Adequacy of basal metabolic rate prediction equations in individuals with severe obesity: A systematic review and meta-analysis.

The determination of energy requirements in clinical practice is based on basal metabolic rate (BMR), frequently predicted by equations that may not be suitable for individuals with severe obesity. This systematic review and meta-analysis examined the accuracy and precision of BMR prediction equations in adults with severe obesity. Four databases were searched in March 2021 and updated in May 2023. Eligible studies compared BMR prediction equations with BMR measured by indirect calorimetry. Forty studies (age: 28-55 years, BMI: 40.0-62.4 kg/m2) were included, most of them with a high risk of bias. Studies reporting bias (difference between estimated and measured BMR) were included in the meta-analysis (n = 20). Six equations were meta-analyzed: Harris & Benedict (1919); WHO (weight) (1985); Owen (1986); Mifflin (1990); Bernstein (1983); and Cunningham (1980). The most accurate and precise equations in the overall analysis were WHO (-12.44 kcal/d; 95%CI: -81.4; 56.5 kcal/d) and Harris & Benedict (-18.9 kcal/d; 95%CI -73.2; 35.2 kcal/d). All the other equations tended to underestimate BMR. Harris & Benedict and WHO were the equations with higher accuracy and precision in predicting BMR in individuals with severe obesity. Additional analyses suggested that equations may perform differently according to obesity BMI ranges, which warrants further investigation.

Instruments and indicators for assessing organisational food environments: a scoping review protocol.

INTRODUCTION: Many studies have explored the food environment to characterise it and understand its role in food practices. Assessment of the organisational food environment can contribute to the development of more effective interventions to promote adequate and healthy eating. However, few instruments and indicators have been developed and validated for assessing this type of setting. The systematisation of those can be useful to support the planning of future assessments and the development of wide-ranging instruments. This study aims to conduct a scoping review to systematise evidence on instruments and indicators for assessing organisational food environments. METHODS AND ANALYSIS: This scoping review was planned according to the methodological framework for scoping reviews proposed by Arksey and O'Malley and subsequently enhanced by Levac et al. For the report of the review, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Extension for Scoping Reviews (PRISMA-ScR) checklist and guidelines will be used. The search will be conducted using PubMed, Embase, Web of Science, PsycINFO, Scopus and Google Scholar databases. The studies to be included were required to have been published in peer-reviewed journals since January 2005. No geographical, population or language restrictions will be applied given the desired breadth of the review. Two researchers will select the articles and extract the data independently. The conceptual model proposed by Castro and Canella will guide the data extraction and analysis. The results will be presented with narrative synthesis for the extracted data accompanying the tabulated and charted results. ETHICS AND DISSEMINATION: This study is based on the analysis of published scientific literature and did not involve patients, medical research, or any type of personal information; therefore, no ethical approval was obtained for this study. The results of this scoping review will be submitted for publication in an international peer-reviewed journal, preferably open access.

Changes in the Gut Microbiota after the Use of Herbal Medicines in Overweight and Obese Individuals: A Systematic Review.

BACKGROUND: Herbal medicine is a low-cost treatment and has been increasingly applied in obesity treatment. Gut microbiota (GM) is strongly associated with obesity pathogenesis. METHODS: We conducted a systematic review guided by the question: "Does the use of herbal medicine change the GM composition in obese individuals?" Randomized clinical trials with obese individuals assessing the effects of herbal medicine intervention in GM were retrieved from the Medline, Embase, Scopus, Web of Science, and Cochrane Library databases, including the Cochrane Controlled Trials Register. Two reviewers independently extracted data using standardized piloted data extraction forms and assessed the study-level risk of bias using an Excel template of the Cochrane "Risk of bias" tool 2-RoB 2. RESULTS: We identified 1094 articles in the databases. After removing duplicates and reading the title and abstract, 14 publications were fully evaluated, of which seven publications from six studies were considered eligible. The herbs analyzed were Moringa oleifera, Punica granatum, Scutellaria baicalensis, Schisandra chinensis, W-LHIT and WCBE. The analysis showed that Schisandra chinensis and Scutellaria baicalensis had significant effects on weight loss herbal intervention therapy composed by five Chinese herbal medicines Ganoderma lucidum, Coptis chinensis, Astragalus membranaceus, Nelumbo nucifera gaertn, and Fructus aurantii (W-LHIT) and white common bean extract (WCBE) on GM, but no significant changes in anthropometry and laboratory biomarkers. CONCLUSIONS: Herbal medicine modulates GM and is associated with increased genera in obese individuals.

Cross-sectional associations between body mass index, waist circumference, and multimorbidity: Pró-Saúde study.

Background: This study aimed (1) To investigate the association between the Body Mass Index (BMI) and waist circumference (WC) with multimorbidity (MM), and (2) To identify patterns of MM and investigate the relationship between BMI and WC with specific combinations of MM (patterns of MM). Methods: A cross-sectional study was conducted with 2,698 participants of the fourth phase of the Brazilian Longitudinal Study of Adult Health (Pró-Saúde Study). MM was defined by the presence of two or more morbidities. MM patterns were identified by exploratory factor analysis based on tetrachoric correlations. Logistic regression models were used to assess associations (odds ratios (OR) with the respective confidence intervals (CI)). Results: Of the total number of participants, 39.5% were overweight and 30.0% were obese; 89.0% (n = 1,468) of women and 77.0% (n = 952) of men were abdominally obese. Indeed, 60.7% (n = 1,635) was identified with MM. For the category four or more morbidities, OR values of 5.98 (95% CI 4.84-7.13) and 7.48 (95% CI 6.14-8.18) were found for each point of increase in BMI, and 6.74 (95% CI 5.48-7.99) and 8.48 (95% CI 7.64-9.29) for each additional centimeter in the WC, for female and male, respectively. Five patterns of MM were identified: respiratory, osteoarticular, cardiometabolic, gastric, and thyroid diseases (56.4% of the total variance). Positive associations were found between BMI and patterns of cardiometabolic, osteoarticular, thyroid and gastric diseases (higher OR of 1.09 [95% CI 1.04-1.14]) and less pronounced between WC and patterns of cardiometabolic and osteoarticular (higher OR of 1.04 [95% CI 1.03-1.04]). Conclusions: The results showed that an increase of both BMI and WC was associated with a higher number of morbidities and with patterns of cardiometabolic and osteoarticular diseases.

Prevalence of vitamin B complex deficiencies in women in reproductive age, pregnant, or lactating woman in Brazil: a systematic review and meta-analysis protocol.

BACKGROUND: Vitamin B deficiencies are involved with several outcomes in fertility and pregnancy. In Brazil, the national prevalence rates of these micronutrient deficiencies in women of reproductive age were not known. This study aims to systematically identify, select, evaluate, analyze, and report the prevalence rates of vitamin B complex deficiencies in women of reproductive age in Brazil and identify variables that may modify the outcome rates. METHODS: A systematic review will be conducted guided by the following question: "What is the prevalence of vitamin B deficiencies in women of reproductive age in Brazil?". The studies will be identified and selected from a literature search using electronic databases, consultation with researchers/specialists, and reference lists of eligible studies and reviews on the topic. Major eligibility criteria include observational cross-sectional and cohort studies carried out in Brazil and performed in women 10-49 years old, or pregnant and lactating mothers, and investigated the deficiency of vitamin B complex by laboratory test. Two reviewers independently will perform the screening and selection of the studies, data extraction, and risk of bias assessment. For the data report, a narrative approach will be used to present the characteristics of the included studies and individual findings. A random meta-analysis model will be implemented to summarize the individual prevalence rates in a global value if the studies are sufficiently homogeneous. DISCUSSION: This study aims to identify the national and regional prevalence rates of vitamin B complex deficiencies in women of reproductive age; allow the policymakers discuss, plan, and implement public policies to screen; and prevent and/or treat these malnutrition conditions. This also aims to know the rates of nutritional deficiencies over the years, serving as an indirect indicator of the socioeconomic and dietary patterns of the population. Specifically for folate, this study allows to compare the prevalence rates of deficiency of this vitamin before and after the mandatory fortification of wheat and corn flours implemented since 2004 in Brazil, in this specific population. The evidence gathered may highlight the need for population-based studies to investigate the deficiency of these vitamins. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020188474.

Nutrients with Antioxidant Properties and Their Effects on Lower-Limb Ulcers: A Systematic Review.

Chronic lower-limb ulcers (LLUs) are ulcers that fail to proceed through an orderly and timely process to produce anatomic and functional integrity. LLUs reduce the quality of life of affected individuals and are a public health problem. The treatment options include medications or surgery. Nutrition therapy is an important adjunct to improve the clinical picture and healing of LLUs. Considering that nutrients with antioxidant properties can improve the process of tissue healing, this systematic review aimed to evaluate the efficacy of antioxidant nutrient supplementation in the treatment of LLUs through randomized clinical trials. This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses and the Cochrane Handbook for Systematic Reviews of Interventions. The guiding question was-can antioxidant nutrients help in the treatment of chronic LLUs? In total, 1184 articles were found when searching for antioxidant nutrients associated with the most common causes of LLUs. Fourteen articles were included in this review after removing duplicates, studies with topical and/or venous use of antioxidants, and articles published in other languages, except English. Omega-3 fatty acids, magnesium, zinc, vitamins A, C, D, and resveratrol along with probiotics positively improved the ulcer healing. These effects were more significant when there was initially a deficiency of the respective supplemented nutrients. Therefore, correcting and maintaining an adequate nutritional status can improve ulcer healing and contribute to the clinical treatment of patients with LLUs.

Globalização e Processamento de Alimentos: Consumo Alimentar no Nordeste Brasileiro / Globalization and Food Processing: Food Consumption in Northeastern Brazil

Introdução: O atual modelo globalizado de produção de alimentos acarreta homogeneização na alimentação, com diminuição no consumo de alimentos in natura e grande participação de ultraprocessados. Objetivo: Investigar os fatores associados ao consumo alimentar de adultos, considerando os níveis de processamento de alimentos. Métodos: Estudo transversal com adultos no estado de Pernambuco que avaliou o consumo alimentar e variáveis socioeconômicas, demográficas, segurança alimentar e outras relacionadas ao modo e prática de aquisição de alimentos. Foi utilizado questionário de frequência alimentar para investigação do consumo, com divisão dos alimentos conforme o nível de processamento, com posterior análise através de escores. Avaliou-se a associação entre consumo alimentar e variáveis explicativas através dos testes "U" de Mann Whitney e Kruskal Wallis, com aplicação, neste último caso, do teste "U" de Mann Whitney a posteriori. Foram consideradas estatisticamente significantes associações com valor de p<0,05. Resultados: Foram entrevistados 1.066 adultos, cuja maioria possuía baixa escolaridade, baixa renda, com participação em programa de transferência de renda e em situação de insegurança alimentar. Essas variáveis mostraram associação com o consumo de determinados grupos alimentares. Também foram observadas diferenças no consumo conforme características como local de moradia, sexo, faixa etária, modo de aquisição de alimentos, local de compra e hábito de leitura do rótulo. Conclusões: Diante do contexto globalizado de estímulo aos industrializados, aspectos como gênero, condições econômicas, local de moradia, ambiente e práticas de compra de alimentos podem se mostrar como protetores para maior consumo de alimentos minimamente processados ou de risco para o consumo de ultraprocessados.

Introduction: The current globalized model of food production leads to the homogenization of diet, with a reduction in the consumption of unprocessed foods and the considerable participation of ultra-processed foods. Objective: Investigate factors associated with food consumption among adults considering the degree of food processing. Methods: A cross-sectional study was conducted with adults in the state of Pernambuco involving the assessment of food consumption. Data were also collected on sociodemographic characteristics, food insecurity and aspects related to food acquisition. A food frequency questionnaire was used to investigate food intake, with the categorization of foods according to the degree of processing and the subsequent analysis of consumption scores. Associations between food consumption and explanatory variables were evaluated using the Mann-Whitney U test and Kruskal- Wallis test, the latter of which was complemented with the post hoc Mann-Whitney U test. Associations with a p-value <0.05 were considered statistically significant. Results: One thousand sixty-six adults were interviewed. Most had a low level of schooling and low income, were beneficiaries of the income transfer program and were in a situation of food insecurity. These variables were associated with the consumption of particular food groups. Differences in consumption were found according to place of residence, sex, age group, mode of food acquisition, place of purchase and the habit of reading food labels. Conclusions: In the globalized context that stimulates the consumption of industrialized foods, aspects such as sex, economic status, place of residence and food purchasing environment and practices can serve as protective factors that ensure the greater consumption of minimally processed foods or risk factors for the consumption of ultra-processed foods products.

Sociodemographic determinants of food consumption pattern: Pró-Saúde Study. / Determinantes sociodemográficos do padrão de consumo de alimentos: Estudo Pró-Saúde.

AIMS: To identify dietary patterns (DP) and to investigate their association with sociodemographic aspects. METHODOLOGY: A cross-sectional data analysis of a sub-sample from Phase 4 of the Pró-Saúde Longitudinal Study (2012-2013), constituting a total of 520 participants. DP were obtained by principal component analysis from a food frequency questionnaire. Association between DP and sociodemographic aspects was analyzed by adjusted logistic regression. RESULTS: Four DP were identified: processed and ultraprocessed products; fresh food; meats and alcoholic beverages; and traditional Brazilian foods. There was a greater adherence chance to "processed and ultraprocessed products" pattern among adults ≥ 55 years and lower chance among men. The probability of adherence to "fresh food" pattern was directly associated to men, subjects with a high educational level and inversely associated to adults aged ≥ 60 years. There was a lower chance of "meats and alcoholic beverages" pattern among men and increased chance of adherence to "traditional Brazilian foods" pattern among whites, subjects with ≥ 60 years and low schooling. CONCLUSION: Sociodemographic factors were important determinants of DP, especially gender, schooling and age. Presence of a DP composed of processed and ultraprocessed products indicates the need for awareness strategies and supply limitation in this population, since it affects their health.

Bioelectrical impedance analysis-derived phase angle is related to risk scores of a first cardiovascular event in adults.

OBJECTIVE: The aim of this study was to investigate the association between phase angle (PhA) and first cardiovascular (CV) event risk. METHODS: This was a cross-sectional study. PhA was determined using a single-frequency bioelectrical impedance analyzer. Scores from the American College of Cardiology/American Heart Association (ACC/AHA; N = 455; 49% men) and the Framingham General Cardiovascular (FRS-CVD; N = 489; 49% men) were used to estimate the risk for a first CV event in adults. Logistic and multinomial regressions were used to evaluate the relationship between ACC/AHA and FRS-CVD risk scores (outcomes) and PhA. Additionally, the consumption of in natura or minimally processed foods was included in the models as an adjustment variable. RESULTS: Men and women, classified according to ACC/AHA (P < 0.001; P = 0.035) and FRS-CVD scores (P = 0.002; P = 0.012) as low risk for first event CV, presented higher PhA values than participants with elevated risk. However, only in men categorized as CV high risk, the third PhA tertile (>7.3°) was associated with a CV lower risk (ACC/AHA, odds ratio, 0.28; 95% confidence interval [CI], 0.14-0.56; FRS-CVD, relative risk ratio, 0.11; 95% CI, 0.03-0.37). The adjustment of all models for consumption of in natura or minimally processed foods did not change the results. CONCLUSION: Higher PhA values were associated with lower risk for a first CV event in men classified in higher-risk categories. In natura or minimally processed food consumption did not influence the relationship between PhA and CV risk. These results may encourage future research about possible applications of PhA as an additional index in primary prevention of CV events.

Food consumption according to degree of processing and sociodemographic characteristics: Estudo Pró-Saúde, Brazil. / Consumo alimentar segundo o grau de processamento e características sociodemográficas: Estudo Pró-Saúde.

OBJECTIVE: To investigate the food consumption according to the degree of processing and associations with sociodemographic characteristics. METHODS: A cross-sectional study of the Estudo Pró-Saúde (Pro-Health Study), with 520 civil servants of university campuses, Rio de Janeiro, 2012-13. A food frequency questionnaire was used to classify food consumption: 1) in natura, minimally processed, food preparations based on these foods; 2) processed foods; 3) ultra-processed foods. The relative energy contribution of each group was determined, and a seemingly unrelated equations regression (SUR) regression model was used to estimate associations with sociodemographic characteristics. RESULTS: The in natura food group (1) contributed with 59% of the energy consumption and was directly associated with age [45-49 years (ß = 1.8 confidence interval of 95% - 95%CI -1.2; 4.8); 50-54 (ß = 1.5 95%CI -1.5; 4.5); 55-59 (ß = 2.9 95%CI -0.4; 6.3) and ≥ 60 (ß = 4.6 95%CI 1.1; 8.2)], compared to age ≤ 44. In contrast, the group of ultra-processed foods contributed 27% and were inversely associated with age [45-49 (ß = -1.7 95%CI -4.3; 0.9); 50-54 (ß = -1.8 95%CI -4.3; 0.9); 55-59 (ß = -4.9 95%CI -8.0; -2.0); ≥ 60 (ß = -4.5 95%CI -7.6; -1.5)]. Gender, income and schooling were not associated with food consumption. CONCLUSION: Younger adults had higher consumption of ultra-processed foods, indicating the need for interventions mainly in this age group. The absence of association with other sociodemographic characteristics may be due to the influence of contextual factors.

OBJETIVO: Investigar o consumo alimentar segundo o grau de processamento e associações com características sociodemográficas. MÉTODOS: Estudo transversal de subamostra do Estudo Pró-Saúde, com 520 funcionários públicos de campi universitários, Rio de Janeiro, 2012-13. Questionário de frequência alimentar foi utilizado para classificar o consumo alimentar: 1) in natura, minimamente processados, preparações culinárias à base desses alimentos; 2) alimentos processados; 3) alimentos ultraprocessados. Determinou-se a contribuição energética relativa de cada grupo, e foi utilizado modelo de regressão seemingly unrelated equations regression (SUR) para estimar associações com as características sociodemográficas. RESULTADOS: O grupo de alimentos in natura (1) contribuiu com 59% do consumo energético e foi diretamente associado à idade [45-49 anos (ß = 1,8 intervalo de confiança de 95% - IC95% -1,2; 4,8); 50-54 (ß = 1,5 IC95% -1,5; 4,5); 55-59 (ß = 2,9 IC95% -0,4; 6,3) e ≥ 60 (ß = 4,6 IC95% 1,1; 8,2)], comparado à idade ≤ 44. Em contraste, ultraprocessados contribuíram com 27% e foram inversamente associados à idade [45-49 (ß = -1,7 IC95% -4,3; 0,9); 50-54 (ß = -1,8 IC95% -4,3; 0,9); 55-59 (ß = -4,9 IC95% -8,0; -2,0); ≥ 60 (ß = -4,5 IC95% -7,6; -1,5)]. Sexo, renda e escolaridade não foram associados ao consumo alimentar. CONCLUSÃO: Adultos mais jovens apresentaram maior consumo de ultraprocessados, indicando a necessidade de intervenções principalmente nessa faixa etária. A ausência de associação com demais características sociodemográficas pode ser por conta da influência de fatores contextuais.

Smoking status affects bioimpedance-derived phase angle in men but not in women: The Pró-Saúde Study, Brazil.

OBJECTIVE: Phase angle (PhA) is determined by bioelectrical impedance (BIA) and it is interpreted as an index of cell membrane integrity. Smokers are susceptible to systemic oxidative stress and often adopt unhealthy habits, which may contribute to cellular damage. This unfavorable conjuncture may result in lower PhA in smokers. The aim of this study was to investigate the association between PhA and smoking status. METHODS: This cross-sectional study included 247 (48%) adult men. Body composition and PhA were determined using dual-energy x-ray absorptiometry and BIA, respectively. Blood sampling, food habits, and smoking status information were collected. Statistical analyses were performed for each sex separately. Analysis of covariance controlling for body mass index and age compared PhA values across smoking categories. Multiple linear regression determined whether smoking status was a PhA predictor. RESULTS: PhA was lower in male current smokers (6.6 ± 0.13°) compared with never-smokers (7 ± 0.06°; P = 0.038). The ratio of extracellular to intracellular water was higher in current (P = 0.003) and former male smokers (P = 0.006) compared with never-smokers. Body composition did not differ in male and female smoking categories. Male current smokers ingested more calories, protein, carbohydrates, and alcohol than never and former smokers (P < 0.05). Current female smokers had higher alcohol consumption compared with never smokers (P = 0.019). Male current smokers presented lower than never-smokers (unstandardized ß coefficient = -0.202; 95% confidence interval, -0.359 to -0.046). Smoking status was associated with PhA decrease only in men. CONCLUSION: The results from the present study suggest that being a current smoker results in lower PhA in men, even when controlling for other variables.

Consumo alimentar segundo o grau de processamento e características sociodemográficas: Estudo Pró-Saúde / Food consumption according to degree of processing and sociodemographic characteristics: Estudo Pró-Saúde, Brazil

RESUMO: Objetivo: Investigar o consumo alimentar segundo o grau de processamento e associações com características sociodemográficas. Métodos: Estudo transversal de subamostra do Estudo Pró-Saúde, com 520 funcionários públicos de campi universitários, Rio de Janeiro, 2012-13. Questionário de frequência alimentar foi utilizado para classificar o consumo alimentar: 1) in natura, minimamente processados, preparações culinárias à base desses alimentos; 2) alimentos processados; 3) alimentos ultraprocessados. Determinou-se a contribuição energética relativa de cada grupo, e foi utilizado modelo de regressão seemingly unrelated equations regression (SUR) para estimar associações com as características sociodemográficas. Resultados: O grupo de alimentos in natura (1) contribuiu com 59% do consumo energético e foi diretamente associado à idade [45-49 anos (β = 1,8 intervalo de confiança de 95% - IC95% -1,2; 4,8); 50-54 (β = 1,5 IC95% -1,5; 4,5); 55-59 (β = 2,9 IC95% -0,4; 6,3) e ≥ 60 (β = 4,6 IC95% 1,1; 8,2)], comparado à idade ≤ 44. Em contraste, ultraprocessados contribuíram com 27% e foram inversamente associados à idade [45-49 (β = -1,7 IC95% -4,3; 0,9); 50-54 (β = -1,8 IC95% -4,3; 0,9); 55-59 (β = -4,9 IC95% -8,0; -2,0); ≥ 60 (β = -4,5 IC95% -7,6; -1,5)]. Sexo, renda e escolaridade não foram associados ao consumo alimentar. Conclusão: Adultos mais jovens apresentaram maior consumo de ultraprocessados, indicando a necessidade de intervenções principalmente nessa faixa etária. A ausência de associação com demais características sociodemográficas pode ser por conta da influência de fatores contextuais.

ABSTRACT: Objective: To investigate the food consumption according to the degree of processing and associations with sociodemographic characteristics. Methods: A cross-sectional study of the Estudo Pró-Saúde (Pro-Health Study), with 520 civil servants of university campuses, Rio de Janeiro, 2012-13. A food frequency questionnaire was used to classify food consumption: 1) in natura, minimally processed, food preparations based on these foods; 2) processed foods; 3) ultra-processed foods. The relative energy contribution of each group was determined, and a seemingly unrelated equations regression (SUR) regression model was used to estimate associations with sociodemographic characteristics. Results: The in natura food group (1) contributed with 59% of the energy consumption and was directly associated with age [45-49 years (β = 1.8 confidence interval of 95% - 95%CI -1.2; 4.8); 50-54 (β = 1.5 95%CI -1.5; 4.5); 55-59 (β = 2.9 95%CI -0.4; 6.3) and ≥ 60 (β = 4.6 95%CI 1.1; 8.2)], compared to age ≤ 44. In contrast, the group of ultra-processed foods contributed 27% and were inversely associated with age [45-49 (β = -1.7 95%CI -4.3; 0.9); 50-54 (β = -1.8 95%CI -4.3; 0.9); 55-59 (β = -4.9 95%CI -8.0; -2.0); ≥ 60 (β = -4.5 95%CI -7.6; -1.5)]. Gender, income and schooling were not associated with food consumption. Conclusion: Younger adults had higher consumption of ultra-processed foods, indicating the need for interventions mainly in this age group. The absence of association with other sociodemographic characteristics may be due to the influence of contextual factors.

Associations of neighborhood socioeconomic, natural and built environmental characteristics with a 13-year trajectory of non-work physical activity among civil servants in Rio de Janeiro, Brazil: The Pro-Saude Study.

Positive influences of natural and built environment characteristics on human physical activity have been observed mainly in high-income countries, but mixed results exist. We explored these relationships in Rio de Janeiro, Brazil, where exuberant nature coexists with high levels of social inequality and urban violence. Data originated from questionnaires self-administered by 1731 civil servants at university campuses who participated in 4 waves (1999, 2001, 2007, 2012) of a longitudinal study, and had their residential addresses geocoded. In multinomial regression models, adjusted for individual sociodemographic characteristics, mutually adjusted associations were estimated between 13-year trajectories of non-work physical activity and 8 contextual variables: distances from waterfronts, cycle paths, outdoor gym equipment, and squares; 2 indicators of exposure to greenness (a vegetation index - NDVI - derived from satellite images, and trees close to home); an indicator of walkability (street density), and neighborhood average income. Compared to participants living in the upper quartile of distance to waterfronts, those living in its lowest quartile had 2.6-fold higher odds (aOR: 2.62, 95% CI: 1.37-5.01) of reporting non-work PA in all 4 study waves. Similar results were observed in relation to distance to cycle paths; no independent associations were observed with other natural and built environment variables.

Intimate partner violence and breastfeeding practices: a systematic review of observational studies / Violência entre parceiros íntimos e práticas de aleitamento materno: uma revisão sistemática de estudos observacionais

Abstract Objective To review the association between intimate partner violence and breastfeeding practices in the literature. Data sources The search was carried out in five databases, including MEDLINE, LILACS, SCOPUS, PsycoINFO, and Science Direct. The search strategy was carried out in February 2017. The authors included original studies with observational design, which investigated forms of intimate partner violence (including emotional, physical, and/or sexual) and breastfeeding practices. The quality of the studies was assessed based on the bias susceptibility through criteria specifically developed for this review. Summary of data The study included 12 original articles (10 cross-sectional, one case-control, and one cohort study) carried out in different countries. The forms of intimate partner violence observed were emotional, physical, and/or sexual. Breastfeeding was investigated by different tools and only assessed children between 2 days and 6 months of life. Of the 12 studies included in this review, eight found a lower breastfeeding intention, breastfeeding initiation, and exclusive breastfeeding during the first six months of the child's life, and a higher likelihood of early termination of exclusive breastfeeding among women living at home where violence was present. The quality varied between the studies and six were classified as having low bias susceptibility based on the assessed items. Conclusions Intimate partner violence is associated with inadequate breastfeeding practices of children aged 2 days to 6 months of life.

Resumo Objetivo Revisar na literatura a associação da violência entre parceiros íntimos e as práticas de aleitamento materno. Fontes dos dados Foram utilizadas para as buscas cinco bases de dados, incluindo o MEDLINE, LILACS, SCOPUS, PsycoINFO e Science Direct. A estratégia de busca foi realizada em fevereiro de 2017. Foram incluídos estudos originais com desenho observacional, os quais investigaram formas de violência entre parceiros íntimos: emocional, física e/ou sexual e as práticas de aleitamento materno. A qualidade dos estudos foi avaliada a partir da susceptibilidade a vieses por critérios especificamente desenvolvidos para esta revisão. Síntese dos dados Foram incluídos 12 artigos originais (10 seccionais, 1 caso-controle e 1 coorte) realizados em diferentes países. As formas de violência entre parceiros íntimos observadas foram emocional, física e/ou sexual. O aleitamento materno investigado nos estudos se fez por diferentes instrumentos e avaliaram apenas crianças entre dois dias e seis meses. Dos doze estudos incluídos nesta revisão, oito encontraram menor chance de intenção de amamentar, menor chance de iniciação ao aleitamento materno e de amamentação exclusiva durante os primeiros seis meses de vida da criança e maior probabilidade de interrupção precoce do aleitamento materno exclusivo entre as mulheres que viviam em domicílios onde a violência estava presente. A qualidade variou entre os estudos e seis foram classificados apresentando baixa suscetibilidade ao viés a partir dos itens julgados. Conclusões A violência entre parceiros íntimos está relacionada às práticas inadequadas de aleitamento materno de crianças entre dois dias e seis meses.

Intimate partner violence and breastfeeding practices: a systematic review of observational studies.

OBJECTIVE: To review the association between intimate partner violence and breastfeeding practices in the literature. DATA SOURCES: The search was carried out in five databases, including MEDLINE, LILACS, SCOPUS, PsycoINFO, and Science Direct. The search strategy was carried out in February 2017. The authors included original studies with observational design, which investigated forms of intimate partner violence (including emotional, physical, and/or sexual) and breastfeeding practices. The quality of the studies was assessed based on the bias susceptibility through criteria specifically developed for this review. SUMMARY OF DATA: The study included 12 original articles (10 cross-sectional, one case-control, and one cohort study) carried out in different countries. The forms of intimate partner violence observed were emotional, physical, and/or sexual. Breastfeeding was investigated by different tools and only assessed children between 2 days and 6 months of life. Of the 12 studies included in this review, eight found a lower breastfeeding intention, breastfeeding initiation, and exclusive breastfeeding during the first six months of the child's life, and a higher likelihood of early termination of exclusive breastfeeding among women living at home where violence was present. The quality varied between the studies and six were classified as having low bias susceptibility based on the assessed items. CONCLUSIONS: Intimate partner violence is associated with inadequate breastfeeding practices of children aged 2 days to 6 months of life.

Potencialidades das atividades de teleconsultorias em Nutrição / Potentialities of teleconsulting in Nutrition

Objetivos: Apresentar os resultados e potencialidades das atividades de teleconsultoria realizadas pelo núcleo Telenutrição–RJ. Material e Método: Dados obtidos através de relatórios administrativos gerados pelo sistema Moodle desde o início das atividades do núcleo, em 2009. Resultados: Foram realizadas 17 teleconsultorias no período de abril de 2012 a setembro de 2013. As solicitações foram feitas prioritariamente por nutricionistas (70%). Apesar Teleconsultorias serem focadas para o Estado do Rio de Janeiro (35% das solicitações) observa-se uma grande demanda de outros estados, principalmente Minas Gerais (35%) e São Paulo (12%). Conclusões: A teleconsultoria é uma nova forma de trabalho, porém ainda pouco inserida no cotidiano dos profissionais da atenção primária de saúde. São necessárias estratégias que promovam um maior vínculo entre profissionais de saúde e equipe do Telenutrição–RJ, auxiliando na melhor utilização da ferramenta.

Aims: This paper presents the results and potentialities of teleconsultation in Nutrition performed by the Telenutrition from the Telehealth-RJ. Materials and methods: Data were obtained by administrative reports generated by “Moodle system” since the beginning of the activities. Results: From April 2012 to September 2013, 17 teleconsultations were requested by different practitioners, of whom 70% were nutritionists. Despite the teleconsultation in nutrition has the focus on the State of Rio de Janeiro (35% of the requests) there is a great demand from other states, especially Minas Gerais (35%) and São Paulo (12%). Conclusion: The results may suggest that the practice of teleconsultation in Nutrition is not yet incorporated into the routine of health primary care. Strategies are needed to strengthen the bond between health professionals and Telenutrition-RJ team, helping them to make the better use of the tool.

O uso de tecnologias de informação e comunicação na área da Nutrição / The use of information and communication technologies in the field of Nutrition

As tecnologias de informação e comunicação (TIC) apresentam o potencial de melhorar a gestão da informação, o acesso a serviços de saúde, a qualidade do cuidado prestado, a continuidade dos serviços, e a contenção de custos. Além disso, fornecem uma oportunidade singular para a promoção de estilos de vida saudáveis e valorização de iniciativas de políticas de saúde pública, atingindo simultaneamente um grande público. O objetivo do presente estudo foi revisar as experiências do uso das TIC na área da Nutrição, além de refletir sobre seus os impactos e desafios. Verificaram-se um contínuo avanço e difusão do uso das TIC na área de nutrição, as quais são utilizadas como ferramentas de educação em saúde, de registro e de informação em saúde, além de apoiarem a tomada de decisões clínicas por profissionais e de serviços de saúde. Contudo, as limitações no emprego das tecnologias de informação e comunicação em nutrição devem ser levadas em consideração, uma vez que dependem do acesso dos potenciais beneficiários a ferramentas de comunicação, da motivação e aptidão para seu manuseio e dos custos de sua execução.

Information and Communication Technologies (ICT) have the potential to improve information management, access to health services, quality of care provided, continuity of services, and cost containment. ICT could be considered as new approach that empowers individuals to make healthy choices, reaching a large number of individuals at same time. This paper reviews the experiences of the use of ICT in the field of nutrition, their impacts and challenges. The advance and spreading of the use of ICT in the field of nutrition were observed as tools designed to promote health education and information, to register, as well as to support clinical decision and health services. However some limitations should be considered in the use of information and communication technologies in nutrition. Effective results require consistent and sustained progress in developing infrastructure and in implementing validated and interoperable applications. It also should be mentioned the need of motivation, basic computer skills and the costs investing in ICT.

Redução de peso na prevenção primária de acidente vascular cerebral / Weight the reduction in primary prevention in the cardiovascular accident

Como as doenças cardiovasculares (DCV) constituem a principal causa de morte na maioria dos países e as tendências de mortalidade não se apresentam totalmenteelucidadas nos países em desenvolvimento, torna-se adequado explorar a evolução da mortalidade das DCV, dando ênfase ao acidente vascular cerebral (AVC) no Brasil. Devido à prevalência de AVC e também devido à associação causal entre sobrepeso ou obesidade e AVC não ser clara, é importante avaliar o efeito da perda de peso na prevenção primária de AVC. Baseado no fato do rimonabant ser a primeira droga de uma nova classe de medicamentos promissora não apenas na redução de peso, mas por sua influência sobre os fatores de risco cardiovascular, torna-se pertinente estabelecer suaeficácia e segurança. Inicialmente, para traçar um panorama sobre a epidemiologia das DCV no Brasil, com ênfase em AVC, foram realizados dois estudos com as tendências temporais de mortalidade por DCV ao longo das três últimas décadas, investigando as diferenças entre as regiões do país e entre indivíduos de diversas faixasetárias e de ambos os sexos. Além disso, duas revisões sistemáticas foram realizadas: uma para avaliar o efeito da perda de peso na prevenção primária de AVC; a segunda para investigar o uso do medicamento rimonabant no tratamento da obesidade. As taxas de mortalidade de AVC diminuíram substancialmente nas últimas três décadas, de 68,2 a 40,9 por 100 000 habitantes. Essa redução foi detectada em ambos os sexos de todas as faixas etárias, e nas diferentes regiões do país, sendo mais acentuadas nas regiões mais ricas. A mesma tendência foi observada nas demais DCV, que em geral apresentaram uma redução anual média de 3,9 por cento. As maiores reduções foram encontradas para AVC (média de 4,0 por cento aoano) seguido por doença coronariana (média de 3,6 por cento ao ano). Não existem estudos avaliando o efeito da redução de peso na prevenção primária de AVC. Houve um efeito dose-resposta com o uso do rimonabant: comp...

Progressive decline in stroke mortality in Brazil from 1980 to 1982, 1990 to 1992, and 2000 to 2002.

BACKGROUND AND PURPOSE: We describe the trends in stroke mortality in Brazil during 3 decades and investigate their differences according to regional disparities, sex, and age distributions. METHODS: Official data on mortality and population estimates were retrieved to calculate standardized mortality rates (with the 1980 Brazilian population as a reference) in 6 age strata and in the 5 political regions for the initial period (3 first years) of the 1980, 1990, and 2000 decades. Data were corrected for undefined causes of death. The Poisson model was used to estimate risk reduction during the 3 decades and to study the interaction between those rates and sex, age strata, and regions. RESULTS: The stroke standardized mortality rate decreased consistently in the last 20 years, from 68.2 to 40.9 per 100,000 habitants. This reduction paralleled a decrease in total cardiovascular mortality rates in the same period, from 208.2 to 126.1 per 100,000 habitants. The reduction in stroke standardized mortality rate was detected in men and women and in all age strata. The reduction was evident in all geopolitical regions of the country, with the wealthiest regions' exhibiting higher initial rates and more marked standardized mortality rate reductions. The risk of dying of stroke in the period 2000 to 2002 was 0.45 (95% CI, 0.44 to 0.45) of that found in the period 1980 to 1982. CONCLUSIONS: The risk of dying of stroke in Brazil declined dramatically between the initial period in the early 1980s and the early 2000s. The decline was especially marked in the most developed regions and may reflect an improvement in general health conditions during the study period.