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.

Association of parental level of education and child factors on length-for-age indicator among socially vulnerable children aged 6-24 months from a Brazilian state using structural equation modelling.

This cross-sectional study employs structural equation modelling (sEM) to explore both direct and indirect effects of parental level of education and child individual factors on the length-for-age outcomes in children aged 6-24 months assisted by the Bolsa Família Program in the State of Alagoas. A total of 1448 children were analysed by the sEM technique. A negative standardised direct effect (sDE) of the children's younger age (sDE: -0·06; P = 0·017), the use of bottle feeding (sDE: -0·11; P < 0·001) and lack of a minimum acceptable diet (sDE: -0·09; P < 0·001) on the length-for-age indicator was found. Being female (SDE: 0·08; P = 0·001), a higher birth weight (SDE: 0·33; P < 0·001), being ever breastfed (sdE: 0·07; P = 0·004) and a higher level of parental education (SDE: 0·09; P < 0·001) showed a positive SDE effect on the child's length-for-age. The model also demonstrated a negative standardised indirect effect (SIE) of the sweet beverage consumption (SIE: -0·08; P = 0·003) and a positive effect of being ever breastfed (SIE: 0·06; P = 0·017) on the child's length-for-age through parental level of education as a mediator. This research underscores the crucial role of proper feeding practices and provides valuable insights for the development of targeted interventions, policies and programmes to improve nutritional well-being and promote adequate linear growth and development among young children facing similar challenges.

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.

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.

Factors Associated with Continued Breastfeeding Practice in Children Under 2 Years of Age Assisted by the Brazilian Conditional Cash Transfer Program, Bolsa Família.

Breastfeeding is the first guarantee of the human right to adequate food and the benefits of continued breastfeeding up to 2 years of age are well established. This cross-sectional study sought to explore the association between socioeconomic, demographic, and nutritional factors and the practice of continued breastfeeding in children aged 6 to 24 months assisted by the Brazilian conditional cash transfer program, Bolsa Família. Our findings emphasize the role of unfavorable socioeconomic conditions in diminishing the practice of continued breastfeeding. They also suggest the importance of policy-level actions to promote and support breastfeeding and to combat early ultra-processed foods consumption.

Association between sitting/lying down, standing, walking time and number of steps per day with the hormonal profile and resting energy expenditure of women with obesity living in a low-income region.

Reducing sedentary behaviour (SB) and increasing physical activity (PA) by sitting less and standing/walking more is advised to prevent chronic diseases. However, the mechanisms underlying this recommendation are not well established, especially in individuals with obesity living in low-income regions. The present study evaluated whether there are associations between PA indicators (PAI - standing time, walking time and the number of steps/d) and SB indicators (SBI - sitting/lying down time) with the hormonal profile and resting energy expenditure (REE) of adult women living in a low-income region. This is a cross-sectional study. We collected data on hormones (insulin resistance, leptin and thyroid axis), body composition (tetrapolar bioimpedance), REE (indirect calorimetry), and PAI and SBI (triaxial accelerometers, ActivPAL). Multivariable linear models adjusting for age and fat-free mass were performed. Fifty-eight women (mean age of 31 years and BMI of 33 kg/m2) were included. The mean sitting/lying down time and standing time were 16·08 and 5·52 h/d, respectively. Sitting/lying down time showed a direct association with free thyroxine (FT4) (ß = 0·56 ng/dl; 95 % CI = -1·10, -0·02). Standing time showed a direct association with FT4 (ß = 0·75 ng/dl; 95 % CI = 0·01; 1·48) and inverse association with free triiodothyronine (ß = -2·83 pg/ml 95 % CI = -5·56, -0·10). There were no associations between PAI and SBI with the REE, insulin resistance, leptin and thyroid-stimulating hormone. Thus, decreased SB is associated with thyroid hormones levels but not with REE, insulin resistance or leptin in women with obesity living in low-income regions.

The relationship between total energy expenditure and physical activity level in women living in an impoverished Brazilian urban area.

OBJECTIVE: This study aimed to describe how strong is the relationship between TEE and PAL in women living in an impoverished Brazilian urban area. METHODS: Anthropometric, hormonal (insulin, TSH, FT4 , and FT3 ), body composition (deuterium), TEE (doubly labeled water) and PAL (metabolic equivalent task [MET]-7-day triaxial accelerometer, ActivPAL®) data were collected from 55 women (mean age: 31y, mean BMI: 27.4 kg/m2 ). Adjusted-TEE models were calculated incorporating the residuals of anthropometric, hormonal, and body composition variables in the TEE, to assess the relation between MET and adjusted-TEE, through three different analyzes: linear regression, nonlinear regression and change-point regression. RESULTS: Most participants (89.1%, n = 49) were classified as low-active. There was no association between crude TEE and MET.h/d (R2  = 0.05; p = 0.09). There was a positive, although weak, linear relationship between adjusted-TEE and MET.h/d (ß = 2705.26 kcal; 95% CI: 436.25; 4974.27; adj-R2  = 0.08). A change point of this relationship was identified in the MET.h/d value of 1.53 (SD = 0.02; adj-R2 = 0.13). The association between adjusted-TEE and MET.h/d before the change point (ß = 5101.46 kcal; 95%CI: 978.84; 9224.08; adj-R2  = 0.11) was stronger than the association in the full linear model, nevertheless, it was still weak. This association stop existing when it is assessed in individuals after the change point (ß = -6609.92 kcal; 95%CI: -16773.24; 3553.40; adj-R2  = 0.08). CONCLUSIONS: These results suggest that the relationship between TEE and PAL is weak and it is not completely linear in women living in an impoverished Brazilian urban area.

Salutogenesis, nutritional status and eating behaviour: a systematic review.

OBJECTIVE: To assess the relationship between the sense of coherence (SOC), eating behaviour and nutritional status. DESIGN: It is a systematic review. SETTING: The following databases were searched: MEDLINE/PubMed, Science Direct/Elsevier, LILACS/Bireme, SciELO and Google Scholar, using the indexed terms 'salutogenesis', 'sense of coherence', 'nutritional status', 'nutrition', 'eating behavior' and 'healthy eating'. The indexed terms were used in Portuguese and English according to the database searched. The data were extracted in a standardised way and the quality of the studies was assessed using the Newcastle-Ottawa Scale. PARTICIPANTS: Observational studies were included, with no limitations on the date of publication or language. RESULTS: After reading the titles and abstracts of 1855 articles, 107 full texts were retrieved, of which 27 were included. Of these, twenty-five were cross-sectional and two were longitudinal. The average score for Newcastle-Ottawa studies was 6 and most studies were rated as moderate and low quality. The cumulative sample size of all included studies was 28 981 adults and the elderly, aged between 18 and 81 years. The studies were carried out in fifteen different countries. Fifteen articles assessed eating behaviour/habit and twelve assessed nutritional status. Studies have shown that SOC has a positive relationship with an appropriate eating behaviour/habit. On the other hand, the relationship between SOC and nutritional status was controversial among studies. The heterogeneity of the data resulting from the use of different methods of evaluation of the outcomes of interest (nutritional status and eating behaviour) made it impossible to perform a meta-analysis. CONCLUSION: SOC was positively associated with adequate eating behaviour. However, it was not possible to establish a relationship between SOC and nutritional status.

Prevalence of food addiction and its association with anxiety, depression, and adherence to social distancing measures in Brazilian university students during the COVID-19 pandemic: a nationwide study.

The study's objective was to determine the prevalence of food addiction (FA) in Brazilian university students and to verify whether there is an association with anxiety, depression, and adherence to the social distancing measures adopted during the COVID-19 pandemic. This is a nationwide cross-sectional study carried out through the application of online questionnaires. Self-reported data on age, sex, economic class, race/skin color, anthropometric data, depression diagnosis, anxiety, modified Yale Food Addiction Scale 2.0 (mYFAS 2.0), and adherence to social distancing measures were collected. 5368 participants were included, with a mean age was 24.1 ± 6.3 years, the majority were female (n = 3990; 74.3%), and the mean BMI in our sample was 24.5 ± 5.3 kg/m2. The prevalence of FA was 19.1% (95%CI: 18.0; 20.0%). An association was observed between FA with depression (PR: 1.60; 95%CI: 1.43; 1.78; p < 0.01), and anxiety (3.13; 95%CI: 2.74; 3.58; p < 0.01), but not with adherence to social distancing measures (p = 0.70). In conclusion, there was a higher prevalence of FA in Brazilian university students. Besides, university students with anxiety, depression, overweight, or obesity and females are more prone to FA.Level of evidence Level V, Opinions of authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

Dietary patterns of children aged 6-24 months assisted by the Bolsa Família Program.

OBJECTIVE: This study aimed to verify the association between socio-economic and demographic characteristics and dietary patterns (DP) of children assisted by the Conditional Cash Transfer Program, Bolsa Família Program (BFP). DESIGN: This is a cross-sectional study. DP were defined using a principal component analysis. The association of the predictive variables and DP was modelled using multilevel linear regression analysis. SETTING: This study was conducted in six municipalities from the State of Alagoas, Brazil. PARTICIPANTS: The participants were children aged 6-24 months who were assisted by the BFP. RESULTS: A total of 1604 children were evaluated. Four DP were identified (DP1, DP2, DP3 and DP4). DP1 is composed of traditional Brazilian food. DP2 is formed mostly from ultra-processed foods (UPF). DP3 consists of milk (non-breast) with added sugar, while DP4 consists of fresh and minimally processed foods. Caregivers with higher age and education (ß = -0·008; (95 % CI -0·017, -0·000); ß = -0·037; (95 % CI -0·056, -0·018), respectively) were negatively associated with DP2. We observed a negative association between households with food insecurity (ß = -0·204; (95 % CI -0·331, -0·078)) and DP4 and a positive association between caregivers with higher age and education (ß = 0·011; (95 % CI (0·003; 0·019); ß = 0·043; (95 % CI 0·025, 0·061), respectively) and DP4. CONCLUSION: This study identified the association between socio-economic inequities and DP early in life, with an early introduction of UPF, in children assisted by BFP in the State of Alagoas.

Association between the consumption of ultra-processed foods and the practice of breast-feeding in children under 2 years of age who are beneficiaries of the conditional cash transfer programme, Bolsa Família.

OBJECTIVE: To evaluate the association between the consumption of ultra-processed foods (UPF) and the practice of breast-feeding in children under 2 years of age assisted by the conditional cash transfer programme, Bolsa Família Programme (PBF). DESIGN: A cross-sectional study. The consumption of UPF and the practice of breast-feeding were assessed using a structured 24-h recall. Associations were calculated using hierarchical Poisson regression, adjusted at the last level by socio-economic, demographic and environmental variables from previous hierarchical levels. SETTING: Six counties from the state of Alagoas, Brazil. PARTICIPANTS: Children aged 6-24 months, assisted by PBF. RESULTS: A total of 1604 children were evaluated, 11·7% of whom were overweight, and most had consumed UPF (90·6%) in the last 24 h. The most consumed UPF were biscuits, chocolate milk and baby food with 74·8, 66·8 and 24·9%, respectively. Through multivariable analysis, an association was found between lower consumption of UPF in the continuation of breast-feeding until the second year of life (prevalence ratio (PR) 0·91, 95 % CI 0·86, 0·96) and in the first year of life (PR 0·93, 95 % CI 0·88, 0·99). CONCLUSIONS: It was found that the studied population had a high consumption of UPF, which harmed continued breast-feeding. We highlight the importance of strengthening public policies aimed at the promotion, protection and support of breast-feeding and healthy complementary feeding aimed at populations that have difficulties in physical and economic access to a healthy and adequate diet.

Association between iron deficiency anaemia and complementary feeding in children under 2 years assisted by a Conditional Cash Transfer programme.

OBJECTIVE: To evaluate the association between Fe deficiency anaemia (IDA) and complementary feeding in children under 2 years old assisted by the Conditional Cash Transfer programme, Bolsa Família (BFP). DESIGN: Cross-sectional study. Data were obtained through a standardised form, questionnaire to assess the eating habits of children under 2 years of age, capillary Hb (HemoCue®) and the Brazilian Household Food Insecurity Measurement Scale. Associations were calculated using hierarchical Poisson regression, adjusted at the last level by socio-economic, demographic and environmental variables from previous hierarchical levels. SETTING: Six municipalities from the State of Alagoas, Brazil. PARTICIPANTS: Children aged 6-24 months assisted by BFP. RESULTS: A total of 1604 children were evaluated, among whom 58·1 % had anaemia. A higher number of food groups consumed (prevalence ratio (PR) = 0·97; 95 % CI 0·95, 0·99; P = 0·009), the consumption of dairy (PR = 0·86; 95 % CI 0·79, 0·84; P = 0·001) and meat (PR = 0·90; 95 % CI 0·83, 0·99; P = 0·030) in addition to bottle feeding (PR = 0·88; 95 % CI 0·82, 0·96; P = 0·004) were associated with a lower prevalence of IDA. CONCLUSIONS: IDA is still a serious public health problem in children under 2 years old assisted by BFP in Alagoas. We highlight the importance of promoting complementary feeding based on a diversified dietary intake, as well strengthening prophylactic supplementation programmes to increase children's adherence in conjunction with the implementation of food and nutrition education to help reduce the prevalence of this condition.

Sitting/lying time is associated with waist-to-hip increase but not with body weight increase or blood cardiovascular risk factors changes in adult women living in social vulnerability: A 2-year longitudinal study.

OBJECTIVE: The present study aimed to determine whether physical activity and energy intake are associated with the anthropometric and blood cardiovascular risk factors alterations in women living in social vulnerability for a period of 2 years. METHODS: The study was carried out with women residing in the outskirts of Maceió-AL, aged between 19 and 45 years. We characterized the socioeconomic and biochemical profile (glucose, insulin, and blood lipids) at the beginning and at the end of the study. Anthropometric evaluation was performed in three moments: at the beginning, and after 1 and 2 years of follow-up. Energy expenditure, measured by doubly labeled water, physical activity, measured by 7-day triaxial accelerometry, and energy intake, measured by 3-day 24-hour food recall, were collected at baseline. RESULTS: After 2 years, 34 women were completely assessed, with a mean age of 33.7 years. Women spent around 16 hours of the day sitting/lying down. There was an increase in body weight (from 64.61 ± 11.69 to 66.37 ± 13.26 kg, P < .01), which was not associated with any of the predictors. There was also an increase in waist/hip ratio (WHR) (from 0.84 ± 0.07 to 0.87 ± 0.05, P < .01), which was positively associated with the amount of sitting/lying time per day. There were no significant alterations in blood cardiovascular risk factors. CONCLUSION: Energy intake did not predict anthropometrical changes. Sitting/lying time was associated with an increase in WHR, but not in body weight or blood cardiovascular risk factors in low-income women.

Food insecurity and weight status of socially vulnerable child beneficiaries of a food assistance programme in Maceió, Northeast Brazil.

OBJECTIVE: To evaluate the association between weight status and food insecurity of children living in social vulnerability who are beneficiaries of a food assistance programme (FAP). DESIGN: Cross-sectional study. SETTING: From all children benefiting from the FAP in the municipality, 30 % were mapped in forty-seven distribution points. Their weight status was evaluated using BMI-for-age and food insecurity was determined with the Brazilian Food Insecurity Scale. Socio-economic data of the participants were collected using regular questionnaires. The main outcome measure was obesity. PARTICIPANTS: To be a beneficiary of the FAP, a family must have a child aged 24-96 months and receive less than half a minimum wage per capita. Participating families receive 1 litre of whole milk per day. RESULTS: In all, 1487 children had BMI-for-age and food insecurity data. Of these children, 376 (25·3 %) had excess weight, of whom 164 (11·0 %) presented with obesity, and only twenty-seven (1·8 %) were underweight; 76 % of the families had some degree of food insecurity. Multivariable analysis revealed no overall association between household food insecurity and weight status. In the specific comparison, children living in severe food insecurity were less likely to present obesity than those children living in food security (prevalence ratio = 0·60; 95 % CI 0·38, 0·96; P = 0·03). CONCLUSIONS: In a socially vulnerable population that participates in a FAP, there was no overall association between food insecurity and weight status in children, a result which is similar to what is observed in more developed contexts.

Agreement between the total energy expenditure calculated with accelerometry data and the BMR yielded by predictive equations v. the total energy expenditure obtained with doubly labelled water in low-income women with excess weight.

Low-income women are the group with the highest levels of obesity worldwide. In low-income settings, the use of predictive equations, which yield a measure of the individuals' BMR, is a feasible approach to estimate the individuals' total energy expenditure (TEE), using the factorial method (calculated-TEE = BMR × physical activity level), an important step of the obesity nutritional care. The present study aimed to identify the predictive equation that, in conjunction with metabolic equivalents of tasks (MET) data from accelerometers, yields the calculated-TEE with better agreement compared with the TEE measured by doubly labelled water (TEE-DLW). Forty-five women aged 19-45 years, with excess weight and mothers of undernourished children, were included. They received DLW to determine TEE (14 d); at the same time, they used triaxial accelerometers (7 d) to estimate their MET. The Bland-Altman method, paired-sample t tests, concordance correlation coefficient and root-mean-square error were used to assess the agreement. Maximum allowed differences were defined as 24 %, based on the within-variance coefficient of the energy intake of the sample. Eleven equations were studied. The calculated-TEE obtained by five equations showed non-significant bias: Dietary Reference Intake (Institute of Medicine (2005) Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids), FAO/WHO/UNU ((2001) Food and Nutrition Technical Report Series), Harris & Benedict ((1919) Proc Natl Acad Sci USA4, 370-373), Henry & Rees ((1991) Eur J Clin Nutr45, 177-185) and Schofield ((1985) Hum Nutr Clin Nutr39, 5-41). The mean percentage differences were -1·5, -0·8, 2·2, -2·2 and 2·0 %, respectively. Considering all parameters, FAO/WHO/UNU ((2001) Food and Nutrition Technical Report Series) equation performed slightly better than the others; nevertheless, no equation in conjunction with the estimated-MET showed a calculated-TEE with its CI for the Bland-Altman limits of agreement inside the pre-defined acceptable range.

Effectiveness of a stunting recovery program for children treated in a specialized center.

BackgroundStunting is still very prevalent in many poor and developing regions in the world. This study assessed the effectiveness of a stunting recovery program in children and its associated factors.MethodsThe retrospective study was conducted in a center of stunting recovery. There, children stayed in a day-hospital system (9 h per day; 5 days per week), and received five meals per day, providing 80% of their energetic daily needs. The main outcome was the stunting recovery rate (i.e., the child present a height-for-age index (HAZ) >-1.0 at the time of data collection). A total of 75 children treated for at least 24 months, aged between 6 and 48 months and with an HAZ <-2.0 at the time of admission were included.ResultsThe average treatment time was 41 months. About 18 children (24.0%) recovered from stunting. The variable "age at admission >24 months" (prevalence rate (PR)=0.39, 95% confidence interval (CI): 0.15-0.99; P=0.04) and the variable "Household crowding index" (PR=0.65, 95% CI: 0.44-0.95; P=0.03) were associated with the success of the treatment.ConclusionThe environmental conditions in which the children live in their households and late admission to the center negatively influenced the success of stunting recovery, even with an intensive treatment.

Waist-to-Height Gain and Triiodothyronine Concentrations in a Cohort of Socially Vulnerable Short-Stature Women: A Four-Year Follow-Up Study.

BACKGROUND: Short stature that results from undernourishment during perinatal period is associated with an increased risk of diabetes and cardiovascular diseases in adulthood, particularly in poor populations. The present study investigated changes on anthropometric and metabolic parameters of socially vulnerable women with short stature. METHODS: A prospective study with 48 women (19-45 years) who were mothers of undernourished children was conducted. Twenty-five of them were short (height ≤150 cm), and 23 were not short, to serve as a control (height >159 cm). Biochemical, anthropometric and dietary intake data were collected, before and after 4 years of follow-up. A mixed within-between analysis of covariance was used to assess the interaction between 'group' and 'time'. RESULTS: Waist-to-height ratio increased only in the short stature group, with significant interaction (+0.03 ± 0.03 in short group vs. +0.01 ± 0.03 in control; p for interaction = 0.04). The short stature group showed a significant decrease in the plasma triiodothyronine (T3) concentrations, without significant interaction (-0.16 ± 0.23 ng/ml in short group vs. -0.04 ± 0.29 ng/ml in control; p for interaction = 0.20). CONCLUSION: Women of short stature presented an increase in waist-to-height ratio, with a simultaneous decrease in total plasma T3. These alterations may lead them to increased risk of comorbidities.

Dietary medium-chain triacylglycerols versus long-chain triacylglycerols for body composition in adults: systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: To assess the effect of replacing dietary long-chain triacylglycerols (LCTs) with medium-chain triacylglycerols (MCTs) on body composition in adults. METHODS: We conducted a meta-analysis of randomized controlled trials (RCTs), to determine whether individuals assigned to replace at least 5 g of dietary LCTs with MCTs for a minimum of 4 weeks show positive modifications on body composition. We systematically searched, through July 2013, the CENTRAL, EMBASE, LILACS, and MEDLINE databases for RCTs that investigated the effects of MCT intake on body composition in adults. Two authors independently extracted data and assessed risk of bias. Weighted mean differences (WMDs) were calculated for net changes in the outcomes. We assessed heterogeneity by the Cochran Q test and I(2) statistic and publication bias with the Egger's test. Prespecified sensitivity analyses were performed. RESULTS: In total, 11 trials were included, from which 5 presented low risk of bias. In the overall analysis, including all studies, individuals who replaced dietary LCT with MCT showed significantly reduced body weight (WMD, -0.69 kg; 95% confidence interval [CI], -1.1 to -0.28; p = 0.001); body fat (-0.89 kg; 95% CI, -1.27 to -0.51; p < 0.001), and WC (-1.78 cm; 95% CI, -2.4 to -1.1; p < 0.001). The overall quality of the evidence was low to moderate. Trials with a crossover design were responsible for the heterogeneity. CONCLUSION: Despite statistically significant results, the recommendation to replace dietary LCTs with MCTs must be cautiously taken, because the available evidence is not of the highest quality.

Weight gain and reduced energy expenditure in low-income Brazilian women living in slums: a 4-year follow-up study.

The present study aimed to investigate the possible changes in anthropometric and biochemical parameters in low-income women living in the outskirts of Maceió (northeast Brazil), and to explore the possible role of dietary intake and physical activity in these changes. A prospective longitudinal study was conducted in a cohort of mothers of malnourished children who attended the Center for Nutritional Recovery and Education, an outreach programme of the Federal University of Alagoas. Socio-economic, anthropometric, biochemical and dietary intake data were assessed at baseline and after a follow-up period of 4 years. Energy expenditure (using doubly labelled water) and physical activity (using triaxial accelerometers) were assessed only in a subgroup of women after 4 years. A total of eighty-five women were assessed. Participants showed an altered biochemical profile, increased systolic blood pressure, decreased thyroid hormone levels, and body-weight gain. However, dietary intakes of the participants did not include large quantities of highly processed and high-glycaemic index foods. The energy intake of the participants did not differ from their total energy expenditure (7990.3 (7173.7-8806.8) v. 8798.1 (8169.0-9432.4) kJ, respectively; P= 0.084). Multivariate analyses showed a significant effect of time spent watching television (ß = 0.639 (0.003 to 1.275); P= 0.048) and dietary diversity score (ß = -1.039 ( -2.010 to -0.067); P = 0.036) on weight gain. The present study indicates that poor women, who are mothers of malnourished children and have a reasonably balanced dietary intake, exhibit weight gain and are at risk of developing chronic diseases.

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.