the pathogenesis of these mutations we have performed different functional studies. By immunohistochemical analysis in healthy human retina, we identified that ZNF408 is expressed in both cone and rod photoreceptors, in a specific type of amacrine and ganglion cells, and in retinal blood vessels. ZNF408 revealed a cytoplasmic localization and a nuclear distribution in areas corresponding with the euchromatin fraction. Immunolocalization studies showed a partial mislocalization of the p.Arg541Cys mutant protein retaining part of the WT protein in the cytoplasm. Our study demonstrates that ZNF408, previously associated with Familial Exudative Vitreoretinopathy (FEVR), is a new gene causing arRP with vitreous condensations supporting the evidence that this protein plays additional functions into the human retina.

Number of Daily Steps to Discriminate Abdominal Obesity in a Sample of Brazilian Children and Adolescents.

PURPOSE: Weight status-referenced pedometer step-count guidelines for young people have been developed for populations from high-income countries and may not be applicable to middle- and low-income countries. The objectives of this study were 1) to develop cut-off points for pedometer-determined step count in young Brazilians using waist circumference (WC) as a reference criterion, and 2) to analyze the capacity of previous recommendations to discriminate abdominal obesity in the sample studied. METHODS: A cross-sectional study was conducted on 1,044 schoolchildren (456 boys) aged 6-17 years from Northeastern Brazil. WC was measured and daily step counts were determined with a pedometer. RESULTS: The area under the curve (AUC) of step count was significant for boys (AUC = 0.55; 95%CI: 0.50-0.59) and girls (AUC = 0.57; 95%CI: 0.53-0.61). Our cut-off points (14,414 and 11,355 steps for boys and girls, respectively) were more balanced in terms of sensitivity and specificity compared with previous recommendations. The use of previous guidelines to classify step count in the sample provided very low sensitivity or specificity and wide variation in the prevalence of insufficient physical activity (39.3-77.0%). CONCLUSIONS: A universal step-count recommendation for young people may not be adequate and specific guidelines seem to be necessary for different countries or regions.

Cut-off values for step count and TV viewing time as discriminators of hyperglycaemia in Brazilian children and adolescents.

BACKGROUND: The use of step count and TV viewing time to discriminate youngsters with hyperglycaemia is still a matter of debate. AIM: To establish cut-off values for step count and TV viewing time in children and adolescents using glycaemia as the reference criterion. SUBJECTS AND METHODS: A cross-sectional study was conducted on 1044 schoolchildren aged 6-18 years from Northeastern Brazil. Daily step counts were assessed with a pedometer over 1 week and TV viewing time by self-report. RESULTS: The area under the curve (AUC) ranged from 0.52-0.61 for step count and from 0.49-0.65 for TV viewing time. The daily step count with the highest discriminatory power for hyperglycaemia was 13 884 (sensitivity = 77.8; specificity = 51.8) for male children and 12 371 (sensitivity = 55.6; specificity = 55.5) and 11 292 (sensitivity = 57.7; specificity = 48.6) for female children and adolescents respectively. The cut-off for TV viewing time with the highest discriminatory capacity for hyperglycaemia was 3 hours/day (sensitivity = 57.7-77.8; specificity = 48.6-53.2). CONCLUSION: This study represents the first step for the development of criteria based on cardiometabolic risk factors for step count and TV viewing time in youngsters. However, the present cut-off values have limited practical application because of their poor accuracy and low sensitivity and specificity.

Comparison of two visual methods for detecting caries among obese and non-obese children.

OBJECTIVE: The study aimed to compare two visual methods for detecting caries among obese and non-obese children in Salvador, Brazil. MATERIALS AND METHODS: A cross-sectional study was conducted from 2011-2012, which evaluated 180 paediatric patients, 6-14 years old, girls and boys, categorized into two groups: obese and non-obese (healthy weight), according to the body mass index. For the evaluation of dental caries, the decayed, missing or filled teeth index (DMFT/dmft) and International Caries Detection and Assessment System II (ICDAS II) visual criteria were used. RESULTS: The mean DMFT value was 0.98 in obese children and 0.57 in the non-obese children, without significant differences between groups (p = 0.206). The mean dmft value in the non-obese children (1.66) was higher than in obese children (0.95), with significant differences between groups (p = 0.021). According to ICDAS II criteria, there was a higher prevalence of non-cavitated enamel lesions (D1-3) in obese children (n = 156, 10.5%) compared to the non-obese children (n = 55, 1.9%), with significant differences between the groups (p < 0.001). CONCLUSIONS: The inclusion of non-cavitated lesions during the caries evaluation represents a challenge in diagnosis, which allows for control of this process before the evolution of these lesions to cavitation.

Factors associated with cesarean delivery in public and private hospitals in a city of northeastern Brazil: a cross-sectional study.

BACKGROUND: To evaluate the prevalence and factors associated with cesarean delivery according to whether care was provided in public or private hospitals in Brazil. METHODS: This was a cross-sectional study based on a cohort of live births between April 2004 and March 2005. A total of 1,344 mother-child pairs were followed up during the first month of life. The variables analyzed were the socioeconomic and demographic characteristics of the mother and newborn, as well as the healthcare provided during pregnancy and childbirth. Hierarchical analysis was carried out for both prediction models, i.e. healthcare provision either within the Brazilian National Health System (public service) or within the private network. Prevalence and association measurement calculations were carried out. Values were considered significant when pless than or equal to 5.0 %. RESULTS: A total of 1,019 (75,8 %) gave birth in public hospital. The prevalences of cesarean delivery were 29.9 % and 86.2 % in the public and private sectors, respectively. Through hierarchical logistic regression, the risk factors for cesarean delivery presented in the public hospital were maternal age greater than or equal to 20 years (p = 0.003), primiparity (p = 0.004), twinning (p = 0.039), prenatal care provided in the private network (p = 0.004), delivery in hospitals providing high complexity medical care (p = 0.000) and prenatal care with greater than or equal to 6 consultations (p = 0.035). In the private sector, no association was observed between the variables studied and cesarean delivery. CONCLUSIONS: The cesarean delivery rates were high in both sectors, although in the private network the rate was almost triple that of the public service. The absence of determinant factors of birth in the private sector drew attention. In planning measures against the growing cesarean rates, it is necessary to take into consideration the environmental determinants as primiparity, twinning and greater maternal age, frequent indications of primary cesarean delivery, as well as to implement actions that might improve the quality of prenatal and delivery care.

[The use of the Family Management Style Framework to evaluate the family management of liver transplantation in adolescence]. / A utilização do Family Management Style Framework para avaliação do manejo familiar do transplante hepático na adolescência*

OBJECTIVE: To understand the family management experience of liver transplantation during adolescence based on the Family Management Style Framework(FMSF). METHOD: This is a case study that used the FMSF as theoretical framework and the hybrid model of thematic analysis as methodological reference. The case presented is from an adolescent's family that lives in Salvador, Bahia. The data were collected through interviews with the mother and the patient charts analysis. RESULTS: The results shows that the family defines the transplantation as threatening and there are divergence between mother and daughter related to the teen's capabilities perception. Facing those discrepancies, the family assumes a protective posture by believing that the teen cannot take care of herself alone. The perceived consequences reflect how much the uncertainty permeates the family environment. CONCLUSION: It is concluded that the use of a model to evaluate the management can help professionals to direct and plan specific interventions.

Electronic cigarettes: "wolves in sheep's clothing".

OBJECTIVE: To provide cutting-edge information on the impact and risks of using Electronic Nicotine Delivery Systems (ENDS) by children and adolescents, based on the latest evidence published in the literature. DATA SOURCE: A comprehensive search was carried out on PubMed, using the expressions ''electronic cigarettes'' OR ''electronic nicotine delivery systems" OR "vaping" AND ''adolescent'' AND "risks" AND ''acute lung injury'. All retrieved articles had their titles and abstracts read to identify and fully read the papers reporting the most recent evidence on each subject. SUMMARY OF FINDINGS: The use of ENDS has alarmingly increased in Brazil and around the world. The possibility of customizing use, the choice of flavors and nicotine content, and the general notion that these devices are harmless when compared to conventional cigarettes are some of the factors responsible for this increase. Numerous scientific studies have proven that electronic cigarettes have serious consequences for the respiratory system, such as EVALI (E-cigarette or Vaping-Associated Lung Injury) and difficult-to-control asthma, as well as harmful effects on the neurological, cardiovascular, gastrointestinal, and immunological systems. High concentrations of nicotine make many young people addicted to this substance. In Brazil, commercialization, import, and advertising are prohibited. The viable interventions to address the use of these devices in children and adolescents are prevention and behavioral counseling. CONCLUSION: There is clear scientific evidence that these devices pose a risk to the physical and mental health of children and adolescents.

Undiagnosed celiac disease in women with infertility.

OBJECTIVE: To determine the prevalence of celiac disease in a group of Brazilian women with infertility. STUDY DESIGN: This was a cross-sectional study of 170 infertile Brazilian women tested for immunoglobulin A anti-tissue transglutaminase (IgA anti-tTG), endomysial antibody and total IgA. Women with positive serologies were recommended for intestinal biopsy. Patients with positive serology and villous atrophy on biopsy had the diagnosis of celiac disease, while those with positive serology but no villous atrophy were identified as having latent celiac disease. All of these women were typed for HLA-DQ2 and HLA-DQ8. RESULTS: The prevalence of celiac disease confirmed by biopsy in the study group was 1.2% (2 out of 170) (95% confidence interval [CI], 0.1-4.2). Considering also those with latent celiac disease, the prevalence was estimated at 2.9% (5 out of 170) (95% CI, 1.0-6.7) and in the subgroup of unexplained infertility the prevalence was 10.3% (3 out of 29) (95% CI, 2.2-27.4). All seropositive patients were also HLA-DQ2 positive. CONCLUSION: Further studies are required to define the role of routine serological screening for celiac disease in infertile women as well as to elucidate the underlying mechanism for infertility in active celiac disease.

Are pediatricians familiar with hereditary angioedema?

Background: Hereditary angioedema (HAE) is an autosomal dominant disease characterized by recurrent episodes of subcutaneous or mucosal edema caused by excess bradykinin. The aim of the present study was to assess the knowledge of pediatricians about hereditary angioedema. Methods: An online survey with 12 HAE-related and 14 demographics-related questions was e-mailed to all pediatricians who were members of the Brazilian Society of Pediatrics (n = 17 145) once a week during the months of June and July 2021. The electronic questionnaire assessed clinical manifestations, diagnosis, and treatment of hereditary angioedema in children and adolescents. Results: Four hundred and fifty-five pediatricians responded to the questionnaire (2.6%), of whom 55 (12.1%) were board certified in Allergy and Immunology (A/I), while 400 (87.9%) were not (N-A/I). Three hundred and sixty-eight (80.9%) were female, 289 (55.7%) were under 50 years of age, 286 (62.9%) graduated from Medical School more than 10 years previously, 83 (18.2%) held an MSc/PhD degree, and 253 (55.6%) were living in the Southeast Region of Brazil. The median number of correct answers to the questions related to HAE among A/I was 7 out of 12 (58.3%), with median ranging from 4.5 to 8 correct answers, while for N-A/I it was 3 (25%), with median ranging from 2.5 to 4 correct answers (p < 0.001). Conclusion: Knowledge about HAE among Brazilian pediatricians, whether board certified in Allergy and Immunology or not, was unsatisfactory. HAE is a rare disease, largely unknown among physicians; therefore, increasing awareness may lead to improvement in diagnosis and treatment.

Development and validation of an instrument for nursing consultation with pediatric patients in the preoperative period.

OBJECTIVE: To develop and validate an instrument for nursing consultation with pediatric patients in the preoperative period. METHOD: This is a methodological study, consisting of five steps: identification of nursing diagnoses, discussion and evaluation of diagnoses with nurses from the institution, instrument development, instrument content validation with experts through the Delphi Technique, and instrument restructuring. The Nursing Minimum Data Set, Wanda Horta's human needs, and the NANDA-NOC-NIC connections were used as theoretical framework. RESULTS: In its final version, the instrument includes an assessment of psychobiological, psychosocial, and psychospiritual human needs, 38 nursing diagnoses, 65 nursing interventions, 113 nursing activities, and 62 nursing outcomes. The instrument obtained a content validity index between 0.90 and 1.0 in the first round, and suggestions, validated in the second round, obtained agreement from 70 to 100%. CONCLUSION: The instrument developed can be a tool for use in nursing consultations in the preoperative period for children, providing greater assertiveness to nursing actions for this clientele.

Breastfeeding in infants seen in private pediatric practices and its relation with type of delivery and history of prematurity.

OBJECTIVE: To describe the type of milk used to feed infants seen in private pediatric practices in Brazil. To evaluate the relationship between breastfeeding, type of delivery, and history of prematurity. METHODS: This is a cross-sectional and observational study that included 4929 infants in the first year of life seen in private pediatric practices in the five geographic regions of Brazil. Mothers provided information about the type of milk used by their infant, the type of delivery (vaginal or cesarean), and whether the birth was premature. RESULTS: Breastfeeding was the only source of milk for 56.1% (1546/2755) of infants in the first six months of life and 32.9% (716/2174) in the second. Of the infants who received other types of milk besides breastfeeding, there was a predominance of infant formula in 98.6% and 93.8% of the infants, respectively, in the first and in the second six months of life. Whole cow's milk was used by 0.7% (20/2755) of infants in the first six months and by 4.1% (90/2174) of infants in the second (p < 0.001). In the first six months of life, breastfeeding as the only type of milk was associated with vaginal delivery (OR = 1.79; p < 0.001) and not having a history of prematurity (OR = 2.48; p < 0.001). CONCLUSION: Breastfeeding was the only milk source for more than half of infants before 180 days of life. Birth by cesarean section and history of prematurity were negatively associated with breastfeeding as the only source of milk used in infant feeding.

NEUROPSYCHOMOTOR DEVELOPMENT IN CHILDREN AND ADOLESCENTS WITH LIVER DISEASES: SYSTEMATIC REVIEW WITH META-ANALYSIS.

BACKGROUND: The nature of liver disease, the evolutionary course and duration of liver diseases, as well as the degree of severity and disability can trigger multiple outcomes with repercussions on neuromotor acquisition and development. OBJECTIVE: To systematically review and conduct a meta-analysis to evaluate the effects of liver disease on the neuropsychomotor development of children and adolescents with their native livers and those who underwent liver transplantation. METHODS: Observational studies published since the early 1980s until June 2019 were sought in the PubMed and Scopus databases. An α value of 0.05 was considered significant. The statistical heterogeneity of the treatment effect between the studies was assessed by the Cochran's Q test and the I2 inconsistency test, in which values above 25 and 50% were considered indicative of moderate and high heterogeneity, respectively. Analyses were performed with Review Manager 5.3. RESULTS: Twenty-five studies met the eligibility criteria, including 909 children and adolescents with liver disease. Meta-analyses showed deficits in total IQ -0.41 (95%CI: -0.51 to -0.32; N: 9,973), verbal IQ -0.38 (95%CI: -0.57 to -0.18; N: 10,284) and receptive language -0.85 (95%CI: -1.16 to -0.53; N: 921) in liver transplantation, and those with native livers who had symptoms early had total and verbal IQ scores (85±8.8; 86.3±10.6 respectively) lower than the scores of those with late manifestations (99.5±13.8; 96.2±9.2). Gross motor skill was reduced -46.29 (95%CI: -81.55 to -11.03; N: 3,746). CONCLUSION: Acute or chronic liver disease can cause declines in cognitive, motor and language functions. Although the scores improve after liver transplantation, children remain below average when compared to healthy children.

Child behavior during the social distancing in the COVID-19 pandemic.

OBJECTIVE: To describe the daily activities performed by children from 6 to 12 years of age incomplete and analyze children's behavior during social distancing in the face of the COVID-19 pandemic. METHODS: Cross-sectional study with children in a learning stage living in Brazil. The data were collected via online form. Fisher's exact test was applied to analyze the association of categorical variables with child behavior; when significant, it was used the odds ratio. It was considered results considered statistically significant those presenting values of p < 0.05. RESULTS: Data from 530 children were analyzed: 50.3% female, 71.3% from the Southeast Region, 73% in fulltime social distancing, 52% presented anxiety, which was significantly associated with changes in sleep and appetite. CONCLUSION: The results indicate the need for parents/caretakers to stimulate moments for the child to express themselves, not minimizing their feelings and providing emotional support to mitigate the negative impact of these feelings on the child's mental and physical health.

Calcium release rates from tooth enamel treated with dentifrices containing whitening agents and abrasives.

Tooth whitening agents containing hydrogen peroxide and carbamide peroxide are used frequently in esthetic dental procedures. However, lesions on the enamel surface have been attributed to the action of these products. Using conventional procedures for separating and isolating biological structures, powdered enamel was obtained and treated with hydrogen peroxide, carbamide peroxide, and sodium bicarbonate, ingredients typically found in dentifrices. The enamel was exposed to different pH levels, and atomic emission spectrometry was used to determine calcium release rates. As the pH level increased, the rate of calcium release from enamel treated with dentifrices containing whitening agents decreased. Carbamide peroxide produced the lowest amount of decalcification, while sodium bicarbonate produced the highest release rates at all pH levels.

Hepatobiliary abnormalities in pediatric patients with sickle cell disease.

OBJECTIVE: to describe clinical, laboratory and ultrasonographic abnormalities in the hepatobiliary system of pediatric patients with sickle cell disease in the city of Salvador, Brazil. MATERIAL AND METHODS: pediatric patients with sickle cell disease were clinically evaluated, their charts were reviewed and findings of supplementary tests were examined to identify hepatobiliary abnormalities. RESULTS: a total of 134 patients were evaluated, 65 of whom (48.9%) presented hepatomegalia. Elevated transaminases were present in 42.2% and 11.4% presented cholelithiasis. There was a statistically significant association between the presence of hepatomegalia and SS homozygotes and between cholelithiasis and patients over 10 years of age (p = 0.01 and p = 0.00, respectively). CONCLUSION: hepatobiliary abnormalities in patients with sickle cell disease were common, particularly in patients with hemoglobin SS and in adolescent patients.

High blood pressure screening in children and adolescents from Amargosa, Bahia: usefulness of anthropometric indices of obesity. / Triagem da pressão arterial elevada em crianças e adolescentes de Amargosa, Bahia: utilidade de indicadores antropométricos de obesidade.

OBJECTIVE: To determine the predictive power of body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR), and their respective cut-off points for high blood pressure (BP) screening in Brazilian children and adolescents. METHOD: Cross-sectional study conducted with 1,139 students aged 6 to 17years. Body weight, height, WC, and BP were measured. High BP was classified as systolic or diastolic ≥ 95th percentile. Receiver Operating Characteristic (ROC) curves were constructed, and the area under the curve, sensitivity, and specificity were calculated. RESULTS: The prevalence of high BP was 27.0%. Anthropometric indices showed a significant association with high BP (accuracy ranging from 0.62 - 0.81), except for WHtR among male adolescents.Sensitivity was low, regardless of the anthropometric index, gender, and age group. CONCLUSION: BMI, WC, and WHtR were associated with high BP, but the cut-off points tested showed low sensitivity. Determining specific cut-off points for each population can enable the use of anthropometric indices in high BP screening.

OBJETIVO: Determinar o poder preditivo do índice de massa corporal (IMC), perímetro da cintura (PC) e razão da cintura pela estatura (RCEst) e de seus respectivos pontos de corte para triagem de pressão arterial (PA) elevada em crianças e adolescentes brasileiros. MÉTODO: Estudo transversal realizado com1.139 escolares de 6 a 17 anos de idade. A massa corporal, a estatura, o PC e a PA foram mensurados. A PA elevada foi classificada como sistólica ou diastólica≥ percentil 95. Curvas Receiver Operating Characteristic (ROC) foram construídas e a área sob a curva, a sensibilidade e a especificidade foram calculadas. RESULTADOS: A prevalência de PA elevada foi de 27,0%. Os indicadores antropométricos apresentaram associação significativa com PA elevada (acurácia variando de 0,62 - 0,81), exceto RCEst entre adolescentes do sexo masculino.Observou-se baixa sensibilidade, independentemente do indicador antropométrico, do sexo e da faixa etária. CONCLUSÃO: OIMC, o PC e a RCEst estiveram associados a PA elevada, porém os pontos de corte testados apresentaram baixa sensibilidade. A determinação de pontos de corte específicos para cada população pode viabilizar a triagem de PA elevada por meio de indicadores antropométricos.

Utility of anthropometric indicators to screen for clustered cardiometabolic risk factors in children and adolescents.

Background Anthropometric indicators are associated with cardiometabolic risk factors (CMRF), but there is no consensus as to which indicator is the most suitable to screen for clustered CMRF. This study aimed to evaluate the utility of five anthropometric indicators to screen for clustered CMRF in children and adolescents. Methods A cross-sectional study was conducted in 1139 schoolchildren aged 6-17 years from Northeastern Brazil. Body weight, height, waist circumference (WC) and subscapular (SSF) and triceps skinfold thickness (TSF) were measured. Body mass index (BMI) and waist-to-height ratio (WHtR) were calculated. The following CMRF were evaluated: elevated total cholesterol, low high-density lipoprotein-cholesterol (HDL-C), elevated low-density lipoprotein-cholesterol (LDL-C), high triglyceride concentration, hyperglycemia and high blood pressure. The participants were categorized into no CMRF, 1 CMRF, 2 CMRF and ≥3 CMRF. Receiver operating characteristic (ROC) curves were constructed to assess the accuracy of the anthropometric indicators in predicting CMRF for age group and sex. Results Poor associations were observed between the anthropometric indicators and 1 CMRF (accuracy of 0.49-0.64). The indicators showed moderate associations with 2 CMRF (accuracy of 0.57-0.75) and ≥3 CMRF (accuracy of 0.59-0.79). In general, TSF exhibited the worst performance in predicting CMRF, followed by WHtR. The highest accuracies were observed for BMI, WC and SSF, with no significant difference between these indicators. Conclusions The routine use of BMI, WC and SSF as epidemiological screening tools for clustered CMRF in childhood and adolescence should be encouraged.

[Impact of hospitalization on breastfeeding practices in a pediatric hospital in Salvador, Bahia State, Brazil]. / Impacto da internação na prática do aleitamento materno em hospital pediátrico de Salvador, Bahia, Brasil.

This cross-sectional study enrolled 97 inpatients at a teaching hospital in Salvador, Bahia, Brazil, to determine breastfeeding prevalence in infants less than 4 months of age hospitalized due to respiratory infection, and to evaluate the impact of hospitalization on breastfeeding. Patients' mothers were interviewed, and a standardized questionnaire was completed. After hospital discharge, medical records were reviewed and information on the infant's feeding practices during hospitalization was recorded. Exclusive breastfeeding was observed in 57.1% of patients, but it was interrupted in 35.4%, with the introduction of infant formula during hospitalization. Mean duration was not associated with the introduction of complementary feeding in the hospital. In the bivariate analysis, early interruption of exclusive breastfeeding was associated with higher maternal schooling and lower family income. Prevalence of exclusive breastfeeding was low. Hospitalization contributed to early interruption of exclusive breastfeeding in 35.4% of infants, possibly due to inadequate hospital infrastructure and insufficient support from health professionals to maintain exclusive breastfeeding.