Contribuição do desmame precoce na ocorrência da anemia ferropriva em lactentes / Contribution of early weaning in the occurrence of iron-deficiency anemia in infants

Introdução: A anemia ferropriva é considerada uma das carências nutricionais mais frequentes e um grande problema para a Saúde Pública mundial, sendo as mulheres e as crianças menores de dois anos de vida os grupos mais suscetíveis. O Ministério da Saúde preconiza o aleitamento materno exclusivo até os seis meses de vida e como complemento, até no mínimo os 24 meses. Aos seis meses, deve-se iniciar a introdução alimentar como complemento ao aleitamento materno, para suprir as necessidades de energia e de nutrientes essenciais para um crescimento adequado. Objetivo: Avaliar se há uma associação entre o desmame precoce e a prevalência de anemia ferropriva em lactentes. Casuística e métodos:Estudo quantitativo, com delineamento transversal, realizado entre outubro de 2016 e fevereiro de 2017, com 31 crianças de zero a 23 meses de idade, acompanhadas na Unidade Básica de Saúde Centro, do município de Gravataí, localizado ao sul do Brasil. Foi realizada a aplicação de um questionário com perguntas relacionadas à amamentação e foram coletados dados de níveis de hemoglobina dos prontuários dos participantes da pesquisa. Foram realizadas análises descritivas e calculada a razão de prevalência, sendo considerados estatisticamente significativos valores de p<0,05. Resultados: Foi observada uma tendência linear entre anemia ferropriva e idade das crianças (p= 0,004), porém a relação entre o desmame precoce e a anemia ferropriva não apresentou associação estatisticamente significativa. No entanto pode haver uma tendência futura de maior prevalência de anemia ferropriva nas crianças que desmamaram precocemente tanto aos quatro, quanto aos seis meses. Conclusão: Na amostra estudada de lactentes, com até 23 meses de idade, o desmame precoce não foi associado com a prevalência de anemia ferropriva. A introdução alimentar precoce e a não realização do aleitamento materno exclusivo podem contribuir para a maior ocorrência de anemia ferropriva em lactentes na faixa etária de zero a seis meses de vida.

Introduction:The iron-deficiency anemia due to iron-deficiency is considered one of the most frequent nutritional deficiencies and a major problem for world public health, where women and children under two years of age are the main group susceptible to its occurrence. The Brazilian Ministry of Health recommends exclusive breastfeeding up to six months of life and after, as a complement, until at least 24 months of age. Feeding should be initiated as a complement to breastfeeding at six months' age, in order to provision energy and other nutrient essential needs for adequate growth. Objective: to evaluate if early weaning is associated with iron-deficiency anemia in infants. Material and methods: A quantitative study with a cross-sectional design was carried out with 31 children from zero to 23 months of age, duly followed up at the Basic Health Center of the city of Gravataí. A questionnaire was applied with questions related to breastfeeding, and hemoglobin levels data were collected from the study participants' charts. Descriptive analyses were performed and the prevalence ratio was calculated, considering p ≤ 0.05 as significant. Results: A linear trend was observed between iron deficiency anemia and age (p = 0.004), but the relationship between early weaning and iron deficiency anemia did not present a statistically significant association. However, there may be a future trend towards a higher prevalence of iron deficiency anemia in children who weaned early at both four and six months. Conclusion: In the studied sample of infants, up to 23 months of age, early weaning was not associated with the prevalence of iron-deficiency anemia. Early feeding and failure to deliver exclusive breastfeeding may contribute to the increased occurrence of iron-deficiency anemia in infants between 0-6 months of age.

Prevalência de síndromes hipertensivas gestacionais em usuárias de um hospital no sul do Brasil / Prevalence of gestational hypertensive syndromes in users of a hospital in southern Brazil / Prevalencia de síndromes hipertensivos gestacionales en usuarias de un hospital en el sur de Brasil

INTRODUÇÃO: As síndromes hipertensivas gestacionais é uma das complicações mais importantes da gravidez e puerpério. Caracteriza-se pela pressão arterial igual ou maior de 140/90mmHg e é classificada em hipertensão gestacional, pré-eclâmpsia, hipertensão crônica, eclâmpsia e pré-eclâmpsia sobreposta à hipertensão crônica. O objetivo deste trabalho foi estimar a prevalência de síndromes hipertensivas gestacionais e descrever os fatores de risco maternos e fetais. MATERIAIS E MÉTODOS: Estudo transversal retrospectivo com amostra de 459 gestantes, que realizaram o parto no Hospital Tacchini, no município de Bento Gonçalves, Brasil. As variáveis quantitativas simétricas foram descritas por média e desvio padrão, e as quantitativas assimétricas, por mediana e amplitude interquartílica. A medida de efeito utilizada foi a Razão de Prevalências. RESULTADOS: A prevalência de síndromes hipertensivas gestacionais, na amostra estudada foi 11,1%, sendo: hipertensão gestacional (39,2%), pré-eclâmpsia (23,5%), hipertensão crônica (21,6%) e hipertensão arterial secundária (3,9%). O parto prematuro foi a complicação mais recorrente (44,4%). DISCUSSÃO: A prevalência de síndromes hipertensivas gestacionais assemelha-se à encontrada na literatura. Diabetes mellitus, excesso de peso, histórico de síndrome hipertensiva gestacional em gestações anteriores e prematuridade, são apontados como fatores de risco associados às síndromes hipertensivas gestacionais. CONCLUSÕES: Constatou-se a importância de um pré-natal de qualidade, uma vez que a saúde da mulher media as complicações e riscos maternos e fetais, como as síndromes hipertensivas gestacionais.

INTRODUCTION: Gestational hypertensive syndromes are among the most important complications during pregnancy and puerperium. It is characterized by blood pressure ≥ 140/90 mmHg and is classified as gestational hypertension, preeclampsia, chronic hypertension, eclampsia, and preeclampsia overlapping with chronic hypertension. The objective of this work was to estimate the prevalence of gestational hypertensive syndromes and describe maternal and fetal risk factors. MATERIALS AND METHODS: This was a retrospective, cross-sectional study with a sample of 459 pregnant women who gave birth at hospital Tacchini in the municipality of Bento Gonçalves, Brazil. The symmetric quantitative variables were described by mean and standard deviation; while the asymmetric quantitative variables by median and interquartile range. Prevalence ratio was used as effect measurement. RESULTS: The prevalence of gestational hypertension syndromes was 11.1% in the sample studied: gestational hypertension (39.2%), preeclampsia (23.5%), chronic hypertension (21.6%), and secondary hypertension (3.9%). Preterm birth was the recurrent complication (44.4%). DISCUSSION: The prevalence of gestational hypertensive syndromes is similar to that found in the literature. Diabetes mellitus, overweight, history of gestational hypertensive syndrome in previous pregnancies, and prematurity are considered risk factors associated to gestational hypertensive syndromes. CONCLUSIONS: The importance of quality prenatal care was verified, given that the woman's healthmediates the complications and maternal and fetal risks, like gestational hypertensive syndromes.

INTRODUCCIÓN: Los síndromes hipertensivos gestacionales es una de las complicaciones más importantes del embarazo y del puerperio. Se caracteriza por la presión arterial igual o mayor de 140/90mmHg y se clasifica en hipertensión gestacional, preeclampsia, hipertensión crónica, eclampsia y preeclampsia superpuesta a la hipertensión crónica. El objetivo de este trabajo fue estimar la prevalencia de síndromes hipertensivos gestacionales y describir los factores de riesgo maternos y fetales. MATERIALES Y MÉTODOS: Estudio transversal retrospectivo con una muestra de 459 gestantes, que realizaron el parto en el Hospital Tacchini, en el municipio de Bento Gonçalves, Brasil. Las variables cuantitativas simétricas fueron descritas por media y desviación estándar, y las cuantitativas asimétricas, por mediana y rango intercuartílico. La medida de efecto utilizada fue la Razón de Prevalencias. RESULTADOS: La prevalencia de síndromes hipertensivos gestacionales, en la muestra estudiada fue 11.1%, siendo: hipertensión gestacional (39.2%), preeclampsia (23.5%), hipertensión crónica (21.6%) e hipertensión arterial secundaria (3.9%). El parto prematuro fue la complicación más recurrente (44.4%). DISCUSIÓN: La prevalencia de síndromes hipertensivos gestacionales se asemeja a la encontrada en la literatura. La diabetes mellitus, el exceso de peso, el historial de síndrome hipertensivo gestacional en gestaciones anteriores y prematuridad, son señalados como factores de riesgo asociados a los síndromes hipertensivos gestacionales. CONCLUSIONES: Se constató la importancia de un prenatal de calidad, ya que la salud de la mujer influye en las complicaciones y riesgos maternos y fetales, como los síndromes hipertensivos gestacionales.

Agreement of dietary fiber and calorie intake values according to the choice of nutrient composition and household measure tables / Concordância dos valores de consumo de fibras alimentares e de calorias diárias de acordo com a escolha da tabela de composição de nutrientes e de medidas caseiras

ABSTRACT Objective: To analyze the variations in the daily intake of dietary fiber and calories according to the different nutrient composition and homemade measure tables. Methods: Five different methods based on different nutrient composition and household measure tables were used to calculate daily calorie and fiber intake, measured using a food frequency questionnaire, of 633 pregnant women receiving care in primary health care units in the Southern region of Brazil; they were selected to participate in a cohort study. The agreement between the five methods was evaluated using the Kappa and weighted Kappa coefficients. The Nutritional Support Table, a Brazilian traditional food composition table and the Brazilian household expenditure survey were used in Method 1. Brazilian Food Composition Table and the Table for the Assessment of Household Measures (Pinheiro) were used in Methods 2 and 3. The average values of all subtypes of food listed in the Brazilian Food Composition Table for each corresponding item in the food frequency questionnaire were calculated in the method 3. The United States Department of Agriculture Food Composition Table and the table complied by Pinheiro were used in Method 4. The Brazilian Food Composition Table and the Brazilian household expenditure survey were used in Method 5. Results: The highest agreement of calorie intake values were found between Methods 2 and 3 (Kappa=0.94; 0.92-0.95), and the lowest agreement was found between Methods 4 and 5 (Kappa=0.46; 0.42-0.50). As for the fiber intake, the highest agreement was found between Methods 2 and 5 (Kappa=0.87; 0.82-0.90), and the lowest agreement was observed between Methods 1 and 4 (Kappa=0.36; 0.3-0.43). Conclusion: Considerable differences were found between the nutritional composition tables. Therefore, the choice of the table can influence the comparability between studies.

RESUMO Objetivo: Analisar a variação no consumo diário de fibras e de calorias de acordo com diferentes tabelas de composição nutricional e de medidas caseiras. Métodos: Cinco métodos baseados em diferentes tabelas de composição nutricional e de medidas caseiras foram utilizados para calcular o consumo diário de calorias e de fibras, aferidos por questionário de frequência alimentar em 633 gestantes atendidas na atenção primária do Sul do Brasil, arroladas para estudo de coorte. A concordância entre os cinco métodos foi avaliada pelo coeficiente Kappa e Kappa Ponderado. A Tabela de Suporte Nutricional e a de medidas caseiras do Estudo Nacional de Despesas Familiares foram usadas no método 1. A Tabela Brasileira de Composição de Alimentos e a Tabela para Avaliação de Consumo Alimentar em Medidas Caseiras (Pinheiro) foram utilizadas pelos métodos 2 e 3, sendo que no método 3 calculou-se a média dos subtipos do alimento encontradas na Tabela Brasileira de Composição de Alimentos correspondente ao item do Questionário de Frequência Alimentar. No método 4, foram utilizadas a Tabela Americana da United States Department of Agriculture e a Pinheiro e, no método 5, a Tabela Brasileira de Composição de Alimentos e a do Estudo Nacional de Despesas Familiares. Resultados: A maior concordância entre valores de calorias ocorreu entre os métodos 2 e 3 (Kappa=0,94; 0,92-0,95) e a menor concordância foi entre os métodos 4 e 5 (Kappa=0,46; 0,42-0,50). Já para os valores de fibras, a melhor concordância foi entre os métodos 2 e 5 (Kappa=0,87; 0,82-0,90) e a menor entre os métodos 1 e 4 (Kappa=0,36; 0,31-0,43). Conclusão: Diferenças encontradas, conforme escolha da tabela de composição nutricional, são relevantes, podendo influenciar a comparabilidade entre estudos.

Eating patterns in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil): an exploratory analysis.

The food consumption of 15,071 public employees was analyzed in six Brazilian cities participating in the baseline for Brazilian Longitudinal Study of Adult Health (ELSA-Brasil, 2008-2010) with the aim of identifying eating patterns and their relationship to socio-demographic variables. Multiple correspondence and cluster analysis were applied. Four patterns were identified, with their respective frequencies: "traditional" (48%); "fruits and vegetables" (25%); "pastry shop" (24%); and "diet/light" (5%) The "traditional" and "pastry shop" patterns were more frequent among men, younger individuals, and those with less schooling. "Fruits and vegetables" and "diet/light" were more frequent in women, older individuals, and those with more schooling. Our findings show the inclusion of new items in the "traditional" pattern and the appearance of the "low sugar/low fat" pattern among the eating habits of Brazilian workers, and signal socio-demographic and regional differences.

Eating patterns in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil): an exploratory analysis / Padrões alimentares no Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil): uma análise exploratória / Patrones alimenticios en el Estudio Longitudinal de Salud del Adulto (ELSA-Brasil): un análisis exploratorio

Abstract: The food consumption of 15,071 public employees was analyzed in six Brazilian cities participating in the baseline for Brazilian Longitudinal Study of Adult Health (ELSA-Brasil, 2008-2010) with the aim of identifying eating patterns and their relationship to socio-demographic variables. Multiple correspondence and cluster analysis were applied. Four patterns were identified, with their respective frequencies: "traditional" (48%); "fruits and vegetables" (25%); "pastry shop" (24%); and "diet/light" (5%) The "traditional" and "pastry shop" patterns were more frequent among men, younger individuals, and those with less schooling. "Fruits and vegetables" and "diet/light" were more frequent in women, older individuals, and those with more schooling. Our findings show the inclusion of new items in the "traditional" pattern and the appearance of the "low sugar/low fat" pattern among the eating habits of Brazilian workers, and signal socio-demographic and regional differences.

Resumo: Foi analisado o consumo alimentar de 15.071 servidores públicos de seis cidades brasileiras participantes da linha de base do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil, 2008-2010), com o objetivo de identificar os padrões alimentares e sua relação com variáveis sociodemográficas. Foram aplicadas análise de correspondência múltipla e cluster. Os quatro padrões identificados e suas respectivas frequências foram: "tradicional" (48%); "frutas e hortaliças" (25%); "pastelaria" (24%); e "diet/light" (5%) Os padrões "tradicional" e "pastelaria" foram mais frequentes entre homens, indivíduos mais jovens e de menor escolaridade. Por outro lado, os padrões "frutas e hortaliças" e "diet/light" foram mais frequente entre mulheres, indivíduos mais velhos e de maior escolaridade. Nossos achados mostram a inclusão de novos itens no padrão "tradicional" e o aparecimento do padrão "low sugar/low fat" entre os hábitos alimentares de trabalhadores brasileiros, e sinalizam diferenças sociodemográficas e regionais.

Resumen Se analizó el consumo alimenticio de 15.071 empleados públicos de seis ciudades brasileñas, participantes de la línea de base del Estudio Longitudinal de Salud del Adulto (ELSA-Brasil, 2008-2010), con el objetivo de identificar los patrones alimenticios y su relación con variables sociodemográficas. Se aplicó un análisis de correspondencia múltiple y clúster. Los cuatro patrones identificados y sus respectivas frecuencias fueron: "tradicional" (48%); "frutas y hortalizas" (25%); "pastelería" (24%); y "diet/light" (5%). Los patrones "tradicional" y "pastelería" fueron más frecuentes entre hombres, individuos más jóvenes y de menor escolaridad. Por otro lado, los patrones "frutas y hortalizas" y "diet/light" fueron más frecuentes entre mujeres, individuos más viejos y de mayor escolaridad. Nuestros hallazgos muestran la inclusión de nuevos ítems en el patrón "tradicional" y la aparición del padrón "low sugar/low fat" entre los hábitos alimenticios de trabajadores brasileños, y señalan diferencias sociodemográficas y regionales.

O papel da terapia cognivo-comportamental na anorexia nervosa / The role of cognitive-behavioral therapy in the nutritional treatment of anorexia nervosa

Apesar da causa da anorexia nervosa (AN), doença caracterizada por medo excessivo de engordar e busca irracional da magreza, ser ainda desconhecida, acredita-se que a sua etiologia é multifatorial, incluindo fatores genéticos e psicológicos. Atualmente há poucas evidências de tratamentos eficientes para a doença, observando-se que a maioria dos participantes abandonam o tratamento, ou mostram uma melhora mínima ou recaídas após o mesmo. A Terapia Cognitivo-Comportamental (TCC), psicoterapia bastante moderna, tem como foco a adesão ao tratamento, o aumento de peso e o desenvolvimento de um padrão regular e flexível de alimentação. Vários modelos cognitivo-comportamentais têm sido propostos, desenvolvidos e testados. Entretanto, sua eficácia a longo prazo não é bem estabelecida. Assim, justifica-se uma revisão atualizada dos estudos investigando o papel da TCC na anorexia nervosa. Este trabalho tem como objetivo geral atualizar as informações relativas à eficiência da terapia cognitivo-comportamental na anorexia nervosa, com foco no tratamento nutricional...

Although the cause of anorexia nervosa (AN), a disease characterized by excessive food restriction and irrational fear of gaining weight, is still unknown, it is believed that its etiology is multifactorial, including genetic and psychological factors. Currently there is no effective treatments for the disease, and most patients drop out of treatment, or show a minimum improvement or relapse after it. Cognitive-behavioral therapy (CBT), which focuses on treatment adherence, weight gain and the development of a regular and flexible eating pattern, has been seen as a possible treatment for AN. Several cognitive-behavioral models have been proposed, developed and tested, but, their long-term effectiveness is not well established. The current study is a review of recent studies investigating the role of TCC in anorexia nervosa, aiming at an update of information regarding the effectiveness of cognitive-behavioral therapy in anorexia nervosa, with focus on nutritional treatment...

O papel da terapia cognivo-comportamental na anorexia nervosa / The role of cognitive-behavioral therapy in the nutritional treatment of anorexia nervosa

Apesar da causa da anorexia nervosa (AN), doença caracterizada por medo excessivo de engordar e busca irracional da magreza, ser ainda desconhecida, acredita-se que a sua etiologia é multifatorial, incluindo fatores genéticos e psicológicos. Atualmente há poucas evidências de tratamentos eficientes para a doença, observando-se que a maioria dos participantes abandonam o tratamento, ou mostram uma melhora mínima ou recaídas após o mesmo. A Terapia Cognitivo-Comportamental (TCC), psicoterapia bastante moderna, tem como foco a adesão ao tratamento, o aumento de peso e o desenvolvimento de um padrão regular e flexível de alimentação. Vários modelos cognitivo-comportamentais têm sido propostos, desenvolvidos e testados. Entretanto, sua eficácia a longo prazo não é bem estabelecida. Assim, justifica-se uma revisão atualizada dos estudos investigando o papel da TCC na anorexia nervosa. Este trabalho tem como objetivo geral atualizar as informações relativas à eficiência da terapia cognitivo-comportamental na anorexia nervosa, com foco no tratamento nutricional.(AU)

Although the cause of anorexia nervosa (AN), a disease characterized by excessive food restriction and irrational fear of gaining weight, is still unknown, it is believed that its etiology is multifactorial, including genetic and psychological factors. Currently there is no effective treatments for the disease, and most patients drop out of treatment, or show a minimum improvement or relapse after it. Cognitive-behavioral therapy (CBT), which focuses on treatment adherence, weight gain and the development of a regular and flexible eating pattern, has been seen as a possible treatment for AN. Several cognitive-behavioral models have been proposed, developed and tested, but, their long-term effectiveness is not well established. The current study is a review of recent studies investigating the role of TCC in anorexia nervosa, aiming at an update of information regarding the effectiveness of cognitive-behavioral therapy in anorexia nervosa, with focus on nutritional treatment.(AU)

Dietary patterns during pregnancy and the association with sociodemographic characteristics among women attending general practices in southern Brazil: the ECCAGe Study.

The assessment of the relationship between food intake and sociodemographic factors is crucial for developing effective public health policies. The present study aimed to examine dietary patterns in pregnant women and the association between these patterns and sociodemographic characteristics. Pregnant women attending general practices in southern Brazil (n = 712) answered a questionnaire and a food-frequency questionnaire with 88 items. Three dietary patterns were identified using cluster analysis. The association between the dietary patterns and sociodemographic variables was analyzed using the chi-square test and adjusted standardized residuals (p < 0,05). The restricted pattern was associated with lower maternal age, not living with a partner and being a non-working student. The varied pattern was associated with older maternal age, living with a partner, being employed and higher levels of education and income. The common-Brazilian dietary pattern included traditional Brazilian food items and was associated with lower levels of education and income, being unemployed and being a non-student.

Healthy eating index for pregnancy: adaptation for use in pregnant women in Brazil.

OBJECTIVE: To evaluate dietary quality in a sample of pregnant women based on one simple and objective parameter. METHODS: Pregnant women (n = 712), between 16 and 36 weeks, attending primary care clinics in Porto Alegre and Bento Gonçalves, Southern Brazil, in 2010 were recruited to take part. The Healthy Eating Index for Brazilian Pregnancy (HEIP-B) was created, derived from the American instrument called Alternate Healthy Eating Index for Pregnancy (AHEI-P). Questionnaires on frequency of consumption and on socio-demographic factors were completed. Focused principal component analysis (ACPF) was used to assess the relationship between the index and nutrients relevant to pregnancy. RESULTS: The median (interquartile range) of AHEI-P and HEIP-B were 66.6 (57.8-72.4) and 67.4 (60.0-73.4), respectively. The HEIP-B showed a good positive correlation with nutrients which are specifically recommended for pregnancy: folate (r = 0.8; p < 0.001), calcium (r = 0.6; p < 0.001) and iron (r = 0.7; p < 0.001). CONCLUSIONS: The quality of the diet of the pregnant women in this study was classified as within the "improvements needed" cut off point, which demonstrates the need for more specific education on nutrition for this stage of life. The index showed good correlations and, thus, may be considered an effective tool for assessing the quality of nutrition during pregnancy.

Dietary patterns during pregnancy and the association with sociodemographic characteristics among women attending general practices in southern Brazil: the ECCAGe Study / Padrões alimentares na gestação e associação com características sociodemográficas em mulheres atendidas em unidades básicas de saúde no Sul do Brasil: Estudo ECCAGe / Padrones alimentarios en la gestación y su asociación con características sociodemográficas en mujeres atendidas en unidades básicas de salud en el sur de Brasil: estudio ECCAGe

The assessment of the relationship between food intake and sociodemographic factors is crucial for developing effective public health policies. The present study aimed to examine dietary patterns in pregnant women and the association between these patterns and sociodemographic characteristics. Pregnant women attending general practices in southern Brazil (n = 712) answered a questionnaire and a food-frequency questionnaire with 88 items. Three dietary patterns were identified using cluster analysis. The association between the dietary patterns and sociodemographic variables was analyzed using the chi-square test and adjusted standardized residuals (p < 0,05). The restricted pattern was associated with lower maternal age, not living with a partner and being a non-working student. The varied pattern was associated with older maternal age, living with a partner, being employed and higher levels of education and income. The common-Brazilian dietary pattern included traditional Brazilian food items and was associated with lower levels of education and income, being unemployed and being a non-student.

A avaliação do consumo alimentar e das condições sociodemográficas é crucial para o desenvolvimento de políticas públicas. Este estudo examinou os padrões alimentares em gestantes e sua associação com características sociodemográficas. Gestantes (n = 712) atendidas em unidades básicas de saúde no sul do Brasil, responderam a um questionário sobre as características sociodemográficas e a um outro de frequência alimentar. Foram identificados três padrões alimentares por análise de cluster. Utilizando-se o teste qui-quadrado com resíduos ajustado verificou-se a associação dos padrões alimentares com as variáveis sociodemográficas (p < 0,05). O padrão restrito foi associado com gestantes mais jovens, que não moram com o companheiro e só estudam; o padrão variado com mulheres mais velhas que moram com o companheiro, trabalham e têm níveis de escolaridade e renda mais altos. Mulheres que não trabalham nem estudam e possuem níveis de renda e escolaridade mais baixos estiveram associadas ao padrão comum-brasileiro, caracterizado por alimentos tradicionais da população brasileira.

La evaluación del consumo alimentario y de las condiciones sociodemográficas es crucial para el desarrollo de políticas públicas. Este estudio examinó padrones alimentarios en gestantes y su asociación con características sociodemográficas. Las gestantes (n = 712) atendidas en unidades básicas de salud en el sur de Brasil, respondieron a un cuestionario sobre características sociodemográficas y a un cuestionario de frecuencia alimentaria. Se identificaron tres padrones alimentarios por análisis de clúster. A través del test chi-cuadrado ajustado con residuos se verificó la asociación de los padrones alimentarios con las variables sociodemográficas (p < 0,05). El padrón restringido fue asociado con gestantes más jóvenes, que no viven con un compañero y sólo estudian; el padrón variado con mujeres más viejas, que viven con compañero, trabajan y tienen niveles de escolaridad y renta más altos. Mujeres que no trabajan ni estudian, y poseen niveles de renta y escolaridad más bajos, estuvieron asociadas al padrón común-brasileño, caracterizado por alimentos tradicionales de la población brasileña.

Diet assessment in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil): Development of a food frequency questionnaire / Avaliação da dieta no Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil): desenvolvimento do Questionário de Frequência Alimentar

OBJECTIVE: The objective of this article is to present the development of the Food Frequency Questionaire used in the Longitudinal Study of Adult Health-Brazil and analyze how diet exposes individuals to cardiovascular diseases and type 2 diabetes Mellitus. METHODS: The Longitudinal Study of Adult Health-Brazil dietary assessment instrument is based on a previously validated Food Frequency Questionaire and the final list of items took into consideration a study done in the six Longitudinal Study of Adult Health-Brazil investigation centers. RESULTS: New foods/preparations were included in the Food Frequency Questionaire with their respective portions, totaling 114 items. The perspectives of dietary analysis and cardiovascular diseases and diabetes are presented in Longitudinal Study of Adult Health-Brazil. CONCLUSION: A new instrument was developed to cover the regional particularities of the study population.

OBJETIVO: Este artigo tem por objetivo apresentar o desenvolvimento do Questionário de Frequência Alimentar utilizado no Estudo Longitudinal de Saúde do Adulto e as perspectivas de análise da dieta, como exposição a doenças cardiovasculares e diabetes Mellitus tipo 2. MÉTODOS: O instrumento de avaliação dietética do Estudo Longitudinal de Saúde do Adulto foi construído a partir de um Questionário de Frequência Alimentar previamente validado. A lista final de itens alimentares levou em consideração um levantamento realizado nos seis centros de investigação do estudo em questão. RESULTADOS: Foram incluídos novos alimentos/preparações no Questionário de Frequência Alimentar, com as respectivas porções, perfazendo um total de 114 itens. São apresentadas as perspectivas de análise da dieta e doenças cardiovasculares e diabetes no Estudo Longitudinal de Saúde do Adulto. CONCLUSÃO: Desenvolveu-se um novo instrumento que busca atender especificidades regionais contempladas na população do estudo.

[Reproducibility and relative validity of the Food Frequency Questionnaire used in the ELSA-Brasil]. / Reprodutibilidade e validade relativa do Questionário de Frequência Alimentar do ELSA-Brasil.

This study evaluated the reproducibility and relative validity of the Food Frequency Questionnaire (FFQ) used in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Participants (n = 281) completed the FFQ and three food records on two occasions during a 12-month period. Energy and nutrient values from food records were disattenuated and log-transformed. Reproducibility and validity were assessed by the intra-class correlation coefficient (ICC). Agreement between the two methods was evaluated by classification in tertiles. In the evaluation of reproducibility, ICC estimated ranged from 0.55 to 0.83 for protein and vitamin E, respectively. On relative validity, ICC ranged from 0.20 to 0.72 for selenium and calcium, respectively. Exact and adjacent agreement between methods varied from 82.9% for vitamin E to 89% for lipids and calcium (mean 86%). Average disagreement was 13.6%. In conclusion, this FFQ showed satisfactory reliability for all nutrients and reasonable validity, especially for energy, macronutrients, calcium, potassium, and vitamins E and C.

Reprodutibilidade e validade relativa do Questionário de Frequência Alimentar do ELSA-Brasil / Reproducibility and relative validity of the Food Frequency Questionnaire used in the ELSA-Brasil / Reproducibilidad y validez relativa del Cuestionario de Frecuencia Alimentaria del ELSA-Brasil

Avaliou-se a reprodutibilidade e a validade do Questionário de Frequência Alimentar (QFA) utilizado no Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). Foram aplicados três registros alimentares e um QFA em dois momentos no período de um ano (n = 281). Valores de energia e nutrientes dos registros alimentares foram deatenuados e Log transformados. Para avaliação da reprodutibilidade e validade foi aplicado o teste de correlação intraclasse (CCI) e calculados percentuais de concordância do consumo de nutrientes após categorização por tercis. Na avaliação da reprodutibilidade, coeficientes de CCI variaram de 0,55-0,83 para proteína e vitamina E, respectivamente; na avaliação da validade, variaram de 0,20-0,72 para selênio e cálcio, respectivamente. Concordâncias exata e adjacente entre métodos variaram de 82,9% para vitamina E a 89% para lipídio e cálcio (média = 86%). Foi encontrada uma discordância média de 13,6%. Conclui-se que o QFA ELSA-Brasil apresenta confiabilidade satisfatória para todos nutrientes e validade relativa razoável para energia, macronutrientes, cálcio, potássio e vitaminas E e C.

This study evaluated the reproducibility and relative validity of the Food Frequency Questionnaire (FFQ) used in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Participants (n = 281) completed the FFQ and three food records on two occasions during a 12-month period. Energy and nutrient values from food records were disattenuated and log-transformed. Reproducibility and validity were assessed by the intra-class correlation coefficient (ICC). Agreement between the two methods was evaluated by classification in tertiles. In the evaluation of reproducibility, ICC estimated ranged from 0.55 to 0.83 for protein and vitamin E, respectively. On relative validity, ICC ranged from 0.20 to 0.72 for selenium and calcium, respectively. Exact and adjacent agreement between methods varied from 82.9% for vitamin E to 89% for lipids and calcium (mean 86%). Average disagreement was 13.6%. In conclusion, this FFQ showed satisfactory reliability for all nutrients and reasonable validity, especially for energy, macronutrients, calcium, potassium, and vitamins E and C.

Se evaluó la reproducibilidad y la validez del Cuestionario de Frecuencia Alimentaria (QFA), utilizado en el Estudio Longitudinal de Salud de Adultos (ELSA-Brasil). Se aplicaron tres registros alimentarios y un QFA en dos momentos durante el período de un año (n = 281). Valores de energía y nutrientes de los registros alimentarios se realizaron sin atenuación y log transformados. Para la evaluación de la reproducibilidad y validez se aplicó el test de Correlación Intraclase (CCI) y se calcularon los porcentajes de concordancia del consumo de nutrientes tras la categorización por terciles. En la evaluación de la reproducibilidad, coeficientes de CCI variaron de 0,55-0,83 en el caso la proteína y vitamina E, respectivamente; en la evaluación de la validez, variaron de 0,20-0,72 en el selenio y calcio, respectivamente. Concordancias exactas y adyacentes entre métodos variaron de un 82,9% en el caso de la vitamina E a un 89% en el lípido y calcio (media = 86%). Se encontró una discordancia media de un 13,6%. Se concluye que el QFA ELSA-Brasil presenta una confiabilidad satisfactoria para todos los nutrientes y validez relativa razonable en los casos la energía, macronutrientes, calcio, potasio y vitaminas E y C.

Índice de alimentação saudável para gestantes: adaptação para uso em gestantes brasileiras / Healthy eating index for pregnancy: adaptation for use in pregnant women in Brazil / Índice de alimentación saludable para gestantes: adaptación para uso en gestantes brasileñas

OBJETIVO: Avaliar a qualidade global da dieta em uma amostra de gestantes, a partir de um parâmetro único, simples e objetivo. MÉTODOS: Gestantes entre a 16ª e 36ª semana de gestação (n = 712) foram arroladas em unidades básicas de saúde em Porto Alegre e Bento Gonçalves, RS, em 2010. Com base no índice americano Alternate Healthy Eating Index for Pregnancy (AHEI-P) foi criado o Índice de Alimentação Saudável para Gestantes Brasileiras (HEIP-B). Foram aplicados o questionário de frequência alimentar e o questionário sociodemográfico. Foi utilizada a análise de componentes principais focada para avaliar a relação entre os índices e os nutrientes relevantes à gestação. RESULTADOS: A mediana e o intervalo interquartílico dos índices AHEI-P e HEIP-B foram 66,6 (57,8-72,4) e 67,4 (60,0-73,4), respectivamente. O HEIP-B mostrou boa correlação positiva com os nutrientes que têm recomendação específica no período gestacional folato (r = 0,8; p < 0,001), cálcio (r = 0,6; p < 0,001) e ferro (r = 0,7; p < 0,001). CONCLUSÕES: A qualidade da dieta das gestantes do presente estudo foi classificada dentro do ponto de corte "precisando de melhorias", o que mostra a necessidade de se trabalhar mais especificamente com educação alimentar nesse ciclo da vida. O índice aplicado mostrou boas correlações e, portanto, pode ser considerado um bom instrumento de avaliação da qualidade da alimentação durante a gestação.

OBJECTIVE: To evaluate dietary quality in a sample of pregnant women based on one simple and objective parameter. METHODS: Pregnant women (n = 712), between 16 and 36 weeks, attending primary care clinics in Porto Alegre and Bento Gonçalves, Southern Brazil, in 2010 were recruited to take part. The Healthy Eating Index for Brazilian Pregnancy (HEIP-B) was created, derived from the American instrument called Alternate Healthy Eating Index for Pregnancy (AHEI-P). Questionnaires on frequency of consumption and on socio-demographic factors were completed. Focused principal component analysis (ACPF) was used to assess the relationship between the index and nutrients relevant to pregnancy. RESULTS: The median (interquartile range) of AHEI-P and HEIP-B were 66.6 (57.8-72.4) and 67.4 (60.0-73.4), respectively. The HEIP-B showed a good positive correlation with nutrients which are specifically recommended for pregnancy: folate (r = 0.8; p < 0.001), calcium (r = 0.6; p < 0.001) and iron (r = 0.7; p < 0.001). CONCLUSIONS: The quality of the diet of the pregnant women in this study was classified as within the "improvements needed" cut off point, which demonstrates the need for more specific education on nutrition for this stage of life. The index showed good correlations and, thus, may be considered an effective tool for assessing the quality of nutrition during pregnancy.

OBJETIVO: Evaluar la calidad global de la dieta en una muestra de gestantes, a partir de um parámetro único, simple y objetivo. MÉTODOS: Gestantes entre 16ª y 36ª semana de gestación (n=712) fueron inventariadas en unidades básicas de salud en Porto Alegre y Bento Gonçalves, RS, Brasil, en 2010. Con base en el índice americano Alternate Healthy Eating Index for Pregnancy (AHEI-P) se creó en índice de Alimentación Saludable para Gestantes (HEIP-B). Se aplicaron el cuestionario de frecuencia alimentaria y el cuestionario sociodemográfico. Se utilizó el análisis de componentes principales para evaluar la relación entre los índices y los nutrientes relevantes para la gestación. RESULTADOS: La mediana y el intervalo intercuartil de los índices AHEI-P y HEIP-B fueron 66,6 (57,8-72,4) y 67,4 (60,0-73,4), respectivamente. El HEIP-B mostró buena correlación positiva con los nutrientes que tienen recomendación específica en el período gestacional folato (r = 0,8; p < 0,001), calcio (r = 0,6; p < 0,001) e hierro (r = 0,7; p < 0,001). CONCLUSIONES: La calidad de la dieta de las gestantes del presente estudio fue clasificada dentro del punto de corte "precisando de mejorías", lo que muestra la necesidad de trabajar más específicamente con educación alimentaria en ese ciclo de la vida. El índice aplicado mostró buenas correlaciones y, por tanto, puede ser considerado un buen instrumento de evaluación de la calidad de la alimentación durante la gestación.

Nutrition, mental health and violence: from pregnancy to postpartum Cohort of women attending primary care units in Southern Brazil--ECCAGE study.

BACKGROUND: Woman's nutritional status, before and during pregnancy, is a strong determinant of health outcomes in the mother and newborn. Gestational weight gain and postpartum weight retention increases risk of overweight or obesity in the future and they depend on the pregestational nutritional status and on food consumption and eating behavior during pregnancy. Eating behavior during pregnancy may be the cause or consequence of mood changes during pregnancy, especially depression, which increases likelihood of postpartum depression. In Brazil, a study carried out in the immediate postpartum period found that one in three women experienced some type of violence during pregnancy. Violence and depression are strongly associated and both exposures during pregnancy are associated with increased maternal stress and subsequent harm to the infant. The main objectives of this study are: to identify food intake and eating behaviors patterns; to estimate the prevalence of common mental disorders and the experience of violence during and after pregnancy; and to estimate the association between these exposures and infant's health and development. METHODS/DESIGN: This is a cohort study of 780 pregnant women receiving care in 18 primary care units in two cities in Southern Brazil. Pregnant women were first evaluated between the 16th and 36th week of pregnancy at a prenatal visit. Follow-up included immediate postpartum assessment and around the fifth month postpartum. Information was obtained on sociodemographic characteristics, living circumstances, food intake, eating behaviors, mental health and exposure to violence, and on infant's development and anthropometrics measurements. DISCUSSION: This project will bring relevant information for a better understanding of the relationship between exposures during pregnancy and how they might affect child development, which can be useful for a better planning of health actions aiming to enhance available resources in primary health care.

Socioeconomic, demographic and nutritional factors associated with maternal weight gain in general practices in Southern Brazil.

In order to describe adequacy of weight gain during pregnancy and its association with pre-pregnancy nutritional status and other factors, a cohort study of pregnant women enrolled at 16-36 weeks of gestation and followed up until delivery was carried out in prenatal care in primary care services in Rio Grande do Sul State, Brazil. Maternal weight was recorded at each prenatal care visit. Weight gain was classified as "adequate," "insufficient" or "excessive" (Institute of Medicine). Poisson regression was used to measure the associations. The sample was comprised of 667 women, and insufficient and excessive weight gain incidences were 25.8% and 44.8%, respectively. Overweight and obese before pregnancy had a significant increased risk of excessive weight gain in pregnancy (RR: 1.75; 95%CI: 1.48-2.07, RR: 1.55; 95%CI: 1.23-1.96, respectively). Women with fewer than six prenatal visits had a 52% increased risk for weight gain below recommended values. Although insufficient weight gain may still be a public health problem, excessive gain is becoming a concern that needs immediate attention in prenatal care.

Socioeconomic, demographic and nutritional factors associated with maternal weight gain in general practices in Southern Brazil / Fatores socioeconômicos, demográficos e nutricionais associados com ganho de peso gestacional em unidades básicas de saúde no Sul do Brasil

In order to describe adequacy of weight gain during pregnancy and its association with pre-pregnancy nutritional status and other factors, a cohort study of pregnant women enrolled at 16-36 weeks of gestation and followed up until delivery was carried out in prenatal care in primary care services in Rio Grande do Sul State, Brazil. Maternal weight was recorded at each prenatal care visit. Weight gain was classified as "adequate," "insufficient" or "excessive" (Institute of Medicine). Poisson regression was used to measure the associations. The sample was comprised of 667 women, and insufficient and excessive weight gain incidences were 25.8 percent and 44.8 percent, respectively. Overweight and obese before pregnancy had a significant increased risk of excessive weight gain in pregnancy (RR: 1.75; 95 percentCI: 1.48-2.07, RR: 1.55; 95 percentCI: 1.23-1.96, respectively). Women with fewer than six prenatal visits had a 52 percent increased risk for weight gain below recommended values. Although insufficient weight gain may still be a public health problem, excessive gain is becoming a concern that needs immediate attention in prenatal care.

Para caracterizar o ganho ponderal gestacional e sua associação com estado nutricional pré-gestacional e fatores relacionados à gravidez, realizou-se estudo de coorte com gestantes arroladas consecutivamente entre a 16ª e a 36ª semanas, e seguidas até o parto em serviços da rede básica de saúde do Estado do Rio Grande do Sul, Brasil. Informações do peso da gestante em cada consulta de pré-natal foram obtidas. Ganho de peso foi classificado conforme o Instituto de Medicina dos Estados Unidos. Regressão de Poisson com variância robusta foi utilizada. Incidências de ganho de peso insuficiente e excessivo das 667 gestantes foram de 25,8 por cento e 44,8 por cento, respectivamente. Gestantes com sobrepeso e obesidade pré-gestacional apresentaram risco para ganho ponderal excessivo (RR: 1,75; IC95 por cento: 1,48-2,07 e RR: 1,55; IC95 por cento: 1,23-1,96). Gestantes com menos de seis consultas de pré-natal tiveram risco de 52 por cento de ganhar peso insuficiente. Embora o ganho ponderal insuficiente persista como um problema de saúde pública, o ganho excessivo está se configurando como uma questão que precisa de atenção imediata nos serviços de pré-natal.

Violence and depressive symptoms during pregnancy: a primary care study in Brazil.

AIM: To estimate the prevalence of violence, depressive symptoms, and associated factors during pregnancy in women attending antenatal care in Brazil. METHODS: Violence was assessed using a modified version of the abuse assessment screen (ASS), and depressive symptoms were evaluated using the primary care evaluation of mental disorders (PRIME-MD). Participants were pregnant women attending 18 primary care units in Rio Grande do Sul, Brazil, between June 2006 and April 2007. A total of 712 pregnant women participated, but only 627 of them responded the ASS. RESULTS: Experience of any lifetime violence was reported by 273 (43.4%) women and 114 (18.2%) reported violence during the current pregnancy. One-third of them (n = 211) reported lifetime domestic violence and 100 (15.9%) women reported this type of violence during the current pregnancy. Experience of domestic violence during pregnancy was more common in unemployed women, among those with two or more children, with a higher consumption of alcohol, and who had not planned their current pregnancy. Of the total of sample (n = 712), 198 (27.8%) women reported six or more depressive symptoms. The presence of depressive symptoms during pregnancy was associated with low educational levels, living in a household with five or more people, and with higher consumption of alcohol during pregnancy. CONCLUSION: Pregnant women attending primary care are exposed to high rates of domestic violence, and many have clinically relevant depressive symptoms. Appropriate interventions to avoid or minimize the effects of violence and mental disorders to the well-being of the mothers and their babies are urgently required. Primary care services play an important role in identifying and supporting women at risk.

Inappropriate eating behaviors during pregnancy: prevalence and associated factors among pregnant women attending primary care in southern Brazil.

OBJECTIVE: To examine the prevalence of inappropriate eating behaviors and associated factors among pregnant women in primary care. METHOD: The Eating Disorder Examination Questionnaire was used to assess eating disorders and the Primary Care Evaluation of Mental Disorders was used to examine anxiety and depressive symptoms. Body mass index (BMI) and pregestational weight were also assessed. RESULTS: Prevalence of binge eating during pregnancy was 17.3% [95% confidence interval (CI) 14.5-20.0], followed by excessive shape (5.6%; 95% CI 4-8) and weight concerns (5.5%; 95% CI 4-8). Binge eating during pregnancy was significantly associated with binge eating before pregnancy [prevalence ratio (PR) = 3.1; 95% CI 2.2-4.3], current anxiety symptoms (PR = 1.8; 95% CI 1.3-2.4), and prepregnancy BMI < 19.8 kg/m(2) (PR = 1.6; 95% CI 1.1-2.5). The prevalence of eating disorders was 0.6% (95% CI 0.01-1.11). DISCUSSION: Eating disorder symptoms should be routinely assessed and treated during prenatal care, along with other comorbid psychiatric symptoms such as anxiety.