Higher consumption of ultra-processed foods is associated with obesity and abdominal obesity in socially vulnerable Brazilian women.

This study aimed to assess the consumption of ultra-processed foods (UPF) and identify their association with obesity and abdominal obesity in adult women of reproductive age living in situations of social vulnerability in Maceió, Northeastern Brazil. This was a cross-sectional study carried out between October 2020 and May 2021. An anthropometric evaluation was carried out to assess obesity and abdominal obesity. A dietary assessment was also conducted using a 24-h food recall to determine the calorie intake from UPF. To estimate intra-individual variability in food consumption, the probabilistic Multiple Source Method was used. These data in the form of tertiles were used to analyse the association between the consumption of UPF and obesity and abdominal obesity. Logistic regressions were used to analyse the association. A directed acyclic graph (DAG) was created for this analysis. This study included 1702 women of which 53.7% were 31 years old or older, and 74.2% lived in poverty. It identified that 36.5% and 38.1% of the women had obesity and abdominal obesity, respectively, and that an average of 33.8% of calories consumed came from UPF. In the analysis of association guided by the DAG, it was observed that women with a high-calorie intake from UPF had a 1.3 times higher probability of being obese. It was also observed that women with a moderate and high-calorie intake from UPF were 1.4 and 1.3 times more likely, respectively, to have abdominal obesity. Thus, it can be concluded that socially vulnerable women in Brazil have a relatively high consumption of UPF and that this condition increases the probability of obesity in this population group.

The Double Burden of Malnutrition is Associated with Continued Breastfeeding and Early Consumption of Ultra-Processed Drinks in Socially Vulnerable Brazilian Children.

This study aimed to assess the association between the double burden of malnutrition (DBM) with continued breastfeeding and the early introduction of ultra-processed drinks in children living in situations of social vulnerability. This cross-sectional population-based study was carried out in a capital city in the Northeast of Brazil, which included 561 children. It was observed that introducing soft drinks into the child's diet during the first year of life was directly associated with DBM but indirectly with continuous breastfeeding for 12 or more months. These results indicate paths that can be followed to reverse the current scenario.

Type 2 diabetes mellitus is associated with food addiction in Brazilian women living in poverty.

Food addiction (FA) has been widely investigated. For the first time, two studies reported its association with type 2 diabetes mellitus (DM2) in the general population and populations with mental disorders and undergoing bariatric surgery. However, the relationship between FA and DM2 needs to be better explored in different social contexts and population groups. Given this, the present study aims to evaluate whether DM2 diagnosis is associated with FA diagnosis in women living in poverty. This is a cross-sectional, population-based study conducted in a Brazilian capital city. FA was assessed by the modified Yale Food Addiction Scale (mYFAS) 2.0, and DM2 diagnosis was assessed by self-reporting of previous medical diagnosis. The association was assessed by multivariable Poisson regression with robust variance estimation adjusted for age, poverty situation, race/skin colour, physical activity and BMI. A total of 1878 women were included, of whom 15·1 % had FA and 3·2 % had a medical diagnosis of DM2. In the multivariable analysis, the medical diagnosis of DM2 was associated with FA (prevalence ratio, PR: 2·18; 95 % CI (1·26, 3·76)). The DM2 diagnosis was also identified to be associated with role interference (PR: 1·93; 95 % CI (1·01, 3·67)) symptom of FA. In conclusion, a positive association between FA and DM2 in women living in poverty was observed, information that adds to the current evidence already available in the literature, pointing to a new line of research and integrated care.

Early introduction of ultra-processed foods is associated with overweight and anaemia in socially vulnerable Brazilian children.

This study aimed to evaluate the early introduction of ultra-processed foods (UPF) and identify its association with overweight and anaemia in Brazilian children living in a situation of social vulnerability. A population-based cross-sectional study was conducted in a Brazilian capital. Children aged 12-59 months were included. The presence of overweight and anaemia was evaluated, as well as the introduction of twelve different UPF in children's first year of life. Association analysis was performed using Poisson regression, with robust estimates of variances. A total of 561 children were studied; 85·5 % had consumed at least one UPF evaluated in the first year of life; 19·1 % were overweight and 52·0 % were anaemic. Adjusted multivariate analyses identified that the early introduction of soft drinks (Prevalence Ratio (PR) = 1·18, 95 % CI (1·02, 1·38)), packaged snacks (PR = 1·17, 95 % CI (1·05, 1·30)) and powdered soft drinks (PR = 1·36, 95 % CI (1·16, 1·60)) increased the likelihood of children being overweight, and the early introduction of chocolate drink (PR = 1·25, 95 % CI (1·02, 1·53)) increased the likelihood of them being anaemic, when comparing children who consumed these UPF before reaching 1 year of age with those who consumed these foods at 12 months of age or older. From the results found, one can see the existing relationship between the early introduction of UPF with overweight and anaemia, being necessary to intensify public health policies to combat malnutrition, focusing on the promotion of proper and healthy eating, especially during the phase of food introduction, focusing on the population living in socially vulnerable situations.

Estimation of the availability of iron in the school meals of Municipal Centers for Early Childhood Education of a capital city in northeastern Brazil.

The final stage of Fe deficiency is Fe deficiency anaemia, with repercussions for human health, especially in children under 5 years of age. Studies conducted in Brazilian public daycare centres show high prevalence of anaemia. The present study aims to evaluate the availability of Fe in the meals of the Municipal Centers of Early Childhood Education in Maceió. The experimental design comprises selection of algorithms, menu evaluation, calculation of the estimates, comparison between the estimates obtained and the recommendations, and analysis of correlation between meal constituents, and of the concordance between the absorbable Fe estimates. Four algorithms were selected and a monthly menu consisting of 22 d. The correlation analysis showed a moderate positive correlation to animal tissue (AT) v. non-heme iron (r = 0·42; P = 0·04), and negative to AT v. Ca (r = -0·54; P = 0·09) and Ca v. phytates (r = -0·46, P = 0·03). Estimates of absorbable Fe ranged from 0·23 to 0·44 mg/d. The amount of Fe available, unlike the total amount of Fe offered, does not meet the nutritional recommendations on most school days. The Bland-Altman analysis indicated that the Monsen and Balinfty and Rickard et al. showed greater agreement. The results confirm the need to adopt strategies to increase the availability of Fe in school meals.

[Assessment of food insecurity in the context of COVID-19: association with emergency aid and collecting food donations among the socially vulnerable population of a capital in Northeastern Brazil]. / Avaliação da insegurança alimentar no contexto da COVID-19: associação com o auxílio emergencial e recebimento de doação de alimentos na população em vulnerabilidade social de uma capital do Nordeste do Brasil.

The scope of this study was to investigate the prevalence of food insecurity in the context of COVID-19 and its association with the emergency aid income-transfer program and the collecting of food donations by the population in a situation of social vulnerability. A cross-sectional study was carried out with socially vulnerable families eight months after confirming the first case of COVID-19 in Brazil. A total of 903 families, living in 22 underprivileged communities of Maceió, in the state of Alagoas, were included. Sociodemographic characteristics were evaluated, and the Brazilian Food Insecurity Scale was applied. The association of food insecurity with the variables studied was performed using Poisson regression with robust variance estimation, considering α = 5%. Of the total sample, 71.1% were food insecure, a situation associated with receiving food donations (PR = 1.14; 95%CI: 1.02; 1.27) and being a beneficiary of emergency aid (PR =1.23; 95%CI: 1.01; 1.49). The results show that the population in a situation of social vulnerability was strongly affected by food insecurity. On the other hand, the population group in question benefited from actions implemented at the outset of the pandemic.

O estudo objetivou investigar a prevalência de insegurança alimentar no contexto da COVID-19 e sua associação com o programa de transferência de renda Auxílio Emergencial e o recebimento de doação de alimentos na população em vulnerabilidade social. Estudo transversal, realizado com famílias em vulnerabilidade social, oito meses após a confirmação do primeiro caso de COVID-19 no Brasil. Foram incluídas 903 famílias, residentes em 22 aglomerados subnormais de Maceió, em Alagoas. Avaliaram-se características sociodemográficas e foi aplicada a Escala Brasileira de Insegurança Alimentar. A associação da insegurança alimentar com as variáveis estudadas foi realizada por meio de regressão de Poisson com estimativa robusta das variâncias, considerando α = 5%. Do total da amostra, 71,1% estavma em insegurança alimentar, situação que se associou com o recebimento de doação de alimentos (RP = 1,14, IC95%: 1,02; 1,27) e ser beneficiário do Auxílio Emergencial (RP = 1,23, IC95%: 1,01; 1,49). Os resultados mostram que a população em vulnerabilidade social foi fortemente afetada pela insegurança alimentar. Em contrapartida, essa população foi beneficiada por ações que foram implementadas no início da pandemia.

Avaliação da insegurança alimentar no contexto da COVID-19: associação com o auxílio emergencial e recebimento de doação de alimentos na população em vulnerabilidade social de uma capital do Nordeste do Brasil / Assessment of food insecurity in the context of COVID-19: association with emergency aid and collecting food donations among the socially vulnerable population of a capital in Northeastern Brazil

Resumo O estudo objetivou investigar a prevalência de insegurança alimentar no contexto da COVID-19 e sua associação com o programa de transferência de renda Auxílio Emergencial e o recebimento de doação de alimentos na população em vulnerabilidade social. Estudo transversal, realizado com famílias em vulnerabilidade social, oito meses após a confirmação do primeiro caso de COVID-19 no Brasil. Foram incluídas 903 famílias, residentes em 22 aglomerados subnormais de Maceió, em Alagoas. Avaliaram-se características sociodemográficas e foi aplicada a Escala Brasileira de Insegurança Alimentar. A associação da insegurança alimentar com as variáveis estudadas foi realizada por meio de regressão de Poisson com estimativa robusta das variâncias, considerando α = 5%. Do total da amostra, 71,1% estavma em insegurança alimentar, situação que se associou com o recebimento de doação de alimentos (RP = 1,14, IC95%: 1,02; 1,27) e ser beneficiário do Auxílio Emergencial (RP = 1,23, IC95%: 1,01; 1,49). Os resultados mostram que a população em vulnerabilidade social foi fortemente afetada pela insegurança alimentar. Em contrapartida, essa população foi beneficiada por ações que foram implementadas no início da pandemia.

Abstract The scope of this study was to investigate the prevalence of food insecurity in the context of COVID-19 and its association with the emergency aid income-transfer program and the collecting of food donations by the population in a situation of social vulnerability. A cross-sectional study was carried out with socially vulnerable families eight months after confirming the first case of COVID-19 in Brazil. A total of 903 families, living in 22 underprivileged communities of Maceió, in the state of Alagoas, were included. Sociodemographic characteristics were evaluated, and the Brazilian Food Insecurity Scale was applied. The association of food insecurity with the variables studied was performed using Poisson regression with robust variance estimation, considering α = 5%. Of the total sample, 71.1% were food insecure, a situation associated with receiving food donations (PR = 1.14; 95%CI: 1.02; 1.27) and being a beneficiary of emergency aid (PR =1.23; 95%CI: 1.01; 1.49). The results show that the population in a situation of social vulnerability was strongly affected by food insecurity. On the other hand, the population group in question benefited from actions implemented at the outset of the pandemic.

Social network of malnourished children and its association with family's food and nutritional security / Rede social de crianças desnutridas e sua relação com a segurança alimentar e nutricional da família

Abstract Objectives: evaluate the relationship between family's food and nutrition insecurity (FNI) and the social network of malnourished children. Methods: cross-sectional study with 92 children, included in the economic class D-E. For the analysis of the children's social network, the mothers answered four simple questions. To investigate the FNI, the Brazilian Scale of Food Insecurity was used. The association between variables was analyzed by Poisson regression with robust analysis of variances. Results: 56.5% of the children had a weak social network (<10 individuals), and the prevalence of FNI was 72.8%. An inverse association was observed between children of the daily social network and FNI family (OR=0.94; CI95%=0.89-0.99], p=0.03). The number of individuals in the children's daily social network was negatively associated with the likelihood of FNI. The mother's educational level was also related to FNI (OR=2.20 [CI95%=1.11-4.34]; p=0.02), being the child up to 2.2 times more likely to be in FNI when the mother has less than four years of study. Conclusion: these results suggest that social network is associated with the FNI of malnourished children. Interventions designed to strengthen instrumental and other forms of support among small social networks can improve the health/nutrition of malnourished children with FNI.

Resumo Objetivos: avaliar a relação entre a insegurança alimentar e nutricional (IAN) da família e a rede social de crianças desnutridas. Métodos: estudo transversal com 92 crianças, inseridas na classe econômica D-E. Para a análise da rede social das crianças, as mães responderam quatro perguntas simples. Para investigar a IAN foi utilizada a Escala Brasileira de Insegurança Alimentar. A associação entre as variáveis foi analisada por regressão de Poisson com análise robusta das variâncias. Resultados: 56,5% das crianças apresentaram rede social fraca (<10 indivíduos), e a prevalência de IAN foi de 72,8%. Foi observada uma associação inversa entre rede social diária das crianças e IAN da família (RP=0,94, [IC95%=0,89-0,99]; p=0,03). O número de indivíduos na rede social diária das crianças se associou negativamente com a probabilidade de IAN. O nível de escolaridade materno também estava relacionado com a IAN (RP=2,20 [IC95%=1,11-4,34]; p=0,02), tendo a criança até 2,2 vezes mais probabilidade de estar em IAN quando a mãe apresenta menos de quatro anos de estudo. Conclusão: esses resultados sugerem que a rede social está associada à IAN de crianças desnutridas. Intervenções destinadas a fortalecer maneiras instrumentais e outras formas de apoio entre pequenas redes sociais podem melhorar a saúde/nutrição de crianças desnutridas com IAN.

Red propolis supplementation does not decrease acute respiratory events in stunted preschool children: A paired nonrandomized clinical trial.

BACKGROUND & AIMS: This study aimed to evaluate the efficacy of "red propolis" supplementation in the frequency of acute respiratory infections incidence in stunted preschool children. We hypothesized that the "red" propolis supplementation is effective in the reduce frequency of acute respiratory complications in stunted children. METHODS: This is a non-randomized, pair-matched clinical trial with 70 children, ranging from 1 to 5 years old, followed for 1 year, which were paired into two groups according to age, sex, and stunting classification. The children were in the day hospital regimen of CREN and received 5 meals/day and an additional 8 ml of honey or honey with "red propolis" in a 3% dilution. The children had access to nutritional, psychological, dental, and physician care. Respiratory complications were recorded in a pre-existing protocol of the institution by the same pediatrician, who was blind for the children's allocation. Anthropometric measurements and biochemical tests such as hemogram, IGF-1, and immunoglobulin E, G, M were conducted. RESULTS: The most prevalent symptoms were coughing, runny nose, nasal congestion and wheezing. The use of "red propolis" did not decrease the frequency of infections between the control and propolis groups, respectively (2 [1-7] vs 3 [1-7], p = 0.10), which was within the estimated by the Pan American Health Organization. There were no differences between groups in anthropometric and biochemical parameters. CONCLUSION: Supplementation with "red propolis" did not reduce the number of infections in stunted children over 1 year. Possibly, the dilution percentage (3%) may have been insufficient to allow effective action. The protocol of published in the Brazilian Registry of Clinical Trials (http://www.ensaiosclinicos.gov.br/rg/RBR-4n7j6h).

Association between phase angle and height-to-age index classifications of children under five years of age.

BACKGROUND & AIMS: The phase angle (PA) has been used as an indicator of prognosis and nutritional status because it reflects the integrity of the individuals' cellular function. In contrast to the investigations that assessed acute malnutrition (weight deficit) and PA in children, studies that evaluated the relationship of this indicator with stunting (height deficit) are still scarce and inconclusive. Thus, we aim to investigate whether there are differences in PA according to the classifications of the height-for-age (H/A) index of children under five years of age. METHODS: This is a cross-sectional study carried out in a nutritional recovery center, in households, and in a daycare center in Maceió-Alagoas, Brazil. Anthropometric data were collected, and resistance and reactance were obtained through the use of tetrapolar electrical bioimpedance, from children aged 2-5 years. The PA and the percentage of body fat were calculated. Children were divided into 3 groups: adequate H/A, at-risk of stunting and stunted. Analysis of covariance for the main outcome was performed using age, sex, and the body mass index-to-age as covariates, and the H/A classification as the exposure. RESULTS: The mean children's PA in the adequate H/A group was 3.9° [95% CI 3.6-4.2], while in the group at-risk of stunting and stunted it was 4.5° [95% CI 4.3-4.7] and 4.6° [95% CI 4.4-4.8], respectively, showing statistical difference (p < 0.01). CONCLUSION: In the present sample, stunted children have higher PA values than children with adequate H/A.

Effects of iron supplementation versus dietary iron on the nutritional iron status: Systematic review with meta-analysis of randomized controlled trials.

This meta-analysis compared the effects of dietary intervention versus iron supplementation on biochemical parameters related to the iron nutritional status in humans. The PubMed, CENTRAL, LILACS, SCIELO, OPENGREY.EU and ClinicalTrials.gov databases were searched for randomized clinical trials that assigned individuals to a dietary intervention or to an iron supplementation regimen, for 12 weeks or more. The primary outcome was the hemoglobin concentration, and secondary outcomes were ferritin, RDW, mean corpuscular volume, soluble transferrin receptor, total iron binding capacity, serum iron, and transferrin saturation. From the 6095 records identified, twelve studies were included, six with children, five with adolescents/adults, and one with pregnant women. In the subgroup of studies that included anemic/iron deficient children, supplementation significantly increased the hemoglobin concentration (weighted mean difference (WMD): 3.19 g/L [95% CI: 1.31, 5.07]) and induced a significantly greater reduction of the soluble transferrin receptor (WMD: -0.46 mg/L [95% CI: -0.70, -0, 21]), when compared to dietary intervention. It also induced a greater reduction of the total binding capacity of iron in adolescents/adults (WMD: -6.96 µmol/L [95% CI: -12.70, -1.21]). Supplementation showed a better effect on hemoglobin recovery in anemic/iron deficient children, while no differences were observed between supplementation and dietary intervention in treating adolescents/adults.

Intake of antioxidants nutrients by pregnant womem: Associated factors / Ingestão de nutrientes antioxidantes por gestantes: fatores associados

ABSTRACT Objective To evaluate the intake of antioxidant nutrients by pregnant women being cared for in the Brazilian public health system and associated factors. Methods A cross-sectional study was carried out with pregnant women cared for in the public health system in the city of Maceió, Brazil, in 2014, including 385 pregnant women and their newborns, and the collection of maternal information (socioeconomic, personal, prenatal, dietary and anthropometric data), and after the babies' birth (gestational age, birth weight and length). Food intake was assessed by two 24-hour dietary reminders per pregnant woman with subsequent adjustments by the Estimated Average Requirement method. Data were processed and Pearson's correlation was used to evaluate associations, considering p<0.05 as significant. Results A total of 388 pregnant women with a mean age of 24.06±5.92 years were studied, with inadequate intake and high variation of the following antioxidants: vitamin A (83.2%/62.7%), vitamin C (50.5%/75.7%), vitamin E (76.5%/60.2%), Selenium (60.8%/50.3%), Copper (98.5%/42.8%) and Zinc (79.6%/43.4%), respectively. Additionally, the following associations were observed: the intake of vitamin A (p=0.02), Copper (p=0.01), and Selenium (p=0.01) with the maternal Body Mass Index; the intake of vitamin A (0.04) and Selenium (p=0.02) with the birth weight; and between vitamin A (p=0.04) with the birth length. Conclusion The low intake of antioxidant nutrients by pregnant women is a reality, being associated to the maternal Body Mass Index and the birth weight and length of the newborn.

RESUMO Objetivo O objetivo deste estudo foi avaliar a ingestão de nutrientes antioxidantes por gestantes atendidas em rede pública de saúde e os fatores associados. Métodos Trata-se de estudo transversal com gestantes atendidas na rede pública de saúde do município de Maceió no ano de 2014, sendo incluídas 385 gestantes e seus recém-nascidos. Foram coletadas informações acerca das mães (dados socioeconômicos, pessoais, de pré-natal, dietéticos e antropométricos) e, após o parto, dos recém-nascidos (idade gestacional, peso e comprimento ao nascer). A ingestão alimentar foi avaliada por dois recordatórios alimentares de 24h, relatados pela gestante, com posteriores ajustes pelo método Estimativa de Requerimento Médio. Os dados foram processados, sendo utilizada a correlação de Pearson para avaliar associações, com p<0,05 como significativo. Resultados Foram estudadas 388 gestantes, com média de idade de 24,06±5,92 anos, com ingestão inadequada e alta variação da ingestão dos antioxidantes: Vitamina A (83,2%/62,7%), Vitamina C (50,5%/75,7%), Vitamina E (76,5%/60,2%), Selênio (60,8%/ 50,3%), Cobre (98,5%/42,8%) e Zinco (79,6%/43,4%), respectivamente. Adicionalmente, foi observada associação entre a ingestão de vitamina A (p=0,02), Cobre (p=0,01) e Selênio (p=0,01), e o Índice de Massa Corporal materno. Observou-se também associação entre a ingestão de vitamina A (0,04) e selênio (p=0,02) e o peso ao nascer; e de vitamina A (p=0,04) com comprimento ao nascer. Conclusão A baixa ingestão de nutrientes antioxidantes por gestantes é uma realidade, estando associada ao Índice de Massa Corporal materno e ao peso e comprimento do recém-nascido ao nascer.

Fatores associados à não utilização de suplemento antianêmico por gestantes de alto risco de Alagoas, Brasil / Associated factors to non-use of antianemic supplementation by high risk pregnant women in Alagoas, Brazil

Introdução: Apesar das estratégias e da implementação de guias e políticas para o combate à anemia carencial terem sido adotadas há bastante tempo, a sua prevalência no país vem se mantendo elevada, especialmente em grupos especiais, sendo esta carência considerada um problema de saúde pública. Assim, o objetivo desse estudo foi avaliar a prevalência e os fatores associados à não utilização de suplemento antianêmico por gestantes de alto risco de Alagoas. Método: Estudo transversal, realizado com gestantes assistidas no hospital universitário de Maceió, sendo estudadas variáveis socioeconômicas, de estilo de vida, antropométricas, e investigado o uso de suplementação ferrosa, com utilização da regressão de Poisson, e resultados expressos em razão de prevalência (RP) e intervalos de confiança (IC) de 95%. Resultados: Foram estudadas 210 gestantes na faixa etária de 13 a 43 anos de idade. O não uso de suplemento ferroso foi referido por 37,6% das mesmas, estando associado (gestantes que não utilizavam suplementação profilática versus gestantes que utilizavam suplementação profilática) ao baixo peso na gravidez, sendo, essa variável fator de proteção para esta condição (RP=0,47; IC de 95%= 0,24 a 0,93; p=0,030). Conclusão: A não utilização da suplementação antianêmica por parte de gestantes de alto risco de Alagoas é um problema de magnitude elevada, tornando evidente a necessidade de aumentar a cobertura da suplementação antianêmica entre elas.