Modifiable behavioral risk factors for NCDs and sleep in Brazilian adolescents.

OBJECTIVE: To analyze the association between modifiable behavioral risk factors for non-communicable diseases and sleep parameters in Brazilian adolescents. METHODS: This was a cross-sectional study that used data from the RPS Cohort Consortium, São Luís, Brazil for the follow-up of adolescents aged 18-19 years (n = 2,515). The outcomes were excessive daytime sleepiness (Epworth Sleepiness Scale - ESS) and sleep quality (Pittsburgh Sleep Quality Index - PSQI). The exposures of interest were the behavioral risk factors for non-communicable diseases (NCDs): screen time, physical inactivity, alcohol, smoking, illicit drugs, caffeine intake, and consumption of sugar-sweetened beverages. Excess weight was considered a possible mediator of this association between the exposures of interest and the outcomes. The models were analyzed by modeling with structural equations. RESULTS: Physical inactivity (standardized coefficient, SC = 0.112; p = 0.001), higher consumption of alcohol (SC = 0.168; p = 0.019) and of sugar-sweetened beverages (SC = 0.128; p < 0.001) were associated with excessive daytime sleepiness in adolescents; better socioeconomic status was also associated with this outcome (SC = 0.128; p < 0.001). Physical inactivity (SC = 0.147; p < 0.001) and higher consumption of sugar-sweetened beverages (SC = 0.089; p = 0.003) were also associated with poor sleep quality. Overweight was neither a mediator nor associated with sleep quality or excessive daytime sleepiness. CONCLUSIONS: The main modifiable behavioral risk factors for NCDs are associated with worse sleep parameters already in adolescence, which serves as a warning toward the accumulation of risks for sleep disorders in the future.

Do childhood depressive symptoms interfere with intelligence in adulthood?

OBJECTIVE: To investigate the effects of depressive symptoms in childhood on the intellectual development of young adults. METHODS: Study conducted with a birth cohort of São Luís, Maranhão, Brazil, composed of 339 participants evaluated between 7 and 9 years and between 18 and 19 years. Structural equation modeling (young adult education, sex, race/color) and childhood variables (nutritional status, depressive symptoms, cognitive function, head of household's and mother's education, family income) were used. In addition, head of household's occupation, mother's age, and presence of partner were tested as determinants of adults' intelligence quotient (IQ). RESULTS: Presence of depressive symptoms in childhood triggered a reduction of 0.342 in standard deviation (SD) and -3.83 points in the average IQ of adults (p-value < 0.001). Cognitive function in childhood had a total and direct positive effect (standardized coefficient [SC] = 0.701; p-value < 0.001) on IQ, increasing 7.84 points with each increase in level. A positive indirect effect of child nutritional status (SC = 0.194; p-value = 0.045), head of household's (SC = 0.162; p-value = 0.036), and mother's education was identified, the latter mediated by cognitive function in childhood (SC = 0.215; p-value = 0.012) on the IQ of young people. CONCLUSION: Presence of depressive symptoms in childhood triggered a long-term negative effect on intelligence, reducing the IQ score in adulthood.

Modifiable behavioral risk factors for NCDs and sleep in Brazilian adolescents / Fatores de risco comportamentais modificáveis para DNT e sono em adolescentes brasileiros

ABSTRACT OBJECTIVE To analyze the association between modifiable behavioral risk factors for non-communicable diseases and sleep parameters in Brazilian adolescents. METHODS This was a cross-sectional study that used data from the RPS Cohort Consortium, São Luís, Brazil for the follow-up of adolescents aged 18-19 years (n = 2,515). The outcomes were excessive daytime sleepiness (Epworth Sleepiness Scale - ESS) and sleep quality (Pittsburgh Sleep Quality Index - PSQI). The exposures of interest were the behavioral risk factors for non-communicable diseases (NCDs): screen time, physical inactivity, alcohol, smoking, illicit drugs, caffeine intake, and consumption of sugar-sweetened beverages. Excess weight was considered a possible mediator of this association between the exposures of interest and the outcomes. The models were analyzed by modeling with structural equations. RESULTS Physical inactivity (standardized coefficient, SC = 0.112; p = 0.001), higher consumption of alcohol (SC = 0.168; p = 0.019) and of sugar-sweetened beverages (SC = 0.128; p < 0.001) were associated with excessive daytime sleepiness in adolescents; better socioeconomic status was also associated with this outcome (SC = 0.128; p < 0.001). Physical inactivity (SC = 0.147; p < 0.001) and higher consumption of sugar-sweetened beverages (SC = 0.089; p = 0.003) were also associated with poor sleep quality. Overweight was neither a mediator nor associated with sleep quality or excessive daytime sleepiness. CONCLUSIONS The main modifiable behavioral risk factors for NCDs are associated with worse sleep parameters already in adolescence, which serves as a warning toward the accumulation of risks for sleep disorders in the future.

RESUMO OBJETIVO Analisar a associação entre fatores de risco comportamentais modificáveis para doenças não transmissíveis e parâmetros do sono em adolescentes brasileiros. MÉTODOS Estudo transversal que utilizou dados do Consórcio de Coortes RPS, São Luís, Brasil para o seguimento de adolescentes de 18-19 anos (n = 2.515). Os desfechos foram a sonolência diurna excessiva (Escala de Sonolência de Epworth - ESE) e a qualidade do sono (Índice de Qualidade do Sono de Pittsburgh - IQSP). As exposições de interesse foram os fatores de risco comportamentais para doenças não transmissíveis (DNT): tempo de tela, inatividade física, álcool, cigarro, drogas ilícitas, consumo de cafeína, consumo de bebidas adoçadas com açúcar. O excesso de peso foi considerado um possível mediador dessa associação entre as exposições de interesse e os desfechos. Os modelos foram analisados por modelagem com equações estruturais. RESULTADOS A inatividade física (Coeficiente padronizado, CP = 0,112; p = 0,001), maior consumo de álcool (CP = 0,168; p = 0,019) e de bebidas adoçadas com açúcar (CP = 0,128; p < 0,001) foram associados a sonolência diurna excessiva nos adolescentes; a melhor situação socioeconômica também foi associada a este desfecho (CP = 0,128; p < 0,001). A inatividade física (CP = 0,147; p < 0,001) e o maior consumo de bebidas adoçadas com açúcar (CP = 0,089; p = 0,003) também se associaram com a qualidade do sono ruim. O excesso de peso não foi mediador e nem associado à qualidade do sono ou à sonolência diurna excessiva. CONCLUSÕES Os principais fatores de risco comportamentais modificáveis para DNT estão associados a piores parâmetros do sono já na adolescência; alertando para um quadro de acúmulos de riscos para distúrbios de sono no futuro.

Do childhood depressive symptoms interfere with intelligence in adulthood? / Sintomas depressivos na infância interferem na inteligência na idade adulta?

ABSTRACT OBJECTIVE To investigate the effects of depressive symptoms in childhood on the intellectual development of young adults. METHODS Study conducted with a birth cohort of São Luís, Maranhão, Brazil, composed of 339 participants evaluated between 7 and 9 years and between 18 and 19 years. Structural equation modeling (young adult education, sex, race/color) and childhood variables (nutritional status, depressive symptoms, cognitive function, head of household's and mother's education, family income) were used. In addition, head of household's occupation, mother's age, and presence of partner were tested as determinants of adults' intelligence quotient (IQ). RESULTS Presence of depressive symptoms in childhood triggered a reduction of 0.342 in standard deviation (SD) and -3.83 points in the average IQ of adults (p-value < 0.001). Cognitive function in childhood had a total and direct positive effect (standardized coefficient [SC] = 0.701; p-value < 0.001) on IQ, increasing 7.84 points with each increase in level. A positive indirect effect of child nutritional status (SC = 0.194; p-value = 0.045), head of household's (SC = 0.162; p-value = 0.036), and mother's education was identified, the latter mediated by cognitive function in childhood (SC = 0.215; p-value = 0.012) on the IQ of young people. CONCLUSION Presence of depressive symptoms in childhood triggered a long-term negative effect on intelligence, reducing the IQ score in adulthood.

RESUMO OBJETIVO Investigar os efeitos dos sintomas depressivos na infância no desenvolvimento intelectual do adulto jovem. MÉTODOS Estudo realizado com uma coorte de nascimentos de São Luís, Maranhão, Brasil, composta por 339 participantes avaliados entre 7 e 9 anos e entre 18 e 19 anos. Utilizou-se modelagem de equações estruturais (escolaridade do adulto jovem, sexo, raça/cor) e variáveis da infância (estado nutricional, sintomas depressivos, função cognitiva, escolaridade do chefe da família e da mãe, renda familiar). Além disso, ocupação do chefe da família, idade da mãe e presença de companheiro foram testadas como determinantes do quociente de inteligência (QI) dos adultos. RESULTADOS A presença de sintomas depressivos na infância gerou redução de 0,342 no desvio-padrão (DP) e -3,83 pontos no QI médio dos adultos (valor de p < 0,001). A função cognitiva na infância apresentou efeito total e direto positivo (coeficiente padronizado [CP] = 0,701; valor de p < 0,001) sobre o QI, elevando 7,84 pontos a cada aumento do nível. Identificou-se efeito indireto positivo do estado nutricional infantil (CP = 0,194; valor de p = 0,045), escolaridade do chefe da família (CP = 0,162; valor de p = 0,036) e da mãe da criança, este último mediado pela função cognitiva na infância (CP = 0,215; valor de p = 0,012) sobre o QI dos jovens. CONCLUSÃO A presença de sintomas depressivos na infância gerou efeito negativo de longo prazo sobre a inteligência, reduzindo a pontuação do QI na idade adulta.

Maternal Mental Health in Late Pregnancy and Longitudinal Changes in Postpartum Serum Vitamin B-12, Homocysteine, and Milk B-12 Concentration Among Brazilian Women.

Background: Little is known regarding the association between mental health distress during pregnancy and postpartum maternal serum biomarkers of vitamin B-12 status and milk B-12 concentration. Objective: To evaluate the association between depressive and anxiety symptoms in the third trimester of pregnancy and changes in postpartum serum B-12, homocysteine, and B-12 milk concentration. Methods: A total of 101 women (18-40 years) were studied in a prospective cohort with data at the third trimester of pregnancy (baseline) and three postpartum time-points (TPs): 2-8 days (TP1), 28-50 days (TP2), and 88-119 days (TP3) postpartum. B-12 concentrations in milk were measured by competitive chemiluminescent enzyme immunoassay at TP1, TP2, and TP3. Serum B-12 and homocysteine concentrations were evaluated at baseline, TP1, TP2, and TP3 by chemiluminescent immunoassays. Depressive and anxiety symptoms were measured with the Edinburgh Postnatal Depression Scale and the State-Trait Anxiety Inventory at baseline. Spearman's correlation test and multiple linear mixed-effect models were performed. Results: The prevalence of depressive and anxiety state symptoms was 35.6 and 39.6% at baseline. High prevalence of low milk B-12 concentration (<310 pmol/L) were observed at TP1 (53.2%), TP2 (71.4%), and TP3 (71.1%). Women with anxiety symptoms at baseline presented higher median concentrations of serum homocysteine at TP1 and lower concentrations of serum and milk B-12 at TP2 compared with women without anxiety symptoms [8 (7; 9) vs. 6 (5; 8) and 266 (188; 369) vs. 332 (272; 413)]. Milk B-12 concentrations were positively and significantly correlated with maternal serum B-12 concentrations at different TP. Women with anxiety symptoms at baseline exhibited a decrease in daily postpartum homocysteine concentrations compared to women without anxiety symptoms (ß = -0.002, SE = 0.001, p = 0.024). Conclusion: Anxiety symptoms at the end of pregnancy were associated with longitudinal changes in maternal serum homocysteine concentrations during the first 3 months postpartum.

Intake of ultra-processed foods is associated with inflammatory markers in Brazilian adolescents.

OBJECTIVE: To evaluate the association of the consumption of foods of the ultra-processed group (UPF) with inflammatory markers in the adolescent population in Northeastern Brazil. DESIGN: A cross-sectional population-based study. Food consumption was evaluated using two 24-h dietary recalls using the NOVA classification for food processing levels. The following inflammatory markers were evaluated: adiponectin, IL-6, IL-8, C-reactive protein (CRP) and TNF-α. Multivariate linear regression was used to investigate the association between the percentage of UPF energy contribution and inflammatory markers. SETTING: São Luís, Maranhão, Brazil. PARTICIPANTS: The sample consisted of 391 male and female adolescents, aged from 17 to 18 years. RESULTS: The average daily energy consumption by adolescents was 8032·9 kJ/d, of which 26·1 % originated from UPF. The upper tertile (T3) of UPF consumption presented higher intake of simple carbohydrates, lipids, saturated fat, and Na and lower protein intake. Individuals in T3 presented higher serum leptin and CRP levels (P < 0·05). Adolescents with UPF energy consumption ≥30·0 % (tertile 3 of UPF) had a 79 % (exp (0·58) = 1·79) increase in IL-8 levels when compared with adolescents in tertile 1 of UPF (P = 0·013). CONCLUSIONS: The association between the consumption of UPF, poor quality diet and pro-inflammatory markers have important harmful effects that can be observed as early as in adolescence.

Prevalence and temporal trends in prepregnancy nutritional status and gestational weight gain of adult women followed in the Brazilian Food and Nutrition Surveillance System from 2008 to 2018.

Prepregnancy body mass index (BMI) and gestational weight gain (GWG) are the most investigated indicators of maternal nutritional status, which is a modifiable factor that plays a vital role in maternal and infant health. This study describes prepregnancy BMI and GWG of 840,243 women with 2,087,765 weight observations in the Brazilian Food and Nutrition Surveillance System from 2008 to 2018. Prepregnancy BMI was classified according to the World Health Organization cut-offs. Total GWG was calculated from weight measurements taken after 36 weeks of pregnancy and classified according to the Institute of Medicine guidelines. Temporal trends in prepregnancy BMI status were examined, and maps were used to evaluate changes in excessive GWG in each Brazilian federation unit. On overall, prepregnancy overweight and obesity increased from 22.6% to 28.8% and from 9.8% to 19.8%, respectively, between 2008 and 2018. The prevalence of excessive GWG rose from 34.2% to 38.7% during the same period and in 11 of the 27 Brazilian federation units between 2008 and 2016. Women with underweight showed the highest values for mean total GWG for all the compared years (overall variation from 12.3 to 13.1 kg), followed by those with normal weight (11.9 to 12.5 kg), overweight (10.1 to 10.9 kg) and obesity (from 8.2 to 8.9 kg). Within each BMI group, values remained fairly stable throughout the studied period for first- and second-trimester GWG and total GWG. These results help to fill a significant gap in understanding the distribution of prepregnancy BMI and GWG in Brazilian women.

Maternal mental health and gestational weight gain in a Brazilian Cohort.

Depression and anxiety are common during pregnancy, but little is known about the influence of these disorders on gestational weight gain (GWG). Data from a prospective cohort of pregnant women followed in a public healthcare center in Rio de Janeiro, Brazil, were used to evaluate the association of depression, anxiety, and suicide risk with GWG. GWG was evaluated at 5-13, 20-26, 30-36, and 37-42 weeks, and GWG adequacy was determined. Statistical analyses included linear mixed-effect models and Poisson regression. We evaluated 206 women, in which 15% (n = 31) presented major depressive disorder, 19.4% (n = 34) suicide risk and 10% (n = 21) generalized anxiety disorder at baseline. Women with depression at the first trimester, persistent depressive symptoms, and anxiety symptoms at the second trimester presented significantly lower rates of GWG per week compared to those without depression or anxiety, respectively. Persistent depressive symptoms represented a 2.40 (95% CI 1.20; 4.81; p = 0.013) increase in the risk of insufficient GWG. There was no significant association between generalized anxiety disorder or suicide risk with GWG. The presence of depression, depressive symptoms, and anxiety during pregnancy were associated with lower GWG rates. Persistent depressive symptoms during pregnancy were directly associated with insufficient GWG.

Brazilian Maternal and Child Nutrition Consortium: establishment, data harmonization and basic characteristics.

Pooled data analysis in the field of maternal and child nutrition rarely incorporates data from low- and middle-income countries and existing studies lack a description of the methods used to harmonize the data and to assess heterogeneity. We describe the creation of the Brazilian Maternal and Child Nutrition Consortium dataset, from multiple pooled longitudinal studies, having gestational weight gain (GWG) as an example. Investigators of the eligible studies published from 1990 to 2018 were invited to participate. We conducted consistency analysis, identified outliers, and assessed heterogeneity for GWG. Outliers identification considered the longitudinal nature of the data. Heterogeneity was performed adjusting multilevel models. We identified 68 studies and invited 59 for this initiative. Data from 29 studies were received, 21 were retained for analysis, resulting in a final sample of 17,344 women with 72,616 weight measurements. Fewer than 1% of all weight measurements were flagged as outliers. Women with pre-pregnancy obesity had lower values for GWG throughout pregnancy. GWG, birth length and weight were similar across the studies and remarkably similar to a Brazilian nationwide study. Pooled data analyses can increase the potential of addressing important questions regarding maternal and child health, especially in countries where research investment is limited.

Diagnostic performance of body mass index in detection of obesity using different cutoff points for excess body fat.

OBJECTIVES: The aim of this study was to assess the diagnostic sensitivity of body mass index (BMI) in detecting obesity according to different cutoff points in order to classify a high body fat percentage (%BF) in adolescents and young adults. METHODS: This was a cross-sectional study conducted with 2447 adolescents 18 and 19 y of age residing in São Luís, Brazil and 951 young adults 21 to 23 y of age residing in Ribeirão Preto, Brazil. Three references were used to define a high %BF (i.e., those of Williams et al., Ramírez-Vélez et al., and Macias et al.). The area under the receiver operating characteristic area under the curve (AUC) was used to assess the performance of BMI. RESULTS: Sensitivity ranged from 38.3% to 54.1% among boys and from 12.7% to 72.7% among girls. Among young adults, it ranged from 52.3% to 67.1% in men and from 33.7% to 86.6% in women. The AUC ranged from 0.69 to 0.76 among boys, from 0.56 from 0.85 among girls, from 0.75 to 0.80 among men, and from 0.67 to 0.88 among women. The best cutoff points for the BMI were 24.79 to 25.10 kg/m2 for boys, 21.89 to 27.04 kg/m2 for girls, 26.43 to 28.22 kg/m2 for men, and 23.34 to 29.28 kg/m2 for women. CONCLUSION: The use of different references for the classification of a high %BF implied a difference in the diagnostic sensitivity of the BMI. Higher cutoff points resulted in greater sensitivity and ability to differentiate individuals with and without obesity.

Assessment of blood biomarkers in adolescents classified by body mass index and body fat percentage. / Avaliação do perfil de biomarcadores sanguíneos em adolescentes classificados pelo índice de massa corporal e percentual de gordura corporal.

The study aimed to compare biomarkers in groups of adolescents classified simultaneously according to body mass index (BMI) and body fat percentage measured by air displacement plethysmography. This was a cross-sectional study with 533 adolescents 18 to 19 years of age in São Luís, Maranhão, Brazil. BMI was classified as adequate (< 25kg/m2) versus excess weight (≥ 25kg/m2). High body fat percentage was defined as ≥ 25% for males and ≥ 30% for females. The adolescents were classified in four groups: "normal weight" (adequate BMI and body fat percentage), "normal weight obese" (adequate BMI with high body fat percentage), "excess weight with adequate body fat percentage", and "excess weight with high body fat percentage". Girls showed higher proportions of "normal weight obesity" (15.6%) and "excess weight with high body fat percentage" (17.1%). "Normal weight obese" adolescents exhibited higher mean values for total cholesterol (172.5mg/dL) and LDL-cholesterol (103.5mg/dL). Those with "excess weight and high body fat percentage" showed lower mean HDL-cholesterol (43.2mg/dL) compared to the other groups, higher mean interleukin-6 (2.7pg/mL) than "normal weight" and "excess weight and adequate body fat percentage" adolescents, and higher median triglycerides (114.0mg/dL) and C-reactive protein (0.14ng/mL) than "normal weight" and "normal weight obese" adolescents. Those with "excess weight and adequate body fat percentage" exhibited the same C-reactive protein levels as those with "excess weight and high body fat percentage". Assessment of nutritional status by BMI alone is limited, since 6.8% of the adolescents presented high body fat percentage despite normal BMI, and those who were "normal weight obese" had two biomarkers that were worse than for adolescents with "excess weight and high body fat percentage".

O objetivo do trabalho foi comparar biomarcadores em grupos de adolescentes classificados simultaneamente pelo índice de massa corporal (IMC) e percentual de gordura corporal, mensurados por meio da pletismografia por deslocamento de ar. Estudo transversal com 533 adolescentes de 18 e 19 anos de São Luís, Maranhão, Brasil. O IMC foi classificado em adequado (< 25kg/m2) e excesso de peso (≥ 25kg/m2). Definiu-se percentual de gordura corporal elevado ≥ 25% para o sexo masculino e ≥ o feminino. Os adolescentes foram classificados em quatro grupos: "eutrófico" (IMC e percentual de gordura corporal adequados), "obeso de peso normal" (IMC adequado com percentual de gordura corporal elevado), "excesso de peso com percentual de gordura corporal adequado" e "excesso de peso com percentual de gordura corporal elevado". As meninas registraram maiores valores de "obesidade de peso normal" (15,6%) e "excesso de peso com percentual de gordura corporal elevado" (17,1%). Os adolescentes "obesos de peso normal" apesentaram maiores médias para colesterol total (172,5mg/dL) e LDL-colesterol (103,5mg/dL). Aqueles com "excesso de peso e percentual de gordura corporal elevado" registraram a menor média para HDL-colesterol (43,2mg/dL) em relação aos outros grupos; maior média para interleucina-6 (2,7pg/mL) em relação aos "eutróficos" e "excesso de peso e percentual de gordura corporal adequado"; e maiores medianas para triglicerídeos (114,0mg/dL) e proteína C reativa (0,14ng/mL) em relação aos "eutróficos" e "obesos de peso normal". Os com "excesso de peso e percentual de gordura corporal adequado" apresentaram proteína C reativa igual aos com "excesso de peso e percentual de gordura corporal elevado". A avaliação do estado nutricional pelo IMC é limitada, pois 6,8% dos adolescentes registraram percentual de gordura corporal elevado apesar do IMC normal, além disto, os "obesos de peso normal" apresentaram dois biomarcadores piores que os adolescentes com "excesso de peso e percentual de gordura corporal elevado".

El objetivo del estudio fue comparar biomarcadores en grupos de adolescentes, clasificados simultáneamente por el índice de masa corporal (IMC) y porcentaje de grasa corporal (PGC), medido mediante pletismografía por desplazamiento de aire. Estudio transversal con 533 adolescentes de 18 y 19 años de São Luís, Maranhão, Brasil. El IMC fue clasificado en adecuado (< 25kg/m2) y exceso de peso (≥ 25kg/m2). Se definió el porcentaje de grasa corporal elevado ≥ 25% para el sexo masculino, y ≥ 30% para el femenino. Los adolescentes se clasificaron en cuatro grupos: "eutrófico" (IMC y porcentaje de grasa corporal adecuados), "obeso de peso normal" (IMC adecuado con porcentaje de grasa corporal elevado), "exceso de peso con porcentaje de grasa corporal adecuado" y "exceso de peso con porcentaje de grasa corporal elevado". Las niñas tuvieron mayores valores de "obesidad de peso normal" (15,6%) y "exceso de peso con porcentaje de grasa corporal elevado" (17,1%). Los adolescentes "obesos de peso normal" presentaron mayores medias para colesterol total (172,5mg/dL) y LDL-colesterol (103,5mg/dL). Aquellos con "exceso de peso y porcentaje de grasa corporal elevado" tuvieron una media menor para HDL-colesterol (43,2mg/dL), en relación con los otros grupos; mayor media para interleucina-6 (2,7pg/mL), en relación a los "eutróficos" y "exceso de peso y porcentaje de grasa corporal adecuado"; y mayores medianas para triglicéridos (114,0mg/dL) y proteína C reactiva (0,14ng/mL), en relación a los "eutróficos" y "obesos de peso normal". Quienes tenían "exceso de peso y porcentaje de grasa corporal adecuado" presentaron proteína C reactiva igual a los de "exceso de peso y porcentaje de grasa corporal elevado". La evaluación del estado nutricional por el IMC es limitada, puesto que un 6,8% de los adolescentes presentaron porcentaje de grasa corporal elevado, a pesar del IMC normal, asimismo los "obesos de peso normal" tuvieron dos biomarcadores peores que los adolescentes con "exceso de peso y porcentaje de grasa corporal elevado".

Association between vitamin D status during pregnancy and total gestational weight gain and postpartum weight retention: a prospective cohort.

OBJECTIVES: To evaluate the association between vitamin D status during pregnancy and total gestational weight gain (GWG), GWG rates and postpartum weight retention. METHODS: Prospective cohort of 163 women from Rio de Janeiro was followed at 5th-13th (baseline), 20th-26th, 30th-36th gestational weeks and at 30-62 days postpartum. Plasma 25-hydroxyvitamin D [25(OH)D] was evaluated during each trimester and was categorized as adequate (≥50 nmol/L) or inadequate (<50 nmol/L). GWG (kg) was calculated as the difference between the weight measured at baseline and 36th-42th gestational weeks. GWG rates (kg/week) were calculated between each visit. Postpartum weight retention (kg) was analysed as the difference between weights measured at 30-62 days postpartum and 5th-13th gestational weeks. Statistical analyses were performed using linear regression models that included interaction terms between vitamin D status and first trimester body mass index (BMI) (<25/≥25 kg/m2). Confounders were selected based on a directed acyclic graph. RESULTS: The prevalence of vitamin D inadequacy was 16.6%, 9.9% and 10.6% in the first, second and third trimesters, respectively. Overweight women with vitamin D inadequacy in the first (ß = 3.70; 95% CI 0.09; 7.31, p-value = 0.045) and third trimester (ß = 4.59, 95% CI 0.07; 9.10, p-value = 0.047) presented higher increases in total GWG than did women with vitamin D adequacy. This association was also observed between first trimester vitamin D status and GWG rates between visits 1 and 2 (ß = 0.17; 95% CI 0.13; 0.36, p-value = 0.07). CONCLUSIONS: There was an interaction effect of first trimester BMI (≥25 kg/m2) on the association between first and third trimester vitamin D status and GWG.

Avaliação do perfil de biomarcadores sanguíneos em adolescentes classificados pelo índice de massa corporal e percentual de gordura corporal / Evaluación del perfil de biomarcadores sanguíneos en adolescentes clasificados por el índice de masa corporal y porcentaje de grasa corporal / Assessment of blood biomarkers in adolescents classified by body mass index and body fat percentage

Resumo: O objetivo do trabalho foi comparar biomarcadores em grupos de adolescentes classificados simultaneamente pelo índice de massa corporal (IMC) e percentual de gordura corporal, mensurados por meio da pletismografia por deslocamento de ar. Estudo transversal com 533 adolescentes de 18 e 19 anos de São Luís, Maranhão, Brasil. O IMC foi classificado em adequado (< 25kg/m2) e excesso de peso (≥ 25kg/m2). Definiu-se percentual de gordura corporal elevado ≥ 25% para o sexo masculino e ≥ o feminino. Os adolescentes foram classificados em quatro grupos: "eutrófico" (IMC e percentual de gordura corporal adequados), "obeso de peso normal" (IMC adequado com percentual de gordura corporal elevado), "excesso de peso com percentual de gordura corporal adequado" e "excesso de peso com percentual de gordura corporal elevado". As meninas registraram maiores valores de "obesidade de peso normal" (15,6%) e "excesso de peso com percentual de gordura corporal elevado" (17,1%). Os adolescentes "obesos de peso normal" apesentaram maiores médias para colesterol total (172,5mg/dL) e LDL-colesterol (103,5mg/dL). Aqueles com "excesso de peso e percentual de gordura corporal elevado" registraram a menor média para HDL-colesterol (43,2mg/dL) em relação aos outros grupos; maior média para interleucina-6 (2,7pg/mL) em relação aos "eutróficos" e "excesso de peso e percentual de gordura corporal adequado"; e maiores medianas para triglicerídeos (114,0mg/dL) e proteína C reativa (0,14ng/mL) em relação aos "eutróficos" e "obesos de peso normal". Os com "excesso de peso e percentual de gordura corporal adequado" apresentaram proteína C reativa igual aos com "excesso de peso e percentual de gordura corporal elevado". A avaliação do estado nutricional pelo IMC é limitada, pois 6,8% dos adolescentes registraram percentual de gordura corporal elevado apesar do IMC normal, além disto, os "obesos de peso normal" apresentaram dois biomarcadores piores que os adolescentes com "excesso de peso e percentual de gordura corporal elevado".

Resumen: El objetivo del estudio fue comparar biomarcadores en grupos de adolescentes, clasificados simultáneamente por el índice de masa corporal (IMC) y porcentaje de grasa corporal (PGC), medido mediante pletismografía por desplazamiento de aire. Estudio transversal con 533 adolescentes de 18 y 19 años de São Luís, Maranhão, Brasil. El IMC fue clasificado en adecuado (< 25kg/m2) y exceso de peso (≥ 25kg/m2). Se definió el porcentaje de grasa corporal elevado ≥ 25% para el sexo masculino, y ≥ 30% para el femenino. Los adolescentes se clasificaron en cuatro grupos: "eutrófico" (IMC y porcentaje de grasa corporal adecuados), "obeso de peso normal" (IMC adecuado con porcentaje de grasa corporal elevado), "exceso de peso con porcentaje de grasa corporal adecuado" y "exceso de peso con porcentaje de grasa corporal elevado". Las niñas tuvieron mayores valores de "obesidad de peso normal" (15,6%) y "exceso de peso con porcentaje de grasa corporal elevado" (17,1%). Los adolescentes "obesos de peso normal" presentaron mayores medias para colesterol total (172,5mg/dL) y LDL-colesterol (103,5mg/dL). Aquellos con "exceso de peso y porcentaje de grasa corporal elevado" tuvieron una media menor para HDL-colesterol (43,2mg/dL), en relación con los otros grupos; mayor media para interleucina-6 (2,7pg/mL), en relación a los "eutróficos" y "exceso de peso y porcentaje de grasa corporal adecuado"; y mayores medianas para triglicéridos (114,0mg/dL) y proteína C reactiva (0,14ng/mL), en relación a los "eutróficos" y "obesos de peso normal". Quienes tenían "exceso de peso y porcentaje de grasa corporal adecuado" presentaron proteína C reactiva igual a los de "exceso de peso y porcentaje de grasa corporal elevado". La evaluación del estado nutricional por el IMC es limitada, puesto que un 6,8% de los adolescentes presentaron porcentaje de grasa corporal elevado, a pesar del IMC normal, asimismo los "obesos de peso normal" tuvieron dos biomarcadores peores que los adolescentes con "exceso de peso y porcentaje de grasa corporal elevado".

Abstract: The study aimed to compare biomarkers in groups of adolescents classified simultaneously according to body mass index (BMI) and body fat percentage measured by air displacement plethysmography. This was a cross-sectional study with 533 adolescents 18 to 19 years of age in São Luís, Maranhão, Brazil. BMI was classified as adequate (< 25kg/m2) versus excess weight (≥ 25kg/m2). High body fat percentage was defined as ≥ 25% for males and ≥ 30% for females. The adolescents were classified in four groups: "normal weight" (adequate BMI and body fat percentage), "normal weight obese" (adequate BMI with high body fat percentage), "excess weight with adequate body fat percentage", and "excess weight with high body fat percentage". Girls showed higher proportions of "normal weight obesity" (15.6%) and "excess weight with high body fat percentage" (17.1%). "Normal weight obese" adolescents exhibited higher mean values for total cholesterol (172.5mg/dL) and LDL-cholesterol (103.5mg/dL). Those with "excess weight and high body fat percentage" showed lower mean HDL-cholesterol (43.2mg/dL) compared to the other groups, higher mean interleukin-6 (2.7pg/mL) than "normal weight" and "excess weight and adequate body fat percentage" adolescents, and higher median triglycerides (114.0mg/dL) and C-reactive protein (0.14ng/mL) than "normal weight" and "normal weight obese" adolescents. Those with "excess weight and adequate body fat percentage" exhibited the same C-reactive protein levels as those with "excess weight and high body fat percentage". Assessment of nutritional status by BMI alone is limited, since 6.8% of the adolescents presented high body fat percentage despite normal BMI, and those who were "normal weight obese" had two biomarkers that were worse than for adolescents with "excess weight and high body fat percentage".

Incomplete childhood immunization with new and old vaccines and associated factors: BRISA birth cohort, São Luís, Maranhão State, Northeast Brazil. / Incompletude vacinal infantil de vacinas novas e antigas e fatores associados: coorte de nascimento BRISA, São Luís, Maranhão, Nordeste do Brasil.

This study estimated the percentages of incomplete immunization with new vaccines and old vaccines and associated factors in children 13 to 35 months of age belonging to a birth cohort in São Luís, the capital of Maranhão State, Brazil. The sample was probabilistic, with 3,076 children born in 2010. Information on vaccination was obtained from the Child's Health Card. The new vaccines, namely those introduced in 2010, were meningococcal C and 10-valent pneumococcal, and the old vaccines, or those already on the childhood immunization schedule, were BCG, hepatitis B, human rotavirus, polio, tetravalent (diphtheria, tetanus, pertussis, Haemophilus influenzae b), yellow fever, and triple viral (measles, mumps, rubella). The study used hierarchical modeling and Poisson regression with robust variance. Prevalence ratios (PR) and 95% confidence intervals (95%CI) were calculated. Incomplete immunization was higher with new vaccines (51.1%) than with old vaccines (33.2%). Children 25 to 35 months of age (PR = 1.27; 95%CI: 1.14-1.41) and those in economic classes D/E (PR = 1.20; 95%CI: 1.06-1.35) were only significantly associated with new vaccines; low maternal schooling (PR = 1.58; 95%CI: 1.21-2.06), unavailability of outpatient and/or hospital care for the child (PR = 1.20; 95%CI: 1.04-1.38), and unavailability of the vaccine in health services (PR: 1.28; 95%CI: 1.12-1.46) were only associated with old vaccines. Immunization strategies should consider the vulnerability of older preschool-age children and those belonging to classes D and E, especially when new vaccines are introduced, as well as children of mothers with low schooling. Strategies should also address problems with the availability of health services and vaccines.

Neste estudo, foram estimados percentuais de incompletude vacinal e fatores associados ao esquema vacinal para novas vacinas (EVNV) e esquema vacinal para antigas vacinas (EVAV) em crianças de 13 a 35 meses de idade de uma coorte de nascimento em São Luís, Maranhão, Brasil. A amostra foi probabilística, com 3.076 crianças nascidas em 2010. Informações sobre vacinação foram obtidas da Caderneta de Saúde da Criança. As vacinas consideradas para o EVNV foram meningocócica C e pneumocócica 10 valente, e para EVAV, vacinas BCG, hepatite B, rotavírus humano, poliomielite, tetravalente (vacina difteria, tétano, coqueluche e Haemophilus influenzae b), febre amarela, tríplice viral (vacina sarampo, caxumba, rubéola). Empregou-se modelagem hierarquizada e regressão de Poisson com variância robusta. Estimaram-se razões de prevalência (RP) e intervalos de 95% de confiança (IC95%). Incompletude vacinal foi maior para EVNV (51,1%) em relação ao EVAV (33,2%). Crianças com 25 a 35 meses de idade (RP = 1,27; IC95%: 1,14-1,41) e pertencer às classes D/E (RP = 1,20; IC95%: 1,06-1,35) se associaram somente ao EVNV; enquanto baixa escolaridade materna (RP = 1,58; IC95%: 1,21-2,06), indisponibilidade de atendimento ambulatorial e/ou hospitalar para a criança (RP = 1,20; IC95%: 1,04-1,38) e de vacina nos serviços de saúde (RP = 1,28; IC95%: 1,12-1,46), apenas ao EVAV. Faz-se importante considerar, nas estratégias de vacinação, a vulnerabilidade de crianças com mais idade e pertencentes às classes D e E, especialmente quando novas vacinas são introduzidas, e ainda de filhos de mães que possuem baixa escolaridade. Assim como, quando há menor disponibilidade de serviços de saúde para a criança e de vacina.

En este estudio se estimaron porcentajes de vacunación no completada y los factores asociados al esquema de vacunas para nuevas vacunas (EVNV) y al de antiguas vacunas (EVAV), en niños de 13 a 35 meses de edad de una cohorte de nacimiento en São Luís, Maranhão, Brasil. La muestra fue probabilística, con 3.076 niños nacidos en 2010. La información sobre la vacunación se obtuvo de la cartilla de salud del niño. Las vacunas consideradas para el EVNV fueron la meningocócica C y neumocócica 10 valente, y para EVAV, vacunas BCG, hepatitis B, rotavirus humano, poliomielitis, tetravalente (vacuna difteria, tétanos, tosferina y Haemophilus influenzae b), fiebre amarilla, triple viral (vacuna contra el sarampión, paperas, rubeola). Se empleó un modelo jerarquizado y la regresión de Poisson con variancia robusta. Se estimaron razones de prevalencia (RP) e intervalos de 95% de confianza (IC95%). La vacunación no completada fue mayor para EVNV (51,1%), en relación con el EVAV (33,2%). Ser niños de 25 a 35 meses de edad (RP = 1,27; IC95%: 1,14-1,41) y pertenecer a las clases D/E (RP = 1,20; IC95%: 1,06-1,35) se asociaron solamente al EVNV; mientras que la baja escolaridad materna (RP = 1,58; IC95%: 1,21-2,06), indisponibilidad de atención ambulatoria y/o hospitalaria para el niño (RP = 1,20; IC95%: 1,04-1,38) y de la vacuna en los servicios de salud (RP = 1,28; IC95%: 1,12-1,46), solamente al EVAV. Es importante considerar, en las estrategias de vacunación, la vulnerabilidad de los niños con más edad y pertenecientes a las clases D y E, especialmente cuando se introducen las nuevas vacunas, incluyendo también a los hijos de madres con baja escolaridad. También es problemática la existencia de una menor disponibilidad de servicios de salud para el niño y de la vacuna.

Incompletude vacinal infantil de vacinas novas e antigas e fatores associados: coorte de nascimento BRISA, São Luís, Maranhão, Nordeste do Brasil / No completar la vacunación infantil tanto de vacunas nuevas como antiguas y sus factores asociados: cohorte de nacimiento BRISA, São Luís, Maranhão, Nordeste de Brasil / Incomplete childhood immunization with new and old vaccines and associated factors: BRISA birth cohort, São Luís, Maranhão State, Northeast Brazil

Neste estudo, foram estimados percentuais de incompletude vacinal e fatores associados ao esquema vacinal para novas vacinas (EVNV) e esquema vacinal para antigas vacinas (EVAV) em crianças de 13 a 35 meses de idade de uma coorte de nascimento em São Luís, Maranhão, Brasil. A amostra foi probabilística, com 3.076 crianças nascidas em 2010. Informações sobre vacinação foram obtidas da Caderneta de Saúde da Criança. As vacinas consideradas para o EVNV foram meningocócica C e pneumocócica 10 valente, e para EVAV, vacinas BCG, hepatite B, rotavírus humano, poliomielite, tetravalente (vacina difteria, tétano, coqueluche e Haemophilus influenzae b), febre amarela, tríplice viral (vacina sarampo, caxumba, rubéola). Empregou-se modelagem hierarquizada e regressão de Poisson com variância robusta. Estimaram-se razões de prevalência (RP) e intervalos de 95% de confiança (IC95%). Incompletude vacinal foi maior para EVNV (51,1%) em relação ao EVAV (33,2%). Crianças com 25 a 35 meses de idade (RP = 1,27; IC95%: 1,14-1,41) e pertencer às classes D/E (RP = 1,20; IC95%: 1,06-1,35) se associaram somente ao EVNV; enquanto baixa escolaridade materna (RP = 1,58; IC95%: 1,21-2,06), indisponibilidade de atendimento ambulatorial e/ou hospitalar para a criança (RP = 1,20; IC95%: 1,04-1,38) e de vacina nos serviços de saúde (RP = 1,28; IC95%: 1,12-1,46), apenas ao EVAV. Faz-se importante considerar, nas estratégias de vacinação, a vulnerabilidade de crianças com mais idade e pertencentes às classes D e E, especialmente quando novas vacinas são introduzidas, e ainda de filhos de mães que possuem baixa escolaridade. Assim como, quando há menor disponibilidade de serviços de saúde para a criança e de vacina.

En este estudio se estimaron porcentajes de vacunación no completada y los factores asociados al esquema de vacunas para nuevas vacunas (EVNV) y al de antiguas vacunas (EVAV), en niños de 13 a 35 meses de edad de una cohorte de nacimiento en São Luís, Maranhão, Brasil. La muestra fue probabilística, con 3.076 niños nacidos en 2010. La información sobre la vacunación se obtuvo de la cartilla de salud del niño. Las vacunas consideradas para el EVNV fueron la meningocócica C y neumocócica 10 valente, y para EVAV, vacunas BCG, hepatitis B, rotavirus humano, poliomielitis, tetravalente (vacuna difteria, tétanos, tosferina y Haemophilus influenzae b), fiebre amarilla, triple viral (vacuna contra el sarampión, paperas, rubeola). Se empleó un modelo jerarquizado y la regresión de Poisson con variancia robusta. Se estimaron razones de prevalencia (RP) e intervalos de 95% de confianza (IC95%). La vacunación no completada fue mayor para EVNV (51,1%), en relación con el EVAV (33,2%). Ser niños de 25 a 35 meses de edad (RP = 1,27; IC95%: 1,14-1,41) y pertenecer a las clases D/E (RP = 1,20; IC95%: 1,06-1,35) se asociaron solamente al EVNV; mientras que la baja escolaridad materna (RP = 1,58; IC95%: 1,21-2,06), indisponibilidad de atención ambulatoria y/o hospitalaria para el niño (RP = 1,20; IC95%: 1,04-1,38) y de la vacuna en los servicios de salud (RP = 1,28; IC95%: 1,12-1,46), solamente al EVAV. Es importante considerar, en las estrategias de vacunación, la vulnerabilidad de los niños con más edad y pertenecientes a las clases D y E, especialmente cuando se introducen las nuevas vacunas, incluyendo también a los hijos de madres con baja escolaridad. También es problemática la existencia de una menor disponibilidad de servicios de salud para el niño y de la vacuna.

This study estimated the percentages of incomplete immunization with new vaccines and old vaccines and associated factors in children 13 to 35 months of age belonging to a birth cohort in São Luís, the capital of Maranhão State, Brazil. The sample was probabilistic, with 3,076 children born in 2010. Information on vaccination was obtained from the Child's Health Card. The new vaccines, namely those introduced in 2010, were meningococcal C and 10-valent pneumococcal, and the old vaccines, or those already on the childhood immunization schedule, were BCG, hepatitis B, human rotavirus, polio, tetravalent (diphtheria, tetanus, pertussis, Haemophilus influenzae b), yellow fever, and triple viral (measles, mumps, rubella). The study used hierarchical modeling and Poisson regression with robust variance. Prevalence ratios (PR) and 95% confidence intervals (95%CI) were calculated. Incomplete immunization was higher with new vaccines (51.1%) than with old vaccines (33.2%). Children 25 to 35 months of age (PR = 1.27; 95%CI: 1.14-1.41) and those in economic classes D/E (PR = 1.20; 95%CI: 1.06-1.35) were only significantly associated with new vaccines; low maternal schooling (PR = 1.58; 95%CI: 1.21-2.06), unavailability of outpatient and/or hospital care for the child (PR = 1.20; 95%CI: 1.04-1.38), and unavailability of the vaccine in health services (PR: 1.28; 95%CI: 1.12-1.46) were only associated with old vaccines. Immunization strategies should consider the vulnerability of older preschool-age children and those belonging to classes D and E, especially when new vaccines are introduced, as well as children of mothers with low schooling. Strategies should also address problems with the availability of health services and vaccines.

Processed and ultra-processed food consumption among children aged 13 to 35 months and associated factors.

The aim of this study was to evaluate the consumption of processed and ultra-processed foods among children aged 13-35 months and its associated factors. We studied 1,185 children within the BRISA cohort in São Luís, Maranhão State, Brazil. The food consumption was investigated using a 24-hour recall, and the percentages of daily caloric intake and nutrients were estimated by food groups according to "NOVA" classification. We chose to categorize children belonging to the upper tertile of the distribution as having a high consumption of processed and ultra-processed food products. The Poisson regression model with robust variance estimation using a hierarchical modeling approach was used to calculate the prevalence ratios (PRs) of variables associated with high consumption of processed and ultra-processed food products. The mean energy intake was 1,226Kcal/day. After adjustments, there was a higher proportion of high consumption of processed and ultra-processed food products among children whose mothers had < 12 years of education and among children who were older than 16 months. Mothers with low schooling and children older than 16 months should be the targets of interventions aimed at reducing consumption of these food products and preventing adverse health outcomes in later life.

Processed and ultra-processed food consumption among children aged 13 to 35 months and associated factors / Consumo de alimentos processados e ultraprocessados e fatores associados em crianças entre 13 e 35 meses de idade / Consumo de alimentos procesados y ultraprocesados y factores asociados en niños entre 13 y 35 meses de edad

Abstract: The aim of this study was to evaluate the consumption of processed and ultra-processed foods among children aged 13-35 months and its associated factors. We studied 1,185 children within the BRISA cohort in São Luís, Maranhão State, Brazil. The food consumption was investigated using a 24-hour recall, and the percentages of daily caloric intake and nutrients were estimated by food groups according to "NOVA" classification. We chose to categorize children belonging to the upper tertile of the distribution as having a high consumption of processed and ultra-processed food products. The Poisson regression model with robust variance estimation using a hierarchical modeling approach was used to calculate the prevalence ratios (PRs) of variables associated with high consumption of processed and ultra-processed food products. The mean energy intake was 1,226Kcal/day. After adjustments, there was a higher proportion of high consumption of processed and ultra-processed food products among children whose mothers had < 12 years of education and among children who were older than 16 months. Mothers with low schooling and children older than 16 months should be the targets of interventions aimed at reducing consumption of these food products and preventing adverse health outcomes in later life.

Resumo: O estudo teve como objetivo avaliar o consumo de alimentos processados e ultraprocessados por crianças entre 13 e 35 meses de idade e fatores associados. Estudamos 1.185 crianças da coorte BRISA em São Luís, Maranhão, Brasil. O consumo alimentar foi investigado com um recordatório de 24 horas, e os percentuais de ingestão diária de calorias e nutrientes foram estimados por grupos de alimentos de acordo com a classificação "NOVA". Optamos por categorizar as crianças pertencentes ao tercil superior da distribuição como tendo consumo elevado de produtos alimentícios processados e ultraprocessados. Foi utilizado um modelo de regressão Poisson com estimativa robusta de variância com modelagem hierárquica para calcular as razões de prevalência (RPs) das variáveis associadas ao consumo elevado de produtos alimentícios processados e ultraprocessados. A ingestão calórica média era 1.226Kcal/dia. Após os ajustes, houve uma proporção maior de consumo elevado de produtos alimentícios processados e ultraprocessados entre crianças cujas mães tinham menos de 12 anos de escola e entre crianças com mais de 16 meses de idade. As mães com baixa escolaridade e crianças acima de 16 meses devem ser alvos de intervenções para reduzir o consumo desses produtos alimentícios e prevenir os desfechos de saúde adversos na adolescência e idade adulta.

Resumen: El objetivo de este estudio fue evaluar el consumo de alimentos procesados y ultraprocesados por parte de niños entre 13 y 35 meses de edad y sus factores asociados. Estudiamos a 1.185 niños de la cohorte BRISA en São Luís, Maranhão, Brasil. El consumo alimentario fue investigado con un recordatorio de 24 horas, y los porcentajes de ingesta diaria de calorías y nutrientes fueron estimados por grupos de alimentos, de acuerdo con la clasificación "NOVA". Optamos por categorizar a los niños pertenecientes al tercil superior de la distribución como de consumo elevado de productos alimenticios procesados y ultraprocesados. Se utilizó un modelo de regresión Poisson de estimativa robusta de variancia con modelaje jerárquico para calcular las razones de prevalencia (RPs) de las variables asociadas al consumo elevado de productos alimenticios procesados y ultraprocesados. La ingesta calórica media era 1.226Kcal/día. Tras los ajustes, hubo una proporción mayor de consumo elevado de productos alimenticios procesados y ultraprocesados entre niños, cuyas madres contaban con menos de 12 años de escuela y entre niños con más de 16 meses de edad. Las madres con baja escolaridad y niños por encima de 16 meses deben ser objetivo de intervenciones para reducir el consumo de esos productos alimenticios y prevenir desenlaces de salud adversos en la adolescencia y edad adulta.