Patterns of beverages consumption and prevalence of non-communicable chronic diseases.

Beverages consumption influences diet quality in general and has been associated with the development of non-communicable chronic diseases (NCCD). We aimed to verify the association between beverage consumption patterns and the prevalence of NCCD. A cross-sectional household and population-based study was conducted with 489 individuals aged 20 years and older. The presence of NCCD (arterial hypertension, diabetes, cancer and hypercholesterolemia) was obtained by self-report, while obesity was diagnosed by measuring body weight, height and waist circumference. Beverage consumption patterns were obtained by principal component analysis. The association between beverages patterns and the prevalence of NCCD was verified using Poisson regression, expressed as prevalence ratio (PR) and adjusted for potential confounding factors. Three beverage patterns were identified: 'ultra-processed beverages', 'alcoholic beverages' and 'healthy beverages'. Individuals with greater adherence to the Ultra-processed Beverages Pattern had a 2·77 times higher prevalence of cancer (PR: 3·77; 95 % CI 1·57, 9·07). Higher adherence to the Alcoholic Beverages Pattern was associated with a higher prevalence of obesity (PR: 1·97; 95 % CI 1·13, 3·44). In contrast, individuals in the second tertile of adherence to the Healthy Beverages Pattern had a 39 % lower prevalence of hypercholesterolemia (PR: 0·61; 95 % CI 0·40, 0·92), and individuals in the third tertile had a 10 % lower prevalence of abdominal obesity estimated by the waist-to-height ratio (PR: 0·90; 95 % CI 0·83, 0·97). Beverage consumption patterns may be associated with a higher prevalence of NCCD, regardless of other risk factors. It is therefore important to conduct more studies investigating the impact of beverages patterns on health.

Dietary inflammatory index and inflammatory markers in Brazilian adolescents.

OBJECTIVE: To evaluate the association between the inflammatory potential of the diet measured by the energy-adjusted diet inflammatory index (E-DII) and inflammatory markers in adolescents. METHODS: This cross-sectional study was conducted among 518 adolescents aged 18 and 19 years from São Luís, Maranhão, Brazil in 2016. A semiquantitative food frequency questionnaire (FFQ) was used to assess dietary intake from which E-DII scores were calculated to determine the inflammatory potential of the diet. The associations between E-DII and inflammatory markers (hs-CRP, IL-6, IL-4, TNF-α, and IFNγ) were analyzed using multivariable linear regression. The variables included in the adjusted model were identified using the directed acyclic graph. RESULTS: The diet of these adolescents was mostly pro-inflammatory; mean E-DII score was 1.71 and ranged from -2.44 to 5.58. Higher E-DII scores were positively associated with higher levels of IFNγ in the adjusted analysis (Adjusted Coef.: 1.19; 95%CI: 0.36-12.04). We observed no associations between E-DII and other inflammatory markers (hs-CRP, IL-6, IL-4, TNF-α). Study results indicate that E-DII is useful in evaluating the inflammatory potential of the diet of Brazilian adolescents. CONCLUSIONS: Cross-sectionally E-DII scores were positively associated with IFNγ concentrations. Future research should examine the association between changes in E-DII scores and levels of inflammatory markers longitudinally.

Association between breast feeding and food consumption according to the degree of processing in Brazil: a cohort study.

BACKGROUND: The benefits of breast feeding may be associated with better formation of eating habits beyond childhood. This study was designed to verify the association between breast feeding and food consumption according to the degree of processing in four Brazilian birth cohorts. METHODS: The duration of exclusive, predominant and total breast feeding was evaluated. The analysis of the energy contribution of fresh or minimally processed foods (FMPF) and ultra-processed foods (UPF) in the diet was evaluated during childhood (13-36 months), adolescence (11-18 years) and adulthood (22, 23 and 30 years). RESULTS: Those who were predominantly breastfed for less than 4 months had a higher UPF consumption (ß 3.14, 95% CI 0.82 to 5.47) and a lower FMPF consumption (ß -3.47, 95% CI -5.91 to -1.02) at age 22 years in the 1993 cohort. Exclusive breast feeding (EBF) for less than 6 months was associated with increased UPF consumption (ß 1.75, 95% CI 0.25 to 3.24) and reduced FMPF consumption (ß -1.49, 95% CI -2.93 to -0.04) at age 11 years in the 2004 cohort. In this same cohort, total breast feeding for less than 12 months was associated with increased UPF consumption (ß 1.12, 95% CI 0.24 to 2.19) and decreased FMPF consumption (ß -1.13, 95% CI -2 .07 to -0.19). Children who did not receive EBF for 6 months showed an increase in the energy contribution of UPF (ß 2.36, 95% CI 0.53 to 4.18) and a decrease in FMPF (ß -2.33, 95% CI -4 .19 to -0.48) in the diet at 13-36 months in the 2010 cohort. In this cohort, children who were breastfed for less than 12 months in total had higher UPF consumption (ß 2.16, 95% CI 0.81 to 3.51) and lower FMPF consumption (ß -1.79, 95% CI -3.09 to -0.48). CONCLUSION: Exposure to breast feeding is associated with lower UPF consumption and higher FMPF consumption in childhood, adolescence and adulthood.

Association of nutritional status with urinary iodine deficiency in Brazilian pregant women / Associação do estado nutricional com deficiência urinária de iodo em gestantes brasileiras

Abstract Objectives: to investigate the association of nutritional status with urinary iodine deficiency in pregnant women attending the Basic Health Units in the city of São Luís - Maranhão. Methods: cross-sectional study carried out with 261 pregnant women. Urine samples were collected for analysis of determination of urinary iodine. Iodine deficiency was considered as <150 µg/L and adequate as ≥150 µg/L. Weight and height measurements were taken at the time of collection and investigation of pre-pregnancy weight calculate BMI). Continuous variables were presented as mean, standard deviation, median, 25th and 75th percentiles, and categorical variables as simple and relative frequencies and percentages. Multivariate analyses investigate the association between pre-pregnancy and current BMI and UIC (urinary iodine concentration). Results: the mean pre-pregnancy BMI was 24.3 ± 4.5 kg/m2, and the current BMI was 27.2 ± 6.5 kg/m2. The median UIC was 181.3 µg/L (113.2-271.7), and 40.6% of the sample showed iodine deficiency. The increase in pre-pregnancy and current BMI was associated with a reduction in the prevalence of iodine deficiency in pregnant women (PR = 0.94; (CI95% = 0.88; 0.99) and PR = 0.95; (CI95% = 0.88 - 0.99), respectively). Conclusion: high BMI is positively associated with UIC and provides a reduction in iodine deficiency prevalence in pregnant women.

Resumo Objetivos: investigar a associação do estado nutricional com deficiência de iodo urinário em gestantes atendidas em Unidades Básicas de Saúde do município de São Luís - MA. Métodos: estudo transversal, realizado com 261 gestantes. Foram coletadas amostras de urina para análise de determinação do iodo urinário, considerou-se deficiência o valor <150 µg/L e adequado, valor ≥150 µg/L. Foram aferidas as medidas de peso e altura no momento da coleta e investigação do peso pré-gestacional para cálculo do IMC. As variáveis contínuas foram expressas em média, desvio padrão, mediana, percentil 25 e 75 e as categóricas em frequência simples e relativa e em percentual. Análises multivariadas investigaram associação entre IMC pré-gestacional e atual e UIC (Concentração urinária de iodo). Resultados: a média do IMC pré-gestacional foi 24,3 ± 4,5 kg/m2 e do IMC atual 27,2 ± 6,5 kg/m2. A mediana de concentração de iodo urinário foi de 181,3 µ/L (113,2-271,7) e 40,6% da amostra possuía deficiência de iodo. O aumento no IMC pré-gestacional e atual foi associado à redução da prevalência de deficiência de iodo em gestantes (RP = 0,94; (IC95% = 0,88; 0,99) e RP = 0,95; (IC95% = 0,88 - 0,99), respectivamente). Conclusão: o IMC elevado está positivamente associado à UIC e proporciona redução na prevalência de deficiência de iodo em gestantes.

Dietary inflammatory index and inflammatory markers in Brazilian adolescents

ABSTRACT OBJECTIVE To evaluate the association between the inflammatory potential of the diet measured by the energy-adjusted diet inflammatory index (E-DII) and inflammatory markers in adolescents. METHODS This cross-sectional study was conducted among 518 adolescents aged 18 and 19 years from São Luís, Maranhão, Brazil in 2016. A semiquantitative food frequency questionnaire (FFQ) was used to assess dietary intake from which E-DII scores were calculated to determine the inflammatory potential of the diet. The associations between E-DII and inflammatory markers (hs-CRP, IL-6, IL-4, TNF-α, and IFNγ) were analyzed using multivariable linear regression. The variables included in the adjusted model were identified using the directed acyclic graph. RESULTS The diet of these adolescents was mostly pro-inflammatory; mean E-DII score was 1.71 and ranged from -2.44 to 5.58. Higher E-DII scores were positively associated with higher levels of IFNγ in the adjusted analysis (Adjusted Coef.: 1.19; 95%CI: 0.36-12.04). We observed no associations between E-DII and other inflammatory markers (hs-CRP, IL-6, IL-4, TNF-α). Study results indicate that E-DII is useful in evaluating the inflammatory potential of the diet of Brazilian adolescents. CONCLUSIONS Cross-sectionally E-DII scores were positively associated with IFNγ concentrations. Future research should examine the association between changes in E-DII scores and levels of inflammatory markers longitudinally.

Is There an Association between Food Consumption According to the Degree of Processing and Body Image (Dis)satisfaction in Adolescents?

(1) Background: Adolescence is characterized by changes in eating habits, with increased consumption of ultra-processed foods and reduced intake of unprocessed or minimally processed foods, which can affect body image satisfaction. Thus, this study aims to verify the association of food consumption according to the degree of processing with body image (dis)satisfaction in adolescents from the 1997/1998 birth cohort of São Luís, Maranhão. (2) Methods: A cross-sectional study was conducted with 2515 adolescents aged between 18 and 19. Food consumption was stratified based on the NOVA classification in culinary preparations, processed foods, and ultra-processed foods, categorized into tertiles. Body image (dis)satisfaction was evaluated based on the Stunkard Body Scale and was classified as satisfaction, dissatisfaction with thinness, and dissatisfaction with excess weight. Multinomial logistic regression was used for associations. (3) Results: Among the adolescents, 77% considered themselves dissatisfied with their body image, with 42.8% dissatisfied with being thin and 34.2% dissatisfied with excess weight. However, food consumption, according to the degree of processing, was not associated with body image (dis)satisfaction. (4) Conclusion: This work highlighted the prevalence of body image dissatisfaction among adolescents but found no association between body (dis)satisfaction and food consumption according to the degree of processing.

Consumption of ultra-processed products is associated with vitamin D deficiency in Brazilian adults and elderly.

Although studies show that the intake of ultra-processed products (UPP) has a negative impact on health, diet quality and dietary vitamin D, its influence on serum concentrations of this vitamin remains unknown; therefore, it is essential to verify the association between the UPP consumption and vitamin D deficiency. This is a cross-sectional, household, population-based study, carried out with 229 individuals aged 20 years or older, residents of the city of Teresina, Piauí, Brazil. Socio-demographic, lifestyle, food consumption and anthropometric data were collected. Food consumption was obtained using a 24-h food recall, and foods were grouped according to the NOVA classification. Plasma concentrations of calcidiol-25 (OH) D3 were determined by HPLC. Crude and adjusted binary logistic regression was applied to estimate the association between UPP consumption and vitamin D deficiency. Most individuals aged 20-39 years were vitamin D deficient (52·1 %). UPP contributed 19·9 % to the energetic intake of the participant's diet. This contribution was higher for individuals with vitamin D deficiency (22·5 %, P = 0·04). In addition, a high intake of UPP was associated with twice the risk of vitamin D deficiency in comparison with low consumption of UPP (OR: 2·05; CI 1·06, 4·50; P: 0·04). Our results suggest that the consumption of UPP may have a negative impact on serum concentrations of vitamin D; more studies are needed.

Birth weight and bone mineral density at 18-19 years: birth cohort 1997-1998.

OBJECTIVE: To analyze the association between birth weight and bone mineral density (BMD) in adolescence. METHODS: A birth cohort study in São Luís, Maranhão, using data from two moments: at birth and at 18-19 years. Exposure was the birth weight in grams, continuously analyzed. The outcome was BMD, using the Z-score index (whole body) measured by double X-ray densitometry (Dexa). A theoretical model was constructed in acyclic graphs to identify the minimum set of adjustment variables - household income, the mother knowing how to read and write at the time of birth, prenatal care, tobacco use during pregnancy, and parity - to evaluate the association between birth weight and bone mineral density in adolescence. Multiple linear regression was used in Stata 14.0 software. A 5% significance level was adopted. RESULTS: From 2,112 adolescents, 8.2% had low birth weight and 2.8% had a low BMD for their age. The mean full-body Z-score was 0.19 (± 1.00). The highest birth weight was directly and linearly associated with BMD values in adolescence (Coef.: 0.10; 95%CI: 0.02-0.18), even after adjustment for the variables household income (Coef.: -0.33; 95%CI: -0.66-0.33) and the mother knowing how to read and write (Coef.: 0.23%; 95%CI: 0.03-0.43). CONCLUSION: Although after adjusting the variables the association attenuated, birth weight positively and linearly relates to BMD in adolescence.

Socioeconomic status, screen time, and time spent at school, and children's food consumption. / Situação socioeconômica, tempo de tela e de permanência na escola e o consumo alimentar de crianças.

The present study aimed to evaluate the association of sociodemographic factors and lifestyle with the consumption of in natura or minimally processed (INMP) foods, ultra-processed foods (UPFs), and fruits and vegetables. This was a cross-sectional study conducted with 403 children, aged 4 to 7 years, from a retrospective cohort. Sociodemographic and lifestyle variables were investigated using a sociodemographic questionnaire. Food consumption was assessed by three food records. Bivariate and multivariate linear regression analyses were used to analyze associations. Children with lower income had a higher consumption of INMP foods and a lower consumption of UPFs. A shorter time spent at school was associated with a lower consumption of INMP foods and a higher consumption of UPFs. Children with more screen time and less educated parents consumed less fruits and vegetables. Unfavorable sociodemographic factors were associated with a better profile of food consumption according to the level of processing, except for fruits and vegetables. The longer time spent at school and a shorter screen time contributed to a healthier diet.

Este estudo objetivou avaliar a associação de fatores sociodemográficos e estilo de vida com consumo de alimentos in natura ou minimamente processados (INMP), ultraprocessados (AUP) e frutas e hortaliças. Trata-se de estudo transversal com 403 crianças de 4 a 7 anos de uma coorte retrospectiva. Variáveis sociodemográficas e estilo de vida foram investigadas através do questionário sociodemográfico. O consumo alimentar foi avaliado por três registros alimentares. Empregaram-se análises de regressão linear bivariadas e multivariadas para analisar as associações. Crianças com menor renda apresentaram maior consumo de alimentos INMP e menor consumo de AUP. Menor tempo de permanência na escola associou-se ao menor consumo de alimentos INMP e maior consumo de AUP. Crianças com maior tempo de tela e com pais de menor escolaridade, consumiram menos frutas e hortaliças. Fatores sociodemográficos desfavoráveis se associaram ao melhor perfil de consumo de alimentos segundo o nível de processamento, exceto para frutas e hortaliças. O maior tempo de permanência na escola e menor tempo de tela contribuíram para uma alimentação mais saudável.

Racial and regional inequality in the temporal trend of stunting and excess weight in Brazilian children under five years of age. / Desigualdade racial e regional na tendência temporal do déficit de estatura e excesso de peso de crianças brasileiras menores de cinco anos.

OBJECTIVE: To analyze the occurrence of racial and regional inequality in the temporal trend of the prevalence of stunting and overweight in Brazilian children under five years of age over the years 2008-2018. METHODS: An ecological time-series study with data from the Food and Nutrition Surveillance System on the prevalence of stunting and overweight in children under five years old according to race/skin color, region, and year. To assess differences between median prevalence per year of outcomes, the Kruskal-Wallis test was performed. Linear regression analyses were proposed to assess trends in the prevalence of outcomes over the years. RESULTS: In Brazil, black children tended to be overweight (ß=4.611; p=0.042). Among black children, there was an increase over the years in stunting in the Southeast (ß=3.960; p=0.014) and a decrease in the South (ß=-4.654; p=0.022). In Brazil and in most regions, the median prevalence of stunting was higher in black children than in white ones (12.86 vs. 11.54%, p<0.001). In the Southeast and South, black children also had the highest prevalence of overweight (15.48 and 15.99%, respectively). CONCLUSION: Children from less developed regions of Brazil and of black skin color/race were more vulnerable to a double burden of malnutrition.

OBJETIVO: Analisar a ocorrência de desigualdade racial e regional na tendência temporal das prevalências de déficit de estatura e excesso de peso de crianças brasileiras menores de cinco anos ao longo dos anos de 2008­2018. MÉTODOS: Estudo ecológico de série temporal com dados do Sistema de Vigilância Alimentar e Nutricional das prevalências de déficit de estatura e excesso de peso em crianças menores de 5 anos de acordo com raça/cor, região e ano. Para avaliar diferenças entre prevalências medianas por ano dos desfechos, realizou-se teste de Kruskal-Wallis. Análises de regressão linear foram propostas para avaliar tendências das prevalências dos desfechos ao longo dos anos. RESULTADOS: No Brasil, as crianças pretas apresentaram tendência de crescimento do excesso de peso (ß=4,611; p=0,042). Entre as crianças pretas, houve aumento ao longo dos anos do déficit de estatura no Sudeste (ß=3,960; p=0,014) e queda no Sul (ß=-4,654; p=0,022). No Brasil e na maioria das regiões, a prevalência mediana do déficit de estatura foi maior nas crianças pretas do que nas brancas (12,86 vs. 11,54%, p<0,001). No Sudeste e Sul, as crianças pretas também apresentaram as maiores prevalências de excesso de peso (15,48 e 15,99%, respectivamente). CONCLUSÃO: Crianças de regiões menos desenvolvidas do Brasil e pretas apresentaram maior vulnerabilidade para dupla carga de má nutrição.

Situação socioeconômica, tempo de tela e de permanência na escola e o consumo alimentar de crianças / Socioeconomic status, screen time, and time spent at school, and children's food consumption

Resumo Este estudo objetivou avaliar a associação de fatores sociodemográficos e estilo de vida com consumo de alimentos in natura ou minimamente processados (INMP), ultraprocessados (AUP) e frutas e hortaliças. Trata-se de estudo transversal com 403 crianças de 4 a 7 anos de uma coorte retrospectiva. Variáveis sociodemográficas e estilo de vida foram investigadas através do questionário sociodemográfico. O consumo alimentar foi avaliado por três registros alimentares. Empregaram-se análises de regressão linear bivariadas e multivariadas para analisar as associações. Crianças com menor renda apresentaram maior consumo de alimentos INMP e menor consumo de AUP. Menor tempo de permanência na escola associou-se ao menor consumo de alimentos INMP e maior consumo de AUP. Crianças com maior tempo de tela e com pais de menor escolaridade, consumiram menos frutas e hortaliças. Fatores sociodemográficos desfavoráveis se associaram ao melhor perfil de consumo de alimentos segundo o nível de processamento, exceto para frutas e hortaliças. O maior tempo de permanência na escola e menor tempo de tela contribuíram para uma alimentação mais saudável.

Abstract The present study aimed to evaluate the association of sociodemographic factors and lifestyle with the consumption of in natura or minimally processed (INMP) foods, ultra-processed foods (UPFs), and fruits and vegetables. This was a cross-sectional study conducted with 403 children, aged 4 to 7 years, from a retrospective cohort. Sociodemographic and lifestyle variables were investigated using a sociodemographic questionnaire. Food consumption was assessed by three food records. Bivariate and multivariate linear regression analyses were used to analyze associations. Children with lower income had a higher consumption of INMP foods and a lower consumption of UPFs. A shorter time spent at school was associated with a lower consumption of INMP foods and a higher consumption of UPFs. Children with more screen time and less educated parents consumed less fruits and vegetables. Unfavorable sociodemographic factors were associated with a better profile of food consumption according to the level of processing, except for fruits and vegetables. The longer time spent at school and a shorter screen time contributed to a healthier diet.

Metabolic syndrome and risk factors in children: a risk score proposal.

INTRODUCTION/OBJECTIVE: The lack of international consensus on the definition of Metabolic Syndrome (MS) in the pediatric population makes it difficult to estimate its prevalence. In this study, we intend to identify MS prevalence and a cutoff point based on a continuous score in children aged four to seven years. METHODS: A cross-sectional study of 402 children (4-7 years) monitored by the Lactation Support Program (PROLAC). A continuous MS risk score was assessed using Principal Component Analysis (PCA). In order to calculate the score, the following MS risk factors were considered: Waist circumference (WC), High Density Lipoprotein (HDL), Triglycerides (TG), Blood Pressure (BP) and Blood sugar. Using a Receiver Operating Characteristics (ROC) curve, the cutoff point for predicting MS risk based on continuous score was evaluated. RESULTS: A progressive increase in MS scores was observed according to increase in the number of risk factors. This increase was also observed when comparing boys and girls (p < 0.001). In the absence of MS, the median score among the children was -0.0486 (-0.2929-0.2151). For children with MS, the median score was 0.5237 (0.2286-0.7104) (p < 0.001). The best cutoff score for predicting MS in children aged four to five years was >0.09 (100% sensitivity and specificity 72.67%). For children aged six to seven years, this value was >0.14 (100% sensitivity and 64.65% specificity). CONCLUSION: The calculated continuous risk score can predict MS with good accuracy and high sensitivity and reasonable specificity.

Desigualdade racial e regional na tendência temporal do déficit de estatura e excesso de peso de crianças brasileiras menores de cinco anos / Racial and regional inequality in the temporal trend of stunting and excess weight in Brazilian children under five years of age

RESUMO Objetivo: Analisar a ocorrência de desigualdade racial e regional na tendência temporal das prevalências de déficit de estatura e excesso de peso de crianças brasileiras menores de cinco anos ao longo dos anos de 2008-2018. Métodos: Estudo ecológico de série temporal com dados do Sistema de Vigilância Alimentar e Nutricional das prevalências de déficit de estatura e excesso de peso em crianças menores de 5 anos de acordo com raça/cor, região e ano. Para avaliar diferenças entre prevalências medianas por ano dos desfechos, realizou-se teste de Kruskal-Wallis. Análises de regressão linear foram propostas para avaliar tendências das prevalências dos desfechos ao longo dos anos. Resultados: No Brasil, as crianças pretas apresentaram tendência de crescimento do excesso de peso (β=4,611; p=0,042). Entre as crianças pretas, houve aumento ao longo dos anos do déficit de estatura no Sudeste (β=3,960; p=0,014) e queda no Sul (β=-4,654; p=0,022). No Brasil e na maioria das regiões, a prevalência mediana do déficit de estatura foi maior nas crianças pretas do que nas brancas (12,86 vs. 11,54%, p<0,001). No Sudeste e Sul, as crianças pretas também apresentaram as maiores prevalências de excesso de peso (15,48 e 15,99%, respectivamente). Conclusão: Crianças de regiões menos desenvolvidas do Brasil e pretas apresentaram maior vulnerabilidade para dupla carga de má nutrição.

ABSTRACT Objective: To analyze the occurrence of racial and regional inequality in the temporal trend of the prevalence of stunting and overweight in Brazilian children under five years of age over the years 2008-2018. Methods: An ecological time-series study with data from the Food and Nutrition Surveillance System on the prevalence of stunting and overweight in children under five years old according to race/skin color, region, and year. To assess differences between median prevalence per year of outcomes, the Kruskal-Wallis test was performed. Linear regression analyses were proposed to assess trends in the prevalence of outcomes over the years. Results: In Brazil, black children tended to be overweight (β=4.611; p=0.042). Among black children, there was an increase over the years in stunting in the Southeast (β=3.960; p=0.014) and a decrease in the South (β=-4.654; p=0.022). In Brazil and in most regions, the median prevalence of stunting was higher in black children than in white ones (12.86 vs. 11.54%, p<0.001). In the Southeast and South, black children also had the highest prevalence of overweight (15.48 and 15.99%, respectively). Conclusion: Children from less developed regions of Brazil and of black skin color/race were more vulnerable to a double burden of malnutrition.

Birth weight and bone mineral density at 18-19 years: birth cohort 1997-1998 / Peso ao nascer e densidade mineral óssea aos 18-19 anos: coorte de nascimentos 1997-1998

ABSTRACT OBJECTIVE To analyze the association between birth weight and bone mineral density (BMD) in adolescence. METHODS A birth cohort study in São Luís, Maranhão, using data from two moments: at birth and at 18-19 years. Exposure was the birth weight in grams, continuously analyzed. The outcome was BMD, using the Z-score index (whole body) measured by double X-ray densitometry (Dexa). A theoretical model was constructed in acyclic graphs to identify the minimum set of adjustment variables - household income, the mother knowing how to read and write at the time of birth, prenatal care, tobacco use during pregnancy, and parity — to evaluate the association between birth weight and bone mineral density in adolescence. Multiple linear regression was used in Stata 14.0 software. A 5% significance level was adopted. RESULTS From 2,112 adolescents, 8.2% had low birth weight and 2.8% had a low BMD for their age. The mean full-body Z-score was 0.19 (± 1.00). The highest birth weight was directly and linearly associated with BMD values in adolescence (Coef.: 0.10; 95%CI: 0.02-0.18), even after adjustment for the variables household income (Coef.: -0.33; 95%CI: -0.66-0.33) and the mother knowing how to read and write (Coef.: 0.23%; 95%CI: 0.03-0.43). CONCLUSION Although after adjusting the variables the association attenuated, birth weight positively and linearly relates to BMD in adolescence.

RESUMO OBJETIVO Analisar a associação entre o peso ao nascer e a densidade mineral óssea (DMO) na adolescência. MÉTODOS Estudo de coorte de nascimentos em São Luís, Maranhão, utilizando dados de dois momentos: ao nascimento e aos 18-19 anos. A exposição foi o peso ao nascer em gramas, analisado de forma contínua. O desfecho foi a DMO, utilizando o índice Z-escore (corpo inteiro) medido pela densitometria por dupla emissão de raios X (DEXA). Foi construído modelo teórico em gráficos acíclicos direcionados para identificar o conjunto mínimo de variáveis de ajuste - renda familiar, a mãe saber ler e escrever à época do nascimento, realização de pré-natal, tabagismo durante a gestação e paridade - para avaliar a associação entre o peso ao nascer e a densidade mineral óssea na adolescência. Utilizou-se regressão linear múltipla no software Stata 14.0. O nível de significância adotado foi de 5%. RESULTADOS Dos 2.112 adolescentes, 8,2% apresentaram baixo peso ao nascer e 2,8% apresentaram DMO considerada baixa para a idade. O Z-escore médio de corpo inteiro foi de 0,19 (± 1,00). O maior peso ao nascer foi associado de forma linear e direta aos valores de DMO na adolescência (Coef.: 0,10; IC95% 0,02-0,18), mesmo após ajuste para as variáveis renda familiar (Coef.: -0,33; IC95% -0,66-0,33) e a mãe saber ler e escrever (Coef.: 0,23; IC95% 0,03-0,43). CONCLUSÕES Apesar de a associação ter sido atenuada após ajuste das variáveis, o peso ao nascer está associado de forma positiva e linear à DMO na adolescência.

Association between prepregnancy and newborn body mass index / Associação entre o índice de massa corporal pré-gestacional e o do recém-nascido

Abstract Objectives: to investigate the association between prepregnancy body mass index (BMI) and newborns' (NB) BMI. Methods: cohort study with 1,365 pregnant women and their newborns from the BRISA survey (Brazilian Ribeirão Preto and São Luís Birth Cohort Studies) in São Luís-MA. Prepregnancy BMI was self-reported, and newborns' BMI was estimated using the weight and length measured at birth. A directed acyclic graph (DAG) was developed to identify the adjustment variables. The association between the prepregnancy BMI and newborns' BMI were analyzed using multiple linear and Poisson regression with robust variance estimation. Results: NBs had 13.4±1.7kg/m2 average BMI at birth. In the linear analysis, we observed that as the prepregnancy BMI increases, the NBs BMI also increases (ß=0.07; CI95%=0.05-0.09;p<0.001). Newborns of mothers with prepregnancy overweight were 3.58 times more likely to be overweight. Conclusion: prepregnancy BMI can affect newborn's BMI early. Thus, women planning to become pregnant should consider conducting nutritional planning to maintain or obtain a healthy weight to minimize the risk of overweight for the newborn.

Resumo Objetivos: investigar a associação entre o Índice de Massa Corporal (IMC) pré-gestacional e o IMC do recém-nascido (RN). Métodos: estudo de coorte, com 1365 gestantes e seus RN, participantes da pesquisa BRISA (Brazilian Ribeirão Preto and São Luís Birth Cohort Studies) em São Luís-MA. O IMC pré-gestacional foi autorreferido e o IMC do RN foi calculado por meio do peso e comprimento aferidos na ocasião do nascimento. Foi elaborado um Gráfico Acíclico Direcionado (DAG)para identificaras variáveis de ajuste. A associação entre o IMC pré-gestacional e IMC do RN foram analisados por regressão linear múltipla e regressão de Poisson com estimativa robusta da variância. Resultados: os RN tiveram IMC ao nascer médio de 13,4 ± 1,7 kg/m2. Na análise linear, foi observada que à medida que o IMC pré-gestacional aumenta, o IMC do RN também aumenta (ß= 0,07; IC95%= 0,05 - 0,09; p<0.001). RN de mães com excesso de peso pré-gestacional tiveram risco 3,58 vezes maior de terem excesso de peso. Conclusão: o IMC pré-gestacional pode afetar precocemente o IMC do RN. Dessa forma, recomenda-se que mulheres que planejem engravidar considerem realizar um planejamento nutricional para a manutenção ou obtenção de um peso saudável, a fim de minimizar o risco de excesso de peso para o RN.

Ultra-processed food consumption is associated with increase in fat mass and decrease in lean mass in Brazilian women: A cohort study.

Objective: To investigate the association between ultra-processed food consumption at 23-25 years of age and measurements of body composition-fat mass, fat mass distribution and lean mass at 37-39 years of age in Brazilian adults. Methods: 1978/1979 birth cohort study conducted with healthy adults from Ribeirão Preto, São Paulo, Brazil. A total of 1,021 individuals participated in the fat mass analysis (measured by air displacement plethysmography) and 815 in the lean mass analysis and fat mass distribution (assessed by dual energy X-ray absorptiometry). Food consumption was evaluated by a food frequency questionnaire. Food items were grouped according to the level of processing as per the NOVA classification. Ultra-processed food consumption was expressed as a percentage of total daily intake (g/day). Linear regression models were used to estimate the effect of ultra-processed food consumption (g/day) on body mass index, body fat percentage, fat mass index, android fat, gynoid fat, android-gynoid fat ratio, lean mass percentage, lean mass index and appendicular lean mass index. Marginal plots were produced to visualize interactions. Results: The mean daily ultra-processed food consumption in grams was 35.8% (813.3 g). There was an association between ultra-processed food consumption and increase in body mass index, body fat percentage, fat mass index, android fat and gynoid fat and decrease in lean mass percentage, only in women. Conclusion: A high ultra-processed food consumption is associated with a long-term increase in fat mass and a decrease in lean mass in adult women.

Relationship between lifestyle and sociodemographic determinants and eating patterns among adults and the elderly: A population-based study

ABSTRACT Objective: To identify dietary patterns in an adult population and to verify the factors associated with them. Methods: We conducted a cross-sectional population-based household study with 1,574 individuals aged >20 years, of both sexes, living in Teresina and Picos, Piauí, Brazil. Sociodemographic, lifestyle and food consumption data were collected. Dietary patterns were obtained using principal component analysis. Results: There was a positive and significant association with the healthy eating pattern in women, elderly people, individuals with secondary and higher education and smokers. The white-meat pattern was positively associated with people without a partner and non-white skin, as well as with women, elderly people and smokers, and inversely with individuals with longer screen time and individuals with high school and college education. The unhealthy pattern was positively associated with individuals with excessive screen time and individuals with secondary and higher education, and inversely associated with individuals who were insufficiently active. Conclusion: Women, the elderly, individuals with a partner, non-smokers and active people have a healthier diet. However, men, smokers, with longer screen time and insufficiently active had a more inadequate diet, while the level of education showed contrasting results.

RESUMEN Objetivo: Identificar patrones dietéticos en una población de adultos y adultos mayoresy verificar los factores asociados a ellos. Métodos: Estudio transversal poblacional y domiciliario realizado en 1574 personas mayores de 20 años, de ambos sexos, residentes en Teresina y Picos, Piauí, Brasil. Se recogieron datos sociodemográficos, de estilo de vida y de consumo de alimentos. Los patrones dietéticos se obtuvieron mediante análisis de componentes principales. Resultados: Hubo asociación positiva y significativa con el patrón de alimentación saludable en mujeres, adultos mayores, individuos con educación secundaria y superior y fumadores. El patrón de carnes blancas se asoció positivamente con personas sin pareja y piel no blanca, así como con mujeres, personas mayores y fumadores, e inversamente con personas con mayor tiempo de pantalla y personas con educación secundaria y universitaria. El patrón insalubre se asoció positivamente con individuos con tiempo de pantalla excesivo y con individuos con educación secundaria y superior, y se asoció inversamente con individuos que eran insuficientemente activos. Conclusión: Las mujeres, los adultos mayores, las personas en pareja, los no fumadores y las personas activas tienen una dieta más saludable. Sin embargo, los hombres, fumadores, con mayor tiempo de pantalla e insuficientemente activos tenían una dieta más inadecuada, mientras que el nivel de educación mostró resultados contrastantes.

Are Fat Mass and Lean Mass Associated with Grip Strength in Adolescents?

Background: The interaction between lean body mass (LBM) and fat mass index (FMI) with grip strength (GS) has not been explored in the same analysis model in adolescents. This study thus aims to analyze the association between FMI and LBM with GS. Methods: This cross-sectional study was conducted with data from the 2016 follow-up of the 1997/98 Birth Cohort of São Luís. Grip strength was assessed by the Jamar Plus + dynamometer. The LBM and FMI indexes were assessed [ratio of the mass (lean or fat-kg) to height (m2)]. The confounding variables identified for the relationship between FMI and LBM with GS in the same analysis model, by directed acyclic graph (DAG), were sex, age, race, work, alcohol consumption, smoking, physical activity, and consumption of ultra-processed foods and culinary preparations, used in the adjusted analysis. Results: A total of 2339 adolescents (52.5% girls) were analyzed. The boys have a higher GS than the girls. In the adjusted analysis, with each increase of 1 kg/m2 in the FMI, GS was reduced by 0.72 kgf for boys and 0.35 kgf for girls. At each increase of 1 kg/m2 in the LBM, GS increased by 2.18 kgf for boys and 1.26 kgf for girls. Conclusions: FMI was associated with lower GS regardless of the LBM. LBM was associated with higher GS regardless of the FMI.

Sex-Dependent Effects of the Intake of NOVA Classified Ultra-Processed Foods on Syndrome Metabolic Components in Brazilian Adults.

Longitudinal studies evaluating the relationship between UPF consumption and the incidence of Metabolic Syndrome (MetS) and its components are still scarce. This study aimed to evaluate the effect of UPF consumption on the incidence of MetS and its components in adults. A prospective study was conducted with 896 participants from the 1978/79 Ribeirão Preto cohort, São Paulo, Brazil. UPF consumption was evaluated in %kcal and %g at ages 23-25 years. Incidence of MetS and its components were estimated at ages 37-39 years, according to the Joint Interim Statement criteria. Poisson regression was used to assess associations, and interactions with sex were investigated. UPF consumption had no association with MetS (%kcal Adjusted PR: 1.00; 95% CI: 0.99-1.01; %g Adjusted PR: 1.00; 95% CI: 0.99-1.01). However, women with higher UPF consumption, in %kcal and %g, had a higher risk of abdominal obesity (%kcal: p = 0.030; %g: p = 0.003); and women with higher UPF consumption, in %g, had a higher risk of low HDL-cholesterol (p = 0.041). For the other components of MetS, no significant associations were observed in either sex. These findings suggest evidence of no association between UPF consumption and MetS; however, consumption of UPF was associated with increased WC and low HDL-c, but only in women.

Cesarean section and body mass index in children: is there a causal effect?

Obesity is considered a global public health problem. Cesarean section has been associated with high body mass index (BMI) and increased obesity throughout life. However, this association has been challenged by some studies. This study aims to assess the causal effect of cesarean section on the BMI of children aged 1-3 years. This is a cohort study of 2,181 children aged 1-3 years, born in 2010, obtained from the BRISA Birth Cohort, in São Luís, state of Maranhão, Brazil. Sociodemographic variables, maternal characteristics, type of childbirth, morbidity, anthropometric measurements, and BMI were assessed. Marginal structural models with a counterfactual approach were used to check the causal effect of the type of childbirth on obesity, weighted by the inverse probability of selection and exposure. Out of the 2,181 children assessed (52% female), 50.6% were born by cesarean section, 5.9% of the newborn infants were large for gestational age, and 10.7% of them had excess weight. No causal effect of cesarean section on BMI was observed (coefficient = -0.004; 95%CI: -0.136; 0.127; p = 0.948). Cesarean section did not have a causal effect on the BMI of children aged 1-3 years.