Online social networks for prevention and promotion of oral health: a systematic review.

Aim: To evaluate the impact of online social networks (OSN) as resources for promoting behaviour changes related to the prevention and promotion of oral health. Methods: This was a systematic review with meta-analysis of randomized clinical trials identified in databases (MEDLINE/Embase/Lilacs), published up until May 2022, and prepared according to Cochrane recommendations. Studies that used OSN (WhatsApp®, Telegram®, TikTok®, Facebook®, Twitter®, YouTube®, Instagram®, Soundcloud®, Flickr®, LinkedIn®, and Webradio®) were included. The protocol was registered in the International Prospective Register of Systematic Reviews (CRD42021248045). Results: In total, 3171 studies were evaluated, of which 12 studies met the inclusion criteria for the review and contained data on 1669 participants. The most frequently investigated OSN were WhatsApp®, followed by Telegram®, and YouTube®. All studies included were at high risk of bias. Data extraction allowed the meta-analysis of gingival index (GI) and oral health knowledge (OHK) outcomes for young people. Findings revealed that young people exposed to digital interventions via OSN showed a reduction in GI when compared with traditional educational interventions. This reduction occurred in all young people (standardized mean difference, -0.48; 95% CI, -0.75 to -0.21; p = 0.0006, I2 = 0%; very low certainty), including those who were undergoing orthodontic treatment (standardized mean difference, -0.58; 95% CI, -0.92 to -0.24; p = 0.0008, I2 = 0%; very low certainty). Furthermore, young people undergoing orthodontic treatment and exposed to OSN showed an increase in OHK when compared with participation in traditional educational interventions (standardized mean difference, +0.86; 95% CI, +0.46 to +1.26; p < 0.0001, I2 = 0%; very low certainty). Conclusion: OSN could be effective tools for improving oral health outcomes in young people.

Objet: Évaluer l'incidence des réseaux sociaux comme ressources pour promouvoir les changements de comportement liés à la prévention et à la promotion de la santé buccodentaire. Méthodes: Il s'agit d'un examen systématique avec méta-analyse d'essais cliniques randomisés répertoriés dans des bases de données (MEDLINE/Embase/Lilacs) publiés jusqu'en mai 2022 et préparés selon les recommandations de Cochrane. Les études utilisant les réseaux sociaux (WhatsApp®, Telegram®, TikTok®, Facebook®, Twitter®, YouTube®, Instagram®, SoundCloud®, Flickr®, LinkedIn®, et Webradio®) ont été incluses. Le protocole a été enregistré dans le PROSPERO (International Prospective Register of Systematic Reviews, numéro CRD42021248045). Résultats: Au total, 3 171 études ont été évaluées. De celles-ci, 12 répondaient aux critères d'inclusion de l'examen et comportaient des données sur 1 669 participants. Les réseaux sociaux qui ont le plus fréquemment fait l'objet d'une enquête sont WhatsApp®, suivi de Telegram® et YouTube®. Toutes les études incluses présentaient un risque élevé de biais. L'extraction des données a permis la méta-analyse des résultats de l'indice gingival (IG) et des connaissances en santé buccodentaire chez les jeunes. Les résultats ont révélé que les jeunes exposés aux interventions numériques par l'intermédiaire des réseaux sociaux présentaient un IG réduit par rapport à ceux exposés aux interventions éducatives traditionnelles. Cette réduction était présente chez tous les jeunes (différence moyenne standardisée, ­0,48; IC à 95 %, ­0,75 à ­0,21; p = 0,0006, I2 = 0 %; certitude très faible), y compris ceux qui suivaient un traitement orthodontique (différence moyenne standardisée, ­0,58; IC à 95 %, ­0,92 à ­0,24; p = 0,0008, I2 = 0 %; certitude très faible). De plus, les jeunes recevant un traitement orthodontique exposés aux réseaux sociaux ont montré une plus grande connaissance en santé buccodentaire que ceux participant aux interventions éducatives traditionnelles (différence moyenne standardisée, +0,86; IC à 95 %, +0,46 à +1,26; p < 0,0001, I2 = 0 %; certitude très faible). Conclusion: Les réseaux sociaux pourraient être des outils efficaces pour améliorer les résultats en matière de santé buccodentaire chez les jeunes.

Community-level interventions for improving access to food in low- and middle-income countries.

BACKGROUND: After decades of decline since 2005, the global prevalence of undernourishment reverted and since 2015 has increased to levels seen in 2010 to 2011. The prevalence is highest in low- and middle-income countries (LMICs), especially Africa and Asia. Food insecurity and associated undernutrition detrimentally affect health and socioeconomic development in the short and long term, for individuals, including children, and societies. Physical and economic access to food is crucial to ensure food security. Community-level interventions could be important to increase access to food in LMICs. OBJECTIVES: To determine the effects of community-level interventions that aim to improve access to nutritious food in LMICs, for both the whole community and for disadvantaged or at-risk individuals or groups within a community, such as infants, children and women; elderly, poor or unemployed people; or minority groups. SEARCH METHODS: We searched for relevant studies in 16 electronic databases, including trial registries, from 1980 to September 2019, and updated the searches in six key databases in February 2020. We applied no language or publication status limits. SELECTION CRITERIA: We included randomised controlled trials (RCTs), cluster randomised controlled trials (cRCTs) and prospective controlled studies (PCS). All population groups, adults and children, living in communities in LMICs exposed to community-level interventions aiming to improve food access were eligible for inclusion. We excluded studies that only included participants with specific diseases or conditions (e.g. severely malnourished children). Eligible interventions were broadly categorised into those that improved buying power (e.g. create income-generation opportunities, cash transfer schemes); addressed food prices (e.g. vouchers and subsidies); addressed infrastructure and transport that affected physical access to food outlets; addressed the social environment and provided social support (e.g. social support from family, neighbours or government). DATA COLLECTION AND ANALYSIS: Two authors independently screened titles and abstracts, and full texts of potentially eligible records, against the inclusion criteria. Disagreements were resolved through discussion or arbitration by a third author, if necessary. For each included study, two authors independently extracted data and a third author arbitrated disagreements. However, the outcome data were extracted by one author and checked by a biostatistician. We assessed risk of bias for all studies using the Effective Practice and Organization of Care (EPOC) risk of bias tool for studies with a separate control group. We conducted meta-analyses if there was a minimum of two studies for interventions within the same category, reporting the same outcome measure and these were sufficiently homogeneous. Where we were able to meta-analyse, we used the random-effects model to incorporate any existing heterogeneity. Where we were unable to conduct meta-analyses, we synthesised using vote counting based on effect direction. MAIN RESULTS: We included 59 studies, including 214 to 169,485 participants, and 300 to 124, 644 households, mostly from Africa and Latin America, addressing the following six intervention types (three studies assessed two different types of interventions). Interventions that improved buying power: Unconditional cash transfers (UCTs) (16 cRCTs, two RCTs, three PCSs): we found high-certainty evidence that UCTs improve food security and make little or no difference to cognitive function and development and low-certainty evidence that UCTs may increase dietary diversity and may reduce stunting. The evidence was very uncertain about the effects of UCTs on the proportion of household expenditure on food, and on wasting. Regarding adverse outcomes, evidence from one trial indicates that UCTs reduce the proportion of infants who are overweight. Conditional cash transfers (CCTs) (nine cRCTs, five PCSs): we found high-certainty evidence that CCTs result in little to no difference in the proportion of household expenditure on food and that they slightly improve cognitive function in children; moderate-certainty evidence that CCTs probably slightly improve dietary diversity and low-certainty evidence that they may make little to no difference to stunting or wasting. Evidence on adverse outcomes (two PCSs) shows that CCTs make no difference to the proportion of overweight children. Income generation interventions (six cRCTs, 11 PCSs): we found moderate-certainty evidence that income generation interventions probably make little or no difference to stunting or wasting; and low-certainty evidence that they may result in little to no difference to food security or that they may improve dietary diversity in children, but not for households. Interventions that addressed food prices: Food vouchers (three cRCTs, one RCT): we found moderate-certainty evidence that food vouchers probably reduce stunting; and low-certainty evidence that that they may improve dietary diversity slightly, and may result in little to no difference in wasting. Food and nutrition subsidies (one cRCT, three PCSs): we found low-certainty evidence that food and nutrition subsidies may improve dietary diversity among school children. The evidence is very uncertain about the effects on household expenditure on healthy foods as a proportion of total expenditure on food (very low-certainty evidence). Interventions that addressed the social environment: Social support interventions (one cRCT, one PCS): we found moderate-certainty evidence that community grants probably make little or no difference to wasting; low-certainty evidence that they may make little or no difference to stunting. The evidence is very uncertain about the effects of village savings and loans on food security and dietary diversity. None of the included studies addressed the intervention category of infrastructure changes. In addition, none of the studies reported on one of the primary outcomes of this review, namely prevalence of undernourishment. AUTHORS' CONCLUSIONS: The body of evidence indicates that UCTs can improve food security. Income generation interventions do not seem to make a difference for food security, but the evidence is unclear for the other interventions. CCTs, UCTs, interventions that help generate income, interventions that help minimise impact of food prices through food vouchers and subsidies can potentially improve dietary diversity. UCTs and food vouchers may have a potential impact on reducing stunting, but CCTs, income generation interventions or social environment interventions do not seem to make a difference on wasting or stunting. CCTs seem to positively impact cognitive function and development, but not UCTs, which may be due to school attendance, healthcare visits and other conditionalities associated with CCTs.

Community-level interventions for improving access to food in low- and middle-income countries.

BACKGROUND: After decades of decline since 2005, the global prevalence of undernourishment reverted and since 2015 has increased to levels seen in 2010 to 2011. The prevalence is highest in low- and middle-income countries (LMICs), especially Africa and Asia. Food insecurity and associated undernutrition detrimentally affect health and socioeconomic development in the short and long term, for individuals, including children, and societies. Physical and economic access to food is crucial to ensure food security. Community-level interventions could be important to increase access to food in LMICs. OBJECTIVES: To determine the effects of community-level interventions that aim to improve access to nutritious food in LMICs, for both the whole community and for disadvantaged or at-risk individuals or groups within a community, such as infants, children and women; elderly, poor or unemployed people; or minority groups. SEARCH METHODS: We searched for relevant studies in 16 electronic databases, including trial registries, from 1980 to September 2019, and updated the searches in six key databases in February 2020. We applied no language or publication status limits. SELECTION CRITERIA: We included randomised controlled trials (RCTs), cluster randomised controlled trials (cRCTs) and prospective controlled studies (PCS). All population groups, adults and children, living in communities in LMICs exposed to community-level interventions aiming to improve food access were eligible for inclusion. We excluded studies that only included participants with specific diseases or conditions (e.g. severely malnourished children). Eligible interventions were broadly categorised into those that improved buying power (e.g. create income-generation opportunities, cash transfer schemes); addressed food prices (e.g. vouchers and subsidies); addressed infrastructure and transport that affected physical access to food outlets; addressed the social environment and provided social support (e.g. social support from family, neighbours or government). DATA COLLECTION AND ANALYSIS: Two authors independently screened titles and abstracts, and full texts of potentially eligible records, against the inclusion criteria. Disagreements were resolved through discussion or arbitration by a third author, if necessary. For each included study, two authors independently extracted data and a third author arbitrated disagreements. However, the outcome data were extracted by one author and checked by a biostatistician. We assessed risk of bias for all studies using the Effective Practice and Organization of Care (EPOC) risk of bias tool for studies with a separate control group. We conducted meta-analyses if there was a minimum of two studies for interventions within the same category, reporting the same outcome measure and these were sufficiently homogeneous. Where we were able to meta-analyse, we used the random-effects model to incorporate any existing heterogeneity. Where we were unable to conduct meta-analyses, we synthesised using vote counting based on effect direction. MAIN RESULTS: We included 59 studies, including 214 to 169,485 participants, and 300 to 124, 644 households, mostly from Africa and Latin America, addressing the following six intervention types (three studies assessed two different types of interventions). Interventions that improved buying power: Unconditional cash transfers (UCTs) (16 cRCTs, two RCTs, three PCSs): we found high-certainty evidence that UCTs improve food security and make little or no difference to cognitive function and development and low-certainty evidence that UCTs may increase dietary diversity and may reduce stunting. The evidence was very uncertain about the effects of UCTs on the proportion of household expenditure on food, and on wasting. Regarding adverse outcomes, evidence from one trial indicates that UCTs reduce the proportion of infants who are overweight. Conditional cash transfers (CCTs) (nine cRCTs, five PCSs): we found high-certainty evidence that CCTs result in little to no difference in the proportion of household expenditure on food and that they slightly improve cognitive function in children; moderate-certainty evidence that CCTs probably slightly improve dietary diversity and low-certainty evidence that they may make little to no difference to stunting or wasting. Evidence on adverse outcomes (two PCSs) shows that CCTs make no difference to the proportion of overweight children. Income generation interventions (six cRCTs, 11 PCSs): we found moderate-certainty evidence that income generation interventions probably make little or no difference to stunting or wasting; and low-certainty evidence that they may result in little to no difference to food security or that they may improve dietary diversity in children, but not for households. Interventions that addressed food prices: Food vouchers (three cRCTs, one RCT): we found moderate-certainty evidence that food vouchers probably reduce stunting; and low-certainty evidence that that they may improve dietary diversity slightly, and may result in little to no difference in wasting. Food and nutrition subsidies (one cRCT, three PCSs): we found low-certainty evidence that food and nutrition subsidies may improve dietary diversity among school children. The evidence is very uncertain about the effects on household expenditure on healthy foods as a proportion of total expenditure on food (very low-certainty evidence). Interventions that addressed the social environment: Social support interventions (one cRCT, one PCS): we found moderate-certainty evidence that community grants probably make little or no difference to wasting; low-certainty evidence that they may make little or no difference to stunting. The evidence is very uncertain about the effects of village savings and loans on food security and dietary diversity. None of the included studies addressed the intervention category of infrastructure changes. In addition, none of the studies reported on one of the primary outcomes of this review, namely prevalence of undernourishment. AUTHORS' CONCLUSIONS: The body of evidence indicates that UCTs can improve food security. Income generation interventions do not seem to make a difference for food security, but the evidence is unclear for the other interventions. CCTs, UCTs, interventions that help generate income, interventions that help minimise impact of food prices through food vouchers and subsidies can potentially improve dietary diversity. UCTs and food vouchers may have a potential impact on reducing stunting, but CCTs, income generation interventions or social environment interventions do not seem to make a difference on wasting or stunting. CCTs seem to positively impact cognitive function and development, but not UCTs, which may be due to school attendance, healthcare visits and other conditionalities associated with CCTs.

Vitamin A supplementation for postpartum women.

BACKGROUND: In areas where vitamin A deficiency (VAD) is a public health concern, the maternal dietary intake of vitamin A may be not sufficient to meet either the maternal nutritional requirements, or those of the breastfed infant, due the low retinol concentrations in breast milk. OBJECTIVES: To evaluate the effects of vitamin A supplementation for postpartum women on maternal and infant health. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (8 February 2016), LILACS (1982 to December 2015), Web of Science (1945 to December 2015), and the reference lists of retrieved studies. SELECTION CRITERIA: Randomised controlled trials (RCTs) or cluster-randomised trials that assessed the effects of vitamin A supplementation for postpartum women on maternal and infant health (morbidity, mortality and vitamin A nutritional status). DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for inclusion, conducted data extraction, assessed risk of bias and checked for accuracy. We assessed the quality of the evidence using the GRADE approach. MAIN RESULTS: Fourteen trials of mainly low or unclear risk of bias, enrolling 25,758 women and infant pairs were included. The supplementation schemes included high, single or double doses of vitamin A (200,000 to 400,000 internation units (IU)), or 7.8 mg daily beta-carotene compared with placebo, no treatment, other (iron); or higher (400,000 IU) versus lower dose (200,000 IU). In all trials, a considerable proportion of infants were at least partially breastfed until six months. Supplement (vitamin A as retinyl, water-miscible or beta-carotene) 200,000 to 400,000 IU versus control (placebo or no treatment) Maternal: We did not find evidence that vitamin A supplementation reduced maternal mortality at 12 months (hazard ratio (HR) 1.01, 95% confidence interval (CI) 0.44 to 2.21; 8577 participants; 1 RCT, moderate-quality evidence). Effects were less certain at six months (risk ratio (RR) 0.50, 95% CI 0.09 to 2.71; 564 participants; 1 RCT; low-quality evidence). The effect on maternal morbidity (diarrhoea, respiratory infections, fever) was uncertain because the quality of evidence was very low (50 participants, 1 RCT). We found insufficient evidence that vitamin A increases abdominal pain (RR 1.28, 95% CI 0.95 to 1.73; 786 participants; 1 RCT; low-quality evidence). We found low-quality evidence that vitamin A supplementation increased breast milk retinol concentrations by 0.20 µmol/L at three to three and a half months (mean difference (MD) 0.20 µmol/L, 95% CI 0.08 to 0.31; 837 participants; 6 RCTs). Infant: We did not find evidence that vitamin A supplementation reduced infant mortality at two to 12 months (RR 1.08, 95% CI 0.77 to 1.52; 6090 participants; 5 RCTs; low-quality evidence). Effects on morbidity (gastroenteritis at three months) was uncertain (RR 6.03, 95% CI 0.30 to 121.82; 84 participants; 1 RCT; very low-quality evidence). There was low-quality evidence for the effect on infant adverse outcomes (bulging fontanelle at 24 to 48 hours) (RR 2.00, 95% CI 0.61 to 6.55; 444 participants; 1 RCT). Supplement (vitamin A as retinyl) 400,000 IU versus 200,000 IUThree studies (1312 participants) were included in this comparison. None of the studies assessed maternal mortality, maternal morbidity or infant mortality. Findings from one study showed that there may be little or no difference in infant morbidity between the doses (diarrhoea, respiratory illnesses, and febrile illnesses) (312 participants, data not pooled). No firm conclusion could be drawn on the impact on maternal and infant adverse outcomes (limited data available).The effect on breast milk retinol was also uncertain due to the small amount of information available. AUTHORS' CONCLUSIONS: There was no evidence of benefit from different doses of vitamin A supplementation for postpartum women on maternal and infant mortality and morbidity, compared with other doses or placebo. Although maternal breast milk retinol concentrations improved with supplementation, this did not translate to health benefits for either women or infants. Few studies reported on maternal and infant mortality and morbidity. Future studies should include these important outcomes.

Effects of a Low Dose of Fish Oil on Inflammatory Markers of Brazilian HIV-Infected Adults on Antiretroviral Therapy: A Randomized, Parallel, Placebo-Controlled Trial.

BACKGROUND: The benefits of antiretroviral therapy for HIV-infected subjects have been limited by an increased risk of metabolic and cardiovascular diseases. The objective of this study was to assess the effects of a low dose of marine omega-3 fatty acids on inflammatory marker concentrations in HIV-infected subjects under antiretroviral therapy (ART). METHODS: This was a randomized, parallel, placebo-controlled trial that investigated the effects of 3 g fish oil/day (540 mg of eicosapentaenoic acid-EPA plus 360 mg of docosahexaenoic acid-DHA) or 3 g soy oil/day (placebo) for 24 weeks in 83 male and non-pregnant female HIV-infected adults on ART. RESULTS: There were no differences between groups for the measures at baseline. Multilevel analyses revealed no statistically significant relationship between the longitudinal changes in high sensitivity-C reactive protein (hs-CRP) (Wald Chi2 = 0.17, p = 0.918), fibrinogen (Wald Chi2 = 3.82, p = 0.148), and factor VIII (Wald Chi2 = 5.25, p = 0.073) with fish oil. No significant changes in interleukin-6 (IL6), interleukin-1 beta (IL1-beta) and tumor necrosis factor-alpha (TNF-alpha) serum concentrations were observed with fish oil supplements for 12 weeks. CONCLUSIONS: Compared to placebo, a low dose of 900 mg omega-3 fatty acids (EPA plus DHA) in fish oil capsules did not change hs-CRP, fibrinogen, factor VIII, IL6, IL1-beta and TNF-alpha serum concentrations in HIV-infected subjects on ART. Further investigations should consider the assessment of more sensitive inflammatory markers or higher doses to evaluate the effects of marine omega-3 fatty acids in this population. Registered at the Nederlands Trial Register, Identifier no. NTR1798.

Abdominal perimeter is associated with food intake, sociodemographic and behavioral factors among adults in southern Brazil: a population-based study / Perímetro abdominal se asocia a la ingesta de alimentos, factores sociodemográficos y de comportamiento entre los adultos en el sur de Brasil: un estudio basado en la población

Objective: The aim of this study is to investigate the abdominal perimeter determinants in adults who live in the city of Lages, SC. Design: A population-based cross-sectional study in adults from 20 to 59 years-old of the urban area (n=2.022). The dependent variable is the abdominal perimeter, the independent variables are: age, skin color self-reported, marital status, number of children, per capita income, education, physical activity, smoking, nutrition, self-reported diabetes mellitus, high blood pressure, body weight index. The differences between the mean perimeters were tested using ANOVA test and multiple linear regression for confounding adjustment. Results: The response rate was 98.2%, 52.3% were women. The mean abdominal perimeter for men was 93.66 cm (SD 13.8) and for women 92.80 cm (SD 14.5). Therewas a positive association of abdominal circumference with age (p<0.001) and negative regarding education. The abdominal perimeter means were higher for those insufficiently active (p<0.001), for former smokers (p<0.001), for those who consumed meat without fat removal (p = 0.001), for those who consumed fruit less than 5 times a week (p<0.001) and for those who were overweight (p<0.001). Remained positively associated with changes in abdominal obesity, insufficient physical activity, smoking, former smoker and consumption of meat without fat removal. All proximal variables remained positively associated with abdominal perimeter. Conclusions: The results have confirmed that diet, lifestyle and sociodemographic conditions determine a different distribution in abdominal fat, it is needed actions to promote a healthy lifestyle (AU)

Objetivo: El objetivo de este estudio fue investigar los determinantes del perímetro abdominal en adultos que viven en la ciudad de Lages, SC. Diseño: Estudio transversal de base poblacional en adultos 20-59 años de edad, de la zona urbana (n= 2022). La variable dependiente fue el perímetro abdominal y las variables independientes fueron: edad, color de la piel auto dicho, estado civil, número de hijos, renta per cápita, nivel educacional, actividad física, tabaquismo, nutrición, diabetes mellitus auto dicho, presión arterial alta e índice de masa corporal. Las diferencias entre los promedios de perímetros se probaron a través de la ANOVA y de la regresión lineal múltiple, ajustada para los factores de confusión. Resultados: La tasa de respuesta fue de un 98,2%, de los cuales un 52,3% eran mujeres. El perímetro abdominal promedio para los hombres fue 93,66 cm (SD= 13,8 cm) y para las mujeres 92,80 cm (SD= 14,5). Hubo asociación positiva entre la circunferencia abdominal y la edad (p<0,001) y negativa entre la circunferencia abdominal y el nivel educacional. El promedio de perímetro abdominal fue más grande en personas insuficientemente activas (p<0,001), en los ex fumadores (p<0,001), en los que consumen carne sin la eliminación de grasa (p=0,001), en aquellos que consumían frutos menos de 5 veces a la semana (p<0,001) y en los que tenían sobrepeso (p<0,001). Se mantuvo na asociación positiva con los cambios en la obesidad abdominal, la insuficiente actividad física, el tabaquismo, ex fumador y el consumo de carne sin la eliminación de grasa. Todas las variables proximales se mantuvieron asociadas positivamente con el perímetro abdominal. Conclusiones: Los resultados confirman que la dieta, el estilo de vida y las condiciones sociodemográficas determinan una distribución diferente de la grasa abdominal, siendo necesarias acciones para promover un estilo de vida saludable (AU)

Abdominal perimeter is associated with food intake, sociodemographic and behavioral factors among adults in southern Brazil: a population-based study.

OBJECTIVE: The aim of this study is to investigate the abdominal perimeter determinants in adults who live in the city of Lages, SC. DESIGN: A population-based cross-sectional study in adults from 20 to 59 years-old of the urban area (n=2.022). The dependent variable is the abdominal perimeter, the independent variables are: age, skin color self-reported, marital status, number of children, per capita income, education, physical activity, smoking, nutrition, self-reported diabetes mellitus, high blood pressure, body weight index. The differences between the mean perimeters were tested using ANOVA test and multiple linear regression for confounding adjustment. RESULTS: The response rate was 98.2%, 52.3% were women. The mean abdominal perimeter for men was 93.66 cm (SD 13.8) and for women 92.80 cm (SD 14.5). There was a positive association of abdominal circumference with age (p.

Objetivo: El objetivo de este estudio fue investigar los determinantes del perímetro abdominal en adultos que viven en la ciudad de Lages, SC. Diseño: Estudio transversal de base poblacional en adultos 20-59 años de edad, de la zona urbana (n= 2022). La variable dependiente fue el perímetro abdominal y las variables independientes fueron: edad, color de la piel auto dicho, estado civil, número de hijos, renta per cápita, nivel educacional, actividad física, tabaquismo, nutrición, diabetes mellitus auto dicho, presión arterial alta e índice de masa corporal. Las diferencias entre los promedios de perímetros se probaron a través de la ANOVA y de la regresión lineal múltiple, ajustada para los factores de confusión. Resultados: La tasa de respuesta fue de un 98,2%, de los cuales un 52,3% eran mujeres. El perímetro abdominal promedio para los hombres fue 93,66 cm (SD= 13,8 cm) y para las mujeres 92,80 cm (SD= 14,5). Hubo asociación positiva entre la circunferencia abdominal y la edad (p.

Effects of fish oil on lipid profile and other metabolic outcomes in HIV-infected patients on antiretroviral therapy: a randomized placebo-controlled trial.

Although antiretroviral therapy has revolutionized the care of HIV-infected patients, it has been associated with metabolic abnormalities. Hence, this study was planned to investigate the effects of fish oil on lipid profile, insulin resistance, and body fat distribution in HIV-infected Brazilian patients on antiretroviral therapy, considering that marine omega-3 fatty acids seem to improve features of the metabolic syndrome. We conducted a randomized, parallel, placebo-controlled trial that assessed the effects of 3 g fish oil/day (540 mg of eicosapentaenoic acid plus 360 mg of docosahexaenoic acid) or 3 g soy oil/day (placebo) on 83 HIV-infected Brazilian men and non-pregnant women on antiretroviral therapy. No statistically significant relationships between fish oil supplementation and longitudinal changes in triglyceride (p = 0.335), low-density lipoprotein cholesterol (p = 0.078), high-density lipoprotein cholesterol (p = 0.383), total cholesterol (p = 0.072), apolipoprotein B (p = 0.522), apolipoprotein A1 (p = 0.420), low-density lipoprotein cholesterol/apolipoprotein B ratio (p = 0.107), homeostasis model assessment for insulin resistance index (p = 0.387), body mass index (p = 0.068), waist circumference (p = 0.128), and waist/hip ratio (p = 0.359) were observed. A low dose of fish oil did not alter lipid profile, insulin resistance, and body fat distribution in HIV-infected patients on antiretroviral therapy.

The influence of vitamin A supplementation on iron status.

Vitamin A (VA) and iron deficiencies are important nutritional problems, affecting particularly preschool children, as well as pregnant and lactating women. A PubMed (National Library of Medicine, National Institutes of Health, Bethesda, MD, USA) literature review was carried out to search for clinical trials published from 1992 to 2013 that assessed the influence of vitamin A supplementation on iron status. Simultaneous use of iron and vitamin A supplements seemed to be more effective to prevent iron deficiency anemia than the use of these micronutrients alone. Some studies did not include a placebo group and only a few of them assessed vitamin A status of the individuals at baseline. Moreover, the studies did not consider any inflammatory marker and a reasonable number of iron parameters. Another important limitation was the lack of assessment of hemoglobin variants, especially in regions with a high prevalence of anemia. Assessment of hemoglobin variants, inflammatory markers and anemia of chronic inflammation would be important to the studies investigated. Studies involving different populations are necessary to elucidate the interaction between the two micronutrients, especially regarding iron absorption and modulation of erythropoiesis.

Omega-3 fatty acids and hypertriglyceridemia in HIV-infected subjects on antiretroviral therapy: systematic review and meta-analysis.

PURPOSE: Antiretroviral therapy (ART) changed the course of AIDS. However, it has been associated with chronic metabolic complications including hypertriglyceridemia. The aim of this systematic review is to evaluate the effects of marine omega-3 fatty acids in triglycerides concentrations of HIV-infected subjects on ART. METHODS: Thirty-three articles were found in a PubMed search; 6 met the inclusion criteria, and 4 of them were considered of adequate quality and included. Meta-analysis with fixed effects was performed and weighted mean differences (WMD; 95% CI) were described. RESULTS: The overall reduction of triglycerides concentrations after 8 to 16 weeks of treatment with 900 to 3360 mg omega-3/day was WMD -80.34 mg/dL (95% CI, -129.08 to -31.60). Short-term (4 to 8 weeks) and a long-term (12 to 16 weeks) interventions were associated with a WMD -134.36 mg/dL (95% CI, -208.04 to -60.69) and WMD -54.09 mg/dL (95% CI, -115.77 to 7.59), respectively. The pooled result of studies with mean triglycerides ≥300 mg/dL at baseline and 1800 to 2900 mg omega-3/day was WMD -129.72 mg/dL (95% CI, -206.54 to -52.91). CONCLUSION: Different doses of omega-3 fatty acids significantly reduce triglycerides concentrations, confirming the potential applicability of this nutrient on the management of hypertriglyceridemia in HIV-infected subjects on ART.

Iron concentrations in breast milk and selected maternal factors of human milk bank donors.

The aim of this study was to evaluate the relationship between iron concentration in mature breast milk and characteristics of 136 donors of a Brazilian milk bank. Iron, vitamin A, zinc, and copper concentrations were assessed in human milk and maternal blood. Data were collected on maternal anthropometrics, obstetric, socioeconomic, demographic, and lifestyle factors. Iron, zinc, and copper in milk and zinc and copper in blood were detected by spectrophotometry. Vitamin A in milk and blood was determined by high-performance liquid chromatography. Hemoglobin was measured by electronic counting and serum iron and ferritin by colorimetry and chemoluminescence, respectively. Transferrin and ceruloplasmin were determined by nephelometry. According to multivariate linear regression analysis, iron in milk was positively associated with vitamin A in milk and with smoking but negatively associated with timing of breast milk donation (P < .001). These results indicate that iron concentration in milk of Brazilian donors may be influenced by nutritional factors and smoking.

Maternal alcohol consumption may influence cord blood ascorbic acid concentration: findings from a study of Brazilian mothers and their newborns.

Studies that have investigated ascorbic acid (AA) concentrations in cord blood have pointed to significant associations with maternal blood AA concentrations, smoking, age, diet, type of delivery, duration of gestation, fetal distress and birth weight. The aim of the present study was to determine the relationship between cord blood AA concentrations in newborns and maternal characteristics. A total of 117 Brazilian healthy parturients were included in this cross-sectional study. The concentrations of AA in blood were determined by the HPLC method. Data concerning socio-economic, demographic, obstetric, nutritional and health characteristics of the parturients, including alcohol consumption and smoking habit, were assessed by a standardised questionnaire. A FFQ was used to investigate the intake of foods rich in vitamin C. Cord blood AA concentration was significantly correlated with per capita income (r 0.26; P = 0.005), maternal blood AA concentration (r 0.48; P < 0.001) and maternal vitamin C-rich food intake score (r 0.36; P < 0.001). The linear regression model including maternal AA concentration, alcohol consumption, smoking, parity, vitamin C-rich food intake score and per capita income explained 31.13 % of the variation in cord blood AA concentrations in newborns. We recommend further experimental studies to assess the effects of ethanol on placental AA uptake, and epidemiological cohort studies to evaluate in detail the influence of maternal alcohol consumption on cord blood AA concentrations.

Relationship between birthweight and arterial elasticity in childhood.

There is a considerable debate about the potential influence of 'fetal programming' on cardiovascular diseases in adulthood. In the present prospective epidemiological cohort study, the relationship between birthweight and arterial elasticity in 472 children between 5 and 8 years of age was assessed. LAEI (large artery elasticity index), SAEI (small artery elasticity index) and BP (blood pressure) were assessed using the HDI/PulseWave CR-2000 CardioVascular Profiling System. Blood concentrations of glucose, total cholesterol and its fractions [LDL (low-density lipoprotein)-cholesterol and HDL (high-density lipoprotein)-cholesterol] and triacylglycerols (triglycerides) were determined by automated enzymatic methods. Insulin was assessed by a chemiluminescent method, insulin resistance by HOMA (homoeostasis model assessment) and CRP (C-reactive protein) by immunonephelometry. Two linear regression models were applied to investigate the relationship between the outcomes, LAEI and SAEI, and the following variables: birthweight, gestational age, glucose, LDL-cholesterol, HDL-cholesterol, triacylglycerols, insulin, CRP, HOMA, age, gender, waist circumference, per capita income, SBP (systolic BP) and DBP (diastolic BP). LAEI was positively associated with birthweight (P=0.036), waist circumference (P<0.001) and age (P<0.001), and negatively associated with CRP (P=0.024) and SBP (P<0.001). SAEI was positively associated with birthweight (P=0.04), waist circumference (P=0.001) and age (P<0.001), and negatively associated with DBP (P<0.001). Arterial elasticity was decreased in apparently healthy children who had lower birthweights, indicating an earlier atherogenetic susceptibility to cardiovascular diseases in adolescence and adult life. Possible explanations for the results include changes in angiogenesis during critical phases of intrauterine life caused by periods of fetal growth inhibition and local haemodynamic anomalies as a way of adaptation to abnormal pressure and flow.

Plasma concentrations of ascorbic acid in parturients from a hospital in Southeast Brazil.

BACKGROUND & AIMS: Pregnancy is a period characterized by high metabolic requirements and physiological changes in the female organism. During this period, low body stores of vitamins and minerals including antioxidants can have adverse effects on the mother and foetus. This cross-sectional study assessed plasma concentrations of ascorbic acid (AA) in 117 parturients admitted into a university hospital in São Paulo city, Brazil. METHODS: The concentrations of AA were determined by the high performance liquid chromatographic method. Data concerning socioeconomic, demographic, obstetric and nutritional characteristics of the parturients were collected by a standardized questionnaire. RESULTS: The prevalence of AA deficiency (<22.7 micromol/L) among the parturients was 30.8%. Mean plasma AA concentrations were lower in single/divorced women (27.84+/-3.48 micromol/L) compared with married/single with partner women (34.78+/-1.85 micromol/L) (p=0.047). Blood AA concentrations were significantly correlated with per capita income (r=0.36, p<0.001) and vitamin C-rich food intake score (r=0.42, p<0.001). CONCLUSION: The high prevalence of hypovitaminosis C detected in this study is probably due to an inadequate intake of foods rich in vitamin C and low income. We alert to the need for increasing the intake of vitamin C-rich foods through educational programs, especially for low income populations.

Influence of iron on vitamin A nutritional status.

Iron deficiency seems to deteriorate vitamin A metabolism leading to a reduction in serum retinol and an increase in hepatic retinol and retinyl ester. These alterations probably result from an increase in retinol sequestration to the liver and/or impairment in the activity of hepatic retinyl ester hydrolases decreasing vitamin A mobilization.

Relationships of blood lead to calcium, iron, and vitamin C intakes in Brazilian pregnant women.

BACKGROUND & AIMS: This study aimed to determine the relationship between blood lead concentrations and calcium, iron and vitamin C dietary intakes of pregnant women. METHODS: Included in the study were 55 women admitted to a hospital, for delivery, from June to August 2002. A food frequency questionnaire was applied to determine calcium, iron and vitamin C intakes, and a general questionnaire to obtain data on demographic-socioeconomic condition, obstetric history, smoking habit, and alcohol intake. Blood lead and haemoglobin were determined, respectively, by atomic absorption spectrometry and by the haemoglobinometer HemoCue. Multiple linear regression models were used to determine the relationship between blood lead and calcium, iron and vitamin C intakes, and haemoglobin levels, controlling for confounders. RESULTS: The final model of the regression analysis detected an inverse relationship between blood lead and age of the women (p=0.011), haemoglobin (p=0.001), vitamin C (p=0.012), and calcium intake (p<0.001) (R(2)=0.952). One hundred percent, 98.2% and 43.6% of the women were below the adequate intake (AI) for calcium, and below the recommended dietary allowances (RDA) for iron, and vitamin C, respectively. CONCLUSION: Despite the small sample size, the results of this study suggest that maternal age, haemoglobin, vitamin C intake, and calcium intake may interfere with blood concentrations of lead.