Use of table sugar and non-caloric sweeteners in Brazil: associated factors and changes across a decade.

This study evaluated changes in the use of sweeteners over one decade and the relationship between socio-demographics, diet and weight status with the type of sweetener. Data came from the Brazilian National Dietary Surveys of 2008-2009 and 2017-2018, including ≥ 10-year-old individuals (n 32 749; n 44 744, respectively, after excluding pregnant and lactating women). The use of table sugar, non-caloric sweeteners (NCS), both or none was reported through a specific question. Food consumption was assessed using two non-consecutive food records (2008-2009) and 24-h recalls (2017-2018). For the last survey, means of energy, macro and micronutrient intake, food groups' contribution (%) to daily energy intake and age- and energy-adjusted nutrient intake were estimated according to the type of sweetener used. Differences in means and proportions across the categories of sweeteners used were evaluated based on the 95 % CI. All analyses were stratified by sex and considered sample design and weights. Over 10 years, the use of table sugar decreased by 8 %, while the habit of not using any sweetener increased almost three times, and the use of NCS remained stable. Larger reductions in the use of table sugar were observed in the highest income level and among men. Regardless of sex, compared with NCS users, table sugar users had greater mean intake of energy, carbohydrates and added sugar and lower micronutrient intake means. Although table sugar is still the most used sweetener, the increased choice of 'no sweetener' is noteworthy in Brazil.

A choice architecture intervention targeting school meals and water frequency intake: A school-based randomized trial.

Our aim was to evaluate the impact of choice architecture on school meals and water intake frequency. We conducted a school-based randomized trial in seven elementary municipal public schools (control = 3; intervention = 4) in Rio de Janeiro, Brazil. The interventions group received the following modifications: (1) banner of the daily school meal menu and two superheroes, (2) waterproof tablecloths, (3) posters on healthy eating habits, (4) displays with playful names, (5) new containers for fruits, and (6) colored footprints for one month. Changes in school meals and daily water frequency consumption were evaluated through intention-to-treat analyses, using generalized estimating equations models for repeated measures, considering the classes' cluster effect. Data from 974 students in the fifth and sixth elementary school grades were analyzed (control = 356; intervention = 618). At baseline, 47.1% of students were female, with a mean age of 12 years (SD = 1.4), 39.2% reported daily consumption of school meals, and 45.7% consumed water from the school drinking fountain three or more times a day. We observed an increase in the odds of daily water intake in the intervention group compared to the control (OR = 1.4 95% CI = 1.1-1.9), no changes in the school meals (OR = 1.2 95% CI = 0.9; 1.6). Low-complexity strategies based on choice architecture applied in the school environment can be promising in increasing water intake frequency among elementary students in public schools. TRIAL REGISTRATION: This study was registered on the Clinicaltrials.gov platform under the number NCT03136016. Access: https://clinicaltrials.gov/ct2/show/NCT03136016.

Regulatory measures for the protection of adequate and healthy diet in Brazil: a 20-year analysis. / Medidas regulatórias de proteção da alimentação adequada e saudável no Brasil: uma análise de 20 anos.

Regulatory measures are among the strategies for the promotion of adequate and healthy diet recommended by the Brazilian National Food and Nutrition Policy (PNAN). Although other actions in the promotion of adequate and healthy diet have made strides in Brazil, regulatory measures have made slow progress. The study aimed to identify and describe factors related to the development and implementation of the principal regulatory measures for the protection of adequate and healthy diet in Brazil in the last 20 years. This qualitative document study assessed a series of federal regulatory measures for the protection of adequate and healthy diet proposed or in discussion from 1999 to 2020. They include the regulation of food advertising, regulation of food product marketing in schools, implementation of mandatory front-of-package labeling on foods, and taxation of sugary drinks. Most of the barriers identified were strategies in corporate political activity led by the private sector, especially by the food industry. The Corporate political activity practices used in the various stages of policy processes include legal actions against the State, substitution of policies (suggesting voluntary or ineffective alternatives), opposition, fragmentation, and destabilization with attempts at support from the community. During the study period, none of the measures was approved. Given this scenario, barriers to the approval of regulatory measures for the protection of adequate and healthy diet need to be overcome in Brazil.

Medidas regulatórias estão entre as estratégias de promoção da alimentação adequada e saudável preconizadas pela Política Nacional de Alimentação e Nutrição (PNAN). Embora outras ações de promoção da alimentação adequada e saudável tenham avançado no Brasil, essas medidas progridem lentamente. O objetivo do trabalho é identificar e descrever fatores relacionados ao desenvolvimento e à implementação das principais medidas regulatórias de proteção da alimentação adequada e saudável no Brasil nos últimos 20 anos. É um estudo qualitativo documental que avaliou algumas medidas regulatórias de proteção à alimentação adequada e saudável federais, propostas ou em discussão, entre 1999 e 2020. São elas: regulação da publicidade de alimentos; regulação da comercialização de alimentos no ambiente escolar; implantação da rotulagem nutricional frontal obrigatória de alimentos; e tributação de bebidas adoçadas. A maioria das barreiras identificadas foram estratégias de atividade política corporativa protagonizadas pelo setor privado, principalmente, pela indústria de alimentos. Dentre as estratégias de atividade política corporativa utilizadas em diversas etapas dos processos políticos destacam-se: ações judiciais contra a ação do Estado; substituição de políticas sugerindo alternativas voluntárias ou inefetivas; oposição, fragmentação e desestabilização, com busca de apoio da comunidade. No período estudado, nenhuma das medidas foi aprovada. Diante desse cenário, os obstáculos para aprovação das medidas regulatórias de proteção a alimentação adequada e saudável necessitam ser superados no Brasil.

Las medidas regulatorias están entre las estrategias de promoción de la alimentación adecuada y saludable, preconizadas por la Política Nacional de Alimentación y Nutrición (PNAN). A pesar de que otras acciones de promoción de la alimentación adecuada y saludable hayan avanzado en Brasil, esas medidas progresan lentamente. El objetivo del estudio es identificar y describir factores relacionados con el desarrollo y la implementación de las principales medidas regulatorias de protección de la alimentación adecuada y saludable en Brasil durante los últimos 20 años. Se trata de un estudio cualitativo documental, que evaluó algunas medidas regulatorias de protección a las alimentación adecuada y saludable federales, propuestas o en discusión, entre 1999 y 2020. Son las siguientes: regulación de la publicidad de alimentos; regulación de la comercialización de alimentos en el entorno escolar; implementación del etiquetado nutricional frontal obligatorio de alimentos; y tributación de bebidas azucaradas. La mayoría de las barreras identificadas fueron estrategias de actividade política corporativa, protagonizadas por el sector privado, principalmente, por la industria de alimentos. Entre las estrategias de actividade política corporativa utilizadas en diversas etapas de los procesos políticos se destacan: acciones judiciales contra la acción del Estado; sustitución de políticas sugiriendo alternativas voluntarias o inefectivas; oposición, fragmentación y desestabilización, con búsqueda de apoyo de la comunidad. En el periodo estudiado, ninguna de las medidas fue aprobada. Ante este escenario, en Brasil, se necesitan superar los obstáculos para la aprobación de las medidas regulatorias de protección a la alimentación adecuada y saludable.

Do they really support "your freedom of choice"? FoPNL and the food industry in Brazil.

Introduction: In 2020, Brazil approved the introduction of a new front-of-package nutrition labeling (FoPNL) in the format of a magnifying glass (MG) after years of discussion. There is currently a lack of understanding of the role of the food industry in that process. This study aimed to describe the corporate political activity (CPA) of the food industry and conflicts of interest situations, as they happened during the development and approval of a new FoPNL system in Brazil. Materials and methods: We undertook bibliographical and documentary searches using material from food companies, trade associations and front groups involved in the regulatory process. We (1) collected information about the case study context, (2) collected data from documentary sources, and (3) prepared a synthesis of the results and a timeline of key events. Results/Discussion: During the FoPNL regulatory process in Brazil, the food industry opposed the introduction of warning labels, a model supported by health authorities and implemented with success in other countries in Latin America. The food industry rather promoted a traffic-light labeling system, known to be less effective at guiding individuals to make healthier food choices. Later in the process, when it was evident that its preferred model would not be used, and a MG would rather be introduced, the food industry argued for the use of a different version of this FoPNL model. We found that the food industry, all along the process, was directly involved in and influenced the development of the FoPNL, by providing technical support, advising and lobbying policymakers. The food industry also established relationships with a consumer non-governmental organization and nutrition professional societies. The food industry also produced and disseminated information supporting its position in order to influence public opinion and high-level decision makers, and used the legal system to delay the process. Conclusion: The FoPNL in Brazil is neither aligned with the recommendations of international health organizations nor with existing independent scientific evidence. The new FoPNL, as adopted in Brazil, reflects some of the preferences of the industry; it is likely that the influence of that sector during the legislative process was pivotal, even if its initial proposal was not adopted.

Breakfast patterns and weight status among adolescents: a study on the Brazilian National Dietary Survey 2008-2009.

Examining the composition of breakfast concerning weight status is essential for evaluating adolescent health and understanding this gap. This study aimed to identify breakfast patterns and investigate the relationship with weight status among Brazilian adolescents. We used a subsample of 7425 adolescents aged 10-19 years from the 2008-2009 Brazilian Household Budget Survey. Breakfast eaters were those with intake of at least 50 kcal (209·2 kJ) between 05.00 and 10.00 hours. Breakfast dietary patterns were derived by principal component factor analysis with varimax rotation. We performed logistic regression analyses between breakfast patterns and weight status, considering the complexity of the survey sample design. Three breakfast patterns were identified explaining 44·8 % of data variability: (1) the Cereal, protein, fruit beverages and Northern/Northeastern pattern, characterised by high consumption of cookies, meats, dairy products, preparations with maize, eggs, fruit juices/fruit drinks/soya-based drinks, tubers/roots/potatoes and cereals, and negative adherence to cold cut meat and savoury snacks/crackers; (2) the Protein-based pattern, characterised by positive loadings for cold cut meat, milk and cheese, and negative for cookies, fruit juices/fruit drinks/soya-based drinks, tubers/roots/potatoes and cereals; and (3) the Mixed pattern, with positive loadings for cakes, coffee/tea, bread, fruit juices/fruit drinks/soya-based drinks, chocolate/desserts and savoury snacks/crackers. No association was found between skipping and weight status. Overweight adolescents had lower adherence to the Cereal, protein, fruit beverages and Northern/Northeastern pattern (OR = 0·67; 95 % CI 0·47, 0·96). This is the first study to address dietary patterns at the meal level with adolescent population-based data, which requires further investigation.

Treatment of Childhood Obesity Based on Brazilian Dietary Guidelines Plus Energy Restriction (PAPPAS HUPE Study): Protocol for a Randomized Clinical Trial.

BACKGROUND: The Food Guide for the Brazilian Population relies on natural or minimally processed foods mainly of plant origin such as beans and rice with low oil, salt, and sugar content and limited consumption of ultraprocessed foods. Reduction of ultraprocessed foods improves diet quality and energy consumption. OBJECTIVE: The goal of this study is to evaluate the effectiveness of an intervention for the treatment of obesity in children, with counseling based on the Brazilian Food Guide plus control of total energy intake. METHODS: A parallel, randomized clinical trial will include children aged 7 to 12 years. Randomization will be performed in blocks of 10 individuals using computer-generated random sequence numbers. Both the control and intervention groups will participate in 6 standardized educational activities based on the 10 steps of the Brazilian Food Guide. These activities will be conducted at the University Hospital Toy Library, located in the pediatric outpatient clinic. For the intervention group, in addition to the educational activities, an individualized food plan based on the nutritional recommendations of the Brazilian Society of Pediatrics will be prescribed and discussed with the mothers and fathers. The primary outcome of the study will be variations in body mass index, and secondary outcomes will include analysis of insulin resistance, blood pressure, body fat percentage, and waist and neck circumference. RESULTS: This project was funded by the National Council for Scientific and Technological Development in December 2017 (grant no 408333/2017-0). Recruitment began in August 2018 and by September 2019, we had enrolled the 101 participants. In addition to the patients referred by the national system of regulation, recruitment was made by medical outpatient referral and external indication. This is an ongoing study. We expect the results to be published in November 2020. CONCLUSIONS: At the end of the project, in case of a positive result, a protocol for the treatment of obesity based on the Brazilian Food Guide will be proposed to the Unified Health System. A successful method to reduce childhood obesity is expected. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials RBR-3st5sn; http://www.ensaiosclinicos.gov.br/rg/RBR-3st5sn. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/16170.

Breakfast Consumption, Family Breakfast, and Adiposity Trajectory in Adolescence-The Adolescent Nutritional Assessment Longitudinal Cohort Study.

BACKGROUND: The relationship between breakfast and family breakfast and adiposity gain during adolescence remains inconclusive. OBJECTIVE: This study aimed to investigate the relationship between breakfast and family breakfast frequency and adiposity trajectory in adolescence. DESIGN: Prospective cohort study with middle school students aged 10 to 16 years enrolled in 2010 (baseline) and followed for 3 years. PARTICIPANTS/SETTING: A total of 945 students from two public and four private schools in the metropolitan area of Rio de Janeiro were included. Among 945 students, 809 participated in the study at baseline. Pregnant or lactating students and those with physical or mental disabilities were excluded. MAIN OUTCOME MEASURES: Body mass index (BMI) was assessed by measuring the participants' weight and height, and percent body fat (%BF) was assessed by performing bioelectrical impedance analysis. STATISTICAL ANALYSES PERFORMED: Linear mixed-effect models were used to examine the relationship between baseline and persistence of breakfast consumption and family breakfast over a 3-year period and change in BMI and %BF. Breakfast and family breakfast were assessed by questions on frequency of consumption. Both variables were classified as regular, intermediate, and no consumption at baseline. Persistence was divided into persistently regular, persistently irregular, changing from regular to irregular, and contrariwise. RESULTS: Overall, frequent breakfast consumption and family breakfast did not have protective effects against adiposity. At baseline, these behaviors were associated with low BMI and %BF among girls. During follow-up, these behaviors and persistence of regular breakfast consumption were associated with an increase in %BF (P<0.05). In boys, those who increased or decreased family breakfast frequency had greater decrease in %BF compared with those persistently regular at both time points. CONCLUSION: Breakfast had no consistent relationship with adolescence adiposity trajectory, which is in line with the results of experimental studies and in contrast with those of many cross-sectional studies.

Changes in breakfast frequency and composition during adolescence: The Adolescent Nutritional Assessment Longitudinal Study, a cohort from Brazil.

OBJECTIVES: To estimate changes over time of breakfast frequency and foods/food groups consumed at breakfast. METHODS: Cohort of 809 students aged 10-16 years old from Rio de Janeiro, Brazil, enrolled in 2010, and followed for three years. Breakfast skippers were those not eating breakfast. Those with breakfast frequency of 4 or less times per week were considered irregular breakfast eaters. Changes over time of breakfast frequency and breakfast foods/food groups were analyzed by generalized estimating equations. RESULTS: At baseline, overweight/obese girls had higher prevalence of irregular breakfast than those non-overweight/obese (40% vs. 26%; p = 0.005); among boys, there was no significant difference in the prevalence of irregular breakfast according to weight status. After three years, among girls there was an increase in the risk of irregular breakfast consumption (RR = 1.29; 95% CI: 1.08; 1.54) and breakfast skipping (RR = 1.63; 95% CI: 1.12; 2.38). Also, overweight/obese boys (RR = 1.40, 95% CI: 1.03, 1.89) and non-overweight/obese girls (RR = 1.54, 95% CI: 1.17, 2.04) had higher risk of irregular breakfast in three years, compared to baseline. After three years, boys changed the consumption of foods/food groups at breakfast and presented higher risk of decreased intake of fruits (RR = 1.60, 95% CI: 1.20, 2.13), sandwiches and snacks (RR = 1.58, 95% CI: 1.12, 2.22), chips (RR = 1.43, 95% CI: 1.01, 2.13), and ham (RR = 1.52, 95% CI: 1.12, 2.07), and lower risk of cheese intake (RR = 0.73, 95% CI: 0.53, 1.00). Girls had higher risk of decreased intake of fruits (RR = 2.08, 95% CI: 1.47, 2.95), milk (RR = 1.49, 95% CI: 1.07, 2.08), chocolate powder (RR = 1.54, 95% CI: 1.11, 2.14) and ham (RR = 1.65, 95% CI: 1.16, 2.36). CONCLUSIONS: Changes in breakfast patterns are different according to sex. Also, different changes in breakfast frequency according to BMI category were found. Consumption patterns of some foods/food groups have a tendency to become changed from initial to middle adolescence.

Food Consumption According to the Days of the Week - National Food Survey, 2008-2009.

OBJECTIVE: Evaluate the variations in energy, nutrients, and food groups intake between days of the week and weekend days in the Brazilian population. METHODS: We used data from the first National Food Survey (2008-2009) of a one-day food log of a representative sample of the Brazilian population aged 10 years or older (n = 34,003). For the analyses, we considered the sample weights and the effect of the study design. The mean (and standard deviations) and frequencies (%) of energy, nutrients, and food groups consumption were estimated for weekdays (Monday to Friday) and weekend (Saturday and Sunday), we then estimated the differences according to the days of the week for the population strata analyzed. RESULTS: The average daily energy intake for the weekend was 8% higher than the one observed for weekdays. The average percentage contribution of carbohydrate to the daily energy intake was higher during the week compared to Saturday and Sunday (56.3% versus 54.1%, p < 0.01). The inverse was observed for averages of the contribution to the daily intake of energy from total fat (26.8% versus 28.4%), saturated fat (9.1% versus 9.9%) and trans fat (1.4% versus 1.6%). The most significant changes between weekdays and weekend days were observed for eggs, sugar-added beverages, puff snacks and chips, beans, and pasta. During weekends, the frequency of beverage with added sugar consumption increased by 34%, the amount consumed increased by 42%, and the contribution to energy intake increased by 62% when compared to weekdays. CONCLUSIONS: The Brazilian population increases energy intake and unhealthy food markers on weekends compared to weekdays.

Breakfast eating among Brazilian adolescents: Analysis of the National Dietary Survey 2008-2009 / Desjejum dos adolescentes brasileiros: análise do Inquérito Nacional de Alimentação 2008-2009

ABSTRACT Objective: To characterize breakfast eating among Brazilian adolescents. Methods: Food intake was estimated based on a 1-day food record of adolescents aged 10-19 years, according to the first National Diet Survey (2008-2009). Breakfast was considered as the first meal of the day eaten between 4 and 11 am. Results: Ninety-three percent of adolescents reported eating breakfast. This meal contributed to 17.7% of the daily energy intake. The most commonly consumed food groups were: coffee and tea, breads, butter/margarine, milk, cakes and cookies, packaged snacks, corn-based dishes, cheese, processed meats, and fruit juice. In the Northern region there was a higher frequency of coffee and tea and roots and tubers intake and lower frequency of milk intake than that in the other regions in the country. In the Northeastern region, the intake of corn and eggs was high; in the Southern region, there was high intake of processed meats and fruits. Adolescents from families in the first income quartile reported higher intake of coffee and tea, packaged snacks, corn, and roots and tubers intake, and lower intake of milk and dairy products. Adolescents from families in the highest income quartile reported higher intake of milk, fruit juice, cheese, and sugar-added beverages. Conclusion: In Brazil, the contribution of breakfast to daily energy intake among adolescents is low. The nutritional quality of breakfast improved with increased income. The three most frequently consumed items were coffee and tea, breads, and butter/margarine.

RESUMO Objetivo: Caracterizar o desjejum dos adolescentes brasileiros. Métodos: O consumo alimentar foi estimado com base em um dia de registro alimentar de adolescentes entre 10 e 19 anos de idade do primeiro Inquérito Nacional de Alimentação (2008-2009). Considerou-se como desjejum a primeira ocasião de consumo alimentar entre 4 e 11 horas da manhã. Resultados: Noventa e três porcento dos adolescentes realizaram desjejum. Essa refeição contribuiu com 17,7% da ingestão diária de energia. Os grupos de alimentos mais consumidos foram: café e chá, pães, manteiga/margarina, leite, bolos e biscoitos, salgadinhos e chips, preparações à base de milho, queijo, carnes processadas e suco da fruta. Na região Norte observou-se frequência mais elevada de consumo de café e chá e de raízes e tubérculos e menor relato para leite do que nas demais regiões. Na região Nordeste, destaca-se o consumo de milho e de ovos e na região Sul, o de carnes processadas e frutas. Adolescentes de famílias do primeiro quartil de renda relataram frequência mais elevada de consumo de café e chá, salgadinhos e chips, milho e raízes e tubérculos e menor relato para o grupo do leite. Os adolescentes de famílias do quartil mais elevado de renda referiram consumo mais expressivo de leite, suco de fruta, queijo e bebidas com adição de açúcar. Conclusão: No Brasil, o desjejum dos adolescentes tem baixa contribuição para o consumo diário de energia. A qualidade nutricional do desjejum melhora com o incremento da renda. Os três principais itens consumidos foram café/chá, pães e manteiga/margarina.

Perception of food consumed at home and dietary intake: A nationwide study from Brazil.

Perception of food consumed is a key factor in acknowledging the need for behavioral change to improve diet quality. We analyzed family dietary intake according to the head of household's perception of satisfaction with food consumed by the family. Households (n = 13,351) that participated in the Brazilian Household Budget Survey and the National Dietary Survey were classified as satisfied or dissatisfied with the food consumed in the home. We compared the family dietary intake of the two groups considering their socio-demographic characteristics. Satisfied families (n = 4429) reported statistically higher intake (in grams/1000 kcal) of vegetables (47.3 vs 33.7), fruits (46.9 vs 21.4), sugar-sweetened beverages (118 vs 71.7), milk and dairy (57.9 vs 34.6), and ultra-processed products (18.6 vs 9.8); and lower intake of rice (86.2 vs 112), beans (91.7 vs 136), and meat (76.5 vs 84.0) when compared to dissatisfied families (n = 1717). Among satisfied families, in the youngest group we found lower consumption of fruits and higher intake of sugar-sweetened beverages and ultra-processed products when compared to the oldest group. Also among satisfied families, those in the highest per capita income group presented higher intake of fruits and lower intake of beans than those in the lowest income group. Satisfied families in the highest income group also consumed more fruits and less beans than dissatisfied families in the same income group. Socio-demographic characteristics may influence perception of satisfaction with food consumed and potentially influence the success of public health efforts to offer nutrition guidance for families satisfied with diets that may or may not be comprised of healthy food and beverages.

Food Consumption According to the Days of the Week - National Food Survey, 2008-2009 / Consumo alimentar segundo os dias da semana - Inquérito Nacional de Alimentação, 2008-2009

ABSTRACT OBJECTIVE Evaluate the variations in energy, nutrients, and food groups intake between days of the week and weekend days in the Brazilian population. METHODS We used data from the first National Food Survey (2008-2009) of a one-day food log of a representative sample of the Brazilian population aged 10 years or older (n = 34,003). For the analyses, we considered the sample weights and the effect of the study design. The mean (and standard deviations) and frequencies (%) of energy, nutrients, and food groups consumption were estimated for weekdays (Monday to Friday) and weekend (Saturday and Sunday), we then estimated the differences according to the days of the week for the population strata analyzed. RESULTS The average daily energy intake for the weekend was 8% higher than the one observed for weekdays. The average percentage contribution of carbohydrate to the daily energy intake was higher during the week compared to Saturday and Sunday (56.3% versus 54.1%, p < 0.01). The inverse was observed for averages of the contribution to the daily intake of energy from total fat (26.8% versus 28.4%), saturated fat (9.1% versus 9.9%) and trans fat (1.4% versus 1.6%). The most significant changes between weekdays and weekend days were observed for eggs, sugar-added beverages, puff snacks and chips, beans, and pasta. During weekends, the frequency of beverage with added sugar consumption increased by 34%, the amount consumed increased by 42%, and the contribution to energy intake increased by 62% when compared to weekdays. CONCLUSIONS The Brazilian population increases energy intake and unhealthy food markers on weekends compared to weekdays.

RESUMO OBJETIVO Avaliar as variações na ingestão de energia, nutrientes e grupos de alimentos entre dias da semana e dias de fim de semana na população brasileira. MÉTODOS Foram utilizados dados obtidos no primeiro Inquérito Nacional de Alimentação (2008-2009) de um dia de registro alimentar de amostra representativa da população brasileira com 10 ou mais anos de idade (n = 34.003). Para as análises, foram considerados os pesos amostrais e o efeito do desenho de estudo. Foram estimadas as médias (e desvios-padrões) e frequências (%) da ingestão de energia, nutrientes e grupos de alimentos para dias de semana (de segunda a sexta-feira) e de final de semana (sábado e domingo), sendo estimadas as diferenças segundo os dias da semana para os estratos populacionais analisados. RESULTADOS A ingestão diária média de energia do fim de semana foi 8% maior que a observada para dias de semana. A contribuição percentual média de carboidrato para a ingestão diária de energia foi maior durante a semana em comparação com sábado e domingo (56,3% versus 54,1%; p < 0,01). O inverso foi observado para as médias da contribuição para a ingestão diária de energia de gordura total (26,8% versus 28,4%), gordura saturada (9,1% versus 9,9%) e gordura trans (1,4% versus 1,6%). As mudanças mais importantes entre os dias de semana e de fim de semana foram observadas para ovos, bebidas com adição de açúcar, salgadinhos e chips, feijão e massas. Nos finais de semana, a frequência de consumo de bebidas com adição de açúcar aumentou em 34%, a quantidade consumida sofreu incremento de 42% e a contribuição para a ingestão de energia se elevou em 62%, quando comparados aos dias de semana. CONCLUSÕES A população brasileira aumenta a ingestão de energia e de marcadores de alimentação pouco saudável nos finais de semana em comparação aos dias de semana.

Maternal mental health and nutritional status of six-month-old infants.

OBJECTIVE: To analyze if maternal mental health is associated with infant nutritional status at six month of age. METHODS: A cross-sectional study with 228 six-month-old infants who used primary health care units of the city of Rio de Janeiro, Southeastern Brazil. Mean weight-for-length and mean weight-for-age were expressed in z-scores considering the 2006 World Health Organization reference curves. Maternal mental health was measured by the 12-item General Health Questionnaire. The following cutoff points were used: ≥ 3 for common mental disorders, ≥ 5 for more severe mental disorders, and ≥ 9 for depression. The statistical analysis employed adjusted linear regression models. RESULTS: The prevalence of common mental disorders, more severe mental disorders and depression was 39.9%, 23.7%, and 8.3%, respectively. Children of women with more severe mental disorders had, on average, a weight-for-length 0.37 z-scores lower than children of women without this health harm (p = 0.026). We also observed that the weight-for-length indicator of children of depressed mothers was, on average, 0.67 z-scores lower than that of children of nondepressed women (p = 0.010). Maternal depression was associated with lower mean values of weight-for-age z-scores (p = 0.041). CONCLUSIONS: Maternal mental health is positively related to the inadequacy of the nutritional status of infants at six months.

Maternal mental health and nutritional status of six-month-old infants / Saúde mental materna e estado nutricional de crianças aos seis meses de vida

ABSTRACT OBJECTIVE To analyze if maternal mental health is associated with infant nutritional status at six month of age. METHODS A cross-sectional study with 228 six-month-old infants who used primary health care units of the city of Rio de Janeiro, Southeastern Brazil. Mean weight-for-length and mean weight-for-age were expressed in z-scores considering the 2006 World Health Organization reference curves. Maternal mental health was measured by the 12-item General Health Questionnaire. The following cutoff points were used: ≥ 3 for common mental disorders, ≥ 5 for more severe mental disorders, and ≥ 9 for depression. The statistical analysis employed adjusted linear regression models. RESULTS The prevalence of common mental disorders, more severe mental disorders and depression was 39.9%, 23.7%, and 8.3%, respectively. Children of women with more severe mental disorders had, on average, a weight-for-length 0.37 z-scores lower than children of women without this health harm (p = 0.026). We also observed that the weight-for-length indicator of children of depressed mothers was, on average, 0.67 z-scores lower than that of children of nondepressed women (p = 0.010). Maternal depression was associated with lower mean values of weight-for-age z-scores (p = 0.041). CONCLUSIONS Maternal mental health is positively related to the inadequacy of the nutritional status of infants at six months.

RESUMO OBJETIVO Analisar se saúde mental materna associa-se ao estado nutricional infantil no sexto mês de vida. MÉTODOS Estudo seccional com 228 crianças aos seis meses atendidas em unidades básicas de saúde do município do Rio de Janeiro. Médias de peso-para-comprimento e peso-para-idade foram expressas em escores z considerando as curvas de referência do World Health Organization 2006. A saúde mental materna foi aferida pelo General Health Questionnaire com 12 itens. Foram empregados os pontos de corte ≥ 3 para transtornos mentais comuns, ≥ 5 para transtornos mentais mais graves e ≥ 9 para depressão. Na análise estatística empregaram-se modelos de regressão linear ajustados. RESULTADOS As prevalências de transtornos mentais comuns, transtornos mentais mais graves e depressão foram de 39,9%, 23,7% e 8,3%, respectivamente. Para peso-para-comprimento, filhos de mulheres com transtornos mentais mais graves tinham, em média, 0,37 escores z mais baixos do que filhos de mulheres sem este agravo (p = 0,026). Também para o indicador peso-para-comprimento observou-se que, em relação aos filhos de mulheres não deprimidas, crianças de mães deprimidas apresentaram, em média, 0,67 escores z mais baixos (p = 0,010). Depressão materna esteve associada com valores médios mais baixos de escore z de peso-para-idade (p = 0,041). CONCLUSÕES A saúde mental materna está positivamente relacionada à inadequação do estado nutricional de crianças aos seis meses.

Saúde mental materna e estado nutricional de crianças aos seis meses de vida / Maternal mental health and nutritional status of infants at six months of life

Apesar do declínio dos déficitis nutricionais em menores de cinco anos nas últimas décadas, a desnutrição infantil ainda se configura como problema de saúde pública, apresentando altas prevalências em algumas regiões do Brasil e em outros países em desenvolvimento, além de inúmeras repercurssões negativas na morbi-mortalidade. A saúde mental materna (SMM) tem sido cada vez mais considerada como um aspecto relevante para a saúde infantil. Apesar disso, pouco enfoque tem sido dado às suas repercurssões sobre o estado nutricional infantil. Investigar a associação entre SMM e estado nutricional no sexto mês de vida. Conduziu-se um estudo seccional inserido em uma coorte prospectiva com 235 crianças aos seis meses advindas de unidades básicas de saúde do município do Rio de Janeiro. Para formar os desfechos, médias de peso-para-comprimento e peso-para-idade foram expressas em escores z usando a nova curva de referência da OMS (2006) para menores de cinco anos. Aplicou-se a versão em português do General Health Questionnaire com 12 itens (GHQ-12) e 4 opções de resposta para aferição da SMM. Utilizou-se sistemas de pontuação de forma a gerar duas variáveis discretas: GHQ-bimodal (zero a 12 pontos) e GHQ-Likert (zero a 36 pontos). Tomando como referência a variável GHQ-bimodal, foram empregados os pontos de corte _>3 para detecção de transtornos mentais comuns (TMC), _>5 para transtornos mentais mais gaves e _>9 para sintomas depressivos. A análise da associação entre SMM e desfechos nutricionais se baseou em modelos de regressão linear. A amostra revelou escores z médios de 0,23 para peso-para-comprimento e de 0,05 para peso-para-idade...