Factors associated with delayed initiation of breast cancer treatment at an oncology referral center in Juiz de Fora, Minas Gerais state, from 2010 to 2019: a cohort study.

OBJECTIVES: To analyze factors associated with delayed initiation of breast cancer treatment at an oncology referral center in Juiz de Fora, Minas Gerais state, between 2010 and 2019. METHODS: This was a cohort study using data from the Hospital-based Cancer Registry. The probability of not starting treatment within 60 days, in accordance with Brazilian law, was estimated using Kaplan-Meier, method and its association with the factors studied was assessed using the Cox model, presenting hazard ratios (HR) and respective 95% confidence intervals (95%CI). RESULTS: Among the 911 participants, the probability of delayed treatment initiation was 18.8% (95%CI 16.4;21.5). Those who underwent treatment at a health service other than the one where the cancer was diagnosed had a significantly higher risk (HR: 3.49; 95%CI 3.00;4.07). CONCLUSION: Receiving a diagnosis and treatment at the same institution may help reduce waiting time to initiate cancer treatment. MAIN RESULTS: The probability of study participants not initiating treatment within 60 days was 18.8%. Undergoing treatment at a healthcare service other than the one where the diagnosis was made was the main factor associated with delay. IMPLICATIONS FOR SERVICES: Organizing healthcare services based on strategies that optimize referral flows and avoid transitions of care, can be crucial in reducing the time to initiation of breast cancer treatment. PERSPECTIVES: It is essential to improve the workflows at the different stages of health care to ensure timely initiation of oncological treatment.

Bitter taste of the tobacco industry interference in Brazil.

OBJECTIVE: Although Brazil became the first country worldwide to ban the sale of all tobacco products with any additive that could alter their flavours and tastes in 2012, its implementation was effectively halted by tobacco industry lawsuits, including a constitutional challenge filed in the Federal Supreme Court in 2013. This study aimed at examining, for the first time in the country, the evolution over time of the new registrations of tobacco products with additives that would have been banned if not for the tobacco industry's interference ('counterfactual scenario'). METHODS: We used the newly available public database on the registration of tobacco products developed by the Health Regulatory Agency (from 2008 onwards). All types of tobacco products intended for the domestic market that contained 'banned additives in a counterfactual scenario' and were registered between January 1 and December 31 of each year were selected. RESULTS: Between 2012 and 2023, a total of 1112 new registrations of tobacco products with 'banned additives' were recorded. The spread of hookah tobacco registrations started in 2014, and by 2023, the cumulative incidence of registrations containing 'banned additives' was 641. Both manufactured cigarettes and hookah products reached their peaks in new registrations in 2020. CONCLUSIONS: After 12 years since the resolution intended to ban all additives that change the aroma and taste of tobacco products in Brazil, primarily to prevent smoking initiation, the tobacco industry's interference continues to successfully block its implementation. Countries facing similar challenges in tobacco control could consider generating comparable national data that might help expose the adverse impacts of tobacco industry interference on public health.

Prevalence and predictors of vitamin D insufficiency in Brazilian children under 5 years of age: Brazilian National Survey on Child Nutrition (ENANI-2019).

To analyse the association of socio-demographic and health factors with vitamin D insufficiency and 25-hydroxyvitamin D (25(OH)D) concentration in Brazilian children aged 6-59 months. Data from 8145 children from the Brazilian National Survey on Child Nutrition (ENANI-2019) were analysed. The serum concentration of 25(OHD)D was measured using a chemiluminescent immunoassay. The prevalence of vitamin D insufficiency (25(OH)D < 50 nmol/l) and 95 % CI was calculated. Logistic and linear regression models were used to identify the variables associated with vitamin D insufficiency and serum 25(OH)D concentrations, respectively. The mean 25(OH)D concentration was 98·6 ± 36·0 nmol/l, and 4·3 % of the children presented vitamin D insufficiency. Children aged 6-23 months (OR = 2·23; 95 % CI 1·52, 3·26); belonging to Southeast (OR = 5·55; 95 % CI 2·34, 13·17) and South (OR = 4·57; 95 % CI 1·77, 11·84) regions; the second tertile of the National Wealth Score (OR = 2·14; 95 % CI 1·16, 3·91) and winter (OR = 5·82; 95 % CI 2·67, 12·71) and spring (OR = 4·84; 95 % CI 2·17, 10·80) seasons of blood collection were associated with a higher chance of vitamin D insufficiency. Female sex (ß = -5·66, 95 % CI - 7·81, -3·51), urban location (ß = -14·19, 95 % CI -21·0, -7·22) and no vitamin D supplement use (ß = -6·01, 95 % CI -9·64, -2·39) were inversely associated with serum 25(OH)D concentration. The age of children and the Brazilian geographical region of household location were the main predictors of vitamin D insufficiency. In Brazil, vitamin D insufficiency among children aged 6-59 months is low and is not a relevant public health problem.

Factors associated with delayed initiation of breast cancer treatment at an oncology referral center in Juiz de Fora, Minas Gerais state, from 2010 to 2019: a cohort study / Factores asociados al retraso en el inicio del tratamiento del cáncer de mama en un centro oncológico de referencia en Juiz de Fora, de 2010 a 2019: estudio de cohorte / Fatores associados ao atraso para o início do tratamento para câncer de mama em um centro oncológico de referência em Juiz de Fora, de 2010 a 2019: estudo de coorte

ABSTRACT Objectives To analyze factors associated with delayed initiation of breast cancer treatment at an oncology referral center in Juiz de Fora, Minas Gerais state, between 2010 and 2019. Methods This was a cohort study using data from the Hospital-based Cancer Registry. The probability of not starting treatment within 60 days, in accordance with Brazilian law, was estimated using Kaplan-Meier, method and its association with the factors studied was assessed using the Cox model, presenting hazard ratios (HR) and respective 95% confidence intervals (95%CI). Results Among the 911 participants, the probability of delayed treatment initiation was 18.8% (95%CI 16.4;21.5). Those who underwent treatment at a health service other than the one where the cancer was diagnosed had a significantly higher risk (HR: 3.49; 95%CI 3.00;4.07). Conclusion Receiving a diagnosis and treatment at the same institution may help reduce waiting time to initiate cancer treatment.

RESUMEN Objetivos Determinar los retrasos en el inicio del tratamiento de cáncer de mama en un centro de referencia en oncología de Juiz de Fora, MG, entre 2010 y 2019. Métodos Se trata de una cohorte con datos del Registro Hospitalario de Cáncer. La probabilidad de no iniciar tratamiento dentro de los 60 días, según la legislación brasileña, fue estimada mediante el método de Kaplan-Meier, y su asociación con los factores estudiados mediante el modelo de Cox, con la presentación del Hazard Ratios (HR) y los respectivos intervalos de confianza de 95% (IC95%). Resultados Se evaluaron 911 participantes, la probabilidad de iniciar el tratamiento con retraso fue del 18,8% (IC95% 16,4;21,5). Quienes se sometieron a tratamiento en un servicio de salud distinto al que estableció el diagnóstico de cáncer tuvieron un riesgo significativamente mayor (HR: 3,49; IC95% 3,00;4,07). Conclusión La realización del diagnóstico y tratamiento en una misma institución puede contribuir a reducir el tiempo de espera para el inicio del tratamiento.

RESUMO Objetivos Analisar fatores associados ao atraso para o início do tratamento do câncer de mama em um centro de referência em oncologia em Juiz de Fora, MG, entre 2010 e 2019. Métodos Trata-se de coorte com dados do Registro Hospitalar de Câncer. A probabilidade de não iniciar o tratamento em até 60 dias, conforme legislação brasileira, foi estimada pelo método de Kaplan-Meier, e sua associação com os fatores estudados pelo modelo de Cox, com apresentação das hazard ratios (HR) e respectivos intervalos de confiança de 95% (IC95%). Resultados Entre as 911 participantes, a probabilidade de iniciar o tratamento com atraso foi de 18,8% (IC95% 16,4;21,5). Aquelas que realizaram o tratamento em um serviço de saúde diferente do que estabeleceu o diagnóstico de câncer apresentaram risco significativamente maior (HR: 3,49; IC95% 3,00;4,07). Conclusão Realizar diagnóstico e tratamento na mesma instituição pode contribuir para a redução do tempo de espera para o início do tratamento.

Minimum dietary diversity and consumption of ultra-processed foods among Brazilian children 6-23 months of age.

The study aimed to estimate the prevalence of minimum dietary diversity (MDD) and consumption of ultra-processed foods in children 6-23 months of age according to sociodemographic variables. Three indicators of complementary feeding of 4,354 children from the Brazilian National Survey on Child Nutrition (ENANI-2019) were built based on a questionnaire about food consumption on the day before the interview: MDD, consumption of ultra-processed foods, and MDD without the consumption of ultra-processed foods. The prevalence and 95%CI were calculated, stratified by macroregion; race/skin color, education and work status of the mother or caregiver; enrollment in the Brazilian Income Transfer Program; household food security; sanitation; and child enrollment in daycare/school. The overall prevalence of MDD was 63.4%, with lower prevalences among children who lived in the North Region (54.8%), whose mothers or caregivers had 0-7 years of education (50.6%), and lived under moderate or severe food insecurity (52.6%). Ultra-processed foods were consumed by 80.5% of the children, with the highest prevalence in the North Region (84.5%). The prevalence of MDD without ultra-processed foods was 8.4% and less prevalent among children with black mothers or caregivers (3.6%) and among those whose mother or caregiver had 8-10 years of education (3.6%). The most frequently consumed food groups from the MDD indicator were grains, roots and tubers (90.2%), dairy products (81%) and those from ultra-processed food were sweet or salty cookies/crackers (51.3%) and instant flours (41.4%). The ubiquitous presence of ultra-processed foods in the diets of Brazilian children and the low frequency of diversified foods, especially among the most vulnerable populations, indicate the need to strengthen policies and programs to ensure adequate and healthy infant nutrition.

Nutrition transition in Brazilian children under 5 years old from 2006 to 2019.

This manuscript aims to report the nutrition transition in Brazilian children under 5 years old from 2006 to 2019. Microdata from the Brazilian National Survey on Demography and Health of Women and Children (PNDS 2006) and the Brazilian National Survey on Child Nutrition (ENANI-2019) were analyzed. The indicators considered were: micronutrient status (anemia and vitamin A deficiency), anthropometric status (stunting and excessive weight), and breastfeeding practice (exclusive breastfeeding among children < 6 months and continued breastfeeding among children 12-23 months). We also analyzed minimum dietary diversity (MDD), consumption of ultra-processed foods, consumption of meat or eggs, and not consuming fruits or vegetables in children 6-59 months of age only for ENANI-2019. Equiplot charts were generated according to geographic region, maternal schooling level, and maternal race/skin color. From 2006 to 2019, the prevalence rates of anemia and vitamin A deficiency decreased from 20.5% to 10.1% and 17.2% to 6%, respectively. The prevalence of stunting remained at 7%, and excessive weight rates increased from 6% to 10.1%. The prevalence of exclusive breastfeeding among children < 6 months increased from 38.6% to 45.8%, and of continued breastfeeding among children 12-23 months from 34.6% to 43.6%. In 2019, 61.5% of children achieved the MDD, 88.8% consumed ultra-processed foods, 83.1% consumed meat or egg, and 25.7% did not consume fruits or vegetables the day before the survey. Trends of decreased micronutrient deficiencies, increased breastfeeding, and excessive weight rates, as well as reductions in disparities related to geographic region, maternal schooling level, and maternal race/skin color, were observed for most of the indicators.

Malnutrition in mother-child dyads in the Brazilian National Survey on Child Nutrition (ENANI-2019).

Malnutrition affects billions of individuals worldwide and represents a global health challenge. This study aimed to determine the prevalence of malnutrition (undernutrition or overweight) among mother-child dyads in children under 5 years old in Brazil in 2019 and to estimate changes in this prevalence from 2006 to 2019. Individual-level data from the Brazilian National Survey on Child Nutrition (ENANI-2019) and the Brazilian National Survey of Demography and Health of Women and Children carried out in 2006 (PNDS 2006) were analyzed. Malnutrition outcomes in mother-child dyads included overweight mother and child, undernourished mother and child, and the double burden of malnutrition, i.e., overweight mother and child having any form of undernourishment (stunting, wasting, or underweight). Prevalence and 95% confidence intervals (95%CI) were estimated. Most women (58.2%) and 9.7% of the children were overweight, 6.9% were stunted, and 3.1% of mothers and 2.9% of the children were underweight. The prevalence of overweight in the mother-child dyad was 7.8% and was statistically higher in Southern Brazil (9.7%; 95%CI: 7.5; 11.9) than in the Central-West (5.4%; 95%CI: 4.3; 6.6). The prevalence of overweight mother and stunted child was 3.5%, with statistically significant difference between the extremes of the mother's education [0-7 vs. ≥ 12 years, 4.8% (95%CI: 3.2; 6.5) and 2.1%, (95%CI: 1.2; 3.0), respectively]. Overweight in the dyad increased from 5.2% to 7.8%, and the double burden of malnutrition increased from 2.7% to 5.2% since 2006. Malnutrition in Brazilian mother-child dyads seems to be a growing problem, and dyads with lower formal education, higher maternal age, and from the South Region of Brazil were more vulnerable.

Factors associated with anemia and vitamin A deficiency in Brazilian children under 5 years old: Brazilian National Survey on Child Nutrition (ENANI-2019).

Factors associated with anemia and vitamin A deficiency were investigated in 7,716 children 6-59 months of age studied in the Brazilian National Survey on Child Nutrition (ENANI-2019). We adopted a hierarchical approach based on a United Nations Children's Fund (UNICEF) theoretical model with three levels, stratifying by age (6-23; 24-59 months). Prevalence ratio (PR) and 95% confidence interval (95%CI) were estimated. Enabling determinants: a higher prevalence of anemia was observed in children 6-23 months whose mothers had ≤ 7 years of schooling (PR = 1.92; 95%CI: 1.10; 3.34), < 20 years old (PR = 2.47; 95%CI: 1.34; 4.56) or 20-30 years old (PR = 1.95; 95%CI: 1.11; 3.44), mixed-race (PR = 1.57; 95%CI: 1.06; 2.23); and in children 24-59 months in the North Region (PR = 3.11; 95%CI: 1.58; 6.13). A higher prevalence for vitamin A deficiency was observed in children 6-23 months from Central-West (PR = 2.32; 95%CI: 1.33; 4.05), and in children 24-59 months living in the North (PR = 1.96; 95%CI: 1.16; 3.30), South (PR = 3.07; 95%CI: 1.89; 5.01), and Central-West (PR = 1.91; 95%CI: 1.12; 3.25) and whose mothers were 20-34 years (PR = 1.62; 95%CI: 1.11; 2.35). Underlying determinants: the presence of more than one child < 5 years old in the household was associated with a higher prevalence of anemia (PR = 1.61; 95%CI: 1.15; 2.25) and vitamin A deficiency (PR = 1.82; 95%CI: 1.09; 3.05) in children 6-23 months. Immediate determinants: consumption of 1-2 groups of ultra-processed foods in children 24-59 months (PR = 0.44; 95%CI: 0.25; 0.81) and lack of breastfeeding in the day before in children 6-23 months (PR = 0.56; 95%CI: 0.36; 0.95) were associated with lower prevalence of anemia and vitamin A deficiency. Public policies focused on geographically and socially vulnerable groups are needed to promote equity.

Trends of breastfeeding indicators in Brazil from 1996 to 2019 and the gaps to achieve the WHO/UNICEF 2030 targets.

BACKGROUND: The comprehension of breastfeeding patterns and trends through comparable indicators is essential to plan and implement public health policies. OBJECTIVE: To evaluate the trends of breastfeeding indicators in Brazil from 1996 to 2019 and estimate the gap to achieve the WHO/UNICEF 2030 targets in children under 5 years. METHODS: Microdata from two National Surveys on Demography and Health of Women and Children (PNDS-1996 and PNDS-2006) and the Brazilian National Survey on Child Nutrition-2019 were used. The indicators of early initiation of breastfeeding (EIBF), exclusive breastfeeding of infants 0-5 months of age (EBF<6 mo), continued breastfeeding at 1 year of age (CBF1yr) and CBF at 2 years of age (CBF2yr) were analysed using prevalence and 95% CI. The average annual variation and years to achieve the WHO/UNICEF 2030 targets were calculated for Brazil and the macroregions. Statistical analyses considered the survey's complex sample design for each database. RESULTS: EIBF increased from 36.3% (95% CI 33.6% to 39.0%) in 1996 to 60.9% (95% CI 56.5% to 65.3%) in 2006 (statistically significant) and 62.5% (95% CI 58.3% to 66.6%) in 2019. EBF<6 mo increased from 26.9% (95% CI 21.3% to 31.9%) in 1996 to 39.0% (95% CI 31.0% to 47.1%) in 2006 and 45.8% (95% CI 40.9% to 50.7%) in 2019 (significant increases for 1996-2019 for Brazil, Northeast and Midwest regions). CBF1yr rose from 36.6% (95% CI 30.8% to 42.4%) in 1996 to 48.7% (95% CI 38.3% to 59.0%) in 2006, and 52.1% (95% CI 45.4% to 58.9%) in 2019. CBF2yr increased from 24.7% (95% CI 19.5% to 29.9%) in 1996 to 24.6% (95% CI 15.7% to 33.5%) in 2006 and 35.5% (95% CI 30.4% to 40.6%) in 2019 (significant increase for 1996-2019). The South and Southeast regions need to double the 2019 prevalence to reach the target for the CBF1yr and CBF2yr; the Northeast and North need to increase 60% the current prevalence for the indicator of EBF<6 mo. CONCLUSION: A substantial improvement in breastfeeding indicators occurred in Brazil from 1996 to 2019, although at an insufficient rate to achieve the WHO/UNICEF 2030 targets.

The National Wealth Score in the Brazilian National Survey on Child Nutrition (ENANI-2019).

The National Wealth Score (IEN) is a synthetic household index that assesses socioeconomic conditions. This study aims to present the methods used to update the IEN using data from the Brazilian National Survey on Child Nutrition (ENANI-2019). The following items were included: the education level of the mother or caregiver of the child; the number of bedrooms and bathrooms, TV sets, and cars in the household; and the presence of a radio, refrigerator or freezer, washing machine, microwave oven, telephone line, computers, air conditioner, media player devices, cable or satellite TV, cell phone ownership and type of service, cell phone internet, and internet at the household. Principal component analysis (PCA) was used to estimate the IEN with and without incorporating the complex sampling design (CSD). Thus, the IEN validation considered proxy indicators of socioeconomic status and living conditions. The first component of the PCA explained 31% and 71% of the variation with and without incorporating the CSD, respectively. The coefficients of variation of the IEN were 53.4% and 2.6% with and without incorporating the CSD, respectively. The mean IEN score was lower in households without access to a sewage system, those that received benefits from Brazilian Income Transfer Program, those with some degree of food insecurity, and those with stunted children. Adding ENANI-2019 items to the calculation of IEN to capture technological advances resulted in a better fit of the model. Incorporating the CSD increased PCA performance and the IEN precision. The new IEN has an adequate performance in determining the socioeconomic status of households with children aged under five years.

Tobacco use by sexual and gender minorities: findings from a Brazilian national survey.

OBJECTIVE: The study aims to identify the prevalence of use of tobacco products by sexual and gender minorities (SGM) in Brazil, the users' profile and associations between tobacco use and social and behavioural variables. METHODOLOGY: The study used data from a representative nationwide household survey of the Brazilian population aged 12-65 years-the first one to address the issue of sexual orientation/gender identity. The study sample consisted of 15 801 individuals. Social and behavioural characteristics and the use of tobacco products were compared according to sexual orientation/gender identity. A multivariate logistic model was constructed to assess the association between tobacco use and sexual orientation/gender identity, as well as models stratified by SGM and non-SGM. RESULTS: Prevalence of any tobacco product use was 44.7% among SGM and 17.0% among non-SGM. Water pipe use was ~8 times higher for SGM than for non-SGM (13.5% vs 1.6%). SGM tobacco users were younger and had more schooling than non-SGM tobacco users. After adjusting for social and behavioural variables, the multivariate model showed that SGM were 150% more likely to use tobacco products than non-SGM (adjusted OR 2.52; 95% CI 1.61 to 3.95). In the model for SGM, schooling, alcohol consumption, illicit drug consumption, violence and anxiety/depression were significantly associated with tobacco use. CONCLUSION: Prevalence of tobacco use among SGM was higher than among non-SGM, and the profile of tobacco users differed between them. It is urgent to monitor health issues in SGM in Brazil and to adopt tobacco control strategies for this group.

Law compliance, why do we need it? Comparative data from the Brazilian National Survey of School Health (PeNSE) on adolescents' access to cigarettes. / Lei, para que te quero? Dados comparativos da Pesquisa Nacional de Saúde do Escolar (PeNSE) sobre acesso a cigarros por adolescentes.

In recent decades, Brazil has made significant progress in fighting the tobacco epidemic. However, recent national data suggest a probable stagnation in the reduction of smoking initiation among youth and adolescents. The objective of this study was to evaluate the evolution over time of compliance with the law that prohibits the sale of cigarettes to minors in Brazil. To this end, data from the Brazilian National Survey of School Health conducted in 2015 and 2019 were used. Percentages were estimated for "sequential" indicators created by combining answers to the questions "Did anyone refuse to sell you cigarettes?" and "How did you obtain your cigarettes?" There was a decrease between 2015 and 2019 in the percentage of smokers aged 13 to 17 who tried to buy cigarettes in the 30 days prior to the survey (72.3% vs. 66.4%; p-value ≤ 0.05). However, regardless of the survey year, approximately 9 out of 10 adolescent smokers were successful in an attempt to buy cigarettes. Of those, approximately 7 out of 10 used direct purchase as the main method of obtaining cigarettes, with purchases at licensed commercial establishments (vs. street vendors) increasing between 2015 and 2019 (81.1% vs. 89.6%; p-value ≤ 0.05). In 2019, 70% of teenagers who bought cigarettes at licensed commercial establishments purchased single cigarettes. Non-compliance with laws aimed at preventing smoking initiation is a huge obstacle to reducing the proportion of smokers. Increased implementation of legislative measures and oversight of cigarettes sales, combined with educational and awareness actions with retailers, is key to protecting new generations from the harmful effects of tobacco use.

Nas últimas décadas, o Brasil obteve importantes avanços no combate à epidemia de tabaco. No entanto, dados recentes nacionais apontam para uma provável estagnação na queda da iniciação ao tabagismo entre jovens e adolescentes. O objetivo deste estudo foi avaliar a evolução no tempo do cumprimento da lei que proíbe a venda de cigarros para menores de idade no Brasil. Para tal, utilizaram-se os dados da Pesquisa Nacional de Saúde do Escolar das edições de 2015 e 2019. Foram estimadas proporções para indicadores "sequenciais" criados da combinação das respostas às perguntas "alguém se recusou a lhe vender cigarros?" e "como conseguiu seus próprios cigarros?". Houve uma queda, entre 2015 e 2019, na proporção de fumantes entre 13 e 17 anos que tentaram comprar cigarros nos 30 dias anteriores à pesquisa (72,3% vs. 66,4%; valor de p ≤ 0,05). Contudo, independentemente do ano da pesquisa, cerca de 9 em cada 10 adolescentes fumantes tiveram sucesso em alguma tentativa de compra de cigarros. Desses, aproximadamente 7 em cada 10 utilizaram a compra ativa como a principal modalidade de acesso ao cigarro, sendo que a respectiva compra em estabelecimentos comerciais autorizados (vs. com ambulantes) aumentou entre 2015 e 2019 (81,1% vs. 89,6%; valor de p ≤ 0,05). Em 2019, 70% dos adolescentes que compraram cigarros em estabelecimentos comerciais autorizados realizaram a compra avulsa. O descumprimento de leis voltadas à prevenção da iniciação ao fumo é um enorme obstáculo para a redução da proporção de fumantes. O fortalecimento das ações legislativas e de fiscalização, aliado a ações educativas e de sensibilização junto aos varejistas, é fundamental para proteger as novas gerações quanto aos efeitos nocivos do uso do tabaco.

En las últimas décadas, Brasil ha logrado importantes avances en el combate a la epidemia del tabaquismo. Pero, recientes datos nacionales apuntan a un probable estancamiento en la recucción de la iniciación tabáquia entre jóvenes y adolescentes. El objetivo de este estudio fue evaluar la evolución en el tiempo de cumplimiento de la ley que prohíbe la venta de cigarrillos a menores en Brasil. Para ello, se utilizaron datos de la Encuesta Nacional de Salud del Escolar de 2015 y 2019. Se estimaron proporciones para los indicadores "secuenciales" creados desde una combinación de las respuestas a las preguntas "alguien se negó a venderte cigarrillos" y "cómo conseguiste cigarrillos". Hubo una disminución entre 2015 y 2019 en la proporción de fumadores de entre 13 y 17 años que intentaron comprar cigarrillos en los treinta días antes de la encuesta (72,3% vs. 66,4%; valor de p ≤ 0,05). Sin embargo, independientemente del año de la encuesta, alrededor de 9 de cada 10 adolescentes fumadores tuvieron éxito en algún intento de comprar cigarrillos. De estos, aproximadamente 7 de cada 10 utilizaron la compra activa como el principal método de acceso a cigarrillos, y la respectiva compra en establecimientos comerciales autorizados (vs. con vendedores ambulantes) aumentó entre 2015 y 2019 (81,1% vs. 89,6%; valor de p ≤ 0,05). En 2019, el 70% de los adolescentes que compraron cigarrillos en establecimientos comerciales autorizados los compraron sueltos. El incumplimiento de la ley destinada a prevenir la iniciación al tabaquismo es un gran obstáculo para reducir la proporción de fumadores. El fortalecimiento de las acciones legislativas y de fiscalización, sumado a acciones educativas y de sensibilización con los comerciantes, es fundamental para proteger a las nuevas generaciones de los efectos nocivos del consumo de tabaco.

The National Wealth Score in the Brazilian National Survey on Child Nutrition (ENANI-2019) / O Indicador Econômico Nacional no Estudo Nacional de Alimentação e Nutrição Infantil (ENANI-2019) / El Indicador Económico Nacional en el Estudio Nacional de Alimentación y Nutrición Infantil (ENANI-2019)

The National Wealth Score (IEN) is a synthetic household index that assesses socioeconomic conditions. This study aims to present the methods used to update the IEN using data from the Brazilian National Survey on Child Nutrition (ENANI-2019). The following items were included: the education level of the mother or caregiver of the child; the number of bedrooms and bathrooms, TV sets, and cars in the household; and the presence of a radio, refrigerator or freezer, washing machine, microwave oven, telephone line, computers, air conditioner, media player devices, cable or satellite TV, cell phone ownership and type of service, cell phone internet, and internet at the household. Principal component analysis (PCA) was used to estimate the IEN with and without incorporating the complex sampling design (CSD). Thus, the IEN validation considered proxy indicators of socioeconomic status and living conditions. The first component of the PCA explained 31% and 71% of the variation with and without incorporating the CSD, respectively. The coefficients of variation of the IEN were 53.4% and 2.6% with and without incorporating the CSD, respectively. The mean IEN score was lower in households without access to a sewage system, those that received benefits from Brazilian Income Transfer Program, those with some degree of food insecurity, and those with stunted children. Adding ENANI-2019 items to the calculation of IEN to capture technological advances resulted in a better fit of the model. Incorporating the CSD increased PCA performance and the IEN precision. The new IEN has an adequate performance in determining the socioeconomic status of households with children aged under five years.

O Indicador Econômico Nacional (IEN) é um índice domiciliar sintético que avalia condições socioeconômicas. Este estudo tem como objetivo apresentar os métodos utilizados para atualização do IEN a partir de dados do Estudo Nacional de Alimentação e Nutrição Infantil (ENANI-2019). Foram incluídos os seguintes itens: escolaridade da mãe/cuidador da criança; o número de quartos e banheiros, aparelhos de TV e carros no domicílio; a presença de rádio, geladeira ou freezer, máquina de lavar, forno micro-ondas, linha telefônica, computadores, ar-condicionado, aparelhos multimídia, TV a cabo ou via satélite, propriedade e tipo de serviço de telefone celular, rede de dados de telefone celular e internet no domicílio. A análise de componentes principais (ACP) foi utilizada para estimar o IEN com e sem a incorporação da amostragem complexa. Assim, a validação do IEN considerou indicadores proxy de nível socioeconômico e condições de vida. O primeiro componente da ACP explicou 31% e 71% da variação com e sem a incorporação da amostragem complexa, respectivamente. Os coeficientes de variação do IEN foram de 53,4% e 2,6% com e sem a incorporação da amostragem complexa, respectivamente. O escore médio do IEN foi menor em domicílios sem acesso a esgoto, naqueles que receberam benefícios do Programa Bolsa Família, naqueles com algum grau de insegurança alimentar e naqueles com crianças com déficit de crescimento. A adição de itens do ENANI-2019 ao cálculo do IEN, a fim de capturar os avanços tecnológicos, resultou em um melhor ajuste do modelo. A incorporação da amostragem complexa aumentou o desempenho da ACP e a precisão do IEN. O novo IEN tem um desempenho adequado na determinação do nível socioeconômico de domicílios com crianças menores de cinco anos.

El Indicador Económico Nacional (IEN) es un índice domiciliar que evalúa las condiciones socioeconómicas. Este estudio tiene como objetivo presentar los métodos utilizados en la actualización del IEN con base en datos del Estudio Nacional de Alimentación y Nutrición Infantil (ENANI-2019). Se incluyeron los siguientes ítems: nivel educativo de la madre/cuidador del niño; la cantidad de dormitorios y baños, televisores y autos en el hogar; la tenencia de radio, heladera o freezer, lavadora, horno de microondas, línea telefónica, computadoras, aire acondicionado, equipo multimedia, televisión por cable o satélite, titularidad y tipo de servicio de telefonía celular, red de datos celular e internet en el hogar. Se utilizó el análisis de componentes principales (ACP) para estimar el IEN con y sin la incorporación de muestreo complejo. Así, la validación del IEN consideró indicadores proxy de nivel socioeconómico y condiciones de vida. El primer componente ACP explicó el 31% y el 71% de la variación con y sin la incorporación de muestreo complejo, respectivamente. Los coeficientes de variación del IEN fueron el 53,4% y el 2,6% con y sin incorporación de muestreo complejo, respectivamente. El puntaje medio del IEN fue menor en los hogares sin acceso a alcantarillado, en aquellos que recibieron beneficios del Programa Bolsa Família, en aquellos con algún grado de inseguridad alimentaria y en aquellos con niños con retraso en el crecimiento. La incorporación de los ítems del ENANI-2019 en el cálculo del IEN, con el fin de capturar los avances tecnológicos, dio como resultado un mejor ajuste del modelo. La incorporación de muestreo complejo incrementó el desempeño de la ACP y la precisión del IEN. El nuevo IEN tiene un desempeño adecuado para estimar el nivel socioeconómico de los hogares con niños menores de cinco años.

Nutrition transition in Brazilian children under 5 years old from 2006 to 2019 / Transição nutricional em crianças brasileiras menores de 5 anos de idade entre 2006 e 2019 / Transición nutricional en niños brasileños menores de 5 años de edad entre 2006 y 2019

Abstract: This manuscript aims to report the nutrition transition in Brazilian children under 5 years old from 2006 to 2019. Microdata from the Brazilian National Survey on Demography and Health of Women and Children (PNDS 2006) and the Brazilian National Survey on Child Nutrition (ENANI-2019) were analyzed. The indicators considered were: micronutrient status (anemia and vitamin A deficiency), anthropometric status (stunting and excessive weight), and breastfeeding practice (exclusive breastfeeding among children < 6 months and continued breastfeeding among children 12-23 months). We also analyzed minimum dietary diversity (MDD), consumption of ultra-processed foods, consumption of meat or eggs, and not consuming fruits or vegetables in children 6-59 months of age only for ENANI-2019. Equiplot charts were generated according to geographic region, maternal schooling level, and maternal race/skin color. From 2006 to 2019, the prevalence rates of anemia and vitamin A deficiency decreased from 20.5% to 10.1% and 17.2% to 6%, respectively. The prevalence of stunting remained at 7%, and excessive weight rates increased from 6% to 10.1%. The prevalence of exclusive breastfeeding among children < 6 months increased from 38.6% to 45.8%, and of continued breastfeeding among children 12-23 months from 34.6% to 43.6%. In 2019, 61.5% of children achieved the MDD, 88.8% consumed ultra-processed foods, 83.1% consumed meat or egg, and 25.7% did not consume fruits or vegetables the day before the survey. Trends of decreased micronutrient deficiencies, increased breastfeeding, and excessive weight rates, as well as reductions in disparities related to geographic region, maternal schooling level, and maternal race/skin color, were observed for most of the indicators.

Resumo: Buscamos reportar a transição nutricional em crianças brasileiras menores de 5 anos de idade entre 2006 e 2019. Foram analisados microdados da Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher (PNDS 2006) e do Estudo Nacional de Alimentação e Nutrição Infantil (ENANI-2019). Foram considerados os seguintes indicadores: status de micronutrientes (anemia e deficiência de vitamina A), estado nutricional antropométrico (excesso de peso e baixa estatura) e a prática de aleitamento materno (aleitamento materno exclusivo entre crianças < 6 meses e aleitamento materno continuado entre crianças de 12-23 meses). Analisamos a diversidade alimentar mínima (DAM), o consumo de alimentos ultraprocessados, de carne ou ovos e o não consumo de frutas ou hortaliças apenas para o ENANI-2019 em crianças de 6-59 meses de idade. Equiplots foram gerados de acordo com a região geográfica, escolaridade e raça/cor da pele maternas. Entre 2006 e 2019, as prevalências de anemia e deficiência de vitamina A diminuíram de 20,5% para 10,1% e de 17,2% para 6%, respectivamente. A prevalência de déficit de estatura manteve-se em 7% e a de excesso de peso aumentou de 6% para 10,1%. A prevalência de aleitamento materno exclusivo entre crianças < 6 meses aumentou de 38,6% para 45,8% e a de aleitamento materno continuado entre crianças de 12-23 meses aumentou de 34,6% para 43,6%. Em 2019, 61,5% das crianças atingiram a DAM, 88,8% consumiram alimentos ultraprocessados, 83,1% consumiram carne ou ovos e 25,7% não consumiram frutas ou hortaliças no dia anterior à pesquisa. Observamos tendências de diminuição das deficiências de micronutrientes, aumento do aleitamento materno e excesso de peso e reduções em disparidades regional, de escolaridade e de raça/cor da pele maternas para a maioria dos indicadores.

Resumen: Buscamos informar sobre la transición nutricional en niños brasileños menores de 5 años entre 2006 y 2019. Se analizaron microdatos de la Encuesta Nacional de Demografía y Salud del Niño y de la Mujer (PNDS 2006) y del Encuesta Nacional de Alimentación Nutrición Infantil (ENANI-2019). Se consideraron los siguientes indicadores: estado de micronutrientes (anemia y deficiencia de vitamina A), estado nuricional antropométrico (sobrepeso y baja estatura) y la práctica de la lactancia materna (lactancia materna exclusiva en niños < 6 meses y lactancia materna continua entre niños de 12-23 meses) como indicadores. Analizamos la diversidad dietética mínima (DDM), el consumo de alimentos ultraprocesados, carne o huevos, y el no consumo de frutas o verduras solo para ENANI-2019 en niños de 6-59 meses de edad. Se generaron equiplots en función de la región geográfica, la educación y raza/color de la piel de la madre. Entre 2006 y 2019, las prevalencias de anemia y deficiencia de vitamina A disminuyeron del 20,5% al 10,1% y del 17,2% al 6%, respectivamente. La prevalencia del déficit de estatura se mantuvo en el 7 % y la de sobrepeso aumentó del 6% al 10,1%. La prevalencia de lactancia materna exclusiva en niños < 6 aumentó del 38,6% al 45,8% y la de lactancia materna continua entre niños de 12-23 meses aumentó del 34,6% al 43,6%. En 2019, el 61,5% de los niños alcanzaron DDM, el 88,8% consumieron alimentos utraprocesados, el 83,1% consumieron carne o huevos y el 25,7% no consumieron frutas o verduras el día anterior a la encuesta. Observamos tendencias de disminución de las deficiencias de micronutrientes, un aumento de la lactancia materna y sobrepeso y reducciones en las disparidades regionales, de escolaridad y de raza/color de la piel de la madre para la mayoría de los indicadores.

Factors associated with anemia and vitamin A deficiency in Brazilian children under 5 years old: Brazilian National Survey on Child Nutrition (ENANI-2019) / Fatores associados à anemia e deficiência de vitamina A em crianças brasileiras menores de cinco anos: Estudo Nacional de Alimentação e Nutrição Infantil (ENANI-2019) / Factores asociados con la anemia y la deficiencia de vitamina A en niños brasileños menores de cinco años: Estudio Nacional de Alimentación y Nutrición Infantil (ENANI-2019)

Abstract: Factors associated with anemia and vitamin A deficiency were investigated in 7,716 children 6-59 months of age studied in the Brazilian National Survey on Child Nutrition (ENANI-2019). We adopted a hierarchical approach based on a United Nations Children's Fund (UNICEF) theoretical model with three levels, stratifying by age (6-23; 24-59 months). Prevalence ratio (PR) and 95% confidence interval (95%CI) were estimated. Enabling determinants: a higher prevalence of anemia was observed in children 6-23 months whose mothers had ≤ 7 years of schooling (PR = 1.92; 95%CI: 1.10; 3.34), < 20 years old (PR = 2.47; 95%CI: 1.34; 4.56) or 20-30 years old (PR = 1.95; 95%CI: 1.11; 3.44), mixed-race (PR = 1.57; 95%CI: 1.06; 2.23); and in children 24-59 months in the North Region (PR = 3.11; 95%CI: 1.58; 6.13). A higher prevalence for vitamin A deficiency was observed in children 6-23 months from Central-West (PR = 2.32; 95%CI: 1.33; 4.05), and in children 24-59 months living in the North (PR = 1.96; 95%CI: 1.16; 3.30), South (PR = 3.07; 95%CI: 1.89; 5.01), and Central-West (PR = 1.91; 95%CI: 1.12; 3.25) and whose mothers were 20-34 years (PR = 1.62; 95%CI: 1.11; 2.35). Underlying determinants: the presence of more than one child < 5 years old in the household was associated with a higher prevalence of anemia (PR = 1.61; 95%CI: 1.15; 2.25) and vitamin A deficiency (PR = 1.82; 95%CI: 1.09; 3.05) in children 6-23 months. Immediate determinants: consumption of 1-2 groups of ultra-processed foods in children 24-59 months (PR = 0.44; 95%CI: 0.25; 0.81) and lack of breastfeeding in the day before in children 6-23 months (PR = 0.56; 95%CI: 0.36; 0.95) were associated with lower prevalence of anemia and vitamin A deficiency. Public policies focused on geographically and socially vulnerable groups are needed to promote equity.

Resumo: Fatores associados a anemia e deficiência de vitamina A foram investigados em 7.716 crianças de 6-59 meses de idade parte da Estudo Nacional de Alimentação e Nutrição Infantil (ENANI-2019). Adotamos uma abordagem hierárquica baseada em um modelo teórico do Fundo das Nações Unidas para a Infância (UNICEF) com três níveis estratificados por idade (6-23; 24-59 meses). Foram estimadas razões de prevalência (RP) e intervalos de 95% de confiança (IC95%). Determinantes habilitadores: observamos maior prevalência de anemia em crianças de 6-23 meses de idade cujas mães tinham ≤ 7 anos de escolaridade (RP = 1,92; IC95%: 1,10; 3,34), < 20 anos de idade (RP = 2,47; IC95%: 1,34; 4,56) ou 20-30 anos de idade (RP = 1,95; IC95%: 1,11; 3,44), cor parda (RP = 1,57; IC95%: 1,06; 2,23); e em crianças de 24-59 meses de idade na Região Norte (RP = 3,11; IC95%: 1,58; 6,13). Encontramos maior prevalência de deficiência de vitamina A em crianças de 6-23 meses de idade no Centro-oeste (RP = 2,32; IC95%: 1,33; 4,05) e em crianças de 24-59 meses de idade residentes nas regiões Norte (RP = 1,96; IC95%: 1,16; 3,30), Sul (RP = 3,07; IC95%: 1,89; 5,01) e Centro-oeste (RP = 1,91; IC95%: 1,12; 3,25) cujas mães tinham entre 20-34 anos de idade (RP = 1,62; IC95%: 1,11; 2,35). Determinantes subjacentes: a presença de mais de uma criança < 5 anos de idade no domicílio se associou a maior prevalência de anemia (RP = 1,61; IC95%: 1,15; 2,25) e deficiência de vitamina A (RP = 1,82; IC95%: 1,09; 3,05) em crianças de 6-23 meses de idade. Determinantes imediatos: o consumo de 1-2 grupos de alimentos ultraprocessados em crianças de 24-59 meses de idade (RP = 0,44; IC95%: 0,25; 0,81) e o não aleitamento materno no dia anterior em crianças de 6-23 meses de idade (RP = 0,56; IC95%: 0,36; 0,95) foram associados com a menor prevalência de anemia e deficiência de vitamina A. Políticas públicas focadas em grupos geográfica e socialmente vulneráveis são necessárias para promover equidade.

resumen está disponible en el texto completo

Malnutrition in mother-child dyads in the Brazilian National Survey on Child Nutrition (ENANI-2019) / Má nutrição em díades mãe-filho no Estudo Nacional de Alimentação e Nutrição Infantil (ENANI-2019) / Malnutrición en díadas madre-hijo en el Estudio Nacional de Alimentación y Nutrición Infantil (ENANI-2019)

Abstract: Malnutrition affects billions of individuals worldwide and represents a global health challenge. This study aimed to determine the prevalence of malnutrition (undernutrition or overweight) among mother-child dyads in children under 5 years old in Brazil in 2019 and to estimate changes in this prevalence from 2006 to 2019. Individual-level data from the Brazilian National Survey on Child Nutrition (ENANI-2019) and the Brazilian National Survey of Demography and Health of Women and Children carried out in 2006 (PNDS 2006) were analyzed. Malnutrition outcomes in mother-child dyads included overweight mother and child, undernourished mother and child, and the double burden of malnutrition, i.e., overweight mother and child having any form of undernourishment (stunting, wasting, or underweight). Prevalence and 95% confidence intervals (95%CI) were estimated. Most women (58.2%) and 9.7% of the children were overweight, 6.9% were stunted, and 3.1% of mothers and 2.9% of the children were underweight. The prevalence of overweight in the mother-child dyad was 7.8% and was statistically higher in Southern Brazil (9.7%; 95%CI: 7.5; 11.9) than in the Central-West (5.4%; 95%CI: 4.3; 6.6). The prevalence of overweight mother and stunted child was 3.5%, with statistically significant difference between the extremes of the mother's education [0-7 vs. ≥ 12 years, 4.8% (95%CI: 3.2; 6.5) and 2.1%, (95%CI: 1.2; 3.0), respectively]. Overweight in the dyad increased from 5.2% to 7.8%, and the double burden of malnutrition increased from 2.7% to 5.2% since 2006. Malnutrition in Brazilian mother-child dyads seems to be a growing problem, and dyads with lower formal education, higher maternal age, and from the South Region of Brazil were more vulnerable.

Resumo: A má nutrição afeta bilhões de indivíduos em todo o mundo e representa um desafio de saúde global. Este estudo teve como objetivo determinar a prevalência de má nutrição (desnutrição ou excesso de peso) entre díades mãe-filho em crianças menores de cinco anos no Brasil em 2019 e estimar as mudanças nessa prevalência de 2006 a 2019. Foram analisados dados individuais do Estudo Nacional de Alimentação e Nutrição Infantil (ENANI-2019) e da Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher realizada em 2006 (PNDS 2006). Os desfechos de má nutrição incluíram mãe e filho com excesso de peso, mãe e filho desnutridos e a dupla carga de má nutrição, ou seja, mãe com excesso de peso e filho com qualquer forma de desnutrição (défict de crescimento, magreza ou baixo peso). Foram estimadas a prevalência e os intervalos de 95% de confiança (IC95%). A maioria das mulheres (58,2%) e 9,7% das crianças estavam acima do peso, 6,9% apresentaram déficit de crescimento e 3,1% das mães e 2,9% das crianças estavam abaixo do peso. A prevalência de excesso de peso na díade mãe-filho foi de 7,8% e foi estatisticamente maior no Sul do Brasil (9,7%; IC95%: 7,5; 11,9) do que no Centro-oeste (5,4%; IC95%: 4,3; 6,6). A prevalência de mãe com sobrepeso e filho com déficit de crescimento foi de 3,5%, com uma diferença estatisticamente significante entre os extremos de escolaridade materna [(0-7 vs. ≥ 12 anos de estudo), 4,8% (IC95%: 3,2; 6,5) and 2,1% (IC95%: 1,2; 3,0), respectivamente]. O excesso de peso na díade aumentou de 5,2% para 7,8% e a dupla carga de má nutrição aumentou de 2,7% para 5,2% desde 2006. A má nutrição nas díades mãe-filho brasileiras parece ser um problema crescente, sendo as mais vulneráveis aquelas com menor escolaridade e maior idade materna e residentes na Região Sul do Brasil.

Resumen: La malnutrición afecta a muchas personas en todo el mundo y representa un desafío para la salud mundial. Este estudio tuvo como objetivo determinar la prevalencia de malnutrición (desnutrición o sobrepeso) entre díadas madre-hijo en niños menores de cinco años en Brasil en 2019 y estimar cambios en esta prevalencia de 2006 a 2019. Se analizaron datos individuales del Estudio Nacional de Alimentación y Nutrición Infantil (ENANI-2019) y de la Encuesta Nacional de Demografía y Salud del Niño y de la Mujer de 2006 (PNDS 2006). Los resultados de la malnutrición incluyeron a madre e hijo con sobrepeso, madre e hijo desnutridos y la doble carga de mala nutrición, es decir, madre con sobrepeso e hijo con cualquier forma de desnutrición (retardo en el crecimiento, emaciación o bajo peso). Se calcularon prevalencias y los intervalos de 95% de confianza (IC95%). La mayoría de las mujeres (58,2%) y el 9,7% de los niños tenían sobrepeso, el 6,9% de los niños presentaban retraso en el crecimiento, y el 3,1% de las madres y el 2,9% de los niños, bajo peso. La prevalencia de sobrepeso en la díada madre-hijo fue del 7,8%, estadísticamente mayor en el Sur de Brasil (9,7%; IC95%: 7,5; 11,9) que en el Centro-Oeste (5,4%; IC95%: 4,3; 6,6). La prevalencia de madres con sobrepeso y de niños con retraso del crecimiento fue del 3,5%, con una diferencia estadísticamente significativa entre los extremos de nivel educativo de la madre [(0-7 vs. ≥ 12 años de nivel educativo), 4,8% (IC95%: 3,2; 6,5) y 2,1% (IC95%: 1,2; 3,0), respectivamente]. El sobrepeso en la díada tuvo un aumento del 5,2% al 7,8%, y la doble carga de mala nutrición aumentó del 2,7% al 5,2% desde 2006. La malnutrición en la díada madre-hijo brasileña resulta ser un problema creciente, siendo las más vulnerables aquellas con menor escolaridad y mayor edad materna y residentes en la Región Sur de Brasil.

Minimum dietary diversity and consumption of ultra-processed foods among Brazilian children 6-23 months of age / Diversidade alimentar mínima e o consumo de alimentos ultraprocessados em crianças brasileiras de 6-23 meses / Diversidad alimentaria mínima y consumo de alimentos ultraprocesados en niños brasileños de 6-23 meses de edad

Abstract: The study aimed to estimate the prevalence of minimum dietary diversity (MDD) and consumption of ultra-processed foods in children 6-23 months of age according to sociodemographic variables. Three indicators of complementary feeding of 4,354 children from the Brazilian National Survey on Child Nutrition (ENANI-2019) were built based on a questionnaire about food consumption on the day before the interview: MDD, consumption of ultra-processed foods, and MDD without the consumption of ultra-processed foods. The prevalence and 95%CI were calculated, stratified by macroregion; race/skin color, education and work status of the mother or caregiver; enrollment in the Brazilian Income Transfer Program; household food security; sanitation; and child enrollment in daycare/school. The overall prevalence of MDD was 63.4%, with lower prevalences among children who lived in the North Region (54.8%), whose mothers or caregivers had 0-7 years of education (50.6%), and lived under moderate or severe food insecurity (52.6%). Ultra-processed foods were consumed by 80.5% of the children, with the highest prevalence in the North Region (84.5%). The prevalence of MDD without ultra-processed foods was 8.4% and less prevalent among children with black mothers or caregivers (3.6%) and among those whose mother or caregiver had 8-10 years of education (3.6%). The most frequently consumed food groups from the MDD indicator were grains, roots and tubers (90.2%), dairy products (81%) and those from ultra-processed food were sweet or salty cookies/crackers (51.3%) and instant flours (41.4%). The ubiquitous presence of ultra-processed foods in the diets of Brazilian children and the low frequency of diversified foods, especially among the most vulnerable populations, indicate the need to strengthen policies and programs to ensure adequate and healthy infant nutrition.

Resumo: O objetivo do estudo foi estimar a prevalência de diversidade alimentar mínima (DAM) e consumo de alimentos ultraprocessados em crianças de 6-23 meses de acordo com variáveis sociodemográficas. Três indicadores de alimentação complementar de 4.354 crianças do Estudo Nacional de Alimentação e Nutrição Infantil (ENANI-2019) foram construídos com base em um questionário sobre o consumo alimentar do dia anterior à entrevista: DAM, consumo de alimentos ultraprocessados e DAM sem consumo de alimentos ultraprocessados. Foram calculadas as prevalências e IC95%, estratificados por macrorregião; raça/cor da pele, escolaridade e situação profissional da mãe ou cuidador; inscrição no Programa Bolsa Família; segurança alimentar do domicílio; saneamento; e matrícula da criança em creche/escola. A prevalência geral de DAM foi de 63,4%, com menores prevalências entre crianças que residiam na Região Norte (54,8%), cujas maẽs ou cuidadores tinham de 0-7 anos de estudo (50,6%) e entre aquelas que viviam em situação de insegurança alimentar moderada ou grave (52,6%). Os alimentos ultraprocessados foram consumidos por 80,5% das crianças, com maior prevalência na Região Norte (84,5%). A prevalência de DAM sem alimentos ultraprocessados foi de 8,4%, sendo menos prevalente entre crianças cuja mãe ou cuidador era negro (3,6%) e entre aquelas cuja mãe ou cuidador tinha 8-10 anos de estudo (3,6%). Os grupos de alimentos do indicador DAM mais consumidos foram os cereais, raizes e tubérculos (90,2%), os derivados do leite (81%) e os dos alimentos ultraprocessados foram os biscoitos (51,3%) e os cereais instantâneos (41,4%). A onipresença de alimentos ultraprocessados na alimentação das crianças brasileiras e a baixa frequência de diversidade alimentar, especialmente entre as populações mais vulneráveis, indicam a necessidade de fortalecer políticas e programas para garantir uma nutrição infantil adequada e saudável.

Resumen: El objetivo del estudio fue estimar la prevalencia de diversidad alimentaria mínima (DDM) y consumo de alimentos ultraprocesados en niños de 6-23 meses según variables sociodemográficas. Se construyeron tres indicadores de alimentación complementaria de 4.354 niños de el Estudio Nacional de Alimentación y Nutrición Infantil (ENANI-2019) a partir de un cuestionario sobre el consumo de alimentos el día anterior a la entrevista: DDM, consumo de alimentos ultraprocesados y DDM sin consumo de alimentos ultraprocesados. Se calcularon la prevalencia y los IC95%, estratificados por macrorregión; raza/color de piel, situación educativa y laboral de la madre o cuidador; inscripción al Programa Bolsa Familia; seguridad alimentaria del hogar; saneamiento; e inscripción de niños en guarderías/escuelas. La prevalencia general de DDM fue del 63,4%, con prevalencias menores entre los niños que vivían en la Región Norte (54,8%), cuyas madres o cuidadores tenían entre 0-7 años de escolaridad (50.6%) y los que vivían en inseguridad alimentaria moderada o grave (52,6%). Los alimentos ultraprocesados fueron consumidos por el 80,5% de los niños, con mayor prevalencia en la Región Norte (84,5%). La prevalencia de DDM sin alimentos ultraprocesados fue del 8,4%, siendo menos prevalente entre niños de padres negros (3,6%) y con 8-10 años de escolaridad (3,6%). Los grupos de alimentos más consumidos del indicador DDM fueron los granos, raíces y tubérculos (90,2%), y los productos lácteos (81%) y los de alimentos ultraprocesados fueron las galletas (51,3%) y los cereales instantáneos (41,4%). La presencia ubicua de alimentos ultraprocesados en las dietas de los niños brasileños y la baja frecuencia diversidad dietética, especialmente entre las poblaciones más vulnerables, indican la necesidad de fortalecer políticas y programas para garantizar una nutrición infantil adecuada y saludable.

Lei, para que te quero? Dados comparativos da Pesquisa Nacional de Saúde do Escolar (PeNSE) sobre acesso a cigarros por adolescentes / Ley ¿para qué te necesito? Datos comparativos del Encuesta Nacional de Salud del Escolar (PeNSE) sobre el acceso a cigarrillos por los adolescentes / Law compliance, why do we need it? Comparative data from the Brazilian National Survey of School Health (PeNSE) on adolescents' access to cigarettes

Nas últimas décadas, o Brasil obteve importantes avanços no combate à epidemia de tabaco. No entanto, dados recentes nacionais apontam para uma provável estagnação na queda da iniciação ao tabagismo entre jovens e adolescentes. O objetivo deste estudo foi avaliar a evolução no tempo do cumprimento da lei que proíbe a venda de cigarros para menores de idade no Brasil. Para tal, utilizaram-se os dados da Pesquisa Nacional de Saúde do Escolar das edições de 2015 e 2019. Foram estimadas proporções para indicadores "sequenciais" criados da combinação das respostas às perguntas "alguém se recusou a lhe vender cigarros?" e "como conseguiu seus próprios cigarros?". Houve uma queda, entre 2015 e 2019, na proporção de fumantes entre 13 e 17 anos que tentaram comprar cigarros nos 30 dias anteriores à pesquisa (72,3% vs. 66,4%; valor de p ≤ 0,05). Contudo, independentemente do ano da pesquisa, cerca de 9 em cada 10 adolescentes fumantes tiveram sucesso em alguma tentativa de compra de cigarros. Desses, aproximadamente 7 em cada 10 utilizaram a compra ativa como a principal modalidade de acesso ao cigarro, sendo que a respectiva compra em estabelecimentos comerciais autorizados (vs. com ambulantes) aumentou entre 2015 e 2019 (81,1% vs. 89,6%; valor de p ≤ 0,05). Em 2019, 70% dos adolescentes que compraram cigarros em estabelecimentos comerciais autorizados realizaram a compra avulsa. O descumprimento de leis voltadas à prevenção da iniciação ao fumo é um enorme obstáculo para a redução da proporção de fumantes. O fortalecimento das ações legislativas e de fiscalização, aliado a ações educativas e de sensibilização junto aos varejistas, é fundamental para proteger as novas gerações quanto aos efeitos nocivos do uso do tabaco.

En las últimas décadas, Brasil ha logrado importantes avances en el combate a la epidemia del tabaquismo. Pero, recientes datos nacionales apuntan a un probable estancamiento en la recucción de la iniciación tabáquia entre jóvenes y adolescentes. El objetivo de este estudio fue evaluar la evolución en el tiempo de cumplimiento de la ley que prohíbe la venta de cigarrillos a menores en Brasil. Para ello, se utilizaron datos de la Encuesta Nacional de Salud del Escolar de 2015 y 2019. Se estimaron proporciones para los indicadores "secuenciales" creados desde una combinación de las respuestas a las preguntas "alguien se negó a venderte cigarrillos" y "cómo conseguiste cigarrillos". Hubo una disminución entre 2015 y 2019 en la proporción de fumadores de entre 13 y 17 años que intentaron comprar cigarrillos en los treinta días antes de la encuesta (72,3% vs. 66,4%; valor de p ≤ 0,05). Sin embargo, independientemente del año de la encuesta, alrededor de 9 de cada 10 adolescentes fumadores tuvieron éxito en algún intento de comprar cigarrillos. De estos, aproximadamente 7 de cada 10 utilizaron la compra activa como el principal método de acceso a cigarrillos, y la respectiva compra en establecimientos comerciales autorizados (vs. con vendedores ambulantes) aumentó entre 2015 y 2019 (81,1% vs. 89,6%; valor de p ≤ 0,05). En 2019, el 70% de los adolescentes que compraron cigarrillos en establecimientos comerciales autorizados los compraron sueltos. El incumplimiento de la ley destinada a prevenir la iniciación al tabaquismo es un gran obstáculo para reducir la proporción de fumadores. El fortalecimiento de las acciones legislativas y de fiscalización, sumado a acciones educativas y de sensibilización con los comerciantes, es fundamental para proteger a las nuevas generaciones de los efectos nocivos del consumo de tabaco.

In recent decades, Brazil has made significant progress in fighting the tobacco epidemic. However, recent national data suggest a probable stagnation in the reduction of smoking initiation among youth and adolescents. The objective of this study was to evaluate the evolution over time of compliance with the law that prohibits the sale of cigarettes to minors in Brazil. To this end, data from the Brazilian National Survey of School Health conducted in 2015 and 2019 were used. Percentages were estimated for "sequential" indicators created by combining answers to the questions "Did anyone refuse to sell you cigarettes?" and "How did you obtain your cigarettes?" There was a decrease between 2015 and 2019 in the percentage of smokers aged 13 to 17 who tried to buy cigarettes in the 30 days prior to the survey (72.3% vs. 66.4%; p-value ≤ 0.05). However, regardless of the survey year, approximately 9 out of 10 adolescent smokers were successful in an attempt to buy cigarettes. Of those, approximately 7 out of 10 used direct purchase as the main method of obtaining cigarettes, with purchases at licensed commercial establishments (vs. street vendors) increasing between 2015 and 2019 (81.1% vs. 89.6%; p-value ≤ 0.05). In 2019, 70% of teenagers who bought cigarettes at licensed commercial establishments purchased single cigarettes. Non-compliance with laws aimed at preventing smoking initiation is a huge obstacle to reducing the proportion of smokers. Increased implementation of legislative measures and oversight of cigarettes sales, combined with educational and awareness actions with retailers, is key to protecting new generations from the harmful effects of tobacco use.