Cross-sectional and prospective associations between screen time and childhood neurodevelopment in two Brazilian cohorts born 11 years apart.

BACKGROUND: The aim of this study was to investigate the associations between screen time from ages 2 to 4 years and child neurodevelopment at age 4. METHODS: The participants were from the 2004 (N = 3787) and 2015 (N = 3604) Pelotas (Brazil) birth cohort studies. Childhood neurodevelopment was assessed at age 4 using the Battelle Development Inventory. The time children spent on screen devices was reported by their guardians at ages 2 and 4 years. Linear regression models were used to investigate the association of: (i) time spent on television at ages 2 and 4 years; (ii) time spent on other screens at age 4; and (iii) total screen time at age 4 (television + other screens) with childhood neurodevelopment at age 4. RESULTS: Average daily screen time among children born in 2004 and those born in 2005 aged 4 years were 3.4 (SD: 2.4) and 4.4 h (SD: 2.9), respectively. Overall, few associations of very small magnitude between screen time and child neurodevelopment were observed. Television time at 2 years of age was statistically associated with lower neurodevelopment at 4 years of age in the 2015 cohort (ß = -0.30, 95%CI = -0.55; -0.05). Conversely, television time (ß = 0.17, 95%CI = 0.07, 0.26) and total screen time (ß = 0.22, 95%CI = 0.13, 0.31) at age 4 were associated with higher neurodevelopment at age 4 in the 2004 cohort. CONCLUSIONS: The findings of this study suggest that the amount of time spent on screen devices might not be associated with neurodevelopment of children under 5 years of age. The small magnitude and inconsistencies in the direction of associations did not find evidence to support the current guidelines for screen time at this age. Therefore, more studies, especially those with longitudinal data, are important to comprehend the true effect of screen time on neurodevelopment and other health outcomes.

RPS Brazilian Birth Cohorts Consortium (Ribeirão Preto, Pelotas and São Luís): history, objectives and methods.

This paper describes the history, objectives and methods used by the nine Brazilian cohorts of the RPS Brazilian Birth Cohorts Consortium (Ribeirão Preto, Pelotas and São Luís) Common thematic axes are identified and the objectives, baseline periods, follow-up stages and representativity of the population studied are presented. The Consortium includes three birth cohorts from Ribeirão Preto, São Paulo State (1978/1979, 1994 and 2010), four from Pelotas, Rio Grande do Sul State (1982, 1993, 2004 and 2015), and two from São Luís, Maranhão State (1997 and 2010). The cohorts cover three regions of Brazil, from three distinct states, with marked socioeconomic, cultural and infrastructure differences. The cohorts were started at birth, except for the most recent one in each municipality, where mothers were recruited during pregnancy. The instruments for data collection have been refined in order to approach different exposures during the early phases of life and their long-term influence on the health-disease process. The investigators of the nine cohorts carried out perinatal studies and later studied human capital, mental health, nutrition and precursor signs of noncommunicable diseases. A total of 17,636 liveborns were recruited in Ribeirão Preto, 19,669 in Pelotas, and 7,659 in São Luís. In the studies starting during pregnancy, 1,400 pregnant women were interviewed in Ribeirão Preto, 3,199 in Pelotas, and 1,447 in São Luís. Different strategies were employed to reduce losses to follow-up. This research network allows the analysis of the incidence of diseases and the establishment of possible causal relations that might explain the health outcomes of these populations in order to contribute to the development of governmental actions and health policies more consistent with reality.

RPS Brazilian Birth Cohorts Consortium (Ribeirão Preto, Pelotas and São Luís): history, objectives and methods / Consórcio RPS (Ribeirão Preto, Pelotas e São Luís) de coortes de nascimento brasileiras: história, objetivos e métodos / Consorcio RPS (Ribeirão Preto, Pelotas y São Luís) cohortes brasileñas de nacimiento: historia, objetivos y métodos

Abstract: This paper describes the history, objectives and methods used by the nine Brazilian cohorts of the RPS Brazilian Birth Cohorts Consortium (Ribeirão Preto, Pelotas and São Luís) Common thematic axes are identified and the objectives, baseline periods, follow-up stages and representativity of the population studied are presented. The Consortium includes three birth cohorts from Ribeirão Preto, São Paulo State (1978/1979, 1994 and 2010), four from Pelotas, Rio Grande do Sul State (1982, 1993, 2004 and 2015), and two from São Luís, Maranhão State (1997 and 2010). The cohorts cover three regions of Brazil, from three distinct states, with marked socioeconomic, cultural and infrastructure differences. The cohorts were started at birth, except for the most recent one in each municipality, where mothers were recruited during pregnancy. The instruments for data collection have been refined in order to approach different exposures during the early phases of life and their long-term influence on the health-disease process. The investigators of the nine cohorts carried out perinatal studies and later studied human capital, mental health, nutrition and precursor signs of noncommunicable diseases. A total of 17,636 liveborns were recruited in Ribeirão Preto, 19,669 in Pelotas, and 7,659 in São Luís. In the studies starting during pregnancy, 1,400 pregnant women were interviewed in Ribeirão Preto, 3,199 in Pelotas, and 1,447 in São Luís. Different strategies were employed to reduce losses to follow-up. This research network allows the analysis of the incidence of diseases and the establishment of possible causal relations that might explain the health outcomes of these populations in order to contribute to the development of governmental actions and health policies more consistent with reality.

Resumo: O artigo descreve a história, objetivos e métodos utilizados pelas nove coortes do Consórcio RPS de Coortes de Nascimento. São identificados eixos temáticos comuns, com apresentação dos objetivos, anos de linha de base, fases de seguimento e representatividade das populações de estudo. O Consórcio inclui três coortes de nascimento de Ribeirão Preto, Estado de São Paulo (1978/1979, 1994 e 2010), quatro de Pelotas, Estado do Rio Grande do Sul (1982, 1993, 2004 e 2015) e duas de São Luís, Estado do Maranhão (1997 e 2010). As coortes provêm de três regiões do Brasil, de três estados diferentes, com importantes diferenças socioeconômicas, culturais e de infraestrutura. As coortes foram iniciadas ao nascer dos participantes, exceto a mais recente em cada município, onde as mães foram recrutadas durante a gestação. Os instrumentos para a coleta de dados foram refinados para aproximar diferentes exposições na primeira infância e a influência, a longo prazo, no processo saúde-doença. Os investigadores das nove coortes realizaram estudos perinatais e depois examinaram o capital humano, saúde mental, nutrição e sinais percursores de doenças crônicas. Um total de 17.636 nascidos vivos foram recrutados em Ribeirão Preto, 19.669 em Pelotas e 7.659 em São Luís. Nas coortes que foram iniciadas durante a gestação, foram entrevistadas 1.400 gestantes em Ribeirão Preto, 3.199 em Pelotas e 1.447 em São Luís. Foram utilizadas diferentes estratégias para reduzir as perdas de seguimento. A rede de pesquisa do Consórcio permite analisar a incidência de doenças e identificar possíveis relações causais que podem explicar os desfechos de saúde nessas populações e contribuir para o desenvolvimento de medidas públicas e políticas de saúde que estejam mais de acordo com as respectivas realidades.

Resumen: El trabajo describe la historia, objetivos y métodos usados por nueve cohortes brasileñas del RPS Consorcio de Cohortes de Nacimiento. Se identificaron los ejes temáticos comunes y los objetivos, así como los periodos de referencia, la presentación del estadio de seguimiento y representatividad de la población estudiada. El consorcio incluye tres cohortes de nacimiento de Ribeirão Preto, Estado de São Paulo (1978/1979, 1994 y 2010), cuatro de Pelotas, Estado del Rio Grande do Sul (1982, 1993, 2004 y 2015), y dos de São Luís, Estado del Maranhão (1997 y 2010). Las cohortes cubren tres regiones de Brasil, de tres estados distintos, con marcadas diferencias socioeconómicas, culturales y de infraestructura. Las cohortes comenzaron con el nacimiento, excepto para la más reciente en cada municipio, donde las madres fueron reclutadas durante la gestación. Los instrumentos para la recogida de datos han sido depurados, con el fin de realizar una aproximación a diferentes exposiciones durante las fases tempranas de la vida y su influencia a largo plazo en el proceso de salud-enfermedad. Se incluyeron a los investigadores de las nueve cohortes, donde se llevaron a cabo estudios perinatales, así como los recursos humanos analizados posteriormente, al igual que la salud mental, nutrición y signos precursores de enfermedades no comunicables. Un total de 17.636 nacidos vivos fueron reclutados en Ribeirão Preto, 19.669 en Pelotas, y 7.659 en São Luís. En los estudios que comenzaron durante el embarazo, 1.400 mujeres embarazadas fueron entrevistadas en Ribeirão Preto, 3.199 en Pelotas, y 1.447 en São Luís. Se usaron diferentes estrategias para reducir pérdidas, con el fin de realizar el seguimiento. Esta red de investigación permite el análisis de la incidencia de enfermedades y el establecimiento de posibles relaciones causales que podrían explicar los resultados de salud de estas poblaciones, con el fin de contribuir al desarrollo de acciones gubernamentales y políticas de salud más consistentes con la realidad.

Behavior Problems in Four-Year-Old Children from a Brazilian Birth Cohort / Problemas de Comportamento em Crianças Brasileiras de Quatro Anos de Idade

Abstract This study aimed to investigate the occurrence of behavior problems in 3750 four years old children from a birth cohort. Children were followed from birth to four years old through home visits, and questionnaires on child health and development and the Child Behavior Checklist 4-18/CBCL were applied. Prevalence rates were high (total problems 35.6%), particularly externalizing problems, which occurred in 44.4 % of children (48.3% girls; 40.6% boys; p < 0.001). Internalizing problems were less prevalent, occurring in 15.5 % of children (19.1% boys; 11.6% girls; p < 0.001). Regardless of sex, there was a higher prevalence of behavioral problems in children with younger siblings, whose mothers had less education and had no partner.

Resumo Este estudo objetivou investigar a ocorrência de problemas de comportamento em 3750 crianças pertencentes a uma coorte de nascimentos. As crianças foram acompanhadas do nascimento aos quatro anos de idade, por meio de visitas domiciliares, tendo sido aplicados instrumentos sobre saúde e desenvolvimento infantil e o Child Behavior Checklist 4-18/CBCL. As prevalências encontradas foram altas (total de problemas de comportamento: 35,6%), com destaque para problemas de externalização, que ocorreram em 44,4% das crianças (48,3% meninas; 40,6% meninos; p < 0,001). Problemas de internalização foram menos prevalentes, ocorrendo em 15,5% das crianças (19,1% meninos; 11,6% meninas; p < 0,001). Independente do sexo, houve maior prevalência de problemas de comportamento em crianças com maior número de irmãos mais novos, cujas mães tinham menor escolaridade e não tinham companheiro.

Prevalence, mortality and risk factors associated with very low birth weight preterm infants: an analysis of 33 years / Prevalência, mortalidade e fatores de risco associados ao prematuro de muito baixo peso ao nascer: uma análise de 33 anos

Abstract Objective: To assess the prevalence, mortality and risk factors associated with the birth of very low birth weight preterm infants over a period of 33 years. Methods: Four cross-sectional studies were analyzed, using data from perinatal interviews of birth cohorts in the city of Pelotas collected in 1982, 1993, 2004, and 2015. Based on perinatal questionnaires, anthropometric measurements of newborns and death certificates were analyzed to obtain the prevalence rate, neonatal mortality, and risk factors (maternal age, income and type of delivery) for very low birth weight. Results: A total of 19,625 newborns were included in the study. In the years 1982, 1993, 2004, and 2015, there were, respectively, 5909, 5232, 4226, and 4258 births. The prevalence of very low birth weight was, respectively, 1.1% (n = 64), 0.9% (n = 46), 1.4% (n = 61), and 1.3% (n = 54). There was no statistical evidence of an increasing trend over time (p = 0.11). Among the risk factors, family income in the three poorest quintiles was associated with prevalence rates that were approximately twice as high as in the richest quintile (p = 0.003). Mortality per 1000 live births for neonates weighing <1500 g decreased from 688 to 259 per thousand from 1982 to 2015 (p < 0.001), but still represented 61% of neonatal deaths in the latter year. Conclusion: Although mortality in very low birth weight decreased by more than 60% in recent years, this group still contributes with more than half of neonatal deaths. Low family income remains an important risk factor in this scenario.

Resumo Objetivo: Verificar a prevalência, mortalidade e fatores de risco associados aos nascimentos de prematuros de muito baixo peso ao nascer (MBPN) ao longo de 33 anos. Métodos: Série de quatro estudos transversais com o uso de dados das entrevistas perinatais das coortes de nascimento da cidade de Pelotas coletados em 1982, 1993, 2004 e 2015. A partir de questionários perinatais, medidas antropométricas dos recém-nascidos e certidões de óbito, foram analisadas a prevalência, a mortalidade neonatal e os fatores de risco (idade materna, renda e tipo de parto) para prematuros de muito baixo peso ao nascer. Resultados: Foram incluídos no estudo 19.625 recém-nascidos. Em 1982, 1993, 2004 e 2015 ocorreram, respectivamente, 5.909, 5.232, 4.226 e 4.258 nascimentos. A prevalência de prematuros de muito baixo peso ao nascer naqueles anos foi, respectivamente, de 1,1% (n = 64), 0,9% (n = 46), 1,4% (n = 61) e 1,3% (n = 54). A tendência de aumento durante o período não alcançou significância estatística (p = 0,11). Entre os fatores de risco, a renda familiar nos três quintis mais pobres esteve associada a prevalências cerca de duas vezes mais altas do que no quintil mais rico (p = 0,003). A mortalidade por 1.000 nascidos vivos para os neonatos com peso < 1500 g caiu de 688 para 259 por mil ao longo dos anos (p < 0,001), mas ainda representa 61% dos óbitos neonatais em 2015. Conclusão: Embora a mortalidade nos prematuros de muito baixo peso ao nascer tenha diminuído em mais de 60% nos últimos anos, esse grupo ainda contribui com mais da metade dos óbitos neonatais. A baixa renda familiar continua a ser fator de risco importante nesse cenário.

Maternal mood symptoms in pregnancy and postpartum depression: association with exclusive breastfeeding in a population-based birth cohort.

PURPOSE: This study aimed to evaluate the association between mood symptoms during pregnancy and exclusive breastfeeding at 3 months, as well as the association between exclusive breastfeeding at 3 months and maternal depression at 12 months postpartum. METHODS: Data from the Pelotas 2004 Birth Cohort with 4231 live births were used. Maternal mood symptoms during pregnancy were assessed through the question "During pregnancy, did you have depression or nervous problems?" and depression symptomatology at 12 months postpartum was assessed with the Edinburg Postnatal Depression Scale (EPDS). Information on exclusive breastfeeding at 3 months was collected through a dietary recall questionnaire. Crude and adjusted relative risks (RR) with 95% confidence intervals (95% CI) were estimated by Poisson regression. RESULTS: Prevalence of mood symptoms during pregnancy was 25.1% (95% CI 23.8; 26.4%) and prevalence of EPDS ≥ 10 at 12 months after birth was 27.6% (95% CI 26.2; 29.0%). Prevalence of exclusive breastfeeding at 3 months was 26.5% (95% CI 25.2; 27.9%). In crude analyses, maternal mood symptoms during pregnancy were associated with non-exclusive breastfeeding at 3 months and non-exclusive breastfeeding at 3 months was associated with postpartum maternal depression at 12 months. In the adjusted analyses, both associations were lost after the inclusion of maternal education (RR 0.92; 95% CI 0.81-1.04 and RR 0.92; 95% CI 0.81-1.03, respectively). CONCLUSION: In our study, the crude association between mood symptoms in pregnancy, exclusive breastfeeding at 3 months, and postpartum depression was due more to the low maternal education than to a true relationship between them.

Prevalence, mortality and risk factors associated with very low birth weight preterm infants: an analysis of 33 years.

OBJECTIVE: To assess the prevalence, mortality and risk factors associated with the birth of very low birth weight preterm infants over a period of 33 years. METHODS: Four cross-sectional studies were analyzed, using data from perinatal interviews of birth cohorts in the city of Pelotas collected in 1982, 1993, 2004, and 2015. Based on perinatal questionnaires, anthropometric measurements of newborns and death certificates were analyzed to obtain the prevalence rate, neonatal mortality, and risk factors (maternal age, income and type of delivery) for very low birth weight. RESULTS: A total of 19,625 newborns were included in the study. In the years 1982, 1993, 2004, and 2015, there were, respectively, 5909, 5232, 4226, and 4258 births. The prevalence of very low birth weight was, respectively, 1.1% (n=64), 0.9% (n=46), 1.4% (n=61), and 1.3% (n=54). There was no statistical evidence of an increasing trend over time (p=0.11). Among the risk factors, family income in the three poorest quintiles was associated with prevalence rates that were approximately twice as high as in the richest quintile (p=0.003). Mortality per 1000 live births for neonates weighing <1500g decreased from 688 to 259 per thousand from 1982 to 2015 (p<0.001), but still represented 61% of neonatal deaths in the latter year. CONCLUSION: Although mortality in very low birth weight decreased by more than 60% in recent years, this group still contributes with more than half of neonatal deaths. Low family income remains an important risk factor in this scenario.

Unsafe storage of household medicines: results from a cross-sectional study of four-year-olds from the 2004 Pelotas birth cohort (Brazil).

BACKGROUND: Unintentional child poisoning represents a significant public health problem across the globe, placing a substantial burden on health services emergency departments. Around the world, every year, thousands of children die as a result of physical injuries, most of which involve children under 5 years old. Medicines are the main products involved in poisoning, and children under 5 years old are the most vulnerable age group. The objective of this study was to measure the prevalence of unsafe storage of medicines in households with a 4-year-old child. METHODS: We used data from the follow-up of 4-year-old in the 2004 Pelotas Birth Cohort Study in Brazil (N = 3799). "Unsafe storage" was considered present when medicines were stored unlocked and within reach of children (at a height below the eye level of the average adult). Independent variables included maternal and family socioeconomic and demographic characteristics and the child's health care. All information was collected during household interviews with the mothers using a standardized questionnaire. The overall prevalence rate with a 95% confidence interval (95% CI) and the prevalence associated with various independent variables were determined. RESULTS: The storage of medicines in unlocked areas was reported by 80.9% of the mothers, and, within reach of children for 26.5%. The overall prevalence rate of unsafe storage of medicines was 21.4% (20.1-22.7%). The main storage locations used were the kitchen (57.0%) and bedroom (53.3%). CONCLUSIONS: The results indicate that medicines were unsafely stored in a 21.4% number of homes, which can contribute to the vulnerability of children to poisoning from medicines. To minimize this risk, education about the safe storage of medicines should be reinforced by health professionals.

Assisted reproductive technology: prevalence and associated factors in Southern Brazil.

OBJECTIVE: To assess the prevalence of successful assisted reproductive technology and to identify the associated factors. METHODS: This population-based birth cohort study was carried out with 4,333 pregnant women expected to deliver in 2015 in the urban area of Pelotas, Southern Brazil. Use of an assisted reproductive technology procedure, type of assisted reproductive technology [in vitro fertilization or intracytoplasmic sperm injection or artificial insemination], number of embryos transferred, success of embryo transfer, number of attempts, and reported reasons for seeking assisted reproductive technology were the main outcomes measured. Use of an assisted reproductive technology procedure was analyzed according to sociodemographic, nutritional, reproductive history, and behavioral characteristics. Unadjusted and adjusted analyses were performed by logistic regression. RESULTS: Among the 4,275 newborns enrolled in the Pelotas 2015 Birth Cohort Study, 18 births (0.4%) were conceived by assisted reproductive technology. Most cases of assisted reproductive technology were by in vitro fertilization (70.6%). All cycles were performed in private clinics under direct out-of-pocket payment. Even after controlling for confounders, maternal age > 35 years, nulliparity and high family monthly income were strongly associated with assisted reproductive technology. CONCLUSIONS: The use of assisted reproductive technology services was reported by only a few women in the Pelotas 2015 Birth Cohort Study. Our study highlights sociodemographic factors associated to assisted reproductive technology procedures. To better understand the patterns and barriers in overall use of assisted reproductive technology services over time, national-level trend studies in assisted reproductive technology treatments and outcomes, as well as studies exploring the characteristics of women who have sought this kind of treatment are needed in low-middle income countries.

Assisted reproductive technology: prevalence and associated factors in Southern Brazil

ABSTRACT OBJECTIVE: To assess the prevalence of successful assisted reproductive technology and to identify the associated factors. METHODS: This population-based birth cohort study was carried out with 4,333 pregnant women expected to deliver in 2015 in the urban area of Pelotas, Southern Brazil. Use of an assisted reproductive technology procedure, type of assisted reproductive technology [in vitro fertilization or intracytoplasmic sperm injection or artificial insemination], number of embryos transferred, success of embryo transfer, number of attempts, and reported reasons for seeking assisted reproductive technology were the main outcomes measured. Use of an assisted reproductive technology procedure was analyzed according to sociodemographic, nutritional, reproductive history, and behavioral characteristics. Unadjusted and adjusted analyses were performed by logistic regression. RESULTS: Among the 4,275 newborns enrolled in the Pelotas 2015 Birth Cohort Study, 18 births (0.4%) were conceived by assisted reproductive technology. Most cases of assisted reproductive technology were by in vitro fertilization (70.6%). All cycles were performed in private clinics under direct out-of-pocket payment. Even after controlling for confounders, maternal age > 35 years, nulliparity and high family monthly income were strongly associated with assisted reproductive technology. CONCLUSIONS: The use of assisted reproductive technology services was reported by only a few women in the Pelotas 2015 Birth Cohort Study. Our study highlights sociodemographic factors associated to assisted reproductive technology procedures. To better understand the patterns and barriers in overall use of assisted reproductive technology services over time, national-level trend studies in assisted reproductive technology treatments and outcomes, as well as studies exploring the characteristics of women who have sought this kind of treatment are needed in low-middle income countries.

Effect of maternal postpartum depression on offspring's growth.

BACKGROUND: Previous studies have linked maternal depression to different child offspring's growth outcomes. However, its effect has not been well established. The aim of this review was to evaluate the available evidence on the effect of maternal postpartum depression on offspring weight and height growth outcomes. METHODS: A systematic review of longitudinal studies that evaluated the effect of maternal depression on child's growth outcomes was conducted in PubMed, LILACs, Web of Science, Science Direct and PsyInfo databases, using maternal postpartum depression related keywords, according to each database searching tool. RESULTS: A total of 9608 articles were screened and 20 met the final inclusion criteria. The child's first-year growth was the most affected by the exposure to maternal depression. Children of depressed mothers had a higher chance of being underweight and stunted in the first year of life. Maternal depression was also associated with child's linear growth impairment after the first year. LIMITATIONS: As a literature review, a publication bias could not be ruled out. The diversity of the published data made it unfeasible for a pooled effect to be estimated. CONCLUSIONS: Considering the results observed on child's first year of life growth, physicians should engage in assessing maternal depression, as it is a treatable and manageable disease, thus avoiding unnecessary harm on child's physical development.

Attention-Deficit/Hyperactivity Disorder and Very Preterm/Very Low Birth Weight: A Meta-analysis.

CONTEXT: Although very preterm (VP), extremely preterm (EP), very low birth weight (VLBW), and extremely low birth weight (ELBW) newborns seem to have a higher risk of later attention-deficit/hyperactivity disorder (ADHD), the magnitude of the risk is not well-defined. OBJECTIVE: To systematically review and meta-analyze the risk of VP/VLBW and EP/ELBW individuals to develop a ADHD categorical diagnosis or dimensional symptomatology compared with controls with normal weight and/or birth age. DATA SOURCES: We used PsycINFO, Medline, Embase, and Cochrane databases. STUDY SELECTION: We selected cross-sectional, prospective, or retrospective studies with no time or language restriction. DATA EXTRACTION: Independent reviewers screened and extracted data using predefined standard procedures. RESULTS: In 12 studies (N = 1787), researchers relying on a categorical diagnosis showed that both VP/VLBW and EP/ELBW subjects have a higher ADHD risk (odds ratio [OR] = 3.04 higher than controls; 95% confidence interval [CI] 2.19 to 4.21). In subgroup analyses, we demonstrated that the more extreme the cases, the higher the ORs (VP/VLBW: OR = 2.25 [95% CI 1.56 to 3.26]; EP/ELBW: OR = 4.05 [95% CI 2.38 to 6.87]). We drew data from 29 studies (N = 3504) on ADHD symptomatology and found significant associations with inattention (standardized mean difference [SMD] = 1.31, 95% CI 0.66 to 1.96), hyperactivity and impulsivity (SMD = 0.74, 95% CI 0.35 to 1.13), and combined symptoms (SMD = 0.55, 95% CI 0.42 to 0.68) when compared with controls. LIMITATIONS: Heterogeneity was significantly high for all analyses involving the 3 ADHD dimensions. CONCLUSIONS: With our results, we provide evidence that VP/VLBW subjects have an increased risk of ADHD diagnosis and symptomatology compared with controls, and these findings are even stronger in the EP/ELBW group. Future researchers should address which risk factors related to prematurity or low birth weight lead to ADHD.

Consumption of ultra-processed foods and body fat during childhood and adolescence: a systematic review.

OBJECTIVE: To review the available literature on the association between consumption of ultra-processed foods and body fat during childhood and adolescence. DESIGN: A systematic review was conducted in the PubMed, Web of Science and LILACS databases. Studies that evaluated the association between consumption of ultra-processed food (exposure) and body fat (outcome) during childhood and adolescence were eligible. SUBJECTS: Healthy children and adolescents. RESULTS: Twenty-six studies that evaluated groups of ultra-processed foods (such as snacks, fast foods, junk foods and convenience foods) or specific ultra-processed foods (soft drinks/sweetened beverages, sweets, chocolate and ready-to-eat cereals) were selected. Most of the studies (n 15) had a cohort design. Consumption was generally evaluated by means of FFQ or food records; and body composition, by means of double indirect methods (bioelectrical impedance analysis and skinfolds). Most of the studies that evaluated consumption of groups of ultra-processed foods and soft drinks/sweetened beverages found positive associations with body fat. CONCLUSIONS: Our review showed that most studies have found positive associations between consumption of ultra-processed food and body fat during childhood and adolescence. There is a need to use a standardized classification that considers the level of food processing to promote comparability between studies.

Impact of Prolonged Breastfeeding on Dental Caries: A Population-Based Birth Cohort Study.

BACKGROUND: Few studies have assessed the effect of breastfeeding, bottle feeding, and sugar consumption on children's dental caries. We investigated whether the duration of breastfeeding is a risk factor for dental caries in the primary dentition, independently of sugar consumption. METHODS: An oral health study (n = 1303) nested in a birth cohort study was carried out in southern Brazil. The average number of decayed, missing, and filled primary tooth surfaces (dmfs) and severe early childhood caries (S-ECC: dmfs ≥6) were investigated at age 5 years. Breastfeeding was the main exposure collected at birth and at 3, 12, and 24 months of age. Data on sugar consumption were collected at 24, 48, and 60 months of age. Marginal structural modeling was used to estimate the controlled direct effect of breastfeeding (0-12, 13-23, and ≥24 months) on dmfs and on S-ECC. RESULTS: The prevalence of S-ECC was 23.9%. The mean number of dmfs was 4.05. Children who were breastfed for ≥24 months had a higher number of dmfs (mean ratio: 1.9; 95% confidence interval: 1.5-2.4) and a 2.4 times higher risk of having S-ECC (risk ratio: 2.4; 95% confidence interval: 1.7-3.3) than those who were breastfed up to 12 months of age. Breastfeeding between 13 and 23 months had no effect on dental caries. CONCLUSIONS: Prolonged breastfeeding increases the risk of having dental caries. Preventive interventions for dental caries should be established as early as possible because breastfeeding is beneficial for children's health. Mechanisms underlying this process should be investigated more deeply.

Exclusive Breastfeeding and Risk of Dental Malocclusion.

OBJECTIVES: The distinct effect of exclusive and predominant breastfeeding on primary dentition malocclusions is still unclear. We hypothesized that exclusive breastfeeding presents a higher protective effect against malocclusions than predominant breastfeeding and that the use of a pacifier modifies the association between breastfeeding and primary dentition malocclusions. METHODS: An oral health study nested in a birth cohort study was conducted at age 5 years (N = 1303). The type of breastfeeding was recorded at birth and at 3, 12, and 24 months of age. Open bite (OB), crossbite, overjet (OJ), and moderate/severe malocclusion (MSM) were assessed. Poisson regression analyses were conducted by controlling for sociodemographic and anthropometric characteristics, sucking habits along the life course, dental caries, and dental treatment. RESULTS: Predominant breastfeeding was associated with a lower prevalence of OB, OJ, and MSM, but pacifier use modified these associations. The same findings were noted between exclusive breastfeeding and OJ and between exclusive breastfeeding and crossbite. A lower prevalence of OB was found among children exposed to exclusive breastfeeding from 3 to 5.9 months (33%) and up to 6 months (44%) of age. Those who were exclusively breastfed from 3 to 5.9 months and up to 6 months of age exhibited 41% and 72% lower prevalence of MSM, respectively, than those who were never breastfed. CONCLUSIONS: A common risk approach, promoting exclusive breastfeeding up to 6 months of age to prevent childhood diseases and disorders, should be an effective population strategy to prevent malocclusion.

Adequação do consumo energético e de macronutrientes de crianças menores de seis anos / Adequacy of energy consumption and macronutrients of children under six years of age / Adecuación del consumo energético y de macronutrientes de niños con menos de seis años en una ciudad en el sur de Brasil

OBJETIVO: Conhecer a adequação do consumo energético e de macronutrientes da alimentação de crianças menores de seis anos de idade da zona urbana de Pelotas, Rio Grande do Sul. MÉTODOS: Recorte de um estudo transversal que compõe a quarta avaliação de uma pesquisa de série temporal realizada na cidade de Pelotas, Rio Grande do Sul, em 2008. A amostra foi constituída por 799 crianças menores de seis anos de idade. Para avaliação da ingestão calórica e da contribuição percentual de macronutrientes no total de calorias da dieta, foram utilizadas as ingestões dietéticas de referência do Instituto de Medicina. As análises incluíram a descrição da amostra e o teste do qui-quadrado para avaliação das associações, considerando-se um nível de significância de 5%. RESULTADOS: A ingestão calórica deficiente foi maior nos meninos (58,0%) e meninas (63,0%) com idade igual ou menor do que seis meses. Foi observada ingestão calórica excessiva nas idades entre 7 e 12 meses e um e dois anos: 61,3 e 73,5% nos meninos e 56,0 e 74,1% nas meninas, respectivamente. A maioria das crianças com três anos de idade ou mais (meninos com 44,9% e meninas com 47,4%) apresentou ingestão calórica adequada para a idade. A ingestão energética de macronutrientes apresentou-se adequada para carboidratos e proteínas e apontou que 54,5% das crianças tinham ingestão deficiente de lipídeos na faixa etária de um a três anos. CONCLUSÕES: Foi evidenciada a necessidade do estímulo de hábitos alimentares saudáveis que equilibrem a ingestão energética e distribuam o consumo de macronutrientes nesse grupo etário.

OBJECTIVE: To recognize the adequacy of dietary energy consumption and macronutrients of children under the age of six in the urban zone of Pelotas, in Southern Brazil. METHODS: A cross-sectional study that comprises the fourth evaluation of a temporal series study conducted in the city of Pelotas, Rio Grande do Sul, Brazil, in 2008. The sample consisted of 799 children under six years of age. In order to evaluate caloric intake rates and macronutrient percentage of contribution to the overall food diet calories, the dietary reference intakes (DRI) of the Institute of Medicine were used. These analyses included descriptions of the sample and chi-square test in order to assess associations at a 5% significance level. RESULTS: The deficient caloric intake was prevalent among male (58.0%) and female (63.0%) children aged six months or less. An excessive caloric intake was noted in children aged 7 to 12 months and one to two years: 61.3 and 73.5% for boys, and 56.0 and 74.1% for girls, respectively. Among the children aged three years or more, 44.9% of boys and of 47.4% of girls presented proper caloric intake rates for their age group. The energy intake deriving from macronutrients was adequate regarding carbohydrates and proteins; and 54.5% of the studied children aged between one and three years presented deficient intake of lipids. CONCLUSIONS: The need of healthy dieting practices stimulation was clear in order to balance the energetic intake rates and the distribution of macronutrients consumption within this target age group.

OBJETIVO: Conocer la adecuación del consumo energético y de macronutrientes de la alimentación de niños menores de seis años de edad del área urbana de Pelotas, Rio Grande do Sul. MÉTODOS: Recorte de un estudio transversal que compone la cuarta evaluación de una investigación de serie atemporal realizada en la ciudad de Pelotas, Rio Grande do Sul, en 2008. La muestra se constituyó por 799 niños con menos de seis años de edad. Para evaluar la ingestión calórica y el aporte porcentual de macronutrientes en el total de calorías de la dieta, se utilizaron las Ingestiones Dietéticas de Referencia del Instituto de Medicina. Los análisis incluyeron la descripción de la muestra y prueba de chi cuadrado para evaluación de las asociaciones, considerándose un nivel de significancia de 5%. RESULTADOS: La ingestión calórica deficiente fue más grande en los muchachos (58,0%) y muchachas (63,0%) con edad igual o inferior a seis meses. Se observó ingestión calórica excesiva en las edades entre 7 y 12 meses y uno y dos años: 61,3 y 73,5% en los muchachos y 56,0 y 74,1% en las muchachas, respectivamente. La mayoría de los niños con tres años de edad o más (44,9% muchachos y 47,4% muchachas) presentó ingestión calórica adecuada para la edad. La ingestión energética de macronutrientes se presentó adecuada para carbohidratos y proteínas y señaló que 54,5% de los niños tenían ingestión deficiente de lípidos en la franja de edad de uno a tres años. CONCLUSIÓNS: Se evidenció la necesidad del estímulo de hábitos alimentares sanos que equilibren la ingestión energética y distribuyan el consumo de macronutrientes en ese grupo de edad.

Gestational age at birth and morbidity, mortality, and growth in the first 4 years of life: findings from three birth cohorts in Southern Brazil.

BACKGROUND: We assessed anthropometric status, breastfeeding duration, morbidity, and mortality outcomes during the first four years of life according to gestational age, in three population-based birth cohorts in the city of Pelotas, Southern Brazil. METHODS: Total breastfeeding duration, neonatal mortality, infant morbidity and mortality, and anthropometric measures taken at 12 and 48 months were evaluated in children of different gestational ages born in 1982, 1993 and 2004 in Southern Brazil. RESULTS: Babies born <34 weeks of gestation and those born between 34-36 weeks presented increased morbidity and mortality, were breastfed for shorter periods, and were more likely to be undernourished at 12 months of life, in comparison with the 39-41 weeks group. Children born with 37 weeks were more than twice as likely to die in the first year of life, and were also at increased risk of hospitalization and underweight at 12 months of life. Post-term infants presented an increased risk of neonatal mortality. CONCLUSION: The increased risks of morbidity and mortality among preterm (<37 weeks of gestation) and post-term (>41 weeks) are well known. In our population babies born at 37 also present increased risk. As the proportion of preterm and early term babies has increased markedly in recent years, this is a cause for great concern.

Fatores de risco comportamentais acumulados para doenças cardiovasculares no sul do Brasil / Accumulated behavioral risk factors for cardiovascular diseases in Southern Brazil

OBJETIVO: Estimar a prevalência e identificar fatores associados ao acúmulo de comportamentos de risco para doenças cardiovasculares entre adultos. MÉTODOS: Estudo transversal de base populacional com amostra representativa de 2.732 adultos de ambos os sexos de Pelotas, RS, em 2010. Os fatores de risco comportamentais investigados foram: tabagismo; inatividade física no lazer; consumo habitual de gordura aparente da carne; e consumo diário de embutidos, carne vermelha e leite integral. O desfecho do estudo foi o escore de aglomeração de fatores de risco comportamentais, variando de zero a três: nenhum fator de risco comportamental para doenças cardiovasculares ou exposição a 1, 2 ou > 3 fatores de risco comportamentais. Realizou-se regressão logística multinomial para avaliar o efeito ajustado das características individuais sobre o acúmulo de fatores de risco comportamentais, tendo como categoria de referência indivíduos sem qualquer dos fatores. RESULTADOS: A inatividade física foi o fator de risco mais prevalente (75,6%), seguido do consumo habitual de gordura aparente da carne (52,3%). Dois terços da população apresentaram dois ou mais fatores de risco comportamentais. A combinação de inatividade física e consumo habitual de gordura aparente da carne ocorreu em 17,5% da amostra; e inatividade física, consumo habitual de gordura aparente da carne e tabagismo, em 6,7%. Os odds ratios de acúmulo de dois ou mais fatores foram maiores entre homens e associaram-se inversamente com o indicador econômico nacional. CONCLUSÕES: O acúmulo de fatores de risco comportamentais para doenças cardiovasculares é elevado na população estudada. São necessárias intervenções públicas capazes de prevenir a ocorrência simultânea desses fatores.

OBJECTIVE: To estimate the prevalence of, and identify factors associated with, accumulated risky behavior relating to cardiovascular diseases among adults. METHODS: This was a population-based cross-sectional study on a representative sample of 2732 adults of both sexes in Pelotas, Southern Brazil, in 2010. The behavioral risk factors investigated were: smoking; leisure-time physical inactivity; habitual consumption of visible fat in meat; and daily consumption of processed meats, red meat and whole milk. The study outcome was the accumulated behavioral risk factors score, ranging from zero to three: no behavioral risk factor for cardiovascular diseases or exposure to 1, 2 or > 3 behavioral risk factors. Multinomial logistic regression was performed to evaluate the adjusted effect of individual characteristics on behavioral risk factors accumulation, taking individuals without any of these factors as the reference category. RESULTS: Physical inactivity was the most prevalent risk factor (75.6%), followed by habitual consumption of visible fat in meat (52.3%). Two thirds of the population presented two or more behavioral risk factors. Combined physical inactivity and habitual consumption of visible fat in meat was observed in 17.5% of the sample; and combined physical inactivity, habitual consumption of visible fat in meat and smoking in 6.7%. The odds ratios for accumulation of two or more risk factors were higher among men and were inversely associated with a national economic indicator. CONCLUSIONS: There was a high accumulation of behavioral risk factors for cardiovascular diseases among the study population. Public interventions with the capacity to prevent simultaneous occurrence of these factors are needed.

Accumulated behavioral risk factors for cardiovascular diseases in Southern Brazil.

OBJECTIVE: To estimate the prevalence of, and identify factors associated with, accumulated risky behavior relating to cardiovascular diseases among adults. METHODS: This was a population-based cross-sectional study on a representative sample of 2732 adults of both sexes in Pelotas, Southern Brazil, in 2010. The behavioral risk factors investigated were: smoking; leisure-time physical inactivity; habitual consumption of visible fat in meat; and daily consumption of processed meats, red meat and whole milk. The study outcome was the accumulated behavioral risk factors score, ranging from zero to three: no behavioral risk factor for cardiovascular diseases or exposure to 1, 2 or > 3 behavioral risk factors. Multinomial logistic regression was performed to evaluate the adjusted effect of individual characteristics on behavioral risk factors accumulation, taking individuals without any of these factors as the reference category. RESULTS: Physical inactivity was the most prevalent risk factor (75.6%), followed by habitual consumption of visible fat in meat (52.3%). Two thirds of the population presented two or more behavioral risk factors. Combined physical inactivity and habitual consumption of visible fat in meat was observed in 17.5% of the sample; and combined physical inactivity, habitual consumption of visible fat in meat and smoking in 6.7%. The odds ratios for accumulation of two or more risk factors were higher among men and were inversely associated with a national economic indicator. CONCLUSIONS: There was a high accumulation of behavioral risk factors for cardiovascular diseases among the study population. Public interventions with the capacity to prevent simultaneous occurrence of these factors are needed.