Development and Validation of Protocol Based on Brazilian Dietary Guidelines for Adults with Diabetes Mellitus Who Attended Primary Health Care.

BACKGROUND: To date, there is no protocol providing dietary guidelines to assist health care professionals in counseling Brazilian individuals with Diabetes Mellitus (DM) assisted in primary health care (PHC) according to the Dietary Guidelines for the Brazilian Population (DGBP). Therefore, this study aimed to develop and validate a protocol based on the DGBP for health care, non-nutritionist professionals in counseling adults with DM in PHC. METHODS: We systematized the recommendations published in the DGBP, the Diabetes Brazilian Society guidelines, and the scientific literature regarding food and nutrition needs of adults with DM. The clarity and relevance were validated by an expert panel (n = 19) and the understanding and applicability were validated by PHC professionals (n = 12). The degree of agreement of the experts was assessed using a Content Validity Index (CVI). Items receiving CVI > 0.8 were considered appropriate. RESULTS: The protocol consisted of six dietary recommendations that encouraged the daily consumption of beans, vegetables, and fruits, advised the avoidance of sugar-sweetened beverages and ultra-processed foods, stimulated eating in appropriate environments, and gave additional guidance addressed to the particularities of DM. The protocol clarity, relevance, and applicability were successfully validated. CONCLUSION: The protocol supports health care, non-nutritionist professionals in the guidance of dietary recommendations and promoting adequate and healthy eating habits for adults with DM in PHC.

Food Insecurity and Micronutrient Deficiency in Adults: A Systematic Review and Meta-Analysis.

Food insecurity is a public health problem as it affects a wide array of individuals in the population. It can be characterized by food deprivation, lack of essential nutrition, lack of dietary education, lack of adequate storage conditions, poor absorption, and poor overall nutrition. The relationship between food insecurity and micronutrient deficiency requires more effort to deepen and discuss the relationship. This systematic review aimed to evaluate the association between food insecurity and micronutrient deficiency in adults. The research was conducted according to PRISMA using the Medline/Pubmed, Lilacs/BVS, Embase, Web of Science, and Cinahl databases. Studies carried out with male and female adults were included, which investigated the correlation or association between food insecurity and the nutritional status of micronutrients. There were no publication year, country, or language restrictions. A total of 1148 articles were found, and 18 of these were included, carried out mainly on the American continent and with women. The most evaluated micronutrients were iron and vitamin A. Food insecurity was associated with nutrient deficiency in 89% (n = 16) of the studies. As a result of the meta-analysis, it was observed that there is a greater chance of anemia and low levels of ferritin among food insecure individuals. It is concluded that food insecurity is associated with micronutrient deficiency. Understanding these problems allows the creation of public policies capable of contributing to changes. Protocol registration: This review was registered on the PROSPERO-International Prospective Register of Systematic Reviews database-CRD42021257443.

Body Fat Is Superior to Body Mass Index in Predicting Cardiometabolic Risk Factors in Adolescents.

BACKGROUND: Excess adiposity is one of the main risk factors for the development of cardiovascular and metabolic diseases. The purpose of this study is to compare cardiometabolic risk factors in eutrophic adolescents with a high body fat percentage (%BF) with eutrophic adolescents with adequate %BF and those with excess weight and %BF. METHODS: Cross-sectional study with 1043 adolescents. This study presented power equal to 99.75%. Body fat and anthropometric, clinical and biochemical indicators were evaluated. Participants were grouped according to body composition classified by body mass index (BMI) and body fat percentage. Statistical analyses were performed using R software version 4.0.2, adopting a significance level of 5%. The Mann-Whitney test, principal components analysis and logistic regression were performed. RESULTS: It was observed that the SG was more similar to GC2 than to GC1 for both sexes, demonstrating that there was a greater similarity between these groups in relation to the evaluated factors. Higher values for TC, SBP and TG were associated with the SG when the CG1 was used as reference, controlled for sex and age. Likewise, higher TC values and lower levels of SBP, TG and LDL were related to SG when the CG2 was used as reference. CONCLUSION: Body fat assessment is more effective in predicting risk factors and cardiometabolic diseases than BMI alone.

Vitamin A deficiency and associated risk factors in children aged 12-59 months living in poorest municipalities in the South Region of Brazil.

OBJECTIVE: To estimate the prevalence of vitamin A deficiency (VAD) in children and associated risk factors. DESIGN: Analysis of data from a cross-sectional multicentre study performed in the primary care units of the municipalities from January to June 2015. The children's legal guardians answered a socio-economic questionnaire, and the children's blood samples were obtained by venipuncture. Plasma retinol was determined by HPLC. Plasma retinol values of <0·70 µmol/l were considered VDA. Poisson multiple regression with robust variance was used. Values of P < 0·05 were considered significant. The data were analysed in the SPSS software, 21.0. SETTING: Forty-eight poorest municipalities in the South Region of Brazil. PARTICIPANTS: Children (n 1503) aged 12-59 months. RESULTS: The prevalence of VAD in the sample was 1·9 % (95 % CI (0·5, 6·8)). The following risk factors were associated with the outcome in the final explanatory model: family received Bolsa Familia program benefits (PR = 3·19; 95 % CI (1·69, 6·02)), child was not being breastfed (PR = 5·22; 95 % CI (1·68, 16·18)) and stunting (PR = 4·75; 95 % CI (2·10, 10·73)). CONCLUSIONS: VAD did not represent a public health problem for children living in socio-economically vulnerable municipalities in the South Region of Brazil, suggesting a new panorama of this nutritional deficiency even in regions of low socio-economic conditions in these three states. Thus, in view of the current nutritional transition scenario, it is necessary to continuously monitor and improve public policies related to vitamin A supplementation in the country.

Weight misperception and substance use: Brazilian Study of Cardiovascular Risks in Adolescents (ERICA).

BACKGROUND: Adolescence is a crucial period for body image formation. Weight misperception is the discrepancy between individuals' body weight perception and their actual nutritional status. Both weight concerns and substance use are common among adolescents, and there is evidence of an associations between these two variables. Thus, the aim of this study was to assess the association between weight misperception and substance use (smoking and alcohol) in a national sample of normal weight Brazilian adolescents. METHODS: Data were obtained from the Brazilian Study of Cardiovascular Risks in Adolescents (ERICA), a cross-sectional, multicenter, national, school-based survey, carried out in 124 municipalities with more than 100,000 inhabitants from Brazil. The sample included adolescents aged 12-17 years, classified as normal weight by nutritional status evaluation. The following measures were collected: weight underestimation and overestimation (exposure); having tried cigarette smoking, current smoking, current alcohol consumption, binge drinking and current smoking and alcohol consumption(outcomes); macro-region, sex, type of school, and excessive screen time (confounders). The frequency of variables was calculated with 95% confidence intervals (CI). Poisson regression models were used to estimate prevalence ratios (PR). RESULTS: In total, data from 53,447 adolescents were analyzed. Weight misperception was present in a third of the adolescents, with similar prevalence of weight underestimation and overestimation. In adolescents aged 12-14 years, weight underestimation and overestimation were associated with having tried cigarette smoking (PR: 1.18 and 1.43, respectively), current alcohol consumption (PR: 1.33 for both weight misperception categories), and binge drinking (PR: 1.96 and 2.01, respectively). Weight underestimation was associated with both having tried cigarette smoking and current alcohol consumption in boys (PR: 1.14 and 1.16, respectively) and girls (PR: 1.32 and 1.15, respectively). In girls, weight overestimation was associated with all substance use variables (PR between 1.19 and 1.41). CONCLUSIONS: Our results showed an association between weight misperception and having tried cigarette smoking, alcohol consumption, and binge drinking in younger adolescents. In addition, weight overestimation was associated with all substance use indicators in girls. Based on our findings, interventions aimed to improve weight perception in normal weight adolescents may contribute to the reduction of substance use in this population.

School Feeding as a Protective Factor against Insulin Resistance: The Study of Cardiovascular Risks in Adolescents (ERICA).

The objective of this study was to use ERICA data from adolescents from Brazilian public schools to investigate the role of school feeding in insulin resistance markers. Public school students (12-17 years old) with available biochemical examinations were selected. Adolescents answered a self-administered questionnaire, and contextual characteristics were obtained through interviews with principals. A multilevel mixed-effects generalized linear model was performed at the contextual and individual levels with each insulin resistance marker (fasting insulin, HOMA-IR, and blood glucose levels). A total of 27,990 adolescents were evaluated (50.2% female). The prevalence of (1) altered insulin was 12.2% (95% CI; 11.1, 13.5), (2) high HOMA-IR was 24.7% (95% CI; 22.8, 26.7), and (3) high blood glucose was 4.6% (95% CI; 3.8, 5.4). School feeding was positively associated with an insulin resistance marker, decreasing by 0.135 units of HOMA-IR (95% CI; -0.19, -0.08), 0.469 µU/L of insulin levels (95% CI; -0.66, -0.28), and 0.634 mg/dL of blood glucose (95% CI; -0.87, -0.39). In turn, buying food increased blood glucose by 0.455 mg/dL (95% CI; 0.16, 0.75). School feeding was positively associated with insulin resistance variables, demonstrating the potential of planned meals in the school environment to serve as a health promoter for the adolescent population.

Effect of physical exercise on muscle strength in adults following bariatric surgery: A systematic review and meta-analysis of different muscle strength assessment tests.

Individuals following bariatric surgery are considered at high risk for the development of sarcopenic obesity (excess fat mass, low muscle mass and low physical function), and exercise may play an important role in its prevention and treatment. We systematically reviewed 5 scientific databases (Embase, Medline, Scopus, SPORTDiscus, and Web of Science) and 2 grey literature databases (ProQuest and Google Scholar) for clinical trials that evaluated the effect of exercise on muscle strength in adults following bariatric surgery and conducted a separate meta-analysis for studies that used different muscle strength tests. Random-effect models, restricted maximum likelihood method and Hedges' g were used. The review protocol was registered at the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42020152142). Fifteen studies were included (638 patients), none had a low risk of bias, and all were included in at least 1 of the 5 meta-analyses (repetition maximum [lower and upper limbs], sit-to-stand, dynamometer, and handgrip tests). Exercise interventions improved both upper (effect size, 0.71; 95% CI, 0.41-1.01; I2 = 0%) and lower (effect size, 1.37; 95% CI, 0.84-1.91; I2 = 46.14) limb muscle strength, as measured by repetition maximum tests. Results were similar for the sit-to-stand (effect size, 0.60; 95% CI, 0.20-1.01; I2 = 68.89%) and dynamometer (effect size, 0.46; 95% CI, 0.06-0.87; I2 = 31.03%), but not for the handgrip test (effect size, 0.11; 95% CI, -0.42-0.63; I2 = 73.27%). However, the certainty level of the meta-analyses was very low. Exercise with a resistance training component performed post bariatric surgery may improve muscle strength, which is related to sarcopenic obesity, functional capacity, and mortality risk, therefore should be included in the follow-up.

Hipertensão Arterial e Parâmetros Lipídicos, Glicídicos e de Adiposidade Associados em Adolescentes Escolares do Distrito Federal / Hypertension and Associated Lipid, Glucose, and Adiposity Parameters in School-Aged Adolescents in the Federal District, Brazil

Resumo Fundamento A prevalência de hipertensão arterial sistêmica (HAS) e de outros distúrbios metabólicos tem aumentado em indivíduos jovens. Entretanto, não há estudos representativos sobre esse assunto com a população do Distrito Federal (DF). Objetivo Estimar a prevalência de HAS e a sua associação com parâmetros lipídicos, glicídicos e de adiposidade em adolescentes do DF. Métodos Trata-se de um estudo observacional transversal com participantes do Estudo de Riscos Cardiovasculares em Adolescentes (ERICA). Foram avaliados pressão arterial, glicemia sanguínea, hemoglobina glicada, insulina, modelo de avaliação da homeostase da resistência à insulina (HOMA-IR), triglicerídeos, colesterol total, lipoproteína de alta densidade, lipoproteína de baixa densidade, índice de massa corporal (IMC) e perímetro da cintura, além de variáveis econômicas, demográficas e de maturação sexual. A análise de dados foi feita no software Stata e foi dividida nas seguintes etapas: análises descritiva, bruta e ajustada. Considerou-se p < 0,05. Resultados Foram incluídos 1.200 adolescentes com média de idade de 14,8 anos. A prevalência de HAS foi de 8% (intervalo de confiança de 95%: 6,3; 9,9). A maioria dos parâmetros se associou com a PA na análise bruta; na ajustada, os parâmetros glicídicos, lipídicos e de adiposidade mantiveram a associação, tendo IMC e HOMA-IR a maior magnitude na relação. Conclusão O estudo revelou elevada prevalência de HAS em adolescentes do DF, e os níveis pressóricos apresentaram-se associados a outros marcadores de perfil lipídico, glicídico e de adiposidade, evidenciando a relevância da vigilância em saúde para o planejamento de ações efetivas para a reversão do quadro e prevenção de novos casos.

Abstract Background The prevalence of hypertension and other metabolic disorders has increased in young individuals. However, no representative studies have been conducted in the population of the Federal District, Brazil. Objective To estimate the prevalence of hypertension and its association with lipid, glucose, and adiposity markers in school-aged adolescents living in the Federal District. Methods This cross-sectional study included participants of the Study of Cardiovascular Risks in Adolescents (Portuguese acronym, ERICA). Blood pressure, blood glucose, glycated hemoglobin, insulin, homeostatic model assessment for insulin resistance (HOMA-IR), triglycerides, total cholesterol, high-density lipoprotein, low-density lipoprotein, body mass index (BMI), waist circumference, and economic, demographic, and sexual maturity variables were assessed. The data were analyzed in Stata, and the analysis was divided into different stages: descriptive, crude, and adjusted. Significant results were set at p < 0.05. Results In total, 1,200 adolescents were included, and their mean age was 14.8 years. The prevalence of hypertension was 8% (95% confidence interval: 6.3; 9.9). Most parameters were associated with blood pressure in crude analysis. In adjusted analysis, glucose, lipid, and adiposity markers maintained the associations, and the highest magnitudes were those of BMI and HOMA-IR. Conclusion The study revealed a high prevalence of hypertension in adolescents living in the Federal District, and blood pressure levels were associated with other markers of lipid, glucose, and adiposity profile. The findings indicate the relevance of health surveillance for planning effective actions aimed at reversing this situation and preventing new cases.

Hypertension and Associated Lipid, Glucose, and Adiposity Parameters in School-Aged Adolescents in the Federal District, Brazil. / Hipertensão Arterial e Parâmetros Lipídicos, Glicídicos e de Adiposidade Associados em Adolescentes Escolares do Distrito Federal.

BACKGROUND: The prevalence of hypertension and other metabolic disorders has increased in young individuals. However, no representative studies have been conducted in the population of the Federal District, Brazil. OBJECTIVE: To estimate the prevalence of hypertension and its association with lipid, glucose, and adiposity markers in school-aged adolescents living in the Federal District. METHODS: This cross-sectional study included participants of the Study of Cardiovascular Risks in Adolescents (Portuguese acronym, ERICA). Blood pressure, blood glucose, glycated hemoglobin, insulin, homeostatic model assessment for insulin resistance (HOMA-IR), triglycerides, total cholesterol, high-density lipoprotein, low-density lipoprotein, body mass index (BMI), waist circumference, and economic, demographic, and sexual maturity variables were assessed. The data were analyzed in Stata, and the analysis was divided into different stages: descriptive, crude, and adjusted. Significant results were set at p < 0.05. RESULTS: In total, 1,200 adolescents were included, and their mean age was 14.8 years. The prevalence of hypertension was 8% (95% confidence interval: 6.3; 9.9). Most parameters were associated with blood pressure in crude analysis. In adjusted analysis, glucose, lipid, and adiposity markers maintained the associations, and the highest magnitudes were those of BMI and HOMA-IR. CONCLUSION: The study revealed a high prevalence of hypertension in adolescents living in the Federal District, and blood pressure levels were associated with other markers of lipid, glucose, and adiposity profile. The findings indicate the relevance of health surveillance for planning effective actions aimed at reversing this situation and preventing new cases.

FUNDAMENTO: A prevalência de hipertensão arterial sistêmica (HAS) e de outros distúrbios metabólicos tem aumentado em indivíduos jovens. Entretanto, não há estudos representativos sobre esse assunto com a população do Distrito Federal (DF). OBJETIVO: Estimar a prevalência de HAS e a sua associação com parâmetros lipídicos, glicídicos e de adiposidade em adolescentes do DF. MÉTODOS: Trata-se de um estudo observacional transversal com participantes do Estudo de Riscos Cardiovasculares em Adolescentes (ERICA). Foram avaliados pressão arterial, glicemia sanguínea, hemoglobina glicada, insulina, modelo de avaliação da homeostase da resistência à insulina (HOMA-IR), triglicerídeos, colesterol total, lipoproteína de alta densidade, lipoproteína de baixa densidade, índice de massa corporal (IMC) e perímetro da cintura, além de variáveis econômicas, demográficas e de maturação sexual. A análise de dados foi feita no software Stata e foi dividida nas seguintes etapas: análises descritiva, bruta e ajustada. Considerou-se p < 0,05. RESULTADOS: Foram incluídos 1.200 adolescentes com média de idade de 14,8 anos. A prevalência de HAS foi de 8% (intervalo de confiança de 95%: 6,3; 9,9). A maioria dos parâmetros se associou com a PA na análise bruta; na ajustada, os parâmetros glicídicos, lipídicos e de adiposidade mantiveram a associação, tendo IMC e HOMA-IR a maior magnitude na relação. CONCLUSÃO: O estudo revelou elevada prevalência de HAS em adolescentes do DF, e os níveis pressóricos apresentaram-se associados a outros marcadores de perfil lipídico, glicídico e de adiposidade, evidenciando a relevância da vigilância em saúde para o planejamento de ações efetivas para a reversão do quadro e prevenção de novos casos.

Individual and Socioeconomic Contextual Factors Associated with Obesity in Brazilian Adolescents: VigiNUTRI Brasil.

This study investigated the association of socioeconomic contextual factors of the municipality of residence of adolescents, their eating behavior and food consumption with the prevalence of obesity. This was a cross-sectional study, based on individual data regarding anthropometry, eating behavior (eating in front of screens and having at least three main meals a day), and markers of healthy and unhealthy eating of 23,509 adolescents aged 10 to 19 years, participating in the Food and Nutrition Surveillance of the Brazilian Population monitored in Primary Health Care (VigiNUTRI Brasil) assessment in 2018. Based on multilevel Poisson regression, a higher prevalence of obesity was observed among adolescents living in municipalities with per capita income above USD209.68 (PR = 1.22; 95% CI 1.05;1.42) and among those who consumed hamburgers and/or processed meats the previous day (PR = 1.09; 95% CI 1.01;1.17). Adolescents who had the habit of having three main meals a day (PR = 0.81; 95% CI 0.73;0.89 p < 0.05) and who consumed fresh fruit the previous day (PR = 0.91; 95% CI 0.84;0.98 p < 0.001) had lower prevalence of obesity. The results reinforce the influence of the social context and food consumption on obesity rates. The persistence of this situation implies a worsening in the current and future health of adolescents.

Effects of Bifidobacterium animalis subspecies lactis supplementation on gastrointestinal symptoms: systematic review with meta-analysis.

CONTEXT: The effects of probiotics on gastrointestinal (GI) symptoms have been increasingly investigated, particularly that of Bifidobacterium animalis. Clinical trials so far have shown differing evidence regarding these effects in healthy adults. OBJECTIVE: To synthesize the published evidence on the effects of B. animalis subspecies lactis on GI symptoms (GIS) in healthy adults. DATA SOURCE: A search of the Medline, Embase, Lilacs, Scopus, Web of Science, ProQuest, and Google Scholar databases was conducted for reports on randomized controlled trials published up to October 2021. DATA EXTRACTION: Population characteristics and data on colonic transit time (CTT), stool consistency, defecation frequency, abdominal pain, bloating, flatulence, volunteer compliance, and adverse events were extracted. A random-effects model was used to estimate the effect of probiotic treatment on these variables. DATA SYNTHESIS: In total, 1551 studies were identified, of which 14 were included in the qualitative synthesis and 13 in the meta-analysis. Overall, probiotic supplementation increased defecation frequency (standardized mean difference [SMD], 0.26; 95%CI, 0.13-0.39). Subgroup analysis revealed a decrease in CTT (SMD, -0.34; 95%CI, -0.62 to -0.07) in short-term treatment (≤14 d) and an improvement in stool consistency (SMD, 0.76; 95%CI, 0.44-1.08) in individuals without GIS. No improvement in abdominal pain and bloating was found. CONCLUSIONS: B. animalis subspecies lactis supplementation may increase defecation frequency and, in short-term treatment, may reduce CTT in healthy adults and improve stool consistency in individuals without GIS. More high-quality randomized controlled trials are needed to develop a clinical protocol for the use of this strain to improve these symptoms. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration no. CRD42020154060.

Physical activity and quality of life among college students without comorbidities for cardiometabolic diseases: systematic review and meta-analysis.

PURPOSE: To systematically review studies on the relationship between physical activity (PA) and quality of life (QOL) in university students without comorbidities for cardiometabolic diseases from around the world. METHODS: We included observational studies with university students of both sexes, from public or private institutions, and that investigated the association or correlation between physical activity and quality of life among these students, without delimitation of date, language, or location. Reviews, letters to the editors, studies with qualitative methodologies, case studies, book chapters, articles with college students who had some specific disease or condition, such as obesity, diabetes, and others; studies with children of parents with chronic diseases, and those that were institutions aimed only at very specific populations, were excluded. Meta-analysis was calculated. RESULTS: Thirty studies, consisting of 19,731 students, were included. The most commonly used instruments to assess the quality of life of the university population were the Quality of Life Questionnaire-short version (WHOQOL-BREF), and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). The International Physical Activity Questionnaire (IPAQ) was the most commonly used instrument to assess PA. For the meta-analysis, 22 studies were included. Weak but positive correlations were found between PA and the QOL domains: physical health (0.16. 95% CI 0.11 0.22; I2 = 99.96%); mental health (0.14; 95% CI 0.07-0.20; I2 = 99.97%); social relations (0.24, 95% CI 0.08-0. 38; I2 = 99.99%); environment (0.23, 95% CI 0.14-0.32; I2 = 99.90%); vitality (0.17. 95% CI 0.15-0.20; I2 = 99.49%) pain (0.02. 95% CI - 0.02 to 0.12; I2 = 99.96%); QOL and PA (0.21, 95% CI 0.08-0.34; I2 = 99.99%).An association of R = 0.60 (95% CI 0.25-0.95; I2 = 85.61%) was found between QOL and PA in total. CONCLUSION: The results of our study showed a weak but positive relationship between physical activity and overall quality of life in college students, and also between PA and the domains of QL: physical health, social relationships, mental health, environment, and vitality, in this same population. It is important to study this population, since risk behaviors in this phase tend to perpetuate in the other phases of life.

Association between body weight misperception and dietary patterns in Brazilian adolescents: Cross-sectional study using ERICA data.

The association between body image and eating behaviors or weight control strategies has been demonstrated in the scientific literature, but there is a lack of evidence on the association between weight misperception and food consumption indicators in adolescents. This study aimed to evaluate the association between weight misperception and dietary patterns (DPs) in the Brazilian Study of Cardiovascular Risks in Adolescents (ERICA). It was a national school-based cross-sectional study conducted among students aged 12-17 years. Data were collected in the form of anthropometric measurements, responses in self-answered questionnaires, and 24-h dietary recall. The following variables were assessed: weight underestimation and overestimation (independent variables), which were defined as the presence of a disagreement between nutritional status and self-perceived weight; dietary patterns (dependent variables), defined by a posteriori method using principal component factor analysis; and individual and demographic variables (covariates). Data analysis was performed using the Poisson regression models method, stratified by sex. A total of 52,038 adolescents with normal weights were evaluated. The weight misperception prevalence was 34.0% (95% confidence interval [CI]: 33.0, 35.0). Three DPs were identified: "Traditional Brazilian," "Processed meat sandwiches and coffee," and "Ultra-processed and sweet foods." In girls, weight underestimation was directly associated with the "Traditional Brazilian" (1.24; 95% CI: 1.08, 1.43) and "Ultra-processed and sweet foods" DPs (1.29; 95% CI: 1.09, 1.54), and overestimation was inversely associated with all the DPs. In boys, a direct association between underestimation and the "Ultra-processed and sweet foods" DP (1.29; 95% CI: 1.10, 1.51) was found. Overestimation was inversely associated with the "Traditional Brazilian" DP (0.79; 95% CI: 0.63, 0.99). The inverse association between overestimation and the "Traditional Brazilian" DP, and the direct association between underestimation and the "Ultra-processed and sweet foods" DP indicated that weight misperception was related to unhealthy eating habits in Brazilian adolescents.

Individual and contextual predictors of children's hemoglobin levels from Southern Brazilian municipalities in social vulnerability.

Few studies have investigated the simultaneous effect of individual and contextual factors on the occurrences of anemia. This study aims to evaluate the variability of children's hemoglobin levels from municipalities in social vulnerability and its association with factors of individual and municipal nature. This is a cross-sectional, multi-center study, with children data (12-59 months) collected from 48 municipalities of the Southern region of Brazil, that were included in the Brazil Without Poverty Plan. Individuals' data were collected using a structured questionnaire, and secondary and ecological data of children's municipalities were collected via national surveys and institutional websites. The outcome was defined as the hemoglobin level obtained by HemoCue. A multilevel analysis was performed using Generalized Linear Models for Location Scale and Shape using R, with a 5% significance level. A total of 1,501 children were evaluated. The mean hemoglobin level was 12.8g/dL (95%CI: 12.7-12.8), with significant variability between municipalities. Lower values of hemoglobin were observed in children who lived in municipalities with a higher urbanization rate and a lower number of Community Health Agents, in relation to the reference categories. At the individual level, lower hemoglobin values were identified for children under 24 months, not enrolled at daycares, who were beneficiaries of the conditional cash transfer program and diagnosed with underweight. The results shed light on important factors at the municipal and the individual levels that were associated to the hemoglobin levels of children living in municipalities in social vulnerability.

EXCLUSIVE BREASTFEEDING AND UNDERWEIGHT IN CHILDREN UNDER SIX MONTHS OLD MONITORED IN PRIMARY HEALTH CARE IN BRAZIL, 2017.

OBJECTIVE: To describe the prevalence of underweight and exclusive breastfeeding (EBF) in children aged zero to six months followed by Primary Care in Brazil in 2017, identifying their spatial distribution. METHODS: This was an observational, descriptive and ecological study based on data analysis of the Food and Nutrition Surveillance System. The distribution of records obtained was compared to the population estimates of the Brazilian Institute of Geography and Statistics (IBGE). In order to evaluate the EBF, Primary Health Care teams used food ingestion from the previous day. As for underweight, we used: Length-for-age (L/A), Weight-for-age (W/A) and BMI-for-age (BMI/A), according to World Health Organization (WHO) references. Confidence Intervals were calculated 95% (95%CI) for prevalences obtained, being plotted on maps by Federation Unit. RESULTS: Data were obtained from 88.7 and 32.2% of Brazilian municipalities regarding anthropometry and food consumption, corresponding to 167,393 and 66,136 children, respectively. Compared to population distribution, the number of records was underestimated in the North and Northeast for anthropometry/consumption, with distinct proportions in the South for anthropometry and Southeast for consumption. The prevalences found were: EBF - 56.6% (95%CI 56.2-56.9); under L/A - 10.6% (95%CI 10.5-10.8); under W/A - 9.0% (95%CI 8.9-9.1); and under BMI/A - 5.8% (95%CI 5.7-6.0). CONCLUSIONS: The estimate of EBF in Brazil was similar to previous studies, but food consumption data still have low coverage, compromising the estimate in some locations. Regarding anthropometry, high rates of low L/A, W/A and BMI/A stood out in some states, considerably above the previous national estimate.

Exclusive breastfeeding and underweight in children under six months old monitored in primary health care in brazil, 2017 / Aleitamento materno exclusivo e baixo peso em crianças de zero a seis meses acompanhadas na atenção básica no brasil, 2017

ABSTRACT Objective: To describe the prevalence of underweight and exclusive breastfeeding (EBF) in children aged zero to six months followed by Primary Care in Brazil in 2017, identifying their spatial distribution. Methods: This was an observational, descriptive and ecological study based on data analysis of the Food and Nutrition Surveillance System. The distribution of records obtained was compared to the population estimates of the Brazilian Institute of Geography and Statistics (IBGE). In order to evaluate the EBF, Primary Health Care teams used food ingestion from the previous day. As for underweight, we used: Length-for-age (L/A), Weight-for-age (W/A) and BMI-for-age (BMI/A), according to World Health Organization (WHO) references. Confidence Intervals were calculated 95% (95%CI) for prevalences obtained, being plotted on maps by Federation Unit. Results: Data were obtained from 88.7 and 32.2% of Brazilian municipalities regarding anthropometry and food consumption, corresponding to 167,393 and 66,136 children, respectively. Compared to population distribution, the number of records was underestimated in the North and Northeast for anthropometry/consumption, with distinct proportions in the South for anthropometry and Southeast for consumption. The prevalences found were: EBF - 56.6% (95%CI 56.2-56.9); under L/A - 10.6% (95%CI 10.5-10.8); under W/A - 9.0% (95%CI 8.9-9.1); and under BMI/A - 5.8% (95%CI 5.7-6.0). Conclusions: The estimate of EBF in Brazil was similar to previous studies, but food consumption data still have low coverage, compromising the estimate in some locations. Regarding anthropometry, high rates of low L/A, W/A and BMI/A stood out in some states, considerably above the previous national estimate.

RESUMO Objetivo: Descrever as prevalências de baixo peso e aleitamento materno exclusivo (AME) em crianças de zero a seis meses acompanhadas na Atenção Básica no Brasil em 2017, identificando sua distribuição espacial. Métodos: Tratou-se de um estudo observacional, descritivo e ecológico a partir da análise de dados do Sistema de Vigilância Alimentar e Nutricional. A distribuição de registros obtidos foi comparada às estimativas populacionais do Instituto Brasileiro de Geografia e Estatística (IBGE). Para avaliação do AME, equipes da Atenção Básica utilizaram marcadores de consumo alimentar do dia anterior. Quanto ao baixo peso, usou-se: estatura/idade (E/I), peso/idade (P/I) e índice de massa corpórea (IMC)/idade (IMC/I), conforme referências da Organização Mundial da Saúde (OMS). Foram calculados os intervalos de confiança de 95% (IC95%) para prevalências obtidas, sendo plotadas em mapas, por Unidade da Federação (UF). Resultados: Obteve-se dados de 88,7 e 32,2% dos municípios brasileiros em relação à antropometria e ao consumo alimentar, correspondendo a 167.393 e 66.136 crianças, respectivamente. Em comparação à distribuição populacional, o número de registros esteve subestimado nas regiões Norte e Nordeste para antropometria/consumo e com proporções distintas na região Sul para antropometria e na região Sudeste para consumo. As prevalências encontradas foram: AME - 56,6% (IC95% 56,2-56,9); baixa E/I - 10,6% (IC95% 10,5-10,8); baixo P/I - 9,0% (IC95% 8,9-9,1); e baixo IMC/I - 5,8% (IC95% 5,7-6,0). Conclusões: A estimativa de AME no Brasil aproximou-se de estudos anteriores, mas dados de consumo alimentar ainda possuem baixa cobertura, comprometendo a estimativa em algumas localidades. Referente à antropometria, destacaram-se elevadas taxas de baixos E/I, P/I e IMC/I em alguns Estados, consideravelmente acima da estimativa nacional anterior.

Common mental disorders prevalence in adolescents: A systematic review and meta-analyses.

An increasing number of original studies suggest the relevance of assessing mental health; however, there has been a lack of knowledge about the magnitude of Common Mental Disorders (CMD) in adolescents worldwide. This study aimed to estimate the prevalence of CMD in adolescents, from the General Health Questionnaire (GHQ-12). Only studies composed by adolescents (10 to 19 years old) that evaluated the CMD prevalence according to the GHQ-12 were considered. The studies were searched in Medline, Embase, Scopus, Web of Science, Lilacs, Adolec, Google Scholar, PsycINFO and Proquest. In addition, the reference lists of relevant reports were screened to identify potentially eligible articles. Studies were selected by independent reviewers, who also extracted data and assessed risk of bias. Meta-analyses were performed to summarize the prevalence of CMD and estimate heterogeneity across studies. A total of 43 studies were included. Among studies that adopted the cut-off point of 3, the prevalence of CMD was 31.0% (CI 95% 28.0-34.0; I2 = 97.5%) and was more prevalent among girls. In studies that used the cut-off point of 4, the prevalence of CMD was 25.0% (CI 95% 19.0-32.0; I2 = 99.8%). Global prevalence of CMD in adolescents was 25.0% and 31.0%, using the GHQ cut-off point of 4 and 3, respectively. These results point to the need to include mental health as an important component of health in adolescence and to the need to include CMD screening as a first step in the prevention and control of mental disorders.

Individual and contextual predictors of children's hemoglobin levels from Southern Brazilian municipalities in social vulnerability / Preditores individuais e contextuais dos níveis de hemoglobina em crianças de municípios do Sul do Brasil com vulnerabilidade social / Predictores individuales y contextuales de los niveles de hemoglobina en niños socialmente vulnerables de municipios del Sur de Brasil

Abstract: Few studies have investigated the simultaneous effect of individual and contextual factors on the occurrences of anemia. This study aims to evaluate the variability of children's hemoglobin levels from municipalities in social vulnerability and its association with factors of individual and municipal nature. This is a cross-sectional, multi-center study, with children data (12-59 months) collected from 48 municipalities of the Southern region of Brazil, that were included in the Brazil Without Poverty Plan. Individuals' data were collected using a structured questionnaire, and secondary and ecological data of children's municipalities were collected via national surveys and institutional websites. The outcome was defined as the hemoglobin level obtained by HemoCue. A multilevel analysis was performed using Generalized Linear Models for Location Scale and Shape using R, with a 5% significance level. A total of 1,501 children were evaluated. The mean hemoglobin level was 12.8g/dL (95%CI: 12.7-12.8), with significant variability between municipalities. Lower values of hemoglobin were observed in children who lived in municipalities with a higher urbanization rate and a lower number of Community Health Agents, in relation to the reference categories. At the individual level, lower hemoglobin values were identified for children under 24 months, not enrolled at daycares, who were beneficiaries of the conditional cash transfer program and diagnosed with underweight. The results shed light on important factors at the municipal and the individual levels that were associated to the hemoglobin levels of children living in municipalities in social vulnerability.

Resumo: Poucos estudos investigaram o efeito simultâneo dos fatores individuais e contextuais sobre a ocorrência da anemia. O estudo procura avaliar a variabilidade dos níveis de hemoglobina em crianças de municípios com vulnerabilidade social e a associação com fatores individuais e municipais. Foi realizado um estudo transversal com dados de crianças de idade pré-escolar (12-59 meses) de um estudo multicêntrico em 48 municípios do Sul do Brasil, incluídos no Plano Brasil Sem Miséria. Os dados dos indivíduos foram coletados com um questionário estruturado, e os dados secundários e ecológicos dos municípios das crianças foram obtidos através de inquéritos nacionais e websites institucionais. O desfecho foi definido como o nível de hemoglobina, obtido com o sistema HemoCue. Foi realizada análise multinível usando modelos lineares generalizados para posição, escala e forma, no R, com nível de 5% de significância . Foram avaliadas 1.501 crianças. O nível médio de hemoglobina foi 12,8g/dL (IC95%: 12,7-12,8), com variabilidade significativa entre os municípios. Níveis de hemoglobina mais baixos foram observados nas crianças em municípios com taxas de urbanização mais altas e menor número de agentes comunitários de saúde, comparado com as categorias de referência. Em nível individual, níveis de hemoglobina mais baixos foram identificados em crianças abaixo de 24 meses, não matriculadas em creches, beneficiárias do Programa Bolsa Família e diagnosticadas com baixo peso. Os resultados destacam fatores importantes nos níveis municipal e individual que estão associados com os níveis de hemoglobina em crianças de municípios com vulnerabilidade social.

Resumen: Pocos estudios han investigado el efecto simultáneo de los factores individuales y contextuales en la incidencia de anemia. El objetivo de este estudio fue evaluar la variabilidad de los niveles de hemoglobina en niños socialmente vulnerables en municipios del sur de Brasil y su asociación con factores en el nivel individual y municipal. Se trata de un estudio trasversal con datos de niños (12-59 meses), procedentes de un estudio multicéntrico, realizado en 48 municipios de la región sur de Brasil, incluidos en el Plan Brasil sin Pobreza. Se recogieron los datos de los participantes, usando un cuestionario estructurado, así como datos secundarios y ecológicos de los municipios de los niños, a través de encuestas nacionales y sitios web institucionales. El resultado se definió como el nivel de hemoglobina obtenido por HemoCue. Se realizó un análisis multinivel, usando modelos lineales generalizados para la escala de localización y forma usando R, con un nivel de un 5% de significancia. Un total de 1.501 niños fueron evaluados. La media de nivel de hemoglobina fue 12,8g/dL (95%CI: 12,7-12,8), con una significativa variabilidad entre municipios. Los valores más bajos de hemoglobina se observaron en niños que vivían en municipios con unas tasas más altas de urbanización, y un número de agentes de salud comunitario más bajo, en relación con las categorías de referencia. En el nivel individual, los valores de hemoglobina más bajos fueron identificados en niños con menos de 24 meses, no matriculados en guarderías, beneficiarios de ayudas económicas, enmarcadas en programas de ayuda económica, y diagnosticados como con bajo peso. Los resultados aclararon importantes factores en el nivel municipal e individual que estaban asociados a los niveles de hemoglobina de niños residentes en municipios, así como vulnerables socialmente.

Food intake and underweight markers in children under 6 months old monitored via the Food and Nutrition Surveillance System, Brazil, 2015. / Marcadores de consumo alimentar e baixo peso em crianças menores de 6 meses acompanhadas no Sistema de Vigilância Alimentar e Nutricional, Brasil, 2015.

OBJECTIVE: to investigate the frequency of exclusive breastfeeding, early introduction of other foods and association with prevalence of low weight in Brazilian children. METHODS: we analyzed records of children under 6 months of age held on the Food and Nutrition Surveillance System for the year 2015; associations were investigated through Poisson Regression. RESULTS: we found prevalence of 56.1% (95%CI 55.3;56.8) for exclusive breastfeeding, 8.1% (95%CI 7.7;8.5) for low weight for age, and 5.7% (95%CI 5.3;6.7) for low BMI for age; water or teas and infant formulas were the earliest foods introduced; underweight prevalence was lower (PR=0.73 - 95%CI 0.61;0.87) as was prevalence of low BMI (PR=0.69 - 95%CI 0.56;0.85) among exclusively breastfed infants; infant formula intake was associated with low weight (PR=1.35 - 95%CI 1.15;1.58). CONCLUSION: the importance of exclusive breastfeeding for adequate growth in the first 6 months of life was reinforced.

Marcadores de consumo alimentar e baixo peso em crianças menores de 6 meses acompanhadas no Sistema de Vigilância Alimentar e Nutricional, Brasil, 2015 / Marcadores de consumo alimentario y bajo peso en menores de 6 meses, acompañados por el Sistema de Vigilancia Alimentaria y Nutricional, Brasil, 2015 / Food intake and underweight markers in children under 6 months old monitored via the Food and Nutrition Surveillance System, Brazil, 2015

Objetivo: investigar a frequência de aleitamento materno exclusivo, a introdução precoce de outros alimentos e a associação com o baixo peso em crianças brasileiras. Métodos: analisaram-se registros de menores de 6 meses com dados inseridos no Sistema de Vigilância Alimentar e Nutricional em 2015; investigaram-se associações, por regressão de Poisson. Resultados: encontraram-se prevalências de aleitamento exclusivo, 56,1% (IC95% 55,3;56,8), baixo peso para idade, 8,1% (IC95% 7,7;8,5), e baixo índice de massa corporal (IMC) para idade, 5,7% (IC95% 5,3;6,7); agua ou chás e fórmulas infantis foram os alimentos introduzidos mais precocemente; crianças em aleitamento materno exclusivo apresentaram menor prevalência de baixo peso (RP=0,73 - IC95% 0,61;0,87) e de baixo IMC (RP=0,69 - IC95% 0,56;0,85); o consumo de fórmulas infantis se associou ao deficit de peso (RP=1,35 - IC95% 1,15;1,58). Conclusão: reforçou-se a importância do aleitamento materno exclusivo para o adequado crescimento até os 6 meses.

Objetivo: investigar la frecuencia de la lactancia materna exclusiva, la introducción precoz de otros alimentos y su asociación con el bajo peso en niños brasileños. Métodos: se analizaron registros de menores de seis meses con datos insertados en el Sistema de Vigilancia Alimentaria y Nutricional en 2015; se investigaron las asociaciones por medio de la Regresión de Poisson. Resultados: se hallaron prevalencias de lactancia exclusiva, 56,1% (IC95% 55,3;56,8), bajo peso para la edad, 8,1% (IC95% 7,7;8,5), y bajo Índice de Masa Corporal (IMC) para la edad, 5,7% (IC95% 5,3;6,7); agua o tés y fórmulas infantiles fueron los alimentos introducidos más precozmente; los niños en lactancia materna exclusiva presentaron menor prevalencia de bajo peso (RP=0,73 - IC95% 0,61;0,87) y de bajo IMC (RP=0,69 - IC95% 0,56;0,85); el consumo de fórmulas se asoció al deficit de peso (RP=1,35 - IC95% 1,15;1,58). Conclusión: se ha reforzado la importancia de la lactancia materna exclusiva para el adecuado crecimiento has los 6 meses.

Objective: to investigate the frequency of exclusive breastfeeding, early introduction of other foods and association with prevalence of low weight in Brazilian children. Methods: we analyzed records of children under 6 months of age held on the Food and Nutrition Surveillance System for the year 2015; associations were investigated through Poisson Regression. Results: we found prevalence of 56.1% (95%CI 55.3;56.8) for exclusive breastfeeding, 8.1% (95%CI 7.7;8.5) for low weight for age, and 5.7% (95%CI 5.3;6.7) for low BMI for age; water or teas and infant formulas were the earliest foods introduced; underweight prevalence was lower (PR=0.73 - 95%CI 0.61;0.87) as was prevalence of low BMI (PR=0.69 - 95%CI 0.56;0.85) among exclusively breastfed infants; infant formula intake was associated with low weight (PR=1.35 - 95%CI 1.15;1.58). Conclusion: the importance of exclusive breastfeeding for adequate growth in the first 6 months of life was reinforced.