Studies on the Child Handbook in Brazil: a scoping review.

OBJECTIVE: To systematically identify and map studies involving the Caderneta da Criança (Child Handbook - CH) in Brazil. METHODS: A scoping review using the methodology proposed by the Joanna Briggs Institute. The databases PubMed, Biblioteca Virtual em Saúde (BVS), Biblioteca Digital Brasileira de Teses e Dissertações, Periódicos Capes and Google Scholar were consulted. Primary and secondary studies that mentioned the use of CH were included, without restrictions regarding design, year of publication or population, published in Portuguese, English or Spanish and gray literature (theses and dissertations). RESULTS: A total of 129 studies were included, mostly descriptive, published as scientific papers. The Northeast region, the population of caregivers of children and the Primary Care scenario were observed in most studies; 47% of the studies used the CH as a source of data, the majority on vaccination. Despite the different criteria to define adequacy of completing the CH, the studies identified weaknesses in filling out all of its items, except for immunization. The utilization and/or completion of the CH were linked to various factors, including the availability of the CH, characteristics of the children (such as sex, age, prematurity and well-child appointments), attributes of the family members and caregivers (such as age, education, income, parity, work status, prenatal care, reading, note-taking and bringing CH to appointments) and features of the professionals (such as workplace, medical specialty, communication style, knowledge about the CH, requesting, guiding and note-taking). CONCLUSIONS: The results reinforce the need to better understand which factors affect the distribution of the CH in the population, as well as pointing to the need for understanding its use and completion by the different care points. The need for intervention studies to improve the implementation of this tool and to include training on the use of the CH in the context of continuing health education becomes evident.

Prevalence and maternal determinants of early and late introduction of complementary foods: results from the Growing Up in New Zealand cohort study.

A nationally generalisable cohort (n 5770) was used to determine the prevalence of non-timely (early/late) introduction of complementary food and core food groups and associations with maternal sociodemographic and health behaviours in New Zealand (NZ). Variables describing maternal characteristics and infant food introduction were sourced, respectively, from interviews completed antenatally and during late infancy. The NZ Infant Feeding Guidelines were used to define early (≤ 4 months) and late (≥ 7 months) introduction. Associations were examined using multivariable multinomial regression, presented as adjusted relative risk ratios and 95 % confidence intervals (RRR; 95% CI). Complementary food introduction was early for 40·2 % and late for 3·2 %. The prevalence of early food group introduction were fruit/vegetables (23·8 %), breads/cereals (36·3 %), iron-rich foods (34·1 %) and of late were meat/meat alternatives (45·9 %), dairy products (46·2 %) and fruits/vegetables (9·9 %). Compared with infants with timely food introduction, risk of early food introduction was increased for infants: breastfed < 6months (2·52; 2·19-2·90), whose mothers were < 30 years old (1·69; 1·46-1·94), had a diploma/trade certificate v. tertiary education (1·39; 1·1-1·70), of Maori v. European ethnicity (1·40; 1·12-1·75) or smoked during pregnancy (1·88; 1·44-2·46). Risk of late food introduction decreased for infants breastfed < 6 months (0·47; 0.27-0·80) and increased for infants whose mothers had secondary v. tertiary education (2·04; 1·16-3·60) were of Asian v. European ethnicity (2·22; 1·35, 3·63) or did not attend childbirth preparation classes (2·23; 1·24-4·01). Non-timely food introduction, specifically early food introduction, is prevalent in NZ. Interventions to improve food introduction timeliness should be ethnic-specific and support longer breast-feeding.

Studies on the Child Handbook in Brazil: a scoping review / Estudos sobre a Caderneta da Criança no Brasil: uma revisão de escopo

ABSTRACT OBJECTIVE To systematically identify and map studies involving the Caderneta da Criança (Child Handbook - CH) in Brazil. METHODS A scoping review using the methodology proposed by the Joanna Briggs Institute. The databases PubMed, Biblioteca Virtual em Saúde (BVS), Biblioteca Digital Brasileira de Teses e Dissertações, Periódicos Capes and Google Scholar were consulted. Primary and secondary studies that mentioned the use of CH were included, without restrictions regarding design, year of publication or population, published in Portuguese, English or Spanish and gray literature (theses and dissertations). RESULTS A total of 129 studies were included, mostly descriptive, published as scientific papers. The Northeast region, the population of caregivers of children and the Primary Care scenario were observed in most studies; 47% of the studies used the CH as a source of data, the majority on vaccination. Despite the different criteria to define adequacy of completing the CH, the studies identified weaknesses in filling out all of its items, except for immunization. The utilization and/or completion of the CH were linked to various factors, including the availability of the CH, characteristics of the children (such as sex, age, prematurity and well-child appointments), attributes of the family members and caregivers (such as age, education, income, parity, work status, prenatal care, reading, note-taking and bringing CH to appointments) and features of the professionals (such as workplace, medical specialty, communication style, knowledge about the CH, requesting, guiding and note-taking). CONCLUSIONS The results reinforce the need to better understand which factors affect the distribution of the CH in the population, as well as pointing to the need for understanding its use and completion by the different care points. The need for intervention studies to improve the implementation of this tool and to include training on the use of the CH in the context of continuing health education becomes evident.

RESUMO OBJETIVO Identificar e mapear de forma sistemática os estudos que envolvem a Caderneta da Criança (CC) no Brasil. MÉTODOS Revisão de escopo utilizando a metodologia proposta pelo Instituto Joanna Briggs. Foram consultadas as bases de dados PubMed, BVS Regional, Biblioteca Digital Brasileira de Teses e Dissertações, Periódicos Capes e Google Scholar. Incluíram-se estudos primários e secundários que mencionavam o uso da CC, sem restrições quanto ao delineamento, ano de publicação ou população, publicados em português, inglês ou espanhol e literatura cinzenta (teses e dissertações). RESULTADOS Foram incluídos 129 estudos, em sua maioria descritivos, publicados como artigos científicos. A região Nordeste, a população de cuidadores das crianças e o cenário da atenção primária foram observados na maioria dos estudos; 47% dos estudos utilizou a CC como fonte de dados, a maioria sobre vacinação. Apesar dos diferentes critérios para definir adequação de preenchimento da CC, os estudos identificaram fragilidades no preenchimento de todos os seus itens, com exceção da vacinação. Características contextuais (como a disponibilidade da CC), das crianças (sexo, idade, prematuridade e consultas de puericultura), dos familiares e cuidadores (idade, escolaridade, renda, paridade, trabalho, pré-natal, ler, fazer anotações e levar a CC nas consultas) e dos profissionais (local de atuação, especialidade médica, comunicação no trabalho, conhecimentos sobre a CC, solicitar, orientar sobre e realizar anotações na CC) foram relacionadas ao uso e/ou preenchimento da CC. CONCLUSÕES Os resultados reforçam a necessidade de melhor compreender quais fatores afetam a distribuição da CC à população, assim como apontam para a necessidade de compreender o seu uso e preenchimento pelos diversos pontos de atenção. Fica clara a necessidade de estudos de intervenção para que a implementação desse instrumento seja aprimorada e de incluir capacitações sobre a caderneta no contexto da educação permanente em saúde.

A vigilância do crescimento e desenvolvimento infantil na atenção primária à saúde do município de Juquiá, São Paulo: resumo executivo / Surveillance of Child Growth and Development in Primary Health Care in the Municipality of Juquiá, São Paulo: executive summary

Introdução Este estudo foca na vital importância do desenvolvimento na primeira infância, destacando os aspectos físicos, cognitivos, emocionais e sociais que ocorrem desde a concepção até os primeiros seis anos de vida. Essa fase crítica demanda a promoção ativa de conexões neurais por meio de interações e vínculos afetivos, influenciando diretamente o desenvolvimento futuro. O "Nurturing Care Framework", proposto pela Organização Mundial de Saúde (OMS) e o Fundo das Nações Unidas para a Infância (UNICEF) destaca a interdependência entre saúde, nutrição, cuidados responsivos, proteção, segurança e aprendizagem precoce. As áreas essenciais - habilidades motoras, cognitivas, de comunicação e linguagem, e sociais - são cruciais para garantir um desenvolvimento saudável. Apesar dos avanços, desigualdades persistem no Brasil, evidenciadas por problemas como desnutrição e obesidade infantil, conforme revelado pelo projeto PIPAS, que aponta a Caderneta da Criança como uma aliada na promoção da saúde e prevenção de doenças desde sua instituição em 2005. Metodologia A pesquisa, realizada em Juquiá, avaliou uma intervenção educativa para profissionais de enfermagem na Atenção Primária, concentrando-se na vigilância do crescimento e desenvolvimento infantil. Resultado e discussão Os resultados indicam melhorias substanciais, evidenciando a eficácia da capacitação e apontando a conexão entre desemprego, dependência de programas sociais, como a transição do Auxílio Brasil para o novo Bolsa família, enfatizam a importância de medidas como transferências de renda, especialmente em contextos vulneráveis, conforme recomendado pela Organização Mundial da Saúde. Análises detalhadas da caderneta da criança revelaram a importância de garantir sua distribuição completa para monitoramento eficaz, enfocando a necessidade de orientação dos profissionais de saúde aos cuidadores.

Dietary Pattern Influences Gestational Weight Gain: Results from the ProcriAr Cohort Study-São Paulo, Brazil.

The maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) influence maternal and infant outcomes. This study identified patterns of habitual dietary intake in 385 pregnant women in São Paulo and explored their associations with excessive weight gain (EGWG). Weight at the first visit (<14 weeks) was used as a proxy for pre-pregnancy weight. Food consumption was assessed using the 24HR method, administered twice at each gestational trimester, and dietary patterns were identified by principal component analysis. Three dietary patterns were identified: "Vegetables and Fruits," "Western," and "Brazilian Traditional." Descriptive data analysis was performed using absolute and relative frequencies for each independent variable and multilevel mixed-effects logistic regression was used to analyze excessive gestational gain weight (EGWG) and dietary patterns (DP). The Brazilian Traditional dietary pattern showed a protective effect on EGWG (p = 0.04) and age > 35 years (p = 0.03), while subjects overweight at baseline had a higher probability of EGWG (p = 0.02), suggesting that the identification of dietary and weight inadequacies should be observed from the beginning of pregnancy, accompanied by nutritional intervention and weight monitoring throughout the gestational period to reduce risks to the mother and child's health.

Factors associated with early childhood development in municipalities of Ceará, Brazil: a hierarchical model of contexts, environments, and nurturing care domains in a cross-sectional study.

Background: This study aims to identify the contexts, environments, and nurturing care predictors that determine whether a child is developmentally on track in Ceará, Brazil. Methods: We analysed data from a cross-sectional study conducted with caregivers of 6,447 children aged 0-59 months during a vaccination campaign in Ceará in October 2019. The validated Child Development Assessment Questionnaire was used to assess early childhood development (ECD) and children with a z-score ≥ -1 SD were considered developmentally on track. We conducted logistic regression models to understand the effects of contexts, environments, and nurturing care domains on ECD. Findings: Children in the early years (< 36 months) were more likely to meet the ECD milestones if they were not born with low birth weight (AOR: 0·64; 95% CI: 0·42-0·97), were exposed to manufactured toys in their house (2·68; 1·97-3·66), their heads of household were employed (1·61; 1·16-2·23), and their caregivers had read the Child Health Handbook (1·42; 1·13-1·77) and engaged them in stimulating activities (1·71; 1·26-2·32). Children aged 36-59 months were more likely to meet the ECD milestones if they were breastfed (never: ref. / < 3 months: 3·72; 1·91-7·26 / 3-5 months: 3·21; 1·74-5·93 / 6-11 months: 3·73; 1·95-7·16 / ≥ 12 months: 3·89; 2·25-6·72), had books at home (0: ref / 1-3: 1·71; 1·22-2·40 / 4-6: 2·24; 1·27-3·94 / 7+: 2·71; 1·05-7·00), and their caregivers received information about ECD (1·49; 1·11-2·01) and engaged them in stimulating activities (1·80; 1·27-2·56). Children aged 36-59 months were less likely to meet developmental milestones if they watched TV or used tablets/smartphones for more than two hours per day (0·61; 0·44-0·84), played with household objects (0·62; 0·41-0·92), participated in governmental early childhood programmes aimed at vulnerable families (0·62; 0·45-0·86), had families that participated in income transfer programmes (0·68; 0·47-0·99) (families living in poverty or extreme poverty), and their caregivers considered slapping (0·67; 0·48-0·94) a necessary disciplinary method. Interpretation: Having favourable socioeconomic conditions, breastfeeding, the absence of harsh discipline, caregivers who provide responsive care, and the provision of opportunities for early learning are the key factors that increase the likelihood of a child achieving their full developmental potential in Ceará, Brazil. Funding: This study was supported by the Maria Cecília Souto Vidigal Foundation (F0245), Brazil. The funder had no role in the design, analysis, or writing of this article.

Magnesium intake in a Longitudinal Study of Adult Health: associated factors and the main food sources.

This study aimed to identify the sociodemographic and lifestyle factors associated with magnesium intake and describe the main food sources in the Brazilian Longitudinal Study of Adult Health (ELSA-Brazil). This observational, cross-sectional study was conducted using the baseline data from the ELSA-Brazil (2008-2010). Associations between usual magnesium intake and sociodemographic and lifestyle factors were analyzed using multiple linear regression. Food sources were identified by calculating the percentage contribution of each FFQ item to the amount of magnesium provided by all foods. The analysis was performed using Stata® software (version 12), assuming a statistical significance level of 5%. The top food sources to magnesium intake were as follows: beans, oats, nuts, white rice, orange, French bread, cooked fish, boneless meat, whole milk, and whole wheat bread. There were positive associations between magnesium intake and female sex; age ≥60 years; self-reported black, indigenous, or brown skin colors; per capita income ≥3 minimum wages, and moderate or vigorous physical activity levels. Sociodemographic and lifestyle factors were associated with magnesium intake among the evaluated individuals.

Magnesium intake in a Longitudinal Study of Adult Health: associated factors and the main food sources / Ingestão de magnésio no Estudo Longitudinal de Saúde do Adulto: fatores associados e os principais alimentos contribuintes

Abstract This study aimed to identify the sociodemographic and lifestyle factors associated with magnesium intake and describe the main food sources in the Brazilian Longitudinal Study of Adult Health (ELSA-Brazil). This observational, cross-sectional study was conducted using the baseline data from the ELSA-Brazil (2008-2010). Associations between usual magnesium intake and sociodemographic and lifestyle factors were analyzed using multiple linear regression. Food sources were identified by calculating the percentage contribution of each FFQ item to the amount of magnesium provided by all foods. The analysis was performed using Stata® software (version 12), assuming a statistical significance level of 5%. The top food sources to magnesium intake were as follows: beans, oats, nuts, white rice, orange, French bread, cooked fish, boneless meat, whole milk, and whole wheat bread. There were positive associations between magnesium intake and female sex; age ≥60 years; self-reported black, indigenous, or brown skin colors; per capita income ≥3 minimum wages, and moderate or vigorous physical activity levels. Sociodemographic and lifestyle factors were associated with magnesium intake among the evaluated individuals.

Resumo O estudo tem por objetivo identificar fatores sociodemográficos e de estilo de vida associados à ingestão de magnésio e descrever seus principais alimentos contribuintes no Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). Trata-se de um estudo observacional, transversal, desenvolvido com dados da linha de base do ELSA-Brasil (2008-2010). Associações entre a ingestão habitual de magnésio e fatores sociodemográficos e de estilo de vida foram testadas por regressão linear múltipla. Contribuintes alimentares foram identificados a partir do cálculo do porcentual de magnésio fornecido por cada item do QFA em relação quantidade total proveniente de todos os alimentos. Os principais alimentos contribuintes para a ingestão de magnésio foram: feijão, aveia, nozes, arroz branco, laranja, pão francês, peixe cozido, carne sem osso, leite integral e pão integral. Foram encontradas associações positivas entre consumo de magnésio e sexo feminino, faixa etária ≥ 60 anos, cor de pele autodeclarada como negra, indígena ou parda, renda "per capita" ≥ 3 salários mínimos e níveis de atividade física moderado ou vigoroso. Alimentos da dieta tradicional do brasileiro foram os maiores contribuintes para a ingestão de magnésio, que também foi influenciada por fatores sociodemográficos e de estilo de vida.

Prudent dietary pattern influences homocysteine level more than folate, vitamin B12, and docosahexaenoic acid: a structural equation model approach.

PURPOSE: A structural equation model (SEM) was used to test multiple and simultaneous relationships between socio-demographic factors, dietary patterns, biochemical levels of folate, vitamin B12, docosahexaenoic acid (DHA), and its effects on homocysteine (Hcy) level. METHODS: Socio-demographic and lifestyle characteristics, blood sample, anthropometric measurements, and a food-frequency questionnaire (FFQ) were obtained from 281 individuals of ISA-Capital study (Sao Paulo, Brazil). The dietary patterns (DP) were estimated using factor analysis with principal component's estimation based on the frequency of daily intake derived from the 38-item FFQ. The SEM considered a theoretical model where the DP were expected to be directly associated with Hcy level, and indirectly via biochemical levels of folate, vitamin B12, and DHA. The variables sex, age, ethnicity, and MTHFR C677T polymorphism were included in the model. RESULTS: The Prudent DP (- 0.12, p = 0.04) had a negative effect, while MTHFR C677T polymorphism (0.16, p = 0.01), age (0.22, p < 0.01), and being man (0.16, p = 0.01) had a positive effect on Hcy level. There were no indirect effects of any dietary patterns on Hcy level, neither via folate, vitamin B12, nor DHA. DHA was negatively associated with the Modern DP (- 0.12, p = 0.04) and positively associated with the Prudent DP (0.19, p < 0.01). CONCLUSIONS: The DP mainly composed of fruits and vegetables, natural juices, potato/cassava/cooked cornmeal, fish, and chicken, which was negatively associated with the Hcy level in this population. These findings support the role of a healthy dietary pattern in health outcomes, rather than promoting specific foods or nutrients, for policy-based health promotion strategies.

Improvement in dietary intake estimates through the combined use of different approaches / Melhora das estimativas de ingestão dietética pela utilização conjunta de duas abordagens

ABSTRACT Objective This study aimed to compare dietary intake estimates using two different methodological approaches: use of new portions obtained with the 24-Hour Diet Recall, which was applied in the current study population, and the application of calibration equations, which were estimated using the same 24h-recalls. Methods Calibration equations were estimated using linear regression. The medians and confidence intervals of energy and nutrient intakes were assessed using all the approaches. The U Mann Whitney test was applied to verify differences among dietary intakes obtained with the 24 Hour Recall and Food Frequency Questionnaire-based methods. The correlation between different measures was assessed with Spearman coefficient. Weighted Kappa was used to verify the capability of the Food Frequency Questionnaire -based methods to classify individuals in the same intake levels of the 24 Hour Recall. Results Nine of the eleven components that were analyzed using the Food Frequency Questionnaire with standard portions and calibrated had medians significantly different from those obtained using the 24 Hour Recall; only the measurements of vitamin E and energy were statistically equal. For the Food Frequency Questionnaire with 24 Hour Recall portions, only the medians of vitamin D and B12 did not significantly differ from the 24 Hour Recall medians. Finally, for the Food Frequency Questionnaire with 24 Hour Recall portions and calibrated, all components, except folate and iron, had medians statistically equal to those obtained using the 24 Hour Recall. Spearman correlation coefficients were higher for the Food Frequency Questionnaire with 24 Hour Recall portions calibrated for all the assessed components, and the values ranged from 0.27 (total fat) to 0.57 (iron). Higher Kappa correlation coefficients were found for the Food Frequency Questionnaire 24 Hour Recall portions calibrated. Conclusion Calibrated FFQ with portions estimated from the own target population obtained better estimates of dietary intake, with values considerably more similar to those obtained with the reference method.

RESUMO Objetivo Comparar estimativas de ingestão alimentar de Questionário de Frequência Alimentar em conjunto a duas abordagens: porções obtidas de Recordatórios-24h aplicados na população de estudo, e equações de calibração, calculadas a partir dos mesmos Recordatórios-24h. Métodos Foram descritas medianas e intervalos de confiança de energia e nutrientes. O teste U de Mann-Whitney foi aplicado para verificar diferenças entre os dados obtidos com o Recordatório-24h e com o Questionário de Frequência Alimentar. A correlação entre as medianas de ingestão foi verificada com o coeficiente de correlação de Spearman; e para verificar se os métodos baseados no Questionário de Frequência Alimentar foram capazes de classificar os indivíduos nos mesmos níveis de ingestão do Recordatório-24h, foi utilizado o coeficiente de Kappa ponderado. Resultados Para o Questionário de Frequência Alimentar Porção Padrão calibrado, 9 dos 11 nutrientes analisados tiveram medianas diferentes das do Recordatório-24h. Para o Questionário de Frequência Alimentar Porção do Recordatório-24h, somente as vitaminas D e B12 não apresentaram diferença significativa em relação ao Recordatório-24h; para o Questionário de Frequência Alimentar Porção do Recordatório-24h calibrado, todos os nutrientes, à exceção de folato e ferro, tiveram medianas estatisticamente iguais às obtidas com o Recordatório-24h. Os coeficientes de correlação de Spearman foram maiores para o Questionário de Frequência Alimentar Porção do Recordatório-24h calibrado para todos os nutrientes avaliados, variando de 0,27 (gordura total) a 0,57 (ferro). Em relação ao Kappa ponderado, os maiores coeficientes foram encontrados para o Questionário de Frequência Alimentar Porção do Recordatório-24h calibrado. Conclusão A utilização do Questionário de Frequência Alimentar calibrado e com porções estimadas na própria população de estudo apresenta melhores estimativas da ingestão alimentar, com valores mais próximos ao método de referência.

Dietary patterns are influenced by socio-demographic conditions of women in childbearing age: a cohort study of pregnant women.

BACKGROUND: Women's health during their reproductive years and whilst pregnant has implications for their children's health, both in utero and during childhood. Associations of women's pre-pregnancy dietary patterns (DP) with maternal socio-demographic characteristics and nutrient intake were investigated in ProcriAr cohort study in São Paulo/Brazil, 2012. METHODS: The DPs of 454 women were investigated by principal component factor analysis, using dietary information from a validated 110-item food frequency questionnaire. Multiple linear regression models identified independent associations between DPs and maternal socio-demographic characteristics and Spearman's correlation determined associations between DPs and nutrients intake. RESULTS: Participants' mean age was 26.1 years (standard deviation = 6.3), 10.3% had more than 8 years of formal education, 30% were migrants from outside of the Southeast of Brazil, 48% were employed, 13% were smokers, and 51% were overweight/obese. Four DPs were derived: 'Lentils, whole grains and soups,' 'Snacks, sandwiches, sweets and soft drinks,' 'Seasoned vegetables and lean meats,' and 'Sweetened juices, bread and butter, rice and beans'. The 'Lentils, whole grains and soups' score was positively related to maternal age, being non-smoker and born in the South, North or Midwest of Brazil. The 'Snacks, sandwiches, sweets and soft drinks' score was positively related to higher maternal education, and negatively related to age, lack of formal work and being born in the Northeast region. The 'Seasoned vegetables and lean meats' score was positively related to higher maternal education. The 'Sweetened juices, bread and butter, rice and beans' score was positively related to unemployment and to no family history of hypertension, and negatively related to maternal overweight and obesity. Dietary intake of fruits and vegetables, foods that require preparation, nutrients from one-carbon metabolism, protein, iron, calcium and vitamin D were correlated with the 'Seasoned vegetables and lean meats'. Dietary intake of sugar-sweetened and alcoholic beverages, industrialized and takeaway foods, and foods rich in sugar, energy, fat, and synthetic folate were correlated with the 'Snacks, sandwiches, sweets and soft drinks'. CONCLUSIONS: Findings from this study add perspectives to be considered in the implementation of health interventions, which could improve women's nutritional status and provide an adequate environment for the developing fetus.

Padrões alimentares, nutrientes do metabolismo do folato e homocisteína e três desfechos em saúde / Dietary patterns, nutrients involved in one-carbon metabolism and three health outcomes

Introdução - Os hábitos alimentares e os nutrientes da via metabólica do folato e homocisteína possuem grande importância na manutenção da saúde. Objetivo - Investigar a relação entre padrões alimentares (PAs) e os nutrientes envolvidos nessa via metabólica, com medidas antropométricas do recém-nascido, duração da infecção por HPV em homens e concentrações de homocisteína (Hcy) em adultos. Métodos - Foram utilizados dados dos estudos de coorte ProcriAr (Influência dos fatores nutricionais e poluentes atmosféricos urbanos na saúde pulmonar de crianças: um estudo de coorte com gestantes da zona oeste do município de São Paulo, n=299); e HIM (História natural da infecção por HPV em homens, n=1.194); e do estudo transversal ISA-Capital 2008 (Inquérito de saúde do estado de São Paulo, n=281). Os padrões alimentares foram derivados por análise fatorial por componentes principais nos estudos ProcriAr e ISA-Capital 2008 e utilizando reduced rank regression (RRR) no estudo HIM. Modelos multivariados de regressão de Poisson e lineares foram utilizados nos estudos ProcriAr e HIM para identificar a relação entre PAs e medidas antropométricas do recém-nascido e duração da infecção por HPV em homens, respectivamente. Utilizando modelo de equação estrutural, investigou-se a relação entre PAs, concentrações bioquímicas de folato, vitamina B12 e ácido docosahexaenoico (DHA) e concentrações de homocisteína em adultos do estudo ISA-Capital, considerando polimorfismo da enzima metilenotetrahidrofolato redutase (MTHFR 677C>T). Os três estudos utilizaram questionário de frequência alimentar para avaliação do consumo alimentar. Resultados - No estudo ProcriAr, a maior adesão materna ao PA "Snacks, sanduíches, doces e refrigerantes", rico em energia, gordura, e folato sintético, esteve diretamente associada a ter um filho pequeno ao nascer (peso e/ou comprimento ao nascer, ajustado pela idade gestacional, abaixo do percentil 10 - INTERGOWTH-21st) (RR: 2,01; IC 95%: 1.13-3.57). No estudo HIM, homens com maior adesão ao "PA3" tiveram, em média, um aumento de 1,15 (IC95% 0,09-2,21) à 1,18 (IC95% 0,11-2,24) meses na duração da infecção por HPV. O "PA3" esteve positivamente correlacionado com vitamina B6 (r = 0,59), vitamina B12 (0,27) e DFE (0,07) e negativamente correlacionado com DHA (-0,37). No estudo ISA-Capital o PA "Prudente" esteve inversamente associado à concentração de Hcy (β = -0,12). O DHA esteve diretamente associado ao PA "Prudente"; composto por verduras e legumes, peixe, frutas, frango, suco natural e batata/mandioca/polenta (cozida ou assada). Conclusões - Os PAs estão associados às medidas antropométricas do recém-nascido, à duração da infecção por HPV em homens e às concentrações de homocisteína em adultos. Estes resultados reforçam a importância de estudos sobre alimentação e nutrição que considerem não somente nutrientes, mas principalmente o consumo de alimentos e suas combinações, servindo como base para a elaboração de estratégias e políticas públicas de promoção à saúde

Introduction - The dietary habits and nutrients involved in one-carbon metabolism are of great importance in health. Objective - To investigate the relationship between dietary patterns (DP) and the nutrients involved in this metabolism, with newborn's anthropometric measurements, duration of HPV infection in men, and homocysteine (Hcy) levels in adults. Methods - Data from the cohort studies ProcriAr (Influence of nutritional factors and urban air pollutants on the pulmonary health of children: a cohort study with pregnant women from the western region of the city of São Paulo, n=299); and HIM (Natural history of HPV infection in men, n=1,194); and the cross-sectional study ISA-Capital 2008 (São Paulo State Health Survey, n=281) were used. The DP were estimated using factor analysis with principal component's estimation in ProcriAr and ISA-Capital 2008 studies and using reduced rank regression (RRR) in HIM study. Multivariate Poisson and linear regression models were used in the ProcriAr and HIM studies to identify the relationship between DP and newborn's anthropometric measurements and duration of HPV infection in men, respectively. Using a structural equation model, the relationship between DP, biochemical levels of folate, vitamin B12 and docosahexaenoic acid (DHA) and homocysteine levels was investigated in adults from the ISA-Capital 2008 study, considering the polymorphism of the enzyme methylenetetrahydrofolate reductase (MTHFR 677C>T). The three studies used a food frequency questionnaire to evaluate dietary intake. Results - In the ProcriAr study, the higher maternal adherence to the "Snacks, sandwiches, sweets and soft drinks" DP, which is a DP rich in energy, fat, and synthetic folate, was directly associated with having a child small at birth (weight and/or birth length by gestational age and sex below the 10th percentile - INTERGOWTH-21st) (RR: 2.01, 95% CI: 1.13-3.57). In the HIM study, men with higher adherence to "DP3" had, on average, an increase from 1.15 (95% CI 0.09-2.21) to 1.18 (95% CI 0.11-2.24) months in the duration of HPV infection. "DP3" was positively correlated with vitamin B6 (r = 0.59), vitamin B12 (0.27) and DFE (0.07) and negatively correlated with DHA (-0.37). In the ISA-Capital study, the "Prudent" DP was inversely associated with Hcy levels (β = -0.12). DHA was directly associated with "Prudent" DP; composed of vegetables, fish, fruits, chicken, natural juice and potato/cassava/polenta (cooked or roasted). Conclusions - Dietary patterns are associated with newborn's anthropometric measurements, duration of HPV infection in men, and Hcy levels in adults. These results reinforce the importance of studies on food and nutrition that consider not only nutrients, but mainly the consumption of foods and their combinations, serving as a basis for the elaboration of public health promotion strategies and policies

Dietary patterns in internal migrants in a continental country: A population-based study.

OBJECTIVE: The objective of this study was to assess the differences and similarities in dietary patterns among migrants and natives. METHODS: A population-based, cross-sectional study was conducted in the city of São Paulo. The study population included internal migrants, defined as individuals born outside São Paulo city who had lived in the city for ten years or longer. The final population (n = 999) was divided into three groups: natives of São Paulo (n = 354), migrants from the Southeast (n = 349) and migrants from the Northeast (n = 296). Factor and principal component analysis was employed to derive dietary patterns. The standardized scores were compared among groups using linear regression. RESULTS: Differences in income per capita, years of education, self-reported race, smoking habits, alcohol consumption, nutritional status and prevalence of hypertension were found for place of birth. Three dietary patterns were identified: prudent (salad dressings, vegetables, natural flavorings, fruits, whole-grain bread, white cheeses and juices), traditional (rice, beans, bread/toast/crackers, butter/margarine, whole milk, coffee/teas, sugar), and modern (sodas, pastries/sandwiches/pizzas, yellow cheeses, pastas, sauces, alcoholic beverages, sweets, processed meats). Compared to natives, migrants from the Southeast had an inversely proportional adherence to the modern pattern whereas migrants from the Northeast had an inverse association with the prudent and modern patterns and a positive association with the traditional pattern. CONCLUSIONS: São Paulo natives and internal migrants from other regions of Brazil exhibited different dietary patterns. The results presented here add perspectives to be considered in the study of non-communicable diseases and its different incidences among migrants and natives.

Validation of self-reported diabetes in a representative sample of São Paulo city.

OBJECTIVE To validate the self-reported diabetes mellitus in adults and older adults living in the city of São Paulo, Brazil. METHODS We have used data of 569 subjects (284 adults and 285 older adults), participants of the population-based cross-sectional study Inquérito de Saúde do Município de São Paulo (Health Survey of São Paulo). Fasting glucose ≥ 7.0 mmol/L (126 mg/dL) and/or use of drugs (oral hypoglycemic and/or insulin) defined the diagnosis of diabetes mellitus. We have validated the self-reported diabetes mellitus by calculating the sensitivity, specificity, positive predictive values, and negative predictive values. We have used Poisson regression with robust variance to verify the factors associated with the sensitivity of the self-reported datum. For all analyses, we have considered the sample design of the study. RESULTS The sensitivity of self-reported diabetes mellitus was 63.8% (95%CI 49.2-76.3), specificity was 99.7% (95%CI 99.1-99.9), positive predictive value was 95.5% (95%CI 84.4-98.8), and negative predictive value was 96.9% (95%CI 94.9-98.2). The correct reporting of diabetes mellitus was more prevalent among older adults (PR = 2.0; 95%CI 1.2-3.5) than among adults. CONCLUSIONS The use of the datum of self-reported diabetes mellitus is valid, especially among older adults living in the city of São Paulo. The results highlight the need to track diabetes mellitus in asymptomatic subjects who have one or more risk factors for it, mainly in the adult population of this city.

Validation of self-reported diabetes in a representative sample of São Paulo city

ABSTRACT OBJECTIVE To validate the self-reported diabetes mellitus in adults and older adults living in the city of São Paulo, Brazil. METHODS We have used data of 569 subjects (284 adults and 285 older adults), participants of the population-based cross-sectional study Inquérito de Saúde do Município de São Paulo (Health Survey of São Paulo). Fasting glucose ≥ 7.0 mmol/L (126 mg/dL) and/or use of drugs (oral hypoglycemic and/or insulin) defined the diagnosis of diabetes mellitus. We have validated the self-reported diabetes mellitus by calculating the sensitivity, specificity, positive predictive values, and negative predictive values. We have used Poisson regression with robust variance to verify the factors associated with the sensitivity of the self-reported datum. For all analyses, we have considered the sample design of the study. RESULTS The sensitivity of self-reported diabetes mellitus was 63.8% (95%CI 49.2–76.3), specificity was 99.7% (95%CI 99.1–99.9), positive predictive value was 95.5% (95%CI 84.4–98.8), and negative predictive value was 96.9% (95%CI 94.9–98.2). The correct reporting of diabetes mellitus was more prevalent among older adults (PR = 2.0; 95%CI 1.2–3.5) than among adults. CONCLUSIONS The use of the datum of self-reported diabetes mellitus is valid, especially among older adults living in the city of São Paulo. The results highlight the need to track diabetes mellitus in asymptomatic subjects who have one or more risk factors for it, mainly in the adult population of this city.

Prevalência de omissão do café da manhã e seus fatores associados em adolescentes de São Paulo: estudo ISA-Capital / Prevalence of breakfast omission and associated factors among adolescents in São Paulo: ISA-Capital

Objective: To describe the patterns of food intake for breakfast, the prevalence of omission of this meal, its relative share in the total intake of energy and nutrients, and the factors associated with its omission. Methods: A population-based, cross-sectional study (ISA - Capital) with 795 adolescents. The prevalence of omission of breakfast was analyzed using Chi-square test and Poisson regression considering a significance level of 5%. Differences in the intake of energy and nutrients among adolescents who omit and have breakfast was determined by the Student?s t-test and differences in the relative share of breakfast were verified by the test of proportion. The pattern of consumption of breakfast was investigated by factor analysis. Results: The prevalence of omission of breakfast was 38%, higher among female adolescents. The energy contribution of breakfast was 23%, with contribution in vitamins ranging from 17% in vitamin C, for males, up to 37% in vitamin A and D, for females. Through factor analysis, 12 food groups consumed for breakfast were characterized in five factors that demonstrate a pattern of consumption. Conclusion: The results show the need for actions that promote regular consumption and selection of appropriate food for this meal.

Objetivos: Caracterizar os padrões de café da manhã, verificar a prevalência e os fatores associados à omissão desta refeição, e a participação relativa na ingestão calórica total e de nutrientes entre adolescentes. Metodologia: Estudo transversal de base populacional (ISA - Capital), com 795 adolescentes. O padrão de consumo de café da manhã foi analisado através da análise fatorial. Para verificar a prevalência de omissão do café da manhã, foram utilizados os Testes qui-quadrado e regressão de Poisson, considerando um nível de significância de 5%. Diferenças da ingestão de energia e nutrientes entre adolescentes que omitem ou consomem o café da manhã, foi determinado pelo Teste t-Student. As diferenças na participação relativa do café da manhã foram verificadas através do teste de proporção. Resultados: Observou-se elevada omissão de café da manhã (38%), além de padrões não saudáveis, incluindo consumo de refrigerantes e salgados. Café e açúcares de adição contribuíram significativamente para o primeiro fator; pães, margarinas e manteigas contribuíram significativamente para o segundo fator; e leite e achocolatados foram os alimentos que contribuíram para o terceiro fator. No quarto fator estão embutidos e refrigerantes e no quinto fator, queijos e frutas. A contribuição energética foi de 23%, com contribuição em vitaminas variando de 17% em vitamina C, para o sexo masculino e 37% em vitaminas A e D, para o sexo feminino. Conclusão: Os resultados apontam para a necessidade de ações que visem não só estimular o consumo do café da manhã, mas também incentivar a oferta e seleção de alimentos ricos em fibras, vitaminas e minerais.

Validity and reproducibility of a food frequency questionnaire for adults of São Paulo, Brazil / Validade e reprodutibilidade de um questionário de frequência alimentar para adultos de São Paulo, Brasil

OBJECTIVES: To assess the validity and reproducibility of a food frequency questionnaire developed for estimating the food consumption of adults in São Paulo, Brazil, based population study. METHODS: A sample of individuals aged above 20 years, of both genders, living in São Paulo, was used for the validation study (n = 77) and reproducibility study (n = 74) of the food frequency questionnaire. To verify the validity and reproducibility of energy and 19 nutrients were applied two food frequency questionnaires (60 items) and three 24-hour dietary recalls (24HR - reference method). The validity was verified by Spearman correlation coefficient (crude and de-attenuated) and weighted Kappa, and reproducibility by intraclass correlation coefficients and weighted kappa. RESULTS: In analyzes of validity de-attenuated correlation coefficients ranged from 0.21 (carbohydrate) to 0.74 (energy), and weighted kappa exceeded 0.40 for 30% of the nutrients. Polyunsaturated fat and folate did not show significant correlation and weighted kappa. In reproducibility correlation coefficients ranged from 0.36 (polyunsaturated fat) to 0.69 (calcium), and weighted kappa exceeded 0.40 for 80% of the nutrients. CONCLUSION: The food frequency questionnaire analyzed has good validity and reproducibility for estimating the food consumption of adults in São Paulo compared to the reference method, so it is an appropriate instrument to be used in epidemiological studies on similar populations. Estimates of polyunsaturated fat and folate should be interpreted with caution. .

OBJETIVOS: Verificar a validade e reprodutibilidade de um questionário de frequência alimentar desenvolvido para estimar o consumo alimentar habitual de adultos do município de São Paulo, Brasil, com base em estudo populacional. MÉTODOS: Foi utilizada amostra de indivíduos com 20 anos ou mais, de ambos sexos, residentes no município de São Paulo, para o estudo de validação (n = 77) e reprodutibilidade (n = 74) do questionário de frequência alimentar. Para verificar a validade e reprodutibilidade do consumo de energia e 19 nutrientes, aplicaram-se dois questionários de frequência alimentar e três recordatórios alimentares de 24 horas (R24h - método de referência). A validade foi verificada por coeficiente de correlação de Spearman (bruto e deatenuado) e Kappa ponderado, e a reprodutibilidade por coeficiente de correlação intraclasse e Kappa ponderado. RESULTADOS: Nas análises de validade, os coeficientes de correlação deatenuados variaram de 0,21 (carboidrato) a 0,74 (energia), e o kappa ponderado excedeu 0,40 para 30% dos nutrientes. Gordura poli-insaturada e folato não apresentaram correlação e kappa ponderado significantes. Na reprodutibilidade, os coeficientes de correlação variaram de 0,36 (gordura poli-insaturada) a 0,69 (cálcio), e kappa ponderado excedeu 0,40 para 80% dos nutrientes. CONCLUSÃO: O questionário de frequência alimentar analisado possui boa validade e reprodutibilidade para estimar o consumo alimentar habitual de adultos de São Paulo em relação ao método de referência, portanto é um instrumento apropriado para estudos epidemiológicos em populações similares. As estimativas de gordura poli-insaturada e folato devem ser interpretadas com cautela. .

Validity and reproducibility of a food frequency questionnaire for adults of São Paulo, Brazil.

OBJECTIVES: To assess the validity and reproducibility of a food frequency questionnaire developed for estimating the food consumption of adults in São Paulo, Brazil, based population study. METHODS: A sample of individuals aged above 20 years, of both genders, living in São Paulo, was used for the validation study (n = 77) and reproducibility study (n = 74) of the food frequency questionnaire. To verify the validity and reproducibility of energy and 19 nutrients were applied two food frequency questionnaires (60 items) and three 24-hour dietary recalls (24HR - reference method). The validity was verified by Spearman correlation coefficient (crude and de-attenuated) and weighted Kappa, and reproducibility by intraclass correlation coefficients and weighted kappa. RESULTS: In analyzes of validity de-attenuated correlation coefficients ranged from 0.21 (carbohydrate) to 0.74 (energy), and weighted kappa exceeded 0.40 for 30% of the nutrients. Polyunsaturated fat and folate did not show significant correlation and weighted kappa. In reproducibility correlation coefficients ranged from 0.36 (polyunsaturated fat) to 0.69 (calcium), and weighted kappa exceeded 0.40 for 80% of the nutrients. CONCLUSION: The food frequency questionnaire analyzed has good validity and reproducibility for estimating the food consumption of adults in São Paulo compared to the reference method, so it is an appropriate instrument to be used in epidemiological studies on similar populations. Estimates of polyunsaturated fat and folate should be interpreted with caution.

Performance of the quantitative food frequency questionnaire used in the Brazilian center of the prospective study Natural History of Human Papillomavirus Infection in Men: The HIM Study.

The Natural History of Human Papillomavirus (HPV) Infection in Men: The HIM Study is a prospective multicenter cohort study that, among other factors, analyzes participants' diet. A parallel cross-sectional study was designed to evaluate the validity and reproducibility of the quantitative food frequency questionnaire (QFFQ) used in the Brazilian center from the HIM Study. For this, a convenience subsample of 98 men aged 18 to 70 years from the HIM Study in Brazil answered three 54-item QFFQ and three 24-hour recall interviews, with 6-month intervals between them (data collection January to September 2007). A Bland-Altman analysis indicated that the difference between instruments was dependent on the magnitude of the intake for energy and most nutrients included in the validity analysis, with the exception of carbohydrates, fiber, polyunsaturated fat, vitamin C, and vitamin E. The correlation between the QFFQ and the 24-hour recall for the deattenuated and energy-adjusted data ranged from 0.05 (total fat) to 0.57 (calcium). For the energy and nutrients consumption included in the validity analysis, 33.5% of participants on average were correctly classified into quartiles, and the average value of 0.26 for weighted kappa shows a reasonable agreement. The intraclass correlation coefficients for all nutrients were greater than 0.40 in the reproducibility analysis. The QFFQ demonstrated good reproducibility and acceptable validity. The results support the use of this instrument in the HIM Study.

Calibration of the dietary data obtained from the Brazilian center of the Natural History of HPV Infection in Men study: the HIM Study / Calibração dos dados dietéticos obtidos no centro Brasileiro do estudo Natural History of HPV Infection in Men: o Estudo HIM

The objective of this study was to estimate the regressions calibration for the dietary data that were measured using the quantitative food frequency questionnaire (QFFQ) in the Natural History of HPV Infection in Men: the HIM Study in Brazil. A sample of 98 individuals from the HIM study answered one QFFQ and three 24-hour recalls (24HR) at interviews. The calibration was performed using linear regression analysis in which the 24HR was the dependent variable and the QFFQ was the independent variable. Age, body mass index, physical activity, income and schooling were used as adjustment variables in the models. The geometric means between the 24HR and the calibration-corrected QFFQ were statistically equal. The dispersion graphs between the instruments demonstrate increased correlation after making the correction, although there is greater dispersion of the points with worse explanatory power of the models. Identification of the regressions calibration for the dietary data of the HIM study will make it possible to estimate the effect of the diet on HPV infection, corrected for the measurement error of the QFFQ.

O objetivo foi estimar as regressões de calibração dos dados dietéticos mensurados pelo questionário quantitativo de freqüência alimentar (QQFA) utilizado no Natural History of HPV Infection in Men: o Estudo HIM. Uma amostra de 98 indivíduos do estudo HIM respondeu, por meio de entrevista, a um QQFA e três recordatórios de 24 horas (R24h). A calibração foi feita por meio de análise de regressão linear, tendo os R24h como variável dependente e o QQFA como variável independente. Idade, índice de massa corporal, atividade física, renda e escolaridade foram utilizadas como variáveis de ajuste nos modelos. As médias geométricas dos R24h e do QQFA corrigido pela calibração são estatisticamente iguais. Os gráficos de dispersão entre os instrumentos demonstraram aumento da correlação após a correção dos dados, porém observa-se maior dispersão dos pontos de acordo com a piora do poder explicativo dos modelos. A identificação das regressões de calibração dos dados dietéticos do estudo HIM permitirá a estimativa do efeito da dieta sobre a infecção por HPV, corrigida pelo erro de medida do QQFA.