Evolution of adolescents' dietary patterns in Northeast Brazil from 2008 to 2018.

OBJECTIVE: To evaluate the evolution of the dietary patterns of adolescents in the northeast region of Brazil. METHODS: Secondary analysis of data from the Pesquisa de Orçamentos Familiares (POF - Household Budget Surveys), collected by the Brazilian Institute of Geography and Statistics (IBGE) in the years 2008-2009 and 2017-2018. A total of 3,095 adolescents were evaluated in 2008-2009 and 3,015 in 2017-2018. Food consumption was assessed using two dietary records in 2008-2009 and two 24-hour recalls in 2017-2018, applied on non-consecutive days. Based on these data, principal components factor analysis (PCFA) was performed, followed by orthogonal rotation of the varimax type, to derive dietary patterns, stratified by sex. The results were described as means or percentage frequencies, with their respective 95% confidence intervals. RESULTS: Three main dietary patterns were identified among adolescents from the northeast region of Brazil. Among boys, in 2008-2009, the patterns were called snacks, traditional Brazilian, and coffee; and in 2017-2018, traditional Brazilian, snacks, and mixed, in this order of representativeness of the group's eating habits. Among female adolescents, in 2008-2009, the patterns were snacks, traditional Brazilian, and coffee; and in 2017-2018, traditional Brazilian, snacks, and processed meats. CONCLUSION: The dietary patterns identified in 2008-2009 and 2017-2018 were similar in both genders; however, the snacks pattern, which explained most of the data variability in 2008-2009, was replaced by the traditional Brazilian.

Evolution of adolescents' dietary patterns in Northeast Brazil from 2008 to 2018

ABSTRACT OBJECTIVE To evaluate the evolution of the dietary patterns of adolescents in the northeast region of Brazil. METHODS Secondary analysis of data from the Pesquisa de Orçamentos Familiares (POF - Household Budget Surveys), collected by the Brazilian Institute of Geography and Statistics (IBGE) in the years 2008-2009 and 2017-2018. A total of 3,095 adolescents were evaluated in 2008-2009 and 3,015 in 2017-2018. Food consumption was assessed using two dietary records in 2008-2009 and two 24-hour recalls in 2017-2018, applied on non-consecutive days. Based on these data, principal components factor analysis (PCFA) was performed, followed by orthogonal rotation of the varimax type, to derive dietary patterns, stratified by sex. The results were described as means or percentage frequencies, with their respective 95% confidence intervals. RESULTS Three main dietary patterns were identified among adolescents from the northeast region of Brazil. Among boys, in 2008-2009, the patterns were called snacks, traditional Brazilian, and coffee; and in 2017-2018, traditional Brazilian, snacks, and mixed, in this order of representativeness of the group's eating habits. Among female adolescents, in 2008-2009, the patterns were snacks, traditional Brazilian, and coffee; and in 2017-2018, traditional Brazilian, snacks, and processed meats. CONCLUSION The dietary patterns identified in 2008-2009 and 2017-2018 were similar in both genders; however, the snacks pattern, which explained most of the data variability in 2008-2009, was replaced by the traditional Brazilian.

Higher atherogenic risk in schoolchildren is associated with MTMR9 rs2293855 gene polymorphism and genetic score.

Childhood dyslipidaemia is associated with the occurrence of cardiovascular diseases in adulthood, so evaluating whether an individual has a genetic predisposition to this pathology is of great importance for early action of prevention and treatment. This study aimed to evaluate the association between the FTO (rs9939609), MC4R (rs17782313) and MTMR9 (rs2293855) polymorphisms, the obesity-related genetic risk score and atherogenic risk in Brazilian children. This is a cross-sectional study conducted in 544 children aged 4-9 years in the city of Viçosa, Minas Gerais state, Brazil. The single nucleotide polymorphisms rs9939609, rs17782313 and rs2293855, were identified by the system TaqMan SNP genotyping and the obesity-related genetic risk score was determined. The lipid profile (serum total cholesterol [TC], high density lipoprotein [HDL] cholesterol, low density lipoprotein [LDL] cholesterol, triglycerides) was analysed and the atherogenic indices (Castelli I and II indices), atherogenic coefficient (AC), lipoprotein combined index (LCI) and plasma atherogenic index (PAI) were calculated. A semi-structured questionnaire was applied, obtaining data on the sociodemographic, economic and lifestyle characteristics of the children. Weight and height measurements were performed in all children, and body composition was evaluated by Dual-Energy X-ray Absorptiometry (DXA). 55.5% of the sample had dyslipidaemia, while 28.5% of the sample had at least one polymorphism and 2.2% had three polymorphisms. Children with the AG/AA genotypes in the rs2293855 polymorphism had lower HDL cholesterol levels and higher TC/HDL cholesterol, LDL/HDL cholesterol ratios and AC. Those with one or more polymorphisms (rs9939609, rs17782313 and rs2293855) in the genetic risk score had lower HDL cholesterol levels and higher TC/HDL cholesterol ratios, AC, LCI and PAI. In conclusion, the risk allele of the rs2293855 polymorphism and a higher obesity-related genetic risk score were positively associated with higher atherogenic risk in Brazilian children.

Higher serum uric acid is associated with body fat, retinol-binding protein 4, and antioxidative status in Brazilian children.

OBJECTIVE: The aim of this study was to evaluate the association of serum uric acid (SUA) with adiposity, adipokines, and anti- and oxidative markers in Brazilian children. METHODS: This was a cross-sectional investigation with 378 children ages 8 to 9 y in Viçosa, Minas Gerais, Brazil. Information on sociodemographic and lifestyle characteristics was obtained via questionnaires, and body fat was determined by dual energy x-ray absorptiometry. We compared the distributions of adiposity (total and central), adipokines (adiponectin, chemerin, leptin, and retinol-binding protein 4 [RBP4]), anti- and oxidative markers (plasma ferric reducing antioxidant power [FRAP], superoxide dismutase [SOD], and malondialdehyde [MDA]) by SUA categories using linear regression. RESULTS: SUA was positively associated with total and central fat. Every standard deviation (SD) of SUA was related, respectively, to a 3.4 (95% confidence interval [CI], 2.4-4.4), 4 (95% CI, 2.8-5.1), 4.2 (95% CI, 2.9-5.5), and 3.5 (95% CI, 2.4-4.6) units higher of total, truncal, android, and gynoid fat. We found a positive association of SUA with RBP4 and FRAP, and a negative association with MDA. Every SD of SUA was related, respectively, to 0.1 (95% CI, 0.01-0.1) and 7.8 (95% CI, 5.5-10.1) units higher of RBP4 and FRAP; and to -0.3 (95% CI, -0.5 to -0.1) units lower of MDA. CONCLUSIONS: SUA was positively associated with adiposity, RBP4, and antioxidative status in Brazilian children.

Associations of adiposity and adipokine concentrations with anti- and oxidative markers in Brazilian children.

OBJECTIVE: The aim of this study was to evaluate the association of body fat, anti- and inflammatory adipokines with anti- and oxidative markers. METHODS: We conducted a cross-sectional study with 378 schoolchildren ages 8 to 9 y in Viçosa, Minas Gerais, Brazil. We obtained information on sociodemographic and lifestyle characteristics via questionnaires, measured height and weight, and estimated body fat by dual energy x-ray absorptiometry. Blood sample was collected to analyze the adipokines (adiponectin, leptin, chemerin, and retinol-binding protein 4) by enzyme-linked immunosorbent assay based on the sandwich principle; and anti- and oxidant markers (plasma ferric reducing antioxidant power [FRAP], superoxide dismutase [SOD], and malondialdehyde [MDA]) by enzymatic methods. Concentrations of anti- and oxidant markers were compared by percent body fat quartiles and adipokine concentrations terciles using of linear regression adjusted for potential confounders. RESULTS: Total and central body fat were positively associated with FRAP. Every 1 standard deviation (SD) of total fat was associated with 4.8 higher FRAP (95% confidence interval [CI], 2.7-7). Additionally, every 1 SD of truncal, android, and gynoid fat were associated with, respectively, 5, 4.6, and 4.6 higher FRAP (95% CI, 2.9-7.1; 2.6-6.7; and 2.4-6.8, respectively). However, adiponectin was inversely associated with FRAP; every adiponectin SD was related to -2.2 lower FRAP (95% CI, -3.9 to -0.5). Chemerin was positively associated with SOD [5.4 (95% CI, 1.9-8.8) SOD units per chemerin SD]. CONCLUSIONS: The body fat measures and adiposity-related inflammation (chemerin) were positively associated with antioxidative markers in children, whereas the adiponectin (anti-inflammatory marker) was inversely associated with FRAP (antioxidative marker).

Interaction effect between breakfast skipping and sedentary behavior in the dietary inflammatory potential of Brazilian school-age children.

OBJECTIVES: Missed nutrients from skipped meals affect diet quality. However, the extent to which breakfast skipping affects the inflammatory potential of a diet, as indicated by Children's Dietary Inflammatory Index (C-DII) score, remains unknown. We aimed to evaluate the association between breakfast skipping and C-DII score, and investigate the presence of interaction with sociodemographic factors and sedentary behavior. METHODS: This representative cross-sectional study enrolled 378 children ages 8 and 9 y from Viçosa, Minas Gerais, Brazil in 2015. We collected sociodemographic data (sex, age, race, and household per-capita income) and screen time using a semistructured questionnaire. Dietary intake and breakfast skipping were evaluated by three 24-h dietary recalls from which energy-adjusted C-DII scores were calculated. We performed linear regression models to test the associations and possible interactions. RESULTS: The prevalence of breakfast skipping and sedentary behavior were 20.1% and 47.6%, respectively. The mean ± standard deviation of the C-DII scores was 0.60 ± 0.94, and ranged from -2.16 (most anti-inflammatory diet) to 2.75 (most proinflammatory diet). Breakfast skipping was associated with a higher intake of lipids, monounsaturated fat, and polyunsaturated fat, as well as lower carbohydrate, calcium, and magnesium intake (P < 0.05). After adjustment, breakfast skippers had higher C-DII scores (ß = 0.33; 95% confidence interval, 0.12-0.54). This association was more pronounced in children with sedentary behavior (ß = 0.53; 95% confidence interval, 0.24-0.82). CONCLUSIONS: Breakfast skipping was associated with a more proinflammatory diet in school-age children, and there was significant interaction with sedentary behavior. Early childhood interventions encouraging the habit of eating a breakfast and engaging in physical activity may help reduce the dietary inflammatory potential and prevent related cardiometabolic disorders.

Pro- and anti-inflammatory adipokines are associated with cardiometabolic risk markers in Brazilian schoolchildren.

Pro- and anti-inflammatory adipokines have been regarded as potential markers of obesity and cardiometabolic comorbidities. However, few studies have evaluated this association in children. We aimed to evaluate the relationship between adipokine concentrations and cardiometabolic risk markers in Brazilian schoolchildren. This was a cross-sectional study with 378 children aged 8-9 years from Viçosa, Minas Gerais, Brazil. We measured adipokines (leptin, retinol-binding protein 4, adiponectin, and chemerin) and cardiometabolic risk markers (fasting glucose, HOMA-IR, lipid profile, and blood pressure). Cardiometabolic risk markers were compared by quintiles of adipokines with linear regression adjusted for potential confounders. Leptin was positively associated with diastolic blood pressure (P = 0.03) and HOMA-IR (P = 0.01), and retinol-binding protein 4 was positively associated with total cholesterol (P = 0.04). Each standard deviation of leptin and retinol-binding protein 4 was associated to, respectively, a 0.1 (95%CI: 0.1; 0.2), 0.3 (95%CI: 0.1; 0.6), and 2.5 (95%CI: 0.1; 4.9) units increase in diastolic blood pressure, HOMA-IR, and total cholesterol. Adiponectin was negatively associated with diastolic blood pressure (P = 0.01) and HOMA-IR (P = 0.01), and chemerin was negatively associated with glucose (P = 0.001). Each standard deviation of adiponectin and chemerin was associated to, respectively, a -0.1 (95%CI: -0.2; -0.1), -0.2 (95%CI: -0.3; -0.1), and -1.2 (95%CI: -1.9; -0.5) units decrease in diastolic blood pressure, HOMA-IR, and glucose.Conclusion: Pro- and anti-inflammatory adipokines were positively and negatively associated with cardiometabolic risk markers, respectively, among schoolchildren, indicating this relationship may be identified at earlier ages. What is Known: • Although leptin, retinol-binding protein 4, and adiponectin are well-known adipokines, a consensus regarding their relationship with cardiometabolic risk markers, especially in schoolchildren, has not yet been reached. • Chemerin is an adipokine that has been studied recently. Yet, due to its dependence on the target cell type, its functions are still a controversial topic. What is New: • Leptin was positively associated with diastolic blood pressure and HOMA-IR, and retinol-binding protein 4 was positively associated with total cholesterol. • Adiponectin was negatively associated with diastolic blood pressure and HOMA-IR, and chemerin was negatively associated with glucose.

Fatores associados ao consumo de alimentos segundo o grau de processamento na Atenção Primária à Saúde / Factors associated with the consumption of food according to the degree of processing in the Primary Health Care

Introdução: O consumo alimentar de uma população pode estar relacionado a fatores socioeconômicos, demográficos e de estilo de vida, podendo sua qualidade ser avaliada de acordo com o grau de processamento de alimentos proposto pela Classificação NOVA. Objetivo: Avaliar o consumo de alimentos de acordo com o grau de processamento entre usuários da atenção primária à saúde em relação às condições socioeconômicas, demográficas e de estilo de vida. Métodos: Estudo transversal realizado entre setembro de 2019 e março de 2020, com adultos e idosos usuários da atenção primária à saúde no município de Guidoval-MG. Foi aplicado um questionário estruturado com variáveis socioeconômicas e demográficas e um questionário de frequência alimentar qualitativo, no qual os alimentos foram classificados conforme a classificação NOVA. Foi realizada regressão de Poisson com variância robusta, permanecendo no modelo final as variáveis com nível de significância menor que 5%. A medida de efeito utilizada foi a razão de prevalência com intervalo de confiança de 95%. Resultados: Foram avaliados 361 indivíduos. Foi encontrada maior prevalência de consumo regular de alimentos ultraprocessados entre indivíduos negros, residentes em localidades urbanas, solteiros e com maior nível socioeconômico. O maior consumo regular de alimentos in natura ou minimamente processados foi associado à cor de pele branca, maior escolaridade e a prática de atividade física. Conclusões: Fatores individuais e contextuais estudados influenciaram o consumo de alimentos in natura ou minimamente processados e de ultraprocessados, sugerindo a necessidade de maior intervenção em grupos populacionais específicos e ressaltando a importância de se adotar uma alimentação saudável. (AU)

Introduction: The consumption of a population can be related to socioeconomic, demographic and lifestyle factors, and its quality can be assessed according to the degree of food processing proposed by the NOVA Classification. Objective: Assess food consumption according to the degree of processing among users of primary health care in relation to socioeconomic, demographic and lifestyle conditions. Methods: Cross-sectional study conducted between September 2019 and March 2020, with adults and elderly users of primary health care in the city of Guidoval-MG. We elaborated a structured questionnaire with socioeconomic and demographic variables and a qualitative food frequency questionnaire, in which foods were classified according to the NOVA classification. We made Poisson regression with robust variance, remaining in the final model as variables with a significance level of less than 5%. We used the prevalence ratio with a 95% confidence interval as measure of effect. Results: We took 361 requests. We found a higher prevalence of regular consumption of ultra-processed foods among black individuals, living in urban areas, single and with higher socioeconomic status. Higher regular consumption of in natura or minimally processed foods was associated with white skin color, higher educational level and the practice of physical activity. Conclusions: Individual and contextual factors studied influence the consumption of in natura or minimally processed and ultra-processed foods, suggesting the need for greater intervention in specific population groups and emphasizing the importance of adopting a healthy diet. (AU)

[Factors associated with dietary patterns in the second half of life]. / Fatores associados aos padrões alimentares no segundo semestre de vida.

The aim of this paper is to identify eating patterns of children aged 6, 9 and 12 months and their association with socioeconomic, behavioral, birth and nutrition variables. Cross-sectional study with children from a cohort in Viçosa-MG, with 112 children at 6 months, 149 at 9 months and 117 at 12 months. Food intake was assessed by a 24-hour recall and patterns extracted by cluster analysis. Breast milk was identified in at least one dietary pattern every month. There was a low participation of ultra-processed foods in the identified dietary patterns. At month 6, children with lower family income were less likely to belong to the dietary pattern composed of milk formulas. Already overweight/obesity was 3.69 times higher in children who made up the pattern 2 (dairy formulas, vegetables, vegetables, beef and pear). At 12 months height deficit (PR = 3.28) and bottle use (PR = 4.51) were associated with the dietary pattern composed of milk formulas and cow's milk. The dietary patterns identified reflected the important participation of breast milk in children's diets. Dietary patterns with the presence of other types of milk were associated with nutritional deviations and bottle feeding.

O objetivo deste artigo é identificar padrões alimentares de crianças com 6, 9 e 12 meses e sua associação com variáveis socioeconômicas, comportamentais, de nascimento e nutrição. Estudo transversal com crianças de uma coorte em Viçosa-MG, sendo 112 crianças com 6 meses, 149 com 9 meses e 117 com 12 meses. O consumo alimentar foi avaliado por um recordatório de 24 horas e os padrões extraídos por análise de agrupamentos. O leite materno foi identificado em pelo menos um padrão alimentar em todos os meses. Houve baixa participação de alimentos ultraprocessados nos padrões alimentares identificados. No 6º mês, crianças com menor renda familiar tiveram menos chance de pertencer ao padrão alimentar composto por fórmulas lácteas. Já o sobrepeso/obesidade foi 3,69 vezes maior em crianças que compunham o padrão 2 (fórmulas lácteas, verduras, legumes, carne bovina e pera). Aos 12 meses o déficit de estatura (RP = 3,28) e o uso de mamadeira (RP = 4,51) estiveram associados ao padrão alimentar composto por fórmulas lácteas e leite de vaca. Os padrões alimentares identificados refletiram a importante participação do leite materno na alimentação das crianças. Padrões alimentares com a presença de outros tipos de leite, foram associados a desvios nutricionais e uso de mamadeiras.

Fatores associados aos padrões alimentares no segundo semestre de vida / Factors associated with dietary patterns in the second half of life

Resumo O objetivo deste artigo é identificar padrões alimentares de crianças com 6, 9 e 12 meses e sua associação com variáveis socioeconômicas, comportamentais, de nascimento e nutrição. Estudo transversal com crianças de uma coorte em Viçosa-MG, sendo 112 crianças com 6 meses, 149 com 9 meses e 117 com 12 meses. O consumo alimentar foi avaliado por um recordatório de 24 horas e os padrões extraídos por análise de agrupamentos. O leite materno foi identificado em pelo menos um padrão alimentar em todos os meses. Houve baixa participação de alimentos ultraprocessados nos padrões alimentares identificados. No 6º mês, crianças com menor renda familiar tiveram menos chance de pertencer ao padrão alimentar composto por fórmulas lácteas. Já o sobrepeso/obesidade foi 3,69 vezes maior em crianças que compunham o padrão 2 (fórmulas lácteas, verduras, legumes, carne bovina e pera). Aos 12 meses o déficit de estatura (RP = 3,28) e o uso de mamadeira (RP = 4,51) estiveram associados ao padrão alimentar composto por fórmulas lácteas e leite de vaca. Os padrões alimentares identificados refletiram a importante participação do leite materno na alimentação das crianças. Padrões alimentares com a presença de outros tipos de leite, foram associados a desvios nutricionais e uso de mamadeiras.

Abstract The aim of this paper is to identify eating patterns of children aged 6, 9 and 12 months and their association with socioeconomic, behavioral, birth and nutrition variables. Cross-sectional study with children from a cohort in Viçosa-MG, with 112 children at 6 months, 149 at 9 months and 117 at 12 months. Food intake was assessed by a 24-hour recall and patterns extracted by cluster analysis. Breast milk was identified in at least one dietary pattern every month. There was a low participation of ultra-processed foods in the identified dietary patterns. At month 6, children with lower family income were less likely to belong to the dietary pattern composed of milk formulas. Already overweight/obesity was 3.69 times higher in children who made up the pattern 2 (dairy formulas, vegetables, vegetables, beef and pear). At 12 months height deficit (PR = 3.28) and bottle use (PR = 4.51) were associated with the dietary pattern composed of milk formulas and cow's milk. The dietary patterns identified reflected the important participation of breast milk in children's diets. Dietary patterns with the presence of other types of milk were associated with nutritional deviations and bottle feeding.

Relação entre os tipos de aleitamento materno e o consumo de vitamina A e ferro em crianças de 6 a 12 meses / Relationship between breastfeeding patterns and intake of vitamin A and iron in children 6-12 months

Resumo O objetivo deste artigo é analisar a associação entre o tipo de aleitamento no primeiro semestre de vida e o consumo de vitamina A e ferro do 6º ao 12º mês. Estudo de coorte com 226 crianças. Avaliou-se o tipo de aleitamento do 1º ao 6º mês de vida e o consumo alimentar do 6º ao 12º mês. O consumo de nutrientes entre os grupos foi comparado pelo teste Kruskal-Wallis. A análise da associação entre o consumo de nutrientes e o tipo de aleitamento se deu pela Regressão de Poisson. O consumo abaixo da recomendação de vitamina A e ferro foi de 33,6% e 67,7%, respectivamente. Crianças amamentadas de maneira exclusiva e predominante no 1º e 2º mês tiveram maior ingestão de vitamina A do 6º ao 12º mês de vida. Já as que estavam em aleitamento materno no 6º mês tiveram maior ingestão de vitamina A e menor de ferro na análise bivariada. O grupo que recebeu aleitamento materno misto e artificial no 1º mês e os não amamentados no 6º mês tiveram consumo de vitamina A abaixo do recomendado do 6º ao 12º mês de vida. Os resultados reforçam a importância do aleitamento materno exclusivo nos seis primeiros meses de vida, contribuindo para o maior consumo de vitamina A. O consumo de ferro foi menor entre as crianças amamentadas, porém, a biodisponibilidade desse nutriente no leite materno é maior.

Abstract The aim of this study was to analyze the association between breastfeeding type in the first six months of life and intake of vitamin A and iron in children 6-12 months of age. It is a cohort study with 226 children. The type of breastfeeding from 1-6 months of life and the food intake from 6 to 12 months were evaluated. Nutrient intake between groups was compared by the Kruskal-Wallis test. The association between nutrient intake and type of breastfeeding was analyzed by Poisson Regression. Consumption below the recommendation of vitamin A and iron was 33.6% and 67.7%, respectively. Infants exclusively and predominantly breastfed from birth to two months had higher vitamin A intake from 6-12 months of life. Infants who were breastfeeding at 6 months had higher vitamin A intake and lower iron by the bivariate analysis. The group that received mixed feeding and artificial feeding at 1 month and the group non-breastfed at 6 months had vitamin A intake below the recommended from 6-12 month of life. The results reinforce the importance of exclusive breastfeeding in the first six months of life contributing to the higher vitamin A intake. Iron intake was lower among breastfed children, but the bioavailability of this nutrient in breast milk is higher.

O consumo de produtos ultraprocessados está associado ao melhor nível socioecocômico das famílias das crianças / The consumption of ultra-processed products is associated with the best socioeconomic level of the children's families

Resumo O objetivo deste artigo é avaliar o consumo de produtos ultraprocessados e fatores associados em crianças pré-púberes. Estudo transversal realizado com 378 crianças de 8 e 9 anos matriculadas em escolas públicas e privadas de Viçosa-MG. O consumo alimentar foi avaliado por três recordatórios de 24h. Os dados dietéticos foram tabulados no software Diet Pro® 5i, para quantificar o consumo energético. Para análise dos grupos de consumo alimentar foi utilizada a técnica Two-Step Cluster, por meio do software Stata versão 13.0. Os alimentos foram agrupados e classificados como marcadores de alimentação "saudável" e "não saudável". A associação entre as variáveis sociodemográficas e os grupos formados foi verificada por meio da Regressão de Poisson. Obteve-se a formação de dois grupos alimentares: "saudável" e "não saudável". A ingestão calórica de ultraprocessados foi menor no grupo "saudável" (20,5%) em relação ao "não saudável" (24,1%; P=0,043). No modelo multivariado, crianças de escola privada (RP = 1,25, P<0,001), que não recebiam Bolsa Família (RP=1,13, P=0,036) e cuja mãe trabalhava (RP=1,38, P<0,001) apresentaram maior chance de consumo "não saudável". O consumo de produtos ultraprocessados associou-se ao maior poder aquisitivo das famílias de crianças pré-púberes.

Abstract The aim of this study was to evaluate the intake of ultra-processed foods and associated factors in prepubertal children. It is a cross-sectional study with 378 children aged 8 and 9 years enrolled in public and private schools in Viçosa-MG. Food intake was assessed by three 24-hour dietary recalls. Dietary data were entered into the Diet Pro® 5i software to quantify energy intake. The Two-Step Cluster technique was used to analyze food consumption groups, with the Stata 13 software package. The foods were grouped and classified as "healthy" and "unhealthy" eating markers. The association between the sociodemographic variables and the groups formed was examined by Poisson Regression. Two food groups were formed: "healthy" and "unhealthy". The caloric intake of ultra-processed foods was lower in the "healthy" group (20.5%) than in the "unhealthy" group (24.1%; P = 0.043). The multivariate model showed that private school children (PR = 1.25, P <0.001), who did not receive Bolsa Familia (PR = 1.13, P = 0.036) and had working mothers (PR = 1.38, P <0.001) had increased probability of unhealthy food consumption. Ultra-processed food intake was associated with greater purchasing power of families of prepubertal children.

Relationship between breastfeeding patterns and intake of vitamin A and iron in children 6-12 months. / Relação entre os tipos de aleitamento materno e o consumo de vitamina A e ferro em crianças de 6 a 12 meses.

The aim of this study was to analyze the association between breastfeeding type in the first six months of life and intake of vitamin A and iron in children 6-12 months of age. It is a cohort study with 226 children. The type of breastfeeding from 1-6 months of life and the food intake from 6 to 12 months were evaluated. Nutrient intake between groups was compared by the Kruskal-Wallis test. The association between nutrient intake and type of breastfeeding was analyzed by Poisson Regression. Consumption below the recommendation of vitamin A and iron was 33.6% and 67.7%, respectively. Infants exclusively and predominantly breastfed from birth to two months had higher vitamin A intake from 6-12 months of life. Infants who were breastfeeding at 6 months had higher vitamin A intake and lower iron by the bivariate analysis. The group that received mixed feeding and artificial feeding at 1 month and the group non-breastfed at 6 months had vitamin A intake below the recommended from 6-12 month of life. The results reinforce the importance of exclusive breastfeeding in the first six months of life contributing to the higher vitamin A intake. Iron intake was lower among breastfed children, but the bioavailability of this nutrient in breast milk is higher.

O objetivo deste artigo é analisar a associação entre o tipo de aleitamento no primeiro semestre de vida e o consumo de vitamina A e ferro do 6º ao 12º mês. Estudo de coorte com 226 crianças. Avaliou-se o tipo de aleitamento do 1º ao 6º mês de vida e o consumo alimentar do 6º ao 12º mês. O consumo de nutrientes entre os grupos foi comparado pelo teste Kruskal-Wallis. A análise da associação entre o consumo de nutrientes e o tipo de aleitamento se deu pela Regressão de Poisson. O consumo abaixo da recomendação de vitamina A e ferro foi de 33,6% e 67,7%, respectivamente. Crianças amamentadas de maneira exclusiva e predominante no 1º e 2º mês tiveram maior ingestão de vitamina A do 6º ao 12º mês de vida. Já as que estavam em aleitamento materno no 6º mês tiveram maior ingestão de vitamina A e menor de ferro na análise bivariada. O grupo que recebeu aleitamento materno misto e artificial no 1º mês e os não amamentados no 6º mês tiveram consumo de vitamina A abaixo do recomendado do 6º ao 12º mês de vida. Os resultados reforçam a importância do aleitamento materno exclusivo nos seis primeiros meses de vida, contribuindo para o maior consumo de vitamina A. O consumo de ferro foi menor entre as crianças amamentadas, porém, a biodisponibilidade desse nutriente no leite materno é maior.

The consumption of ultra-processed products is associated with the best socioeconomic level of the children's families. / O consumo de produtos ultraprocessados está associado ao melhor nível socioecocômico das famílias das crianças.

The aim of this study was to evaluate the intake of ultra-processed foods and associated factors in prepubertal children. It is a cross-sectional study with 378 children aged 8 and 9 years enrolled in public and private schools in Viçosa-MG. Food intake was assessed by three 24-hour dietary recalls. Dietary data were entered into the Diet Pro® 5i software to quantify energy intake. The Two-Step Cluster technique was used to analyze food consumption groups, with the Stata 13 software package. The foods were grouped and classified as "healthy" and "unhealthy" eating markers. The association between the sociodemographic variables and the groups formed was examined by Poisson Regression. Two food groups were formed: "healthy" and "unhealthy". The caloric intake of ultra-processed foods was lower in the "healthy" group (20.5%) than in the "unhealthy" group (24.1%; P = 0.043). The multivariate model showed that private school children (PR = 1.25, P <0.001), who did not receive Bolsa Familia (PR = 1.13, P = 0.036) and had working mothers (PR = 1.38, P <0.001) had increased probability of unhealthy food consumption. Ultra-processed food intake was associated with greater purchasing power of families of prepubertal children.

O objetivo deste artigo é avaliar o consumo de produtos ultraprocessados e fatores associados em crianças pré-púberes. Estudo transversal realizado com 378 crianças de 8 e 9 anos matriculadas em escolas públicas e privadas de Viçosa-MG. O consumo alimentar foi avaliado por três recordatórios de 24h. Os dados dietéticos foram tabulados no software Diet Pro® 5i, para quantificar o consumo energético. Para análise dos grupos de consumo alimentar foi utilizada a técnica Two-Step Cluster, por meio do software Stata versão 13.0. Os alimentos foram agrupados e classificados como marcadores de alimentação "saudável" e "não saudável". A associação entre as variáveis sociodemográficas e os grupos formados foi verificada por meio da Regressão de Poisson. Obteve-se a formação de dois grupos alimentares: "saudável" e "não saudável". A ingestão calórica de ultraprocessados foi menor no grupo "saudável" (20,5%) em relação ao "não saudável" (24,1%; P=0,043). No modelo multivariado, crianças de escola privada (RP = 1,25, P<0,001), que não recebiam Bolsa Família (RP=1,13, P=0,036) e cuja mãe trabalhava (RP=1,38, P<0,001) apresentaram maior chance de consumo "não saudável". O consumo de produtos ultraprocessados associou-se ao maior poder aquisitivo das famílias de crianças pré-púberes.

Association of Dietary Patterns with Excess Weight and Body Adiposity in Brazilian Children: The Pase-Brasil Study.

BACKGROUND: Obesity is a multifactorial disease and a serious public health problem. Some of the associated factors are modifiable and, among them, the diet is highlighted. OBJECTIVE: To evaluate the association of dietary patterns of schoolchildren with obesity and body adiposity. METHODS: A cross-sectional study was carried out with 378 children aged 8 and 9 years, enrolled in urban schools in the city of Viçosa, Minas Gerais, Brazil. A semi-structured questionnaire was applied to the children and their caregivers on sociodemographic characteristics and life habits. Three 24-hour food recalls were used to identify dietary patterns; the Principal Component Analysis was employed. Weight and height were measured for the calculation of the body mass index (BMI) of the children and their mothers, waist circumference and neck circumference. Body composition was also evaluated through dual-energy X-ray absorptiometry (DXA). For all performed tests, the level of significance was set at 5%. RESULTS: Five dietary patterns (DP) were identified: "unhealthy", "snacks", "traditional", "industrialized" and "healthy". There was an association between excess weight (prevalence ratio [PR]: 1.38, 95% confidence interval [95%CI]: 1.02 to 1.87) and body fat (PR: 1.32, 95%CI : 1.07 to 1.64) with industrialized DP. There was an association between excess body fat (PR: 1.31, 95%CI: 1.01 to 1.74) and lower adherence to traditional DP. The other patterns were not associated with obesity and body adiposity. CONCLUSION: Children with excess weight and body adiposity showed greater adherence to the industrialized DP and lower adherence to the traditional DP. We suggest that early assessments of dietary habits should be undertaken for monitoring and modifying these habits when necessary.

Association of Dietary Patterns with Excess Weight and Body Adiposity in Brazilian Children: The Pase-Brasil Study / Associação dos Padrões Alimentares com Excesso de Peso e Adiposidade Corporal em Crianças Brasileiras: Estudo Pase-Brasil

Abstract Background: Obesity is a multifactorial disease and a serious public health problem. Some of the associated factors are modifiable and, among them, the diet is highlighted. Objective: To evaluate the association of dietary patterns of schoolchildren with obesity and body adiposity. Methods: A cross-sectional study was carried out with 378 children aged 8 and 9 years, enrolled in urban schools in the city of Viçosa, Minas Gerais, Brazil. A semi-structured questionnaire was applied to the children and their caregivers on sociodemographic characteristics and life habits. Three 24-hour food recalls were used to identify dietary patterns; the Principal Component Analysis was employed. Weight and height were measured for the calculation of the body mass index (BMI) of the children and their mothers, waist circumference and neck circumference. Body composition was also evaluated through dual-energy X-ray absorptiometry (DXA). For all performed tests, the level of significance was set at 5%. Results: Five dietary patterns (DP) were identified: "unhealthy", "snacks", "traditional", "industrialized" and "healthy". There was an association between excess weight (prevalence ratio [PR]: 1.38, 95% confidence interval [95%CI]: 1.02 to 1.87) and body fat (PR: 1.32, 95%CI : 1.07 to 1.64) with industrialized DP. There was an association between excess body fat (PR: 1.31, 95%CI: 1.01 to 1.74) and lower adherence to traditional DP. The other patterns were not associated with obesity and body adiposity. Conclusion: Children with excess weight and body adiposity showed greater adherence to the industrialized DP and lower adherence to the traditional DP. We suggest that early assessments of dietary habits should be undertaken for monitoring and modifying these habits when necessary.

Resumo Fundamentos: A obesidade é uma doença multifatorial e um grave problema de saúde pública. Alguns dos fatores associados são modificáveis; dentre eles destaca-se a alimentação. Objetivo: Avaliar a associação dos padrões alimentares de escolares com a obesidade e adiposidade corporal. Métodos: Estudo transversal, com 378 crianças de 8 e 9 anos, matriculadas em escolas urbanas no município de Viçosa, Minas Gerais (MG), Brasil. Foi aplicado um questionário semiestruturado com as crianças e seus responsáveis sobre características sociodemográficas e hábitos de vida. Utilizaram-se três recordatórios 24 horas para identificar os padrões alimentares; a Análise de Componentes Principais foi empregada. Foram aferidos peso e estatura para o cálculo do índice de massa corporal (IMC) das crianças e de suas mães, perímetro da cintura e perímetro do pescoço A composição corporal também foi avaliada, por meio de absorciometria por dupla emissão de raios X (DXA, do inglês dual energy X-ray absorptiometry). Para todos os testes realizados, o nível de significância adotado foi de 5%. Resultados: Foram identificados cinco padrões alimentares (PA): "não saudável", "lanche", "tradicional", "industrializado" e "saudável". Houve associação entre o excesso de peso (razão de prevalência [RP]: 1,38; intervalo de confiança de 95% [IC95%]: 1,02 a 1,87) e gordura corporal (RP: 1,32; IC95%: 1,07 a 1,64) com o PA industrializado. Foi encontrada associação entre o excesso de gordura corporal (RP: 1,31; IC95%: 1,01 a 1,74) e a menor adesão ao PA tradicional. Os demais padrões não estiveram associados a obesidade e adiposidade corporal. Conclusão: As crianças com excesso de peso e de adiposidade corporal apresentaram maior adesão ao PA industrializado e menor adesão ao PA tradicional. Sugerimos que avaliações precoces dos hábitos alimentares devam ser realizadas para monitoramento e modificação destes, quando necessário.

Increased C-Reactive Protein in Brazilian Children: Association with Cardiometabolic Risk and Metabolic Syndrome Components (PASE Study).

C-reactive protein (CRP) is a marker of subclinical inflammation that has been found to be associated with cardiovascular disease risk. However, few studies have investigated the relationship between CRP and cardiometabolic markers in a representative sample of prepubescent children. The objective was to evaluate the high-sensitive CRP (hs-CRP) and its association with traditional and nontraditional cardiometabolic risk factors, as well as metabolic syndrome (MetS) components in Brazilian children. This is a cross-sectional representative study, with participants of the Schoolchildren Health Assessment Survey (PASE). Children from 8 to 9 years old (n=350) enrolled in public and private schools in the municipality of Viçosa, Minas Gerais, Brazil, were evaluated. Sociodemographic evaluation was performed through a semistructured questionnaire. Anthropometric, body composition, clinical, and biochemical measures were analyzed for cardiometabolic risk assessment. The total mean of serum hs-CRP concentration was 0.62 (±1.44) mg/L. hs-CRP was significantly correlated with several anthropometric, biochemical, and clinical parameters in this population (P < 0.05). hs-CRP was positively associated with the accumulation of cardiometabolic risk factors and MetS components (P < 0.05). Children with excessive weight; abdominal obesity; increased gynoid and android body fat; low HDL-c; hyperglycemia; and elevated uric acid, homocysteine, and apoB had higher chances of presenting increased hs-CRP (P < 0.05). In this study, Brazilian children with cardiometabolic risk already presented elevated serum hs-CRP concentration. hs-CRP was associated with the increase of traditional and nontraditional cardiometabolic risk factors, as well as the accumulation of MetS components.

Efect of vitamin A suplementation: a systematic review.

To evaluate the effect of vitamin A supplementation in postpartum infants and women on serum retinol levels and breast milk. The databases Medline, PubMed, Lilacs and SciELO were consulted. The descriptors used were vitamin A, dietary supplement, child, postpartum period, infant and nutrition programs policies. Search found 7432 articles. After elimination of duplicity and application of eligibility criteria, 8 studies remained. All evaluated the effect of vitamin A supplementation on immediate postpartum, five studies used retinyl palmitate supplementation, one with retinyl palmitate and two did not specify the form of supplementation. Six studies evaluated colostrum and two included supplementation of children. It was found that supplementation in the puerperium increases the concentrations of serum retinol and breast milk, however, this result was in the short term and was relevant when the previous concentrations of the mother were low. When maternal serum concentrations are adequate, the retinol content in milk does not change, with little relevance for children. Further studies should be performed to evaluate the effect of megadoses supplementation on serum concentrations of children.

Efect of vitamin A suplementation: a systematic review / Efeito da suplementação de vitamina A: uma revisão sistemática

Abstract To evaluate the effect of vitamin A supplementation in postpartum infants and women on serum retinol levels and breast milk. The databases Medline, PubMed, Lilacs and SciELO were consulted. The descriptors used were vitamin A, dietary supplement, child, postpartum period, infant and nutrition programs policies. Search found 7432 articles. After elimination of duplicity and application of eligibility criteria, 8 studies remained. All evaluated the effect of vitamin A supplementation on immediate postpartum, five studies used retinyl palmitate supplementation, one with retinyl palmitate and two did not specify the form of supplementation. Six studies evaluated colostrum and two included supplementation of children. It was found that supplementation in the puerperium increases the concentrations of serum retinol and breast milk, however, this result was in the short term and was relevant when the previous concentrations of the mother were low. When maternal serum concentrations are adequate, the retinol content in milk does not change, with little relevance for children. Further studies should be performed to evaluate the effect of megadoses supplementation on serum concentrations of children.

Resumo Avaliar o efeito da suplementação de vitamina A, em lactentes e mulheres no pós-parto, nos níveis de retinol sérico e no leite materno. Foram consultadas as bases de dados Medline, PubMed, Lilacs e SciELO. Os descritores utilizados foram: vitamin A, dietary supplement, child, postpartum period, infant e nutrition programs policies. A busca identificou 7432 artigos. Após eliminação da duplicidade e aplicação dos critérios de elegibilidade permaneceram 8 estudos. Todos avaliaram o efeito da suplementação de vitamina A no pós parto imediato, cinco estudos utilizaram a suplementação com retinil palmitato, um com palmitato de retinila e dois não especificaram a forma de suplementação. Seis estudos avaliaram o colostro e dois incluíram a suplementação de crianças. Encontrou-se que a suplementação no puerpério aumenta as concentrações de retinol sérico e do leite materno, no entanto, este resultado foi a curto prazo e foi relevante quando as concentrações prévias da mãe eram baixas. Quando as concentrações séricas maternas encontram-se adequadas, pouco se altera o teor de retinol no leite, tendo pouco relevância para as crianças. Mais estudos devem ser realizados para avaliar o efeito da suplementação com megadoses nas concentrações séricas de crianças.