Food frequency questionnaires developed and validated for pregnant women: Systematic review.

OBJECTIVES: Assessing food intake of pregnant women is extremely important, because maternal dietary patterns can influence fetal development as well as have either positive or negative effects on both the mother and fetus. Thus, the aim of the present study was to carry out a systematic review of the literature on food frequency questionnaires developed and validated for pregnant women, in order to assess their methodological quality and validation process. METHODS: A systematic review of studies focused on validating food frequency questionnaires for pregnant women was carried out in the PubMed, Embase, Scopus, LILACS, and OpenGrey databases. The selected studies were assessed based on their correlation coefficient in validation and reproducibility analyses, whereas their methodological quality was assessed based on the scoring system proposed by the EURopean micronutrient RECommendations Aligned Network of Excellence. RESULTS: In total, 10 965 articles were identified in these databases; among them, 14 studies, with sample sizes ranging from 46 to 221 participants, and with participants (pregnant women) at a mean age of 28.68 ± 4.34 y, were selected. Most of the included studies used the 24-h food recall as the method for developing the food list (n = 6), with composition ranging from 46 to 255 items. With respect to the methodological assessment of the selected articles, half of the assessed tools were classified as having excellent methodological quality; their validation and reproducibility correlation coefficients were classified as moderate and high (r ≥ 0.40). CONCLUSIONS: Food frequency questionnaires developed for pregnant women appear to be reliable tools to assess food intake by this group. Overall, they had good methodological quality and adequate correlation coefficients compared with reference methods.

Prevalência de hipofosfatemia e risco de síndrome de realimentação em idosos internados em uma unidade de terapia intensiva / Prevalence of hypophosphatemia and risk of refeeding syndrome in elderly patients admitted to an intensive care unit

Introdução: A presença de hipofosfatemia é fortemente relacionada à ocorrência de síndrome de realimentação em pacientes críticos, na qual um dos principais grupos de risco é a população idosa. Objetivos: Avaliar a prevalência de hipofosfatemia e o risco de síndrome de realimentação em idosos internados em uma unidade de terapia intensiva. Métodos: Estudo observacional prospectivo, realizado numa unidade de terapia intensiva com pacientes idosos de ambos os sexos e em uso de terapia nutricional enteral. Foram coletados dados demográficos, clínicos e exames bioquímicos, e realizadas triagem e avaliação nutricional. As necessidades nutricionais foram calculadas e adotou-se o ponto de corte de 90% para estabelecer a adequação da oferta calórica. Para avaliar o risco e a ocorrência de síndrome de realimentação, foram utilizados os critérios propostos pelo grupo NICE. A análise estatística foi realizada com o auxílio do programa SPSS 13.0, com um intervalo de confiança (IC) de 95%. Resultados: Foram estudados 44 pacientes, dos quais 34,1% estavam em magreza; 86,4% dos pacientes iniciaram a terapia nutricional enteral em até 48 horas, com 43,2% de adequação calórica em até 72 horas. A hipofosfatemia foi encontrada em 9,1% dos pacientes na admissão e em 29,5% após o início da dieta. Com isso, 88,6% dos pacientes apresentaram algum risco para desenvolver síndrome de realimentação e 40,9% deles manifestaram a síndrome. Conclusão: Foi identificada elevada prevalência de hipofosfatemia após o início da terapia nutricional. Além disso, o risco de desenvolver síndrome de realimentação foi elevado e sua manifestação se assemelha aos dados encontrados na literatura. (AU)

Introduction: The presence of hypophosphatemia is strongly related to the occurrence of refeeding syndrome in critically ill patients, in which one of the main risk groups is the elderly population. Objectives: To assess the prevalence of hypophosphatemia and the risk of refeeding syndrome in elderly patients admitted to an intensive care unit. Methods: Prospective observational study carried out in an intensive care unit with elderly patients of both genders using enteral nutritional therapy. Demographic, clinical and biochemical data were collected, and nutritional screening and assessment were performed. The energy and nutrient requirements were calculated and a cutoff point of 90% was adopted to establish the adequacy of the caloric supply. To assess the risk and occurrence of refeeding syndrome, the criteria proposed by the NICE group were used. Statistical analyses were performed using the SPSS 13.0 program, with a 95% confidence interval (CI). Results: 44 patients were studied, of which 34.1% were malnourished; 86.4% of patients started enteral nutritional therapy within 48 hours, with 43.2% of caloric adequacy within 72 hours. Hypophosphatemia was found in 9.1% of patients on admission and in 29.5% after starting the diet. Thus, 88.6% of patients had some risk of developing the refeeding syndrome and 40.9% of them manifested the syndrome. Conclusion: A high prevalence of hypophosphatemia was identified after starting nutritional therapy. In addition, the risk of developing refeeding syndrome was high and its manifestation is similar to data found in the literature. (AU)

Padrão de consumo dietético de gestantes e sua relação com a insegurança alimentar no domicílio / Dietary intake patterns of pregnant women and its relationship with food insecurity at household

Introdução: Na gestação, as demandas energéticas estão aumentadas visando à promoção de um adequado desenvolvimento. Tal grupo populacional, quando acometido pela insegurança alimentar (IA), tem comprometimento na qualidade da alimentação, pois há influência no consumo de alimentos. Método: Estudo transversal com gestantes atendidas pela rede pública de saúde de Maceió, AL, em 2014. O padrão de consumo dietético foi avaliado por meio de recordatórios alimentares de 24 horas e de questionário de frequência de consumo alimentar, e a presença da IA no domicílio pela Escala Brasileira de IA, com utilização dos testes do χ2 e o teste T de Student, considerando p<0,05 como significativo. Resultados: Foram estudadas 356 gestantes, sendo 42,7% com IA. A maioria tinha elevado consumo diário de arroz (95,5%), feijão (82,0%) e pães (72,7%). Por outro lado, leite e derivados (53,3%), ovos (26,5%) e as carnes (59,0%) foram alimentos de baixo consumo, sendo o último ainda menor nas gestantes com IA (p=0,025). Adicionalmente, esse padrão de consumo refletiu em uma alimentação com baixo aporte energético, dos micronutrientes ácido fólico, ferro, selênio, zinco e cálcio, e de fibras. Conclusão: O padrão de consumo alimentar das gestantes estudadas é caracterizado pelo baixo consumo energético e de nutrientes essenciais ao bom êxito da gravidez. A presença da IA no domicílio não levou a maior comprometimento desse padrão dietético, exceção ao consumo de carnes.(AU)

Introduction: During the pregnancy the energy demands are increased aimed at promoting a proper development. This population group when affected by food insecurity (FI) has compromised the quality of food, it influences on food consumption. Methods: Cross-sectional study of pregnant women by the public health Maceió, AL, in 2014. The pattern of dietary intake was assessed by food 24-hour recalls and a questionnaire of food intake frequency, and the presence of FI in home by the Brazilian Scale FI, using the χ2 and Student's t test, considering p<0.05 as significant. Results: We studied 356 pregnant women, being 42.7% FI. Most had high daily consumption of rice (95.5%), beans (82.0%) and bread (72.7%). On the other hand, dairy products (53.3%), eggs (26.5%) and meat (59.0%) were low-energy food, the latter being even lower in pregnant women with FI (p=0.025). In addition, this consumption pattern reflected in a power low energy intake, micronutrients folic acid, iron, selenium, zinc and calcium and fiber. Conclusion: The dietary patterns of pregnant women studied is characterized by low energy and nutrients essential to the successful pregnancy. The presence of FI in the household has not led to greater commitment of this dietary pattern, except to meat consumption, which it was lower in the presence of FI.(AU)

Insegurança alimentar em gestantes da rede pública de saúde de uma capital do nordeste brasileiro / Eating insecurity among pregnant women in the public health system in a state capital in the northeast of Brazil

Resumo O objetivo deste artigo é avaliar a insegurança alimentar e os seus fatores associados em gestantes atendidas pela rede pública de saúde de uma capital do nordeste brasileiro. Estudo transversal, realizado com gestantes que residiam em Maceió, e que eram atendidas pela rede pública de saúde municipal, das quais foram coletados dados socioeconômicos, antropométricos e realizadas medidas de hemoglobina e glicemia capilar e aferição da pressão arterial. A insegurança alimentar foi avaliada através da Escala Brasileira de Insegurança Alimentar e sua associação com os fatores de risco foi testada por meio de análise de regressão de Poisson, com os resultados expressos pela Razão de Prevalência e Intervalo de Confiança de 95%. Foram analisadas 363 gestantes, com prevalência de insegurança alimentar de 42,7%, sendo 8,0% delas em insegurança grave. Houve associação da insegurança alimentar com: hiperglicemia materna e níveis pressóricos maternos elevados. Foi elevada a prevalência de insegurança alimentar em gestantes atendidas pela rede pública de saúde de uma capital do nordeste brasileiro, estando associada à hiperglicemia materna e a níveis pressóricos elevados. Os resultados precisam ser vistos para que sejam realizadas mais ações que garantam o direito à alimentação adequada a essa população.

Abstract The scope of this article is to evaluate food insecurity and its associated factors among pregnant women attended in the public health network of a northeastern Brazilian capital. It is a cross-sectional study with pregnant women living in the capital of the State of Maceió who were attended by the public municipal health network, from which socioeconomic, anthropometric and hemoglobin and blood glucose and blood pressure measurement data were collected. Food insecurity was assessed using the Brazilian Food Insecurity Scale and its association with the risk factors was tested using Poisson regression analysis, with the results assessed using the Prevalence Ratio and 95% Confidence Interval. Analysis was conducted on 363 pregnant women with a prevalence of food insecurity of 42.7%, of which 8% had severe insecurity. There was an association of food insecurity with maternal hyperglycemia and high maternal blood pressure levels. The prevalence of food insecurity was high among pregnant women attended in the public health network of a northeastern Brazilian capital, being associated with maternal hyperglycemia and high blood pressure. The results should be studied such that more actions are implemented to ensure the right to adequate food for this population group.

Maternal Factors and Adverse Perinatal Outcomes in Women with Preeclampsia in Maceió, Alagoas / Fatores Maternos e Resultados Perinatais Adversos em Portadoras de Pré-eclâmpsia em Maceió, Alagoas

Abstract Background: Preeclampsia has been associated with several risk factors and events. However, it still deserves further investigation, considering the multitude of related factors that affect different populations. Objective: To evaluate the maternal factors and adverse perinatal outcomes in a cohort of pregnant women with preeclampsia receiving care in the public health network of the city of Maceió. Methods: Prospective cohort study carried out in 2014 in the public health network of the city with a sample of pregnant women calculated based on a prevalence of preeclampsia of 17%, confidence level of 90%, power of 80%, and ratio of 1:1. We applied a questionnaire to collect socioeconomic, personal, and anthropometric data, and retrieved perinatal variables from medical records and certificates of live birth. The analysis was performed with Poisson regression and chi-square test considering p values < 0.05 as significant. Results: We evaluated 90 pregnant women with preeclampsia (PWP) and 90 pregnant women without preeclampsia (PWoP). A previous history of preeclampsia (prevalence ratio [PR] = 1.57, 95% confidence interval [95% CI] 1.47 - 1.67, p = 0.000) and black skin color (PR = 1.15, 95% CI 1.00 - 1.33, p = 0.040) were associated with the occurrence of preeclampsia. Among the newborns of PWP and PWoP, respectively, 12.5% and 13.1% (p = 0.907) were small for gestational age and 25.0% and 23.2% (p = 0.994) were large for gestational age. There was a predominance of cesarean delivery. Conclusion: Personal history of preeclampsia and black skin color were associated with the occurrence of preeclampsia. There was a high frequency of birth weight deviations and cesarean deliveries.

Resumo Fundamento: A pré-eclâmpsia tem sido associada a vários fatores de risco e eventos. No entanto, esta doença é merecedora de mais investigações, tendo em vista a multiplicidade de fatores relacionados que acometem diferentes populações. Objetivo: Avaliar os fatores maternos e os resultados perinatais adversos em uma coorte de gestantes com pré-eclâmpsia da rede pública de saúde de Maceió. Métodos: Estudo de coorte prospectivo realizado em 2014 na rede pública de saúde do município com uma amostra de gestantes calculada com base na prevalência de pré-eclâmpsia de 17%, nível de confiança de 90%, poder de 80% e razão de 1:1. Foi aplicado um questionário para coleta de dados socioeconômicos, pessoais e antropométricos, e obtidas variáveis perinatais de prontuário e da declaração de nascido vivo. Análise realizada com regressão de Poisson e teste do qui-quadrado, considerando p < 0,05 como significativo. Resultados: Foram estudadas 90 gestantes com pré-eclâmpsia (GCP) e 90 gestantes sem pré-eclâmpsia (GSP). História prévia de pré-eclâmpsia (razão de prevalência [RP] = 1,57, intervalo de confiança de 95% [IC 95%] 1,47-1,67, p = 0,000) e cor da pele negra (RP = 1,15, IC 95% 1,00-1,33, p = 0,040) estiveram associadas à ocorrência de pré-eclâmpsia. Entre os recém-nascidos das GCP e GSP, 12,5% e 13,1%, respectivamente, eram pequenos para a idade gestacional (p = 0,907) e 25,0% e 23,2%, respectivamente, eram grandes para a idade gestacional (p = 0,994). Houve predomínio da via de parto cesariana. Conclusão: História pessoal de pré-eclâmpsia e cor da pele negra estiveram associadas à ocorrência de pré-eclâmpsia. Houve elevadas frequências de desvios de peso ao nascer e da via de parto cesariana.

Maternal Factors and Adverse Perinatal Outcomes in Women with Preeclampsia in Maceió, Alagoas.

BACKGROUND: Preeclampsia has been associated with several risk factors and events. However, it still deserves further investigation, considering the multitude of related factors that affect different populations. OBJECTIVE: To evaluate the maternal factors and adverse perinatal outcomes in a cohort of pregnant women with preeclampsia receiving care in the public health network of the city of Maceió. METHODS: Prospective cohort study carried out in 2014 in the public health network of the city with a sample of pregnant women calculated based on a prevalence of preeclampsia of 17%, confidence level of 90%, power of 80%, and ratio of 1:1. We applied a questionnaire to collect socioeconomic, personal, and anthropometric data, and retrieved perinatal variables from medical records and certificates of live birth. The analysis was performed with Poisson regression and chi-square test considering p values < 0.05 as significant. RESULTS: We evaluated 90 pregnant women with preeclampsia (PWP) and 90 pregnant women without preeclampsia (PWoP). A previous history of preeclampsia (prevalence ratio [PR] = 1.57, 95% confidence interval [95% CI] 1.47 - 1.67, p = 0.000) and black skin color (PR = 1.15, 95% CI 1.00 - 1.33, p = 0.040) were associated with the occurrence of preeclampsia. Among the newborns of PWP and PWoP, respectively, 12.5% and 13.1% (p = 0.907) were small for gestational age and 25.0% and 23.2% (p = 0.994) were large for gestational age. There was a predominance of cesarean delivery. CONCLUSION: Personal history of preeclampsia and black skin color were associated with the occurrence of preeclampsia. There was a high frequency of birth weight deviations and cesarean deliveries.