The effects of blueberry and cranberry supplementation on blood pressure in patients with cardiovascular diseases: A systematic review and meta-analysis of randomized clinical trials.

Blueberries and cranberries are berry fruits with the highest number of randomized clinical trials (RCTs) focusing on blood pressure (BP). This systematic review and meta-analysis of RCTs analyzed the effects of blueberry and cranberry supplementation alone and in concert with systolic BP (SBP) and diastolic BP (DBP) in patients with cardiometabolic diseases. The searches were performed until August 2023 in the following databases: PubMed, Scopus, Web of Science, Cochrane, and Embase. Studies that examined the effects of blueberry or cranberry intake/supplementation were included. The risk of bias was evaluated using the Rob 2 scale. A meta-analysis was performed to estimate the effects of blueberry and cranberry supplementation on BP levels in patients with cardiometabolic diseases. A total of 17 articles were included, from which two found significant results from blueberry and/or cranberry supplementation in reducing BP. Pooled results revealed statistically non-significant reductions of -0.81 mm Hg for SBP (95% confidence interval [CI]: -2.26, 0.63; I2 = 0%) and -0.15 mm Hg for DBP (95% CI: -1.36, 1.05; I2 = 27%). Blueberry and/or cranberry supplementation had neutral effects on SBP and DBP in patients with cardiometabolic diseases, regardless of duration or age. Further high-quality studies are needed to firmly establish clinical efficacy.

Physical Activity and Chronic Stress in Early Life: Findings From the 2015 Pelotas (Brazil) Birth Cohort.

BACKGROUND: The association of physical activity through early childhood on children's chronic stress still is unclear. Therefore, the aim of the present study is to test the association of physical activity through early childhood (1-4 y) with chronic stress, measured by hair cortisol at age 4. METHODS: Longitudinal study including children from the 2015 Pelotas (Brazil) Birth Cohort. Cortisol at age 4 was measured using a hair sample, which provided cortisol concentration from the past months. Physical activity was measured using accelerometers at 1, 2, and 4 years. Linear regression models were used to assess the association between physical activity and chronic stress. Trajectory models were also applied to examine chronic stress in relation to physical activity patterns throughout early childhood. RESULTS: Children with valid physical activity and hair cortisol data were included in the analyses (N = 1475). Three groups of physical activity trajectories between 1 and 4 years were identified: low, medium, and high. No association between physical activity at 1, 2, and 4 years and chronic stress at age 4 was observed. However, children in the "high" physical activity trajectory presented low cortisol concentration; the magnitude of the regression coefficient was slightly larger in girls (ß = -0.125; 95% confidence interval, -0.326 to 0.074) than boys (ß = -0.051; 95% confidence interval, -0.196 to 0.09). CONCLUSION: There was no clear association between physical activity and chronic stress in early childhood. Trajectories models suggest that higher activity throughout early childhood may positively impact chronic stress; however, more studies are needed to confirm that hypothesis.

Bi-directional associations between physical activity and growth indicators of pre-school aged children.

Physical activity for young children provides a wealth of benefits for health and development. However, little is known about the inter-relationship of physical activity and growth indicators. The aim of this study was to test the bi-directional associations of physical activity and growth indicators in children under five years of age. This prospective study included 1,575 children with data on physical activity and growth indicators at ages 12, 24 and 48 months. Accelerometers were used to measure physical activity. Z-scores for length/height-for-age, weight-for-length/height, weight-for-age and body mass index (BMI)-for-age were calculated. Bi-directional associations between physical activity and growth indicators were evaluated using cross-lagged panels based on Generalized Estimating Equations and cross-lagged structural equation models. Physical activity was consistently associated with lower weight-related growth indicators: BMI-for-age: ß=-0.12; Weight-for-age: ß=-0.11; Weight-for-length/height: ß=-0.12. Higher BMI-for-age indicated lower physical activity (ß=-0.06). When the exposure was lagged, the association of physical activity on weight-related growth indicators remained, but weight-related growth indicators showed a negative association on physical activity. A bi-directional association between physical activity and weight-related growth indicators was observed. The magnitude of associations were stronger when physical activity was modelled as exposure. These results reinforce the importance of physical activity since early years.

Overweight, obesity and risk of multimorbidity: A systematic review and meta-analysis of longitudinal studies.

This study aimed to review and quantify the association between overweight and obesity in the risk of multimorbidity among the general population. We conducted a systematic review and meta-analysis in the databases of Pubmed, Lilacs, Web of Science, Scopus, and Embase. We included cohort studies that assessed the association between overweight and/or obesity with the risk of multimorbidity. The Newcastle-Ottawa assessed the studies' individual quality. A random-effect model meta-analysis was performed to evaluate the association between overweight and obesity with the relative risk (RR) of multimorbidity; the I2 test evaluated heterogeneity. After excluding duplicates, we found 1.655 manuscripts, of which eight met the inclusion criteria. Of these, seven (87.5%) evidenced an increased risk of multimorbidity among subjects with overweight and/or obesity. Overall, we observed an increased risk of multimorbidity among subjects with overweight (RR: 1.26; CI95%: 1.12; 1.40, I2 = 98%) and obesity (RR: 1.99; CI95%: 1.45;2.72, I2 = 99%) compared to normal weight. According to the I2 test, the heterogeneities of the meta-analyses were high. The Newcastle-Ottawa scale showed that all studies were classified as high quality. Further longitudinal studies are needed, including different populations and stratifications by sex, age, and other variables.

Emergency department use and Artificial Intelligence in Pelotas: design and baseline results.

OBJETIVO: To describe the initial baseline results of a population-based study, as well as a protocol in order to evaluate the performance of different machine learning algorithms with the objective of predicting the demand for urgent and emergency services in a representative sample of adults from the urban area of Pelotas, Southern Brazil. METHODS: The study is entitled "Emergency department use and Artificial Intelligence in PELOTAS (RS) (EAI PELOTAS)" (https://wp.ufpel.edu.br/eaipelotas/). Between September and December 2021, a baseline was carried out with participants. A follow-up was planned to be conducted after 12 months in order to assess the use of urgent and emergency services in the last year. Afterwards, machine learning algorithms will be tested to predict the use of urgent and emergency services over one year. RESULTS: In total, 5,722 participants answered the survey, mostly females (66.8%), with an average age of 50.3 years. The mean number of household people was 2.6. Most of the sample has white skin color and incomplete elementary school or less. Around 30% of the sample has obesity, 14% diabetes, and 39% hypertension. CONCLUSION: The present paper presented a protocol describing the steps that were and will be taken to produce a model capable of predicting the demand for urgent and emergency services in one year among residents of Pelotas, in Rio Grande do Sul state.

Time evolution of advice on healthy habits in Brazilians with hypertension and diabetes: National Health Survey / Evolução temporal de orientações sobre hábitos saudáveis em brasileiros com hipertensão e diabetes: Pesquisa Nacional de Saúde

Abstract To evaluate time evolution of receiving advice on healthy habits among Brazilians with hypertension and diabetes mellitus. Cross-sectional study with data from the 2013 and 2019 National Health Survey. We used linear regression weighted by least squares of variance to verify time evolution of the outcome estimating the annual percentage change (APC) presented according to sex, skin color, age group, and quintiles of wealth index. The analytical sample in 2013 was 11,129 individuals with hypertension and 3,182 individuals with diabetes, and in 2019 19,107 individuals with hypertension and 6,317 individuals with diabetes. For those with hypertension, there were statistically significant reductions in receiving advice for not smoking (APC: -1.49), not drinking excessive alcoholic beverages (APC: -1.48), ingesting less salt (APC: -0.56), and for all healthy habits (APC: -1.17). For those with diabetes, statistically significant reductions were observed only for not smoking (APC: -1.13) and not drinking excessive alcoholic beverages (APC: -1.11). The results suggest a reduction in all types of advice on healthy habits evaluated for hypertension and diabetes, with greater magnitude among individuals belonging to the richest quintiles.

Resumo O objetivo foi avaliar a evolução temporal do recebimento de orientações sobre hábitos saudáveis entre brasileiros com hipertensão arterial e diabetes mellitus. Estudo transversal com dados da Pesquisa Nacional de Saúde de 2013 e 2019. Para verificar a evolução temporal das prevalências de orientações sobre hábitos saudáveis, realizadas por profissionais de saúde nos atendimentos para as morbidades, utilizou-se regressão linear ponderada pelos quadrados mínimos da variância, estimando a variação percentual anual (VPA) apresentada de acordo com sexo, cor da pele, faixa etária e quintis do índice de bens. A amostra analítica, em 2013, foi de 11.129 indivíduos com hipertensão e 3.182 com diabetes, e em 2019, de 19.107 indivíduos com hipertensão e 6.317 com diabetes. Para hipertensão, observou-se reduções nas orientações para não fumar (VPA: -1.49), não ingerir bebidas alcoólicas em excesso (VPA: -1.48), ingerir menos sal (VPA: -0.56) e, ainda, para todas as orientações (VPA: -1.17). Para diabetes, foram observadas reduções estatisticamente significativas apenas para não fumantes (APC: -1.13) e para os que não consomem bebidas alcoólicas em excesso (APC: -1.11). Os resultados sugerem redução de todas as orientações avaliadas para hipertensão e diabetes, com maior magnitude entre os indivíduos pertencentes aos quintis mais ricos.

Time evolution of advice on healthy habits in Brazilians with hypertension and diabetes: National Health Survey.

To evaluate time evolution of receiving advice on healthy habits among Brazilians with hypertension and diabetes mellitus. Cross-sectional study with data from the 2013 and 2019 National Health Survey. We used linear regression weighted by least squares of variance to verify time evolution of the outcome estimating the annual percentage change (APC) presented according to sex, skin color, age group, and quintiles of wealth index. The analytical sample in 2013 was 11,129 individuals with hypertension and 3,182 individuals with diabetes, and in 2019 19,107 individuals with hypertension and 6,317 individuals with diabetes. For those with hypertension, there were statistically significant reductions in receiving advice for not smoking (APC: -1.49), not drinking excessive alcoholic beverages (APC: -1.48), ingesting less salt (APC: -0.56), and for all healthy habits (APC: -1.17). For those with diabetes, statistically significant reductions were observed only for not smoking (APC: -1.13) and not drinking excessive alcoholic beverages (APC: -1.11). The results suggest a reduction in all types of advice on healthy habits evaluated for hypertension and diabetes, with greater magnitude among individuals belonging to the richest quintiles.

Emergency department use and Artificial Intelligence in Pelotas: design and baseline results / Uso serviços de serviços de urgência e emergência e Inteligência Artificial em Pelotas: protocolo e resultados iniciais

RESUMO Objetivo: To describe the initial baseline results of a population-based study, as well as a protocol in order to evaluate the performance of different machine learning algorithms with the objective of predicting the demand for urgent and emergency services in a representative sample of adults from the urban area of Pelotas, Southern Brazil. Methods: The study is entitled "Emergency department use and Artificial Intelligence in PELOTAS (RS) (EAI PELOTAS)" (https://wp.ufpel.edu.br/eaipelotas/). Between September and December 2021, a baseline was carried out with participants. A follow-up was planned to be conducted after 12 months in order to assess the use of urgent and emergency services in the last year. Afterwards, machine learning algorithms will be tested to predict the use of urgent and emergency services over one year. Results: In total, 5,722 participants answered the survey, mostly females (66.8%), with an average age of 50.3 years. The mean number of household people was 2.6. Most of the sample has white skin color and incomplete elementary school or less. Around 30% of the sample has obesity, 14% diabetes, and 39% hypertension. Conclusion: The present paper presented a protocol describing the steps that were and will be taken to produce a model capable of predicting the demand for urgent and emergency services in one year among residents of Pelotas, in Rio Grande do Sul state.

RESUMO Objetivo: Descrever os resultados iniciais da linha de base de um estudo de base populacional, bem como um protocolo para avaliar o desempenho de diferentes algoritmos de aprendizado de máquina, com o objetivo de predizer a demanda de serviços de urgência e emergência em uma amostra representativa de adultos da zona urbana de Pelotas, no Sul do Brasil. Métodos: O estudo intitula-se "Emergency department use and Artificial Intelligence in PELOTAS (RS) (EAI PELOTAS)" (https://wp.ufpel.edu.br/eaipelotas/). Entre setembro e dezembro de 2021, foi realizada uma linha de base com os participantes. Está previsto um acompanhamento após 12 meses para avaliar a utilização de serviços de urgência e emergência no último ano. Em seguida, serão testados algoritmos de machine learning para predizer a utilização de serviços de urgência e emergência no período de um ano. Resultados: No total, 5.722 participantes responderam à pesquisa, a maioria do sexo feminino (66,8%), com idade média de 50,3 anos. O número médio de pessoas no domicílio foi de 2,6. A maioria da amostra tem cor da pele branca e ensino fundamental incompleto ou menos. Cerca de 30% da amostra estava com obesidade, 14% com diabetes e 39% eram hipertensos. Conclusão: O presente trabalho apresentou um protocolo descrevendo as etapas que foram e serão tomadas para a produção de um modelo capaz de prever a demanda por serviços de urgência e emergência em um ano entre moradores de Pelotas, no estado do Rio Grande do Sul.

Intergenerational transmission of birth weight: a systematic review and meta-analysis.

The objectives of this study were (1) to systematically review the literature on the association between birth weight in children born in the first and second generation and (2) to quantify this association by performing a meta-analysis. A systematic review was carried out in six databases (PubMed, Science Direct, Web of Science, Embase, Scopus, CINAHL and LILACS), in January 2021, for studies that recorded the birth weight of parents and children. A meta-analysis using random effects to obtain a pooled effect of the difference in birth weight and the association of low birth weight (LBW) between generations was performed. Furthermore, univariable meta-regression was conducted to assess heterogeneity. Egger's tests were used to possible publication biases. Of the 9878 identified studies, seventy were read in full and twenty were included in the meta-analysis (ten prospective cohorts and ten retrospective cohorts), fourteen studies for difference in means and eleven studies for the association of LBW between generations (twenty-three estimates). Across all studies, there was no statistically significant mean difference (MD) birth weight between first and second generation (MD 19·26, 95 % CI 28·85, 67·36; P = 0·43). Overall, children of LBW parents were 69 % more likely to have LBW (pooled effect size 1·69, 95 % CI (1·46, 1·95); I2:85·8 %). No source of heterogeneity was identified among the studies and no publication bias. The average birth weight of parents does not influence the average birth weight of children; however, the proportion of LBW among the parents seems to affect the offspring's birth weight.

Pre-pregnancy weight excess and body mass index: Analysis of three generations Brazilian birth cohort.

To evaluate the relationship between the grandmother's maternal pre-pregnancy body mass index (BMI) (first generation-G1), the BMI of the female members of the birth cohort of Pelotas/RS, Brazil, 1993 (second generation-G2) and the children of the cohort members (third generation-G3). a longitudinal study using data from the 1993 Pelotas/RS cohort. The maternal pre-pregnancy BMI of the mothers of the members (first generation-G1) was self-reported, and of the participants in the cohort (second generation-G2) was collected using weight and height in follow-ups prior to 22 years of age. Children from the third generation (G3) were included in this last follow-up (22 years) and anthropometric measurements were collected. The outcome was BMI-for-age z-score obtained using weight and height measures collected in every follow-up. Linear regression was performed with adjustment for possible confounding factors. The cohort's original sample consists of 5249 participants and 855 children (their first children). At 12 and 48 months, the average increase in BMI-for-age z-score of children of women with pre-pregnancy weight excess was 0.11 and 0.47 kg/m2 , respectively, increasing to around 0.60 kg/m2 in adolescence, reaching an average increase of 2.71 kg/m2 in BMI at 22 years of age. The G2 pre-pregnancy weight excess was also associated with G3 BMI-for-age z-score [ß = 0.43 kg/m2 (95% CI 0.21; 0.65)]. Maternal pre-pregnancy weight excess was associated with the child's BMI-for-age z-score, in both G2 and G3, suggesting a proximal relationship, with no association between G1 and G3.

Consumption of ultra-processed foods and growth outcomes in early childhood: 2015 Pelotas Birth Cohort.

The current study aims to describe the consumption of ultra-processed foods, from 2 to 4 years old, and evaluate its association with growth outcomes during the same period. It is a prospective cohort study using data from the 2015 Pelotas-Brazil Birth Cohort. Outcomes assessed at the 2- and 4-year-old follow-ups were BMI-for-age Z-score and length/height-for-age Z-score. The exposure was a score of ultra-processed food consumption calculated at each follow-up by summing up the positive answers for the consumption of nine specific items/subgroups of ultra-processed foods: (i) instant noodles; (ii) soft drink; (iii) chocolate powder in milk; (iv) nuggets, hamburger or sausages; (v) packaged salty snacks; (vi) candies, lollipops, chewing gum, chocolate or jelly; (vii) sandwich cookie or sweet biscuit; (viii) juice in can or box or prepared from a powdered mix and (ix) yogurt. Crude and adjusted analyses between the score of ultra-processed foods and the outcomes were run using generalised estimating equations. Prevalence of consumption of ultra-processed foods increased from 2 to 4 years old, for all evaluated items/subgroups, except yogurt. In prospective analyses, higher scores of ultra-processed food consumption were associated with higher BMI-for-age Z-score and lower length/height-for-age Z-score, after adjustment for confounders. Ultra-processed food consumption, measured using a short questionnaire with low research burden, increased from 2 to 4 years old and was related to deleterious growth outcomes in early childhood. These results reinforce the importance of avoiding the consumption of these products in childhood to prevent the double burden of malnutrition and non-communicable chronic diseases throughout the life.

Inequalities in care for the people with diabetes in Brazil: A nationwide study, 2019.

The purpose of this paper is to evaluate inequalities in care for people with diabetes in Brazil. This cross-sectional population-based study was carried out in 2019 and evaluated care provided by receiving advice, requesting laboratory tests, and performing examinations. We used the slope index of inequality and concentration index to assess inequalities according to educational level and Poisson regression to estimate prevalence ratios for each outcome in the education category. We assessed a total of 6317 people with diabetes, 41.8% had their eyes checked, and 36.1% had their feet examined in the previous year. Prevalence for both examinations was 2.45 times higher in those from the highest level of education compared to those from the lowest level. The largest absolute differences (in percentage points) between the lowest and highest education levels in care indicators were the following: request for glycated hemoglobin test (39.0), glucose curve test (31.4), and eyes checked in the previous year (29.7). There were notable inequalities in the prevalence ratios of care provided to people with diabetes in Brazil. Requests for glycated hemoglobin tests, glucose curve tests, eye and feet examinations should be emphasized, especially for people from lower educational levels.

[Socioeconomic inequalities in the food consumption of the elderly Brazilian population: National Health Survey, 2019]. / Desigualdades socioeconômicas no consumo alimentar da população idosa brasileira: Pesquisa Nacional de Saúde, 2019.

Food consumption, when performed in an unhealthy manner, has consequences for the health of individuals, such as a higher incidence of excess weight and the exacerbation of pre-existing chronic diseases. The scope of this article was to assess summary inequalities in food consumption among the elderly population in Brazil. It involved a cross-sectional study, with data from the 2019 National Health Survey. The following outcomes were evaluated: consumption of beans, greens/vegetables, fruit, milk, meat, soda, candies and salt. The main exposure variable was education. An adjusted analysis was conducted and two indices were also used to measure inequality: the slope index (SII) and the concentration index (CIX). A total of 43,554 elderly people were investigated. It was identified that the more educated were 80% more likely to consume vegetables, fruit and milk, while the consumption of beans and meat was up to 50% lower among the less educated. The analyses of relative and absolute inequality reinforce the lower consumption of foods considered healthy among the less educated elderly individuals. The results reveal inequalities in food consumption among the elderly, with greater magnitude in food recognized as being healthy.

O consumo alimentar, quando realizado de forma não saudável, traz consequências para a saúde dos indivíduos, como uma maior ocorrência de excesso de peso e o agravamento de doenças crônicas prévias. O objetivo deste artigo foi avaliar as desigualdades sumárias no consumo alimentar da população idosa no Brasil. Trata-se de um estudo transversal, com dados da Pesquisa Nacional de Saúde de 2019. Foram avaliados os seguintes desfechos: consumo de feijão, verduras/legumes, frutas, leite, carnes, refrigerante, doces e sal. A principal variável de exposição foi escolaridade. Para mensuração da desigualdade foi realizada análise ajustada e também foram utilizados dois índices: slope index (SII) e o concentration index (CIX). Foram investigados 43.554 idosos. Identificou-se que os mais escolarizados tinham até 80,0% mais probabilidade de consumir verduras, frutas e leite, enquanto o consumo de feijão e de carnes foi até 50,0% menor nos mais escolarizados. As análises de desigualdade relativa e absoluta reforçam o menor consumo de alimentos considerados saudáveis entre os idosos menos escolarizados. Os resultados revelam iniquidades no consumo alimentar entre idosos, com maior magnitude nos alimentos reconhecidamente saudáveis.

[Delay in quadrivalent vaccine (DTP+Hib) in children 12 to 23 months of age: Brazilian National Health Survey, 2013]. / Atraso na vacina tetravalente (DTP+Hib) em crianças de 12 a 23 meses de idade: Pesquisa Nacional de Saúde, 2013.

The study aimed to estimate the prevalence of delay in the three doses of quadrivalent vaccine (DTP+Hib) in children 12 to 23 months of age in Brazil, based on data from the Brazilian National Health Survey (PNS) of 2013 and to analyze the delay in each of the doses according to sociodemographic variables and use of health services and public health interventions. The data are from the PNS a cross-sectional study performed in 2013. The outcome was delay in at least one of the three doses of the quadrivalent vaccine. Delay was defined as a dose received at least 30 days after the recommended date according to information on the child's vaccination card. Prevalence of delay was analyzed according to sociodemographic variables and use of health services. A descriptive analysis was performed to obtain absolute and relative frequencies and their respective 95% confidence intervals. Of the 2,016 children with information collected, 1,843 were analyzed. The prevalence of delay in at least one dose of the vaccine was 44%. There was a delay of 14.8% in the first dose, 28.8% in the second, and 45.4% in the third, and 10% of the children had delays in all three doses. Higher prevalence of delay was associated with male gender, brown skin color, the poorest income quintile, and residence in rural areas and the North of Brazil. The study revealed high prevalence of delay with the quadrivalent vaccine (DTP+Hib) in children 12 to 23 months of age in Brazil, with the highest delay in the third dose.

O objetivo foi estimar a prevalência do atraso nas três doses da vacina tetravalente (DTP+Hib) em crianças de 12 a 23 meses de idade, no Brasil, por meio dos dados da Pesquisa Nacional de Saúde (PNS) de 2013 e descrever o atraso em cada uma das doses segundo variáveis sociodemográficas, utilização de serviços e intervenções públicas de saúde. Foram utilizados dados da PNS, estudo transversal realizado em 2013. O desfecho foi o atraso pelo menos em uma das três doses da vacina tetravalente. Considerou-se como atraso a dose recebida pelo menos 30 dias após a data preconizada, segundo informação da caderneta de vacinação. A prevalência do atraso foi descrita segundo variáveis sociodemográficas e utilização de serviços de saúde. Realizou-se análise descritiva obtendo-se frequências absolutas e relativas e seus respectivos intervalos de 95% de confiança. Das 2.016 crianças com informações coletadas, 1.843 foram analisadas. A prevalência de atraso de pelo menos uma dose da vacina foi de 44%. Observou-se atraso de 14,8% na primeira, 28,8% na segunda e 45,4% na terceira dose, sendo que 10% das crianças tiveram atraso nas três doses. Maiores prevalências de atraso foram encontradas em crianças do sexo masculino, de cor da pele parda, pertencentes ao quintil mais pobre de riqueza, moradores da zona rural e da Região Norte do Brasil. Evidenciou-se alta prevalência de atraso na vacina tetravalente (DTP+Hib) em crianças de 12 a 23 meses do Brasil, sendo maior na terceira dose.

El objetivo fue estimar la prevalencia del atraso en las tres dosis de la vacuna tetravalente (DTP+Hib) en niños de 12 a 23 meses de edad, en Brasil, mediante los datos de la Encuesta Nacional de Salud (PNS) de 2013 y describir el retraso en cada una de las dosis, según variables sociodemográficas, utilización de servicios e intervenciones públicas de salud. Se trata de un estudio transversal, realizado en 2013, con datos de la PNS. El resultado fue el retraso por lo menos en una de las tres dosis de la vacuna tetravalente. Se consideró como un atraso la dosis recibida por lo menos 30 días tras la fecha prefijada, según la información de la cartilla de vacunación. La prevalencia del atraso fue descrita según variables sociodemográficas y utilización de servicios de salud. Se realizó un análisis descriptivo, obteniéndose frecuencias absolutas y relativas, así como sus respectivos intervalos de 95% de confianza. De los 2016 niños con información recogida, se analizaron 1843. La prevalencia de atraso de por lo menos una dosis de la vacuna fue de un 44%. Se observó un retraso de 14,8% en la primera, un 28,8% en la segunda y un 45,4% en la tercera dosis, siendo que un 10% de los niños sufrieron atraso en las tres dosis. Las mayores prevalencias de atraso se encontraron en niños de sexo masculino, mestizos, pertenecientes al quintil más pobre de riqueza, habitantes de la zona rural y de la Región Norte de Brasil. Se evidenció una alta prevalencia de atraso en la vacuna tetravalente (DTP+Hib) en niños de 12 a 23 meses de Brasil, siendo mayor en la tercera dosis.

Ultra-processed food and risk of type 2 diabetes: a systematic review and meta-analysis of longitudinal studies.

BACKGROUND: The consumption of some food groups is associated with the risk of diabetes. However, there is no evidence from meta-analysis which evaluates the consumption of ultra-processed products in the risk of diabetes. This study aimed to review the literature assessing longitudinally the association between consumption of ultra-processed food and the risk of type 2 diabetes and to quantify this risk through a meta-analysis. METHODS: We conducted a systematic review and meta-analysis with records from PubMed, Latin American and Caribbean Literature in Health Sciences (LILACS), Scielo, Scopus, Embase, and Web of Science. We included longitudinal studies assessing ultra-processed foods and the risk of type 2 diabetes. The review process was conducted independently by two reviewers. The Newcastle Ottawa scale assessed the quality of the studies. A meta-analysis was conducted to assess the effect of moderate and high consumption of ultra-processed food on the risk of diabetes. RESULTS: In total 2272 records were screened, of which 18 studies, including almost 1.1 million individuals, were included in this review and 72% showed a positive association between ultra-processed foods and the risk of diabetes. According to the studies included in the meta-analysis, compared with non-consumption, moderate intake of ultra-processed food increased the risk of diabetes by 12% [relative risk (RR): 1.12; 95% confidence interval (CI): 1.06-1.17, I2 = 24%], whereas high intake increased risk by 31% (RR: 1.31; 95% CI: 1.21-1.42, I2 = 60%). CONCLUSIONS: The consumption of ultra-processed foods increased the risk for type 2 diabetes as dose-response effect, with moderate to high credibility of evidence.

Atraso na vacina tetravalente (DTP+Hib) em crianças de 12 a 23 meses de idade: Pesquisa Nacional de Saúde, 2013 / Delay in quadrivalent vaccine (DTP+Hib) in children 12 to 23 months of age: Brazilian National Health Survey, 2013 / Retraso en la vacuna tetravalente (DTP+Hib) en niños de 12 a 23 meses de edad: Encuesta Nacional de Salud, 2013

Resumo: O objetivo foi estimar a prevalência do atraso nas três doses da vacina tetravalente (DTP+Hib) em crianças de 12 a 23 meses de idade, no Brasil, por meio dos dados da Pesquisa Nacional de Saúde (PNS) de 2013 e descrever o atraso em cada uma das doses segundo variáveis sociodemográficas, utilização de serviços e intervenções públicas de saúde. Foram utilizados dados da PNS, estudo transversal realizado em 2013. O desfecho foi o atraso pelo menos em uma das três doses da vacina tetravalente. Considerou-se como atraso a dose recebida pelo menos 30 dias após a data preconizada, segundo informação da caderneta de vacinação. A prevalência do atraso foi descrita segundo variáveis sociodemográficas e utilização de serviços de saúde. Realizou-se análise descritiva obtendo-se frequências absolutas e relativas e seus respectivos intervalos de 95% de confiança. Das 2.016 crianças com informações coletadas, 1.843 foram analisadas. A prevalência de atraso de pelo menos uma dose da vacina foi de 44%. Observou-se atraso de 14,8% na primeira, 28,8% na segunda e 45,4% na terceira dose, sendo que 10% das crianças tiveram atraso nas três doses. Maiores prevalências de atraso foram encontradas em crianças do sexo masculino, de cor da pele parda, pertencentes ao quintil mais pobre de riqueza, moradores da zona rural e da Região Norte do Brasil. Evidenciou-se alta prevalência de atraso na vacina tetravalente (DTP+Hib) em crianças de 12 a 23 meses do Brasil, sendo maior na terceira dose.

Abstract: The study aimed to estimate the prevalence of delay in the three doses of quadrivalent vaccine (DTP+Hib) in children 12 to 23 months of age in Brazil, based on data from the Brazilian National Health Survey (PNS) of 2013 and to analyze the delay in each of the doses according to sociodemographic variables and use of health services and public health interventions. The data are from the PNS a cross-sectional study performed in 2013. The outcome was delay in at least one of the three doses of the quadrivalent vaccine. Delay was defined as a dose received at least 30 days after the recommended date according to information on the child's vaccination card. Prevalence of delay was analyzed according to sociodemographic variables and use of health services. A descriptive analysis was performed to obtain absolute and relative frequencies and their respective 95% confidence intervals. Of the 2,016 children with information collected, 1,843 were analyzed. The prevalence of delay in at least one dose of the vaccine was 44%. There was a delay of 14.8% in the first dose, 28.8% in the second, and 45.4% in the third, and 10% of the children had delays in all three doses. Higher prevalence of delay was associated with male gender, brown skin color, the poorest income quintile, and residence in rural areas and the North of Brazil. The study revealed high prevalence of delay with the quadrivalent vaccine (DTP+Hib) in children 12 to 23 months of age in Brazil, with the highest delay in the third dose.

Resumen: El objetivo fue estimar la prevalencia del atraso en las tres dosis de la vacuna tetravalente (DTP+Hib) en niños de 12 a 23 meses de edad, en Brasil, mediante los datos de la Encuesta Nacional de Salud (PNS) de 2013 y describir el retraso en cada una de las dosis, según variables sociodemográficas, utilización de servicios e intervenciones públicas de salud. Se trata de un estudio transversal, realizado en 2013, con datos de la PNS. El resultado fue el retraso por lo menos en una de las tres dosis de la vacuna tetravalente. Se consideró como un atraso la dosis recibida por lo menos 30 días tras la fecha prefijada, según la información de la cartilla de vacunación. La prevalencia del atraso fue descrita según variables sociodemográficas y utilización de servicios de salud. Se realizó un análisis descriptivo, obteniéndose frecuencias absolutas y relativas, así como sus respectivos intervalos de 95% de confianza. De los 2016 niños con información recogida, se analizaron 1843. La prevalencia de atraso de por lo menos una dosis de la vacuna fue de un 44%. Se observó un retraso de 14,8% en la primera, un 28,8% en la segunda y un 45,4% en la tercera dosis, siendo que un 10% de los niños sufrieron atraso en las tres dosis. Las mayores prevalencias de atraso se encontraron en niños de sexo masculino, mestizos, pertenecientes al quintil más pobre de riqueza, habitantes de la zona rural y de la Región Norte de Brasil. Se evidenció una alta prevalencia de atraso en la vacuna tetravalente (DTP+Hib) en niños de 12 a 23 meses de Brasil, siendo mayor en la tercera dosis.

Desigualdades socioeconômicas no consumo alimentar da população idosa brasileira: Pesquisa Nacional de Saúde, 2019 / Socioeconomic inequalities in the food consumption of the elderly Brazilian population: National Health Survey, 2019

Resumo O consumo alimentar, quando realizado de forma não saudável, traz consequências para a saúde dos indivíduos, como uma maior ocorrência de excesso de peso e o agravamento de doenças crônicas prévias. O objetivo deste artigo foi avaliar as desigualdades sumárias no consumo alimentar da população idosa no Brasil. Trata-se de um estudo transversal, com dados da Pesquisa Nacional de Saúde de 2019. Foram avaliados os seguintes desfechos: consumo de feijão, verduras/legumes, frutas, leite, carnes, refrigerante, doces e sal. A principal variável de exposição foi escolaridade. Para mensuração da desigualdade foi realizada análise ajustada e também foram utilizados dois índices: slope index (SII) e o concentration index (CIX). Foram investigados 43.554 idosos. Identificou-se que os mais escolarizados tinham até 80,0% mais probabilidade de consumir verduras, frutas e leite, enquanto o consumo de feijão e de carnes foi até 50,0% menor nos mais escolarizados. As análises de desigualdade relativa e absoluta reforçam o menor consumo de alimentos considerados saudáveis entre os idosos menos escolarizados. Os resultados revelam iniquidades no consumo alimentar entre idosos, com maior magnitude nos alimentos reconhecidamente saudáveis.

Abstract Food consumption, when performed in an unhealthy manner, has consequences for the health of individuals, such as a higher incidence of excess weight and the exacerbation of pre-existing chronic diseases. The scope of this article was to assess summary inequalities in food consumption among the elderly population in Brazil. It involved a cross-sectional study, with data from the 2019 National Health Survey. The following outcomes were evaluated: consumption of beans, greens/vegetables, fruit, milk, meat, soda, candies and salt. The main exposure variable was education. An adjusted analysis was conducted and two indices were also used to measure inequality: the slope index (SII) and the concentration index (CIX). A total of 43,554 elderly people were investigated. It was identified that the more educated were 80% more likely to consume vegetables, fruit and milk, while the consumption of beans and meat was up to 50% lower among the less educated. The analyses of relative and absolute inequality reinforce the lower consumption of foods considered healthy among the less educated elderly individuals. The results reveal inequalities in food consumption among the elderly, with greater magnitude in food recognized as being healthy.