Excesso de peso pré-gestacional e ácidos graxos poli-insaturados no leite humano: modelo teórico de causalidade / Pre-gestational overweight and polyunsaturated fatty acids in human milk: theoretical causality model

Resumo Inúmeros estudos têm se detido na avaliação da associação entre o excesso de peso pré-gestacional e os ácidos graxos poli-insaturados no leite humano. Todavia, diante da complexidade de fatores de risco potencialmente confundidores, é recomendável a utilização de ferramentas gráficas para identificar possíveis vieses. O objetivo deste artigo é propor um modelo teórico de causalidade utilizando o gráfico acíclico direcionado entre o excesso de peso pré-gestacional e os ácidos graxos poli-insaturados no leite humano. Foi realizada ampla revisão da literatura para identificar as variáveis com relações causais com a exposição e/ou desfecho. A escolha das variáveis para ajuste seguiu o algoritmo gráfico que compreende seis critérios para a seleção de um conjunto mínimo de variáveis potencialmente confundidoras. Condições socioeconômicas, intervalo interpartal, idade materna e padrão de consumo alimentar foram as variáveis ajustadas a fim de se estimar o efeito total do excesso de peso pré-gestacional sobre o conteúdo dos ácidos graxos poli-insaturados no leite humano. O conjunto mínimo de variáveis encontrado pelo presente estudo pode ser utilizado na análise de outros estudos que avaliem essa associação.

Abstract A number of studies have focused on the evaluation of the relationship between pre-pregnancy overweight and polyunsaturated fatty acids content in human milk. However, given the complexity of potentially confounding risk factors, the use of graphical tools is recommended to identify possible biases. This article aims to propose a theoretical model of causality using the directed acyclic graph between pre-pregnancy overweight and polyunsaturated fatty acids content in human milk. Methods: An extensive literature review was performed to identify variables with causal relationships with exposure and/or outcome. The choice of variables for adjustment followed the graphic algorithm that comprises six criteria for selecting a minimum set of potentially confounding variables. Socioeconomic conditions, interpartum interval, maternal age and food consumption pattern were the variables that would have to be adjusted in order to estimate the total effect of pre-pregnancy overweight on polyunsaturated fatty acids content in human milk. The minimum set of variables found in the present study can be used in the analysis of other studies that evaluate this association.

Actividad física durante el embarazo y su relación con la ganancia de peso gestacional / Physical activity during pregnancy and its relationship with gestational weight gain / Atividade física durante a gestação e sua relação com o ganho de peso gestacional

Objetivo: describir los patrones de actividad física de una cohorte de gestantes de nuestro medio y explorar su asociación con la ganancia de peso en cada uno de los trimestres del embarazo. Método: estudio descriptivo longitudinal sobre una muestra de 151 mujeres. Se utilizó el Cuestionario Internacional de Actividad Física para evaluar la actividad física durante el embarazo en función del volumen, intensidad y ámbito de realización. Se llevaron a cabo diferentes modelos de regresión lineal múltiple para analizar la asociación entre actividad física y ganancia de peso gestacional. Resultados: la actividad física disminuyó durante el embarazo, tanto en tiempo como en intensidad. El índice de masa corporal pre-gestacional fue el principal factor asociado con una menor ganancia de peso a lo largo de todo el embarazo. La influencia de la actividad física sobre la ganancia de peso gestacional se limitó al tercer trimestre del embarazo en el que se observó una asociación inversa entre ambas variables. Conclusión: los resultados de este estudio muestran un importante descenso de la actividad física en la época del embarazo y sugieren una influencia limitada de ésta sobre la ganancia de peso gestacional.

Objective: to describe the physical activity patterns of a cohort comprised by pregnant women from our environment and to explore its association with weight gain in each of the trimesters of pregnancy. Methods: a descriptive and longitudinal study conducted with a sample of 151 women. The International Physical Activity Questionnaire was used to assess physical activity during pregnancy based on volume, intensity and setting where it is performed. Different multiple linear regression models were performed to analyze the association between physical activity and gestational weight gain Results: physical activity decreased during pregnancy, both in terms of time and intensity. Pre-gestational Body Mass Index was the main factor associated with lower weight gain throughout pregnancy. The influence of physical activity on gestational weight gain was limited to the third trimester of pregnancy, where an inverse association was observed between both variables. Conclusion: the results of this study show an important reduction in physical activity during pregnancy and suggest that it exerts a limited influence on gestational weight gain

Objetivo: descrever os padrões de atividade física de uma coorte de gestantes em nosso meio e explorar sua associação com o ganho de peso em cada um dos trimestres de gestação. Método: estudo descritivo longitudinal com uma amostra de 151 mulheres. O Questionário Internacional de Atividade Física foi utilizado para avaliar a atividade física durante a gestação de acordo com o volume, intensidade e escopo do desempenho. Diferentes modelos de regressão linear múltipla foram utilizados para analisar a associação entre atividade física e ganho de peso gestacional. Resultados: a atividade física diminuiu durante a gestação, tanto em tempo quanto em intensidade. O índice de massa corporal pré-gestacional foi o principal fator associado ao menor ganho de peso ao longo da gestação. A influência da atividade física no ganho de peso gestacional limitou-se ao terceiro trimestre de gestação, no qual foi observada associação inversa entre ambas as variáveis. Conclusão: os resultados deste estudo mostram uma diminuição significativa da atividade física no momento da gravidez e sugerem uma influência limitada desta no ganho de peso gestacional.

O nível de ansiedade, a renda e o acompanhamento psicológico podem influenciar na recorrência de peso corporal em mulheres submetidas a cirurgia bariátrica / Anxiety level, income and psychological monitoring can influence the recurrence of body weight in women submitted to bariatric surgery

Introdução: A melhora nos sintomas de ansiedade após a cirurgia bariátrica pode não permanecer estável em longo prazo, favorecendo a adoção de comportamentos alimentares disfuncionais. Objetivo: Testar a correlação entre o nível de ansiedade e a recorrência de peso em mulheres no pós-operatório tardio de cirurgia bariátrica e metabólica. Métodos: Foram avaliadas 50 mulheres adultas com no mínimo 24 meses após a cirurgia bariátrica e metabólica. Foram coletados dados sociodemográficos (idade, renda e nível de escolaridade) e de acompanhamento psicológico. Foram aferidos dados antropométricos (peso e altura). Para avaliar o nível de sintomas de ansiedade, foi utilizado o Inventário de Beck. Resultados: Foi encontrada média de idade de 40,9±11,4 anos. Todas apresentavam sintomas de ansiedade moderados a graves. Aquelas que estavam sem acompanhamento psicológico apresentavam maior peso corporal (p=0,049) e maior recorrência de peso (p=0,040). Observou-se correlação positiva entre o escore de ansiedade e a recorrência de peso, e correlação negativa entre o escore de ansiedade e a renda familiar. No modelo de regressão linear, a correlação entre o escore de ansiedade com a recorrência de peso (B=0,276; IC 0,003;0,594; p=0,048) e a renda (B=-0,310; IC -0,004;0,000; p=0,027) permaneceu significativa. Contudo, ao adicionar a variável "tempo de cirurgia", observou-se perda de significância entre ansiedade e recorrência de peso (B=0,270; IC -0,040; -0,624; p=0,083), mas manteve-se a correlação com a renda (B=-0,310; IC -0,004;-0,000; p=0,029). Conclusões: Ressalta-se a importância de suporte financeiro no pós-operatório, pelos custos com o tratamento, além de manter o acompanhamento com a equipe multiprofissional em longo prazo.

Introduction: The improvement in anxiety symptoms after bariatric surgery may not remain stable in the long term, favoring the adoption of dysfunctional eating behaviors. Objective: To test the correlation between anxiety level and weight recurrence in women in the late postoperative period of bariatric and metabolic surgery. Methods: Fifty adult women with at least 24 months after bariatric and metabolic surgery were evaluated. Sociodemographic data (age, income and level of education) and psychological monitoring were collected. Anthropometric data (weight and height) were measured. To assess the level of anxiety symptoms, the Beck Anxiety Inventory was used. Results: A mean age of 40.9±11.4 years was found. All had moderate to severe anxiety symptoms. Those who were without psychological support had higher body weight (p=0.049) and greater recurrence of weight (p=0.040). There was a positive correlation between the anxiety score and body weight recurrence, and a negative correlation between the anxiety score and family income. In the linear regression model, the correlation between anxiety score and weight recurrence (B=0.276; CI 0.003; 0.594; p=0.048) and income (B=-0.310; CI -0.004; 0.000; p=0.027) remained significant. However, when adding the variable "surgery time", there was a loss of significance between anxiety and weight recurrence (B=0.270; CI -0.040; -0.624; p=0.083), but the correlation with income was maintained (B=-0.310; CI -0.004; -0.000; p=0.029). Conclusions: We emphasize the importance of financial support in the postoperative period, due to treatment costs, in addition to maintaining monitoring with the multidisciplinary team in the long term.

The efficacy of liraglutide combined with intragastric balloon on weight loss

SUMMARY OBJECTIVE: Intragastric balloon placement is an effective method for weight reduction. The aim of this study was to evaluate the efficacy of combining liraglutide with intragastric balloon. METHODS: Initially, demographic data of patients such as age, gender, comorbid diseases, adverse events, initial weight, height, body mass index, percent body fat, and waist-hip ratio were collected. Weight, body mass index, percent body fat, and waist-hip ratio were measured in the second, third, fourth, fifth, and sixth months. Then, intragastric balloon was removed and liraglutide was stopped. RESULTS: A total of 50 patients were included in the study, of whom 28 (56%) were in Group A (intragastric balloon) and 22 (44%) were in Group B (plus liraglutide). Weight change at the time of balloon removal was higher in Group B [median weight change 13.8 (7.8 min to 16.8 max) versus 7.9 (4.8 min to 11.8 max); p<0.01]. When the weight, percent body fat, body mass index, and waist-hip ratio changes were compared according to gender, no significant difference was observed in the groups. Comorbid diseases were hypertension in 7 patients (4 in Group A and 3 in Group B) and diabetes in 9 patients (5 in Group A and 4 in Group B). No statistical significance was found. CONCLUSION: Liraglutide has benefits in terms of weight, percent body fat, and body mass index reduction when administered with intragastric balloon.

Weight regain and the metabolic profile of women in the postoperative period of bariatric surgery: a multivariate analysis / Reganho de peso e perfil metabólico de mulheres no pós-operatório de cirurgia bariátrica: análise multiariada

ABSTRACT BACKGROUND: Weight regain in the postoperative period after bariatric surgery is directly related to the relapse of preoperative comorbidities and a negative impact on the patients' biochemical profile. AIMS: To assess the metabolic impact of weight regain on preoperative comorbidities and on patients' biochemical profiles, in order to show the impact of the complications on the metabolic outcomes of bariatric surgery. METHODS: A retrospective study was carried out with 75 women in the late postoperative period of bariatric surgery who presented pathological weight regain (≥20% of the maximum weight loss). Data of interest consisted of glycemic, lipid, and inflammatory profile measurements at three different moments of evaluation: preoperative period, at the weight nadir (minimum weight), and after weight regain. A multivariate analysis was performed. RESULTS: The mean age was 46.39±12.09 years. Preoperative body mass index was 40.10±4.11 kg/m2. There was an overall increase of 3.36 points in the mean body mass index between the nadir and after regain: from 26.30±3.9 kg/m2 to 29.66±4.66 kg/m2. The mean time to reach the nadir was 18±7.6 months, with an average percentage of excess weight loss of 91.08±11.8%. The median time for pathological weight regain was 48 months, and the mean regain amongst the sample was 8.85±5.65 kg. There was a significant correlation between pathological weight regain and levels of insulin (r=0.351; p<0.011), C-peptide (r=0.303; p<0.011), C-reactive protein (r=0.402; p<0.001), and vitamin D (r=-0.435; p<0.001), the last two being the most influenced by the percentage of weight regained. CONCLUSIONS: The pathological weight regain in the postoperative period of bariatric surgery results in losses in the patients' metabolic and inflammatory profiles. However, the biochemical benefits are sustained up to the preoperative levels of the parameters analyzed.

RESUMO RACIONAL: Reganho de peso no pós-operatório de cirurgia bariátrica está diretamente relacionado à recidiva das comorbidades pré-operatórias e a um impacto negativo no perfil bioquímico desses pacientes. OBJETIVOS: avaliar o impacto metabólico do reganho de peso nas comorbidades pré-operatórias e no perfil bioquímico desses pacientes, a fim de mostrar o impacto das complicações nos desfechos metabólicos finais da cirurgia bariátrica. MÉTODOS: Estudo retrospectivo que analisou 75 mulheres no pós-operatório tardio de cirurgia bariátrica que apresentaram reganho patológico de peso (=20% do máximo de peso perdido). Foram coletados dados referentes às medidas dos perfis glicêmico, lipídico e inflamatório em três momentos distintos de avaliação: no pré-operatório, no nadir de peso (menor peso) e após o reganho ponderal. Foi realizada uma análise multivariada. RESULTADOS: A idade média foi 46.39±12.09 anos. IMC médio pré-operatório foi 40.10±4.11 kg/m2. Houve um aumento de 3,36 pontos no IMC médio entre o nadir e após reganho: de 26.30±3.9 Kg/m2 para 29.66±4.66 Kg/m2. O tempo médio para atingir o nadir foi de 18±7.6 meses, com uma %PEP de 91.08±11.8%. O tempo médio para o reganho patológico foi de 48 meses, e a média de reganho foi 8.85±5.65 kg. Houve correlação significativa entre o reganho patológico e os níveis de insulina (r=0.351; p<0.011), peptídeo C (r=0.303; p<0.011), proteína C reativa (r=0.402; p<0.001) e vitamina D (r=-0.435; p<0.001), sendo os dois últimos os mais influenciados pela porcentagem de reganho de peso. CONCLUSÕES: O reganho de peso patológico no pós-operatório de cirurgia bariátrica resulta em prejuízos ao perfil metabólico e inflamatório dos pacientes. No entanto, os benefícios bioquímicos perduram em relação aos níveis pré-operatórios dos parâmetros analisados

Determinants of poor sleep quality in adults during the coronavirus disease pandemic: COVID-Inconfidentes, a population-based study

ABSTRACT BACKGROUND: The coronavirus disease (COVID-19) pandemic has adversely affected the health of the global population, with sleep quality being one of the affected parameters. OBJECTIVES: To evaluate sleep quality and its associated factors in adults during the COVID-19 pandemic in Brazil. DESIGN AND SETTING: A population-based cross-sectional serological survey of 1,762 adults in the Iron Quadrangle region of Brazil. METHODS: The Pittsburgh Sleep Quality Index was used to assess sleep quality. Sociodemographic variables, health conditions, health-related behaviors, anxiety, vitamin D levels, weight gain/loss, and pandemic characteristics were assessed using a structured questionnaire. Univariate and multivariate analyses using Poisson regression with robust variance were performed to identify factors associated with sleep quality. RESULTS: More than half of the participants reported poor sleep quality (52.5%). Multivariate analysis revealed that the factors associated with poor sleep quality included living alone (prevalence ratio [PR] = 1.34; 95% confidence interval [CI]: 1.04-1.73), anxiety disorder (PR = 1.32; 95% CI: 1.08-1.62), 5.0% weight loss (PR = 1.21; 95% CI: 1.02-1.44), 5.0% weight gain (PR = 1.27; 95% CI: 1.03-1.55), vitamin D deficiency (PR = 1.16; 95% CI: 1.01-1.35), and COVID-19 symptoms (PR = 1.29; 95% CI: 1.10-1.52). CONCLUSIONS: Our study revealed that more than half of the participants experienced poor sleep quality during the COVID-19 pandemic. Factors associated with poor sleep quality included vitamin D deficiency and weight changes related to the pandemic.

Nutritional and immunological parameters as prognostic factors in patients with advanced oral cancer

Abstract Objective: The aim of the present study was to analyze the prognostic relationship of weight loss and preoperative hematological indexes in patients surgically treated for pT4a squamous cell carcinoma of the oral cavity. Methods: A retrospective cohort study. Results: Percent weight loss greater than 10% was identified in 49 patients (28.2%), and any weight loss in relation to the usual weight occurred in 140 patients (78.7%). Percent weight loss greater than 10% (HR = 1.679), Red cell distribution width (RDW) values greater than 14.3% (HR = 2.210) and extracapsular spread (HR = 1.677) were independent variables associated with risk of death. Conclusion: Patients with advanced squamous cell carcinoma of the oral cavity present significant weight loss and as significantly immunocompromised. Increased values of RDW and higher percentages of weight loss in relation to the individual's usual weight, together with extracapsular spread of metastatic lymph nodes, were risk factors for lower survival, regardless of other clinical and anatomopathological characteristics. Level of evidence: 3.

Incidência de aumento e redução do Índice de Massa Corporal na meia-idade: seguimento de quatro anos / Incidence of increase and decrease in Body Mass Index in middle-aged men and women: four-year follow-up

Resumo Objetivou-se analisar a incidência de aumento e de redução do Índice de Massa Corporal (IMC) entre homens e mulheres de meia-idade segundo características sociodemográficas e classificação do estado nutricional. Trata-se de uma coorte de base populacional com 689 adultos com idade entre 40 e 64 anos seguidos por quatro anos. Verificou-se a proporção de redução e de aumento do IMC (≥1 kg/m²) segundo variáveis sociodemográficas e classificação do estado nutricional na linha de base mediante regressão de Poisson bruta e ajustada. A maior incidência de redução do IMC foi observada entre os homens na faixa etária de 55 a 64 anos (RR: 1,78; IC95%: 1,06-3,00), naqueles sem companheira (RR: 1,85; IC95%: 1,09-3,14), nos classificados com sobrepeso (RR: 2,06; IC95%: 1,13-3,74) e obesidade (RR: 2,33; IC95%: 1,24-4,35), e entre as mulheres na faixa etária de 55 a 64 anos (RR: 1,43; IC95%: 1,02-2,00) e nas classificadas com obesidade (RR: 2,10; IC95%: 1,30-3,38). A incidência de aumento do IMC foi menor na faixa etária de 55 a 64 anos entre os homens (RR: 0,62; IC95%: 0,41-0,95) e mulheres (RR: 0,68; IC95%: 0,49-0,95). Estes dados são importantes para compreensão dos fatores relacionados à variação do IMC e elaboração de políticas públicas que visem o cuidado à saúde na meia-idade.

Abstract The scope of this study was to analyze the incidence of increase and decrease in Body Mass Index (BMI) among middle-aged men and women according to sociodemographic characteristics and classification of nutritional status. It involved a population-based cohort of 689 adults aged 40 to 64 years followed up for four years. The proportion of reduction and increase in BMI (≥1 kg/m²) was verified according to sociodemographic variables and classification of nutritional status in the baseline by means of crude and adjusted Poisson regression. There was a higher incidence of reduced BMI among men in the 55-64 age group (RR: 1.78; 95%CI: 1.06-3.00), in those without a partner (RR: 1.85; 95%CI: 1.09-3.14), in those classified as overweight (RR: 2.06; 95%CI: 1.13-3.74) and in those classified as obese (RR: 2.33; 95%CI: 1.24-4.35), and among women in the 55-64 age group (RR: 1.43; 95%CI: 1.02-2.00) and in those classified as obese (RR: 2.10; 95%CI%: 1.30-3.38). The incidence of increased BMI was lower in the 55 to 64 age group among men (RR: 0.62; 95%CI: 0.41-0.95) and women (RR: 0.68; 95%CI: 0.49-0.95). These data are important for understanding the factors related to the variation of BMI and the elaboration of public policies aimed at the health care of middle-aged adults.

Birth weight, weight gain, and obesity among children in uruguay: a prospective study since birth / Peso ao nascer, ganho ponderal e obesidade em crianças no uruguai: estudo prospectivo desde

ABSTRACT Objective: To examine the effect of birth weight and subsequent weight gain on children being overweight and obese in serial assessments of Uruguayan children living at urban areas. Methods: We used secondary data of pediatric anthropometric measurements and health and socioeconomic characteristics of families that were included in a longitudinal and prospective nationally representative survey ("Encuesta de Nutrición, Desarrollo Infantil y Salud"). The associations of conditional weight gain, being overweight and obesity were tested through correlation coefficients. Multivariate binary logistic regression models were performed to calculate the effect of birth weight on childhood obesity and were adjusted for covariates. Results: For macrosomic babies, there was an increase in the prevalence of overweight and obesity in 70% compared with non-macrosomic babies, when we adjusted for sex, exclusive breastfeeding duration, and household income. The correlation between weight gain and the body mass index for age indicated that the greatest (positive) difference in Z score between measurements increased the obesity levels. Conclusions: Our findings suggest that ensuring optimal birth weight and monitoring and controlling posterior weight gain represent the first steps toward primary prevention of childhood obesity.

RESUMO Objetivo: Analisar o efeito do peso ao nascer e do ganho ponderal subsequente em crianças com sobrepeso e obesidade com base em avaliações consecutivas de crianças uruguaias vivendo em áreas urbanas. Métodos: Foram utilizados dados secundários de medidas antropométricas pediátricas, além de características de saúde e socioeconômicas de famílias incluídas em um inquérito prospectivo e longitudinal de representatividade nacional ("Encuesta de Nutrición, Desarrollo Infantil y Salud"). As associações entre ganho ponderal condicional, sobrepeso e obesidade foram testadas por meio de coeficientes de correlação. Modelos de regressão logística binária multivariada foram construídos para calcular o efeito do peso ao nascer sobre a obesidade infantil e ajustados por covariáveis. Resultados: Bebês macrossômicos tiveram um aumento de 70% na prevalência de sobrepeso e obesidade em comparação a bebês não-macrossômicos, quando ajustado por sexo, duração do aleitamento materno exclusivo e renda familiar. A correlação entre ganho ponderal e índice de massa corporal para idade mostrou que a maior diferença (positiva) de escore z entre as medições aumentou os níveis de obesidade. Conclusões: Os achados deste estudo sugerem que garantir o peso ideal ao nascer e monitorar e controlar o ganho ponderal subsequente são os primeiros passos para a prevenção primária da obesidade infantil.

Factors associated with falls in hemodialysis patients: a case-control study / Factores asociados a caídas en pacientes hemodializados: un estudio de caso-control / Fatores associados às quedas em pacientes de hemodiálise: um estudo caso-controle

Objective: to identify possible associations between a higher probability of falls among hemodialysis patients and laboratory values, comorbidities, pharmacological treatment, hemodynamic changes, dialysis results and stabilometric alterations. Method: this was a retrospective case-control study with hemodialysis patients. Patients in a hemodialysis unit who had suffered one or more falls were included in the case group. Patients from the same unit who had not suffered falls were the controls. Data were gathered from the patients' clinical history and also from the results of a balance test conducted six months before the study. Results: thirty-one patients were included (10 cases and 21 controls). Intradialytic body weight change was significantly greater among cases (p <0.05). Patients in the case group also presented greater lateral instability after dialysis (p <0.05). Other factors such as high blood pressure, antihypertensives, beta-blockers, and lower heart rates were also associated with falls. Conclusion: a greater intradialytic weight change was associated with an increase in risk of falls. Nursing staff can control these factors to prevent the incidence of falls in dialysis patients.

Objetivo: identificar la posible asociación entre los valores analíticos, comorbilidades, tratamiento farmacológico, cambios hemodinámicos, resultado de la diálisis y alteraciones estabilométricas con una mayor probabilidad de caídas en pacientes en hemodiálisis. Método: estudio retrospectivo de casos y controles en pacientes en hemodiálisis. Se consideraron como casos pacientes de una unidad de hemodiálisis que habían sufrido una o varias caídas. Los controles fueron pacientes de la misma unidad que no sufrieron caídas. Se obtuvieron los datos de la historia clínica de los pacientes y, también, se valoró una prueba de equilibrio realizada 6 meses antes a dichos pacientes. Resultados: se incluyeron 31 pacientes (10 casos y 21 controles). El cambio de peso durante la diálisis fue significativamente mayor en el grupo de personas que sufrieron una caída (p <0,05). Los pacientes que sufrieron una caída presentaron mayor inestabilidad lateral después de la diálisis (p <0.05). Otros factores como la hipertensión arterial, los antihipertensivos, los betabloqueantes y las frecuencias cardiacas más bajas también se relacionaron con las caídas. Conclusión: un mayor cambio de peso intradiálisis se relaciona con mayor riesgo de caídas. El control de estos factores por parte del personal de enfermería podría prevenir la incidencia de caídas en pacientes dializados.

Objetivo: identificar a possível associação entre valores laboratoriais, comorbidades, tratamento farmacológico, alterações hemodinâmicas, resultado da diálise e alterações estabilométricas com uma maior probabilidade de quedas em pacientes de hemodiálise. Método: estudo caso-controle retrospectivo em pacientes de hemodiálise. Foram analisados os casos de pacientes de uma unidade de hemodiálise que sofreram uma ou mais quedas. Os controles foram pacientes da mesma unidade que não sofreram quedas. Os dados foram obtidos a partir do histórico clínico dos pacientes e, também, de um teste de equilíbrio realizado seis meses antes nesses pacientes. Resultados: 31 pacientes foram avaliados (10 casos e 21 controles). A alteração de peso durante a diálise foi significativamente maior no grupo de pessoas que sofreu uma queda (p <0,05). Pacientes que sofreram queda apresentaram maior instabilidade lateral após a diálise (p <0,05). Outros fatores, como hipertensão, anti-hipertensivos, betabloqueadores e frequência cardíaca mais baixa, também foram associados às quedas. Conclusão: uma maior alteração do peso intradialítico está relacionada a um maior risco de quedas. O controle desses fatores pela equipe de enfermagem poderia prevenir a incidência de quedas em pacientes em diálise.

Retenção de peso pós-parto em mulheres assistidas no serviço público de saúde: estudo de coorte / Retención de peso posparto en mujeres asistidas en el servicio de salud pública: estudio de cohorte / Postpartum weight retention in women assisted in the public health service: cohort study

Objetivo analisar a retenção de peso pós-parto em mulheres assistidas no serviço público de saúde em um município do Sul do Brasil. Método estudo de coorte realizado com 85 puérperas. Dados socioeconômicos, obstétricos, antropométricos, hábitos alimentares, atividade física, amamentação e fatores emocionais foram coletados mediante entrevista em dois momentos: no hospital, no puerpério imediato; e no domicílio, seis meses após o parto. Na análise, utilizou-se estatística descritiva e inferencial. Resultados a incidência da retenção de peso pós-parto maior que 1 kg foi de 54,1%, associada ao ganho de peso gestacional excessivo (68,4%), estado nutricional eutrófico/baixo peso no início da gestação (65,8%) e excesso de peso seis meses pós-parto (61,8%). Mulheres que não amamentaram exclusivamente até seis meses retiveram mais peso. A prevalência de insatisfação corporal foi alta (82,4%). Conclusão os fatores de risco para retenção de peso pós-parto foram estado nutricional eutrófico pré-gestacional e ganho de peso excessivo na gestação

Objetivo analizar la retención de peso posparto en mujeres atendidas en el servicio público de salud en un municipio del sur de Brasil. Método estudio de cohorte realizado con 85 puérperas. Los datos socioeconómicos, obstétricos, antropométricos, hábitos alimenticios, actividad física, lactancia materna y factores emocionales fueron recolectados a través de entrevistas en dos momentos: en el hospital, en el puerperio inmediato; y en casa, seis meses después del parto. En el análisis se utilizó estadística descriptiva e inferencial Resultados la incidencia de retención de peso posparto mayor de 1 kg fue de 54,1%, asociada a aumento excesivo de peso gestacional (68,4%), estado nutricional eutrófico/bajo peso al inicio del embarazo (65,8%) y sobrepeso seis meses postparto (61,8%). Las mujeres que no amamantaron exclusivamente hasta seis meses retuvieron más peso. La prevalencia de insatisfacción corporal fue alta (82,4%). Conclusión los factores de riesgo para la retención de peso posparto fueron el estado nutricional eutrófico pre-gestacional y el aumento de peso excesivo durante el embarazo.

Objective to analyze postpartum weight retention in women assisted in the public health service in a municipality in southern Brazil. Method cohort study conducted with 85 puerperal women. Socioeconomic, obstetric, anthropometric data, eating habits, physical activity, breastfeeding and emotional factors were collected through interviews in two moments: in the hospital, in the immediate puerperium; and at home, six months after delivery. Descriptive and inferential statistics were used in the analysis. Results the incidence of postpartum weight retention greater than 1 kg was 54.1%, associated with excessive gestational weight gain (68.4%), eutrophic nutritional status/low weight at the beginning of pregnancy (65.8%) and overweight six months postpartum (61.8%). Women who did not breastfeed exclusively up to six months retained more weight. The prevalence of body dissatisfaction was high (82.4%). Conclusion the risk factors for postpartum weight retention were pre-gestational eutrophic nutritional status and excessive weight gain during pregnancy.

Ganho de peso gestacional excessivo no Sistema Único de Saúde / Aumento de peso gestacional excesivo en el Sistema Único de Salud / Excessive gestational weight gain in the Brazilian Unified Health System

Resumo Objetivo Verificar a prevalência e os fatores associados ao ganho de peso excessivo na gestação. Métodos Estudo transversal, realizado em município do interior do sul do Brasil, com 462 mulheres que tiveram parto financiado pelo Sistema Único de Saúde. Coletado dados sociodemográficos, antropométricos, obstétricos, hábitos alimentares e prática de atividade física. Realizou-se análise estatística bivariada (Qui-quadrado) e múltipla por meio de modelo de regressão logística. Resultados Participaram deste estudo, predominantemente, mulheres casadas/ em união estável, maiores de 25 anos e das classes econômicas C, D ou E. A prevalência de ganho de peso excessivo na gestação foi de 38,3%. As mulheres com renda per capita menor que um salário-mínimo apresentaram menor frequência de ganho de peso excessivo na gestação (p=0,020). Já as gestantes que referiram planejar a gestação (p=0,048), que tinham excesso de peso pré-gestacional (p<0,001), que aumentaram a ingesta alimentar (p<0,001) e que consumiram produtos industrializados mais do que três vezes por semana (p=0,002) foram as que apresentaram maior frequência de ganho de peso excessivo. Conclusão A prevalência de ganho de peso gestacional excessivo foi de 38,3% e esteve associada à maior renda per capita, gestação planejada, excesso de peso pré-gestacional, aumento da ingesta alimentar e maior frequência semanal no consumo de produtos industrializados.

Resumen Objetivo Verificar la prevalencia y los factores asociados al aumento de peso excesivo en la gestación. Métodos Estudio transversal, realizado en un municipio del interior de la región Sur de Brasil, con 462 mujeres cuyo parto fue financiado por el Sistema Único de Salud. Se recopilaron datos sociodemográficos, antropométricos, obstétricos, hábitos alimentarios y práctica de actividad física. Se realizó un análisis estadístico bivariado (ji cuadrado) y múltiple mediante el modelo de regresión logística. Resultados Participaron en este estudio principalmente mujeres casadas/con unión de hecho, mayores de 25 años y de clase económica C, D o E. La prevalencia del aumento de peso excesivo en la gestación fue del 38,3 %. Las mujeres con ingreso per cápita menor a un salario mínimo presentaron menor frecuencia de aumento de peso excesivo en la gestación (p=0,020). Por otro lado, las mujeres embarazadas que indicaron una gestación planificada (p=0,048), que tenían exceso de peso pregestacional (p<0,001), que aumentaron la ingesta de alimentos (p<0,001) y que consumieron productos industrializados más de tres veces por semana (p=0002) fueron las que presentaron mayor frecuencia de aumento de peso excesivo. Conclusión La prevalencia de aumento de peso gestacional excesivo fue del 38,3 % y se relacionó con mayores ingresos por cápita, gestación planificada, exceso de peso pregestacional, aumento de la ingesta de alimentos y mayor frecuencia semanal de productos industrializados.

Abstract Objective To check the prevalence and factors associated with excessive weight gain during pregnancy. Methods This is a cross-sectional study carried out in a municipality in the countryside of southern Brazil, with 462 women who had a birth financed by the Brazilian Unified Health System. Sociodemographic, anthropometric, obstetric, eating habits and physical activity data were collected. Bivariate (chi-square) and multiple statistical analysis were performed using a logistic regression model. Results The study was predominantly carried out by women who were married/in a stable relationship, over 25 years of age and from economic classes C, D or E. The prevalence of excessive weight gain during pregnancy was 38.3%. Women with per capita income below one minimum wage had a lower frequency of excessive weight gain during pregnancy (p=0.020). The pregnant women who reported planning their pregnancy (p=0.048), who were overweight pre-pregnancy (p <0.001), who increased their food intake (p <0.001) and who consumed industrialized products more than three times a week (p=0.002) were those that presented a higher frequency of excessive weight gain. Conclusion The prevalence of gain of excessive gestational weight was 38.3% and was associated with higher per capita income, planned pregnancy, pre-gestational excess weight, increased food intake and higher weekly frequency of consumption of industrialized products.

Condições de saúde e mudança de peso de idosos em dez anos do Estudo SABE / Condiciones de salud y cambio de peso de personas mayores en diez años del Estudio SABE / Health conditions and weight change among the older adults over ten years of the SABE Survey

Objetivo: Analisar a relação das condições de saúde com a mudança de peso entre idosos em um período de dez anos em São Paulo/SP. Métodos: Estudo longitudinal que acompanhou (2000-baseline, 2006 e 2010) a mudança do peso corporal (variável desfecho) e condições de saúde associadas (variáveis de exposição) em idosos (n=571); análises de regressão logística multinomial foram empregadas. Resultados: O aumento médio de peso no período foi de 29,0%. Perderam peso 34,0% (2006) e 12,5% (2010); e ganharam peso 18,2% (2006) e 39,9% (2010). A prevalência de doenças crônicas aumentou de 34,1% (2000) para 51,9% (2006) e 60,1% (2010). Idosos com aumento de peso avaliaram pior sua saúde geral em 2006 (RR:3,15; IC95% 1,21;8,17) e 2010 (RR:2,46; IC95% 1,02;5,94). Maior número de doenças (RR:2,12; IC95% 1,00;4,46) e internações (RR:3,50; IC95% 1,40;8,72) associaram-se a diminuição de peso em 2010. Conclusão: Mudanças de peso estão relacionadas a um pior estado de saúde entre idosos.

Objetivo: Analizar la relación entre las condiciones de salud y el cambio de peso entre adultos mayores durante un período de diez años en São Paulo/SP. Métodos: Estudio longitudinal (2000-baseline, 2006 y 2010) que siguió el cambio en el peso corporal (variable de resultado) y las condiciones de salud asociadas (variables de exposición) en adultos mayores (n=571); se emplearon análisis de regresión logística multinomial. Resultado: El aumento de peso promedio en el período evaluado fue del 29,0%. Un 34,0% (2006) y 12,5% (2010) perdieron peso; 18,2% (2006) y 39,9% (2010) ganaron peso. La prevalencia de enfermedades crónicas aumentó del 34,1% (2000) para 51,9% (2006) y 60,1% (2010). Las personas mayores con aumento de peso calificaron su salud general peor en 2006 (RR:3,15; IC95% 1,21;8,17) y 2010 (RR:2,46; IC95% 1,02;5,94). El mayor número de enfermedades (RR:2,12; IC95% 1,00;4,46) y hospitalizaciones (RR:3.50; IC95% 1,40;8,72) se asociaron con una disminución del peso en 2010. Conclusión: Los cambios de peso están relacionados con un peor estado de salud entre los adultos mayores.

Objective: To analyze the relationship between health conditions and weight changes among elderly people monitored by the SABE Survey over a ten-year period in São Paulo/SP. Methods: This was a longitudinal study that followed (2000-baseline, 2006 and 2010) change in body weight (outcome variable) and associated health conditions (exposure variables) in the elderly (n=571); multinomial logistic regression analyses were employed. Results: Average weight increase in the evaluated period was 29.0%. 34.0% (2006) and 12.5% (2010) lost weight and 18.2% (2006) and 39.9% (2010) gained weight. Prevalence of chronic diseases increased from 34.1% (2000) to 51.9% (2006) and 60.1% (2010). Older people with weight gain also rated their overall health as poorer in 2006 (RR:3.15; 95%CI 1.21;8.17) and 2010 (RR:2.46; 95%CI 1.02;5.94). The higher numbers of diseases (RR:2.12; 95%CI 1.00;4.46) and hospitalizations (RR:3.50; 95%CI 1.40;8.72) were associated with a decrease in weight in 2010. Conclusion: Weight changes are related to poorer health status among the elderly.

The association of pre-pregnancy body mass and weight gain during pregnancy with macrosomia: a cohort study / 中华预防医学杂志

Objective@#To examine the association of pre-pregnancy body mass and weight gain during pregnancy with macrosomia. @*Methods@#From January 2015 to December 2015, a total of 20 477 pregnant women were recruited by probabilistic proportional scale sampling with simple randomization in Sichuan, Yunnan and Guizhou Provinces. Basic information of pregnant women, weight gain during pregnancy and weight of newborn were collected. A multiple logistic regression model was used to assess the association between the pre-pregnancy body mass and gestational weight gain indicators with macrosomia. @*Results@#20 321 mother-infant were included in the final analysis. 20 321 pregnant women were (30.09±4.10) years old and delivered at (39.20±1.29) weeks, among which 12 341 (60.73%) cases were cesarean delivery. The birth weight of 20 321 infants were (3 292.26±431.67) grams, and 970 (4.77%) were macrosomia. The multiple logistic regression model showed that after adjusting for the age of women, compared to the normal weight group in the pre-pregnancy, the overweight and obesity group elevated the risk of macrosomia, with OR (95%CI) about 1.99 (95%CI: 1.69−2.35) and 4.05 (95%CI: 3.05−5.39), respectively. After adjusting for the age, the pre-pregnancy BMI, delivery weeks, delivery mode and infant′s gender, compared to the weight-gain appropriate group, higher weight gain rate in the mid-pregnancy and excessive total gestational weight gain elevated the risk of macrosomia, with OR (95%CI) about 1.99 (95%CI: 1.66−2.39) and 1.80 (95%CI: 1.55−2.08), respectively. @*Conclusion@#The overweight before pregnancy, obesity before pregnancy, the rate of weight gain in the second trimester and the high total weight gain during pregnancy could increase the risk of macrosomia.

Correlates of the Pregnancy Experience and Attitude regarding Weight Change during Pregnancy in Primigravida Women / 여성건강간호학회지

PURPOSE: We aimed to examine the correlations between pregnancy experience and attitude regarding weight change during pregnancy. METHODS: This correlative study was conducted from July 2017 to October 2017 by involving 156 primigravida women who were over pregnancy 20 weeks in Seoul and Gyeonggi-do province. Data were collected using a questionnaire, which included questions on demographic data, experience during pregnancy, and attitude regarding weight change during pregnancy. Descriptive statistics were calculated. Also, independent t-test, ANOVA, and Pearson's correlation coefficients were used for data analysis. RESULTS: The mean age of the participants was 30.62 years and their score of attitude regarding weight gain during pregnancy was low. Moreover, a significant correlation was found between the pregnancy experience and attitude regarding weight gain during pregnancy in primigravida women. CONCLUSION: As a result of analyzing the correlation between pregnancy experience and attitude towards weight gain during pregnancy, it is apparent that attitudes toward weight change are different according to experience during pregnancy in women. Based on these results, it can be concluded that nursing intervention programs are necessitated to enhance the attitude of pregnant primigravida women towards pregnancy and weight gain.

Body weight perception and body weight control behaviors in adolescents / Percepção do peso corporal e comportamentos para controle de peso em adolescentes

Abstract Objective: To investigate the association between the perception of body weight (as above or below the desired) and behaviors for body weight control in adolescents. Methods: This was a cross-sectional study that included 1051 adolescents (aged 15-19 years) who were high school students attending public schools. The authors collected information on the perception of body weight (dependent variable), weight control behaviors (initiative to change the weight, physical exercise, eating less or cutting calories, fasting for 24 h, taking medications, vomiting, or taking laxatives), and measured body weight and height to calculate the body mass index and then classify the weight status. Associations were tested by multinomial logistic regression analysis. Results: Adolescents of both sexes who perceived their body weight as below the expected weight took more initiatives to gain weight, and those who perceived themselves as overweight made more efforts to lose weight. In adolescents who perceived themselves as overweight, the behavior of not taking medication was associated with the outcome only in boys (Odds Ratio = 8.12), whereas in girls, an association was observed with the variables eating less, cutting calories, or avoiding fatty foods aiming to lose or avoid increasing body weight (Odds Ratio = 3.39). Adolescents of both sexes who practiced exercises were more likely to perceive themselves as overweight (male Odds Ratio = 2.00; Odds Ratio = 1.93 female). Conclusion: The perception of the body weight as above and below one's expected weight was associated with weight control behaviors, which were more likely to result in initiatives to lose and gain weight, respectively.

Resumo Objetivo: Verificar a associação da percepção (acima ou abaixo) do peso corporal esperado com os comportamentos para controle de peso em adolescentes. Métodos: Estudo transversal, feito com 1.051 adolescentes (15 a 19 anos) do ensino médio de escolas públicas estaduais. Foram coletadas informações sobre a percepção do peso corporal (variável dependente), comportamentos de controle de peso (iniciativa para mudar o peso, prática de exercícios físicos, comer menos ou cortar calorias, ficar 24 h sem comer, tomar medicamentos, vomitar ou tomar laxantes) e aferidas as medidas de massa corporal e estatura para cálculo do índice de massa corporal e classificação do status do peso. As associações foram testadas por meio da regressão logística multinomial. Resultados: Adolescentes de ambos os sexos com percepção do peso corporal abaixo do peso esperado apresentaram mais iniciativas para ganhar peso e aqueles que se percebiam acima do peso tiveram mais iniciativas para perder peso. Nos adolescentes que se percebiam acima do peso, o comportamento de não tomar medicamento esteve associado ao desfecho apenas nos rapazes (OR = 8,12), enquanto nas moças observou-se associação com comer menos, cortar calorias ou evitar alimentos gordurosos para perder ou para não aumentar o peso corporal (OR = 3,39). Adolescentes de ambos os sexos que faziam exercício físico tiveram maior chance de se perceber acima do peso (masculino OR = 2,00; feminino OR = 1,93). Conclusão: A percepção do peso acima e abaixo do peso esperado esteve associada aos comportamentos de controle de peso, nos quais, respectivamente, tinham mais chances de tomar iniciativas para perder e para ganhar peso.

Gestational weight gain and optimal ranges in Chinese mothers giving singleton and full-term births in 2013 / 中华预防医学杂志

Objective@#To analyze the status of gestational weight gain (GWG) among Chinese mothers who gave singleton and full-term births, and to look at optimal GWG ranges.@*Methods@#In 2013, using the multi-stage stratified and population proportional cluster sampling method, we investigated 8 323 mother-child pairs at their 0-24 months postpartum from 55 counties (cities/districts) of 30 provinces (except Tibet) in mainland China. Questionnaire was used to collect data on body weight before pregnancy and delivery, diseases during gestation, hemorrhage or not at postpartum, child birth weight and length, and other information about pregnant outcomes. We measured mother's body weight and height, and child's body weight and length. Based on 'Chinese Adult Body Weight Standard’, we divided mothers into four groups according to their body weight before pregnancy: low weight (BMI<18.5 kg/m2), normal weight (BMI 18.5-23.9 kg/m2), overweight (BMI 24.0-27.9 kg/m2) and obesity (BMI≥28.0 kg/m2). The status of GWG was assessed by IOM optimal GWG guidelines. Chinese optimal GWG ranges were calculated according to the association of GWG with pregnant outcomes and anthropometry of mothers and children, and according to P25-P75 of GWG among mothers who had good pregnant outcomes and good anthropometry, and whose children had good anthropometry. The status of GWG was assessed by the new optimal ranges.@*Results@#P50 (P25-P75) of GWG among the 8 323 mothers was 15.0 (10.0-19.0) kg. According to the proposed optimal GWG ranges of IOM, the proportions of inadequate, optimal and excessive GWG accounted for 27.2% (2 263 mothers), 36.2% (3 016 mothers) and 36.6% (3 044 mothers). The optimal GWG ranges for low weight, normal weight, overweight and obesity were 11.5-18.0, 10.0-15.0, 8.0-14.0 and 5.0-11.5 kg. Based on these optimal GWG ranges established in this study, the rates of inadequate, optimal and excessive GWG were 15.7% (1 303 mothers), 45.0% (3 744 mothers) and 39.3% (3 276 mothers), and these rates were significantly different from that defined by the IOM standards (χ2=345.36, P<0.001).@*Conclusion@#The median of GWG among Chinese mothers is 15.0 kg, which is at a relatively higher level. This study suggests the optimal GWG ranges for Chinese women who give singleton and full-term babies, which appears lower than IOM's.

Status and related factors for gestational weight gain of Chinese pregnant women during 2010-2012 / 中华预防医学杂志

Objective@#To examine the status and related factors for gestational weight gain of Chinese pregnant women at different trimesters in 2010-2012.@*Methods@#Participants were from Chinese National Nutrition and Health Surveillance in 2010-2012. Using a multi-stage stratified cluster random sampling method, we recruited 2 805 singleton pregnant women with gestational age 13 weeks or more from 31 provinces of China. A standard questionnaire was used to collect general information and pre-pregnancy weight; body weight and height of pregnant women were measured using a unified weighing scale and stadiometer, dietary intake during the previous year was collected using a food frequency questionnaire. A multiple logistic regression was used to analyze potential factors associated with appropriate gestational weight gain.@*Results@#Among 2 805 pregnant women, 1 441 were in the second (13-27 weeks) and 1 364 in the third trimesters (≥28 weeks) . In the 2nd trimester, 229 cases (15.9%), 440 cases (30.5%) and 772 cases (53.6%) were insufficient gestational weight gain, appropriate gestational weight gain and excessive gestational weight gain respectively. So were 256 cases (18.8%), 474 cases (34.8%), 634 cases (46.5%) in the 3rd trimester respectively. In the multivariate unconditional logistic model, less fruit intake was associated with insufficient weight gain for women in the 2nd trimester (OR (95%CI): 1.58 (1.06-2.34)). Pregnant women with Han ethnicity who live in the small/medium city had lower risk of insufficient weight gain in the 3rd trimester (OR (95%CI): 0.58 (0.34-0.98)). Those pregnant women with physical activity <1 hour/day had a higher risk of excessive weight gain (OR (95%CI): 1.33 (1.02-1.73)).@*Conclusion@#The prevalence of appropriate gestational weight gain was low in China. Our study suggests that pregnant weight gain is associated with fruit intake, types of residential area and physical activity.

Trajetórias biográficas do aumento e excesso de peso de mulheres do Programa Bolsa Família, Brasil / Biographical trajectories about body weight changes and overweight of women from Family Allowance Program, Brazil

OBJETIVO: apresentar e discutir resultados de pesquisas sobre narrativas biográficas de mulheres obesas beneficiárias do Programa Bolsa Família no Brasil. MÉTODO: trata-se da descrição de cinquenta narrativas biográficas de mulheres com IMC acima de 30 kg/m2, das cinco macrorregiões brasileiras, utilizando o método história de vida. As mulheres foram identificadas pelos bancos de dados do Sistema de Vigilância Alimentar e Nutricional e do Cadastro Único para Programas Sociais (ano base 2015) e as entrevistas foram realizadas por telefone. RESULTADOS: A construção do espaço narrativo biográfico das mulheres identificou a baixa estatura (mediana de 1,57m), a predominâcia de mulheres negras ou pardas (71,6%), nascidas em sua maioria na região nordeste (48,6%), com IMC mediano de 33,9 kg/m2 e mediana de peso de 83,0 kg e os tabus linguisticos relacionados as palavras fome e obesa. Nas trajetórias biográficas foram identificados os constructos de corpo-força e corpo-acima do peso. O corpo-força internaliza as relações de temporalidade entre os ciclos biológicos reprodutivos e de assunção dos papéis de mãe e de dona de casa para enfrentar as dificuldades sociais e econômicas da sobrevivência. O corpo-acima do peso é uma atribuição de externalidade decorrente do julgamento biomédico e estético. CONCLUSÃO: os resultados podem contribuir para o advento de novos caminhos de abordagem que auxiliem as ações de programas e políticas públicas para promover a compreensão do fenômeno do excesso de peso como expressão histórico-econômica e social, circunscrita na biografia das pessoas que vivem esta experiência num país com grandes desigualdades sociais.

OBJECTIVE: to present and discuss results of research on biographical narratives of obese women beneficiaries of the Bolsa Família Program in Brazil. METHOD: this is a description of fifty biographical narratives of women with BMI above 30 kg / m2, from the five Brazilian macro regions, using the life history method. The women were identified by the databases of the Food and Nutrition Surveillance System and the Single Register for Social Programs (base year 2015) and the interviews were conducted by telephone. RESULTS: The construction of the biographical narrative space of the women identified the short stature (median of 1.57m), the predominance of black or brown women (71.6%), born mostly in the northeast region (48.6%), with a mean BMI of 33.9 kg / m2 and a mean weight of 83.0 kg and the linguistic taboos related to the words hunger and obese. In the biographical trajectories, body-force and body-over-weight constructs were identified. The body-force internalizes the relations of temporality between the reproductive biological cycles and assumption of the roles of mother and housewife to face the social and economic difficulties of survival. The body-over-weight is an attribution of externality arising from biomedical and aesthetic judgment. CONCLUSION: the results can contribute to the advent of new approaches that help the actions of public programs and policies to promote the understanding of the phenomenon of overweight as a historical-economic and social expression, circumscribed in the biography of the people who live this experience in a country with great social inequalities.

A correlation analysis of PICC tip position and weight gaining in very low birth weight infants / 中华护理杂志

Objective To investigate the correlation of PICC tip position and weight gaining in very low birth weight infants.Methods We performed a retrospective study using chest X-ray films of very low birth weight infants in NICU who had PICCs inserted in a tertiary hospital.We recorded the tip positions on plain radiographs and calculated the position change,and calculated weight gaining ratio.Spearman regression model was used to analyze the relationship between tip position migration and weight gaining ratio.Results A total of 57 cases of very low birth weight infants were included,containing 246 X-ray films.On the first day of taking X-ray,weight was 0.6-1.46 (1.06±0.25) kg,the median and interquartile spacing are 5(3,7)d.The last time of taking X-ray was(24.0±9.1) dafter PICC placement;weight gaining ratio was 11.8％～114.8％,the median and interquartile spacing are 41.5％ (27.1％,65.3％).All PICCs tip position changed,75％ of which migrated more than 2 vertebrae,50％ of which migrated 3 vertebrae,and the median and interquartile spacing are 3 (1.8,3.5) vertebrae.The distances of tip migration were correlated with weight gaining ratio.With an approximate 2,3 and 4 vertebrae of PICC tip migration,the corresponding weight gaining ratio was about 40％,70％ and 100％.The correlation coefficient between PICC tip position migration and weight gaining ratio was-0.7(P＜0.01),but there was difference in different insertion sites.Conclusion PICC tip position is greatly influenced by weight gaining among very low birth weight infants.By considering the initial placement position,the crucial moment to assess catheter location is at 40％ and 70％ weight gaining ratio.After 100％ weight gaining,PICCs should be removed or replaced.PICCs can easily be affected by bone growth and limb movement,require higher frequency of catheter localization.