Linkage Between 2 Information Systems: Combined Live Births and Food and Nutrition Surveillance as a Public Health Tool for Investigation of the Determinants of Obesity Among Children and Adolescents in Southern Brazil.

BACKGROUND: Childhood obesity has been growing steadily, at an earlier age, and currently comprises a public health issue. A number of studies have pointed to perinatal factors as possible determinants in the development of childhood obesity. OBJECTIVE: To evaluate the influence of perinatal factors on the development of obesity in children and adolescents in southern Brazil. DESIGN: Retrospective cohort study in which a linkage was made between anthropometric data of children and adolescents aged 0 to 15 years who had been registered in the Food and Nutrition Surveillance System (SISVAN) from 2008 to 2016 and their perinatal data registered in the Live Birth Information System (SINASC) from 2000 to 2014. The SINASC was used to extract maternal covariables (age, schooling, marital status), prenatal variables (parity and number of prenatal visits), and perinatal variables (type of delivery, sex, and birth weight). Variables such as age, inclusion in the Bolsa Família income transfer program, and the number of anthropometric evaluations were extracted from SISVAN. RESULTS: The sample comprised 537 children and adolescents. The median age was 8 years (interquartile range: 2-11 years). The prevalence of obesity was 15.1%. Poisson regression revealed a higher risk of obesity in children born via cesarean delivery (relative risk [RR] = 1.48; 95% CI: 1.01-2.17), children of primiparous mothers (RR = 1.72; 95% CI: 1.16-2.53), girls (RR = 1.77; 95% CI:1.21-2.60), and those aged between 5 and 9 years (RR = 26.8; 95% CI: 3.75-191.55) and older than 10 years (RR = 20.74; 95% CI: 2.89-148.61). CONCLUSIONS: The linkage between SINASC and SISVAN allowed identification of prenatal and perinatal risk factors for the development of childhood obesity. These findings should contribute to the development of health promotion and prevention policies.

Adesão à alimentação escolar e sua influência na qualidade da dieta e no estado nutricional de adolescentes do ensino público brasileiro / Adherence to school meals and its influence among diet quality and nutritional status of adolescents from Brazilian public schools

Introdução - A alimentação inadequada é um dos principais fatores de risco para ocorrência de diversas doenças, incluindo a obesidade. Evidências apontam a escola como um ambiente potencial para a promoção de hábitos alimentares saudáveis. O Programa Nacional de Alimentação Escolar (PNAE) brasileiro é um dos maiores programas do mundo e internacionalmente reconhecido. No entanto, há carência de estudos que explorem o impacto da alimentação escolar brasileira na qualidade da dieta e no estado nutricional, especialmente envolvendo uma amostra nacional que inclua o amplo espectro etário da adolescência. Objetivo - Avaliar se a adesão à alimentação escolar servida pelo PNAE influencia na qualidade da dieta e estado nutricional de adolescentes do ensino público. Métodos - Foram avaliados dados de 12.376 estudantes de escolas públicas de 11 a 19 anos, a partir da Pesquisa Nacional de Saúde Escolar de 2015. Dados sobre o consumo alimentar foram obtidos a partir de um questionário de frequência alimentar convertido em três escores de avaliação de qualidade da dieta, sendo eles: consumo de alimentos saudáveis, alimentos não saudáveis e qualidade global da alimentação. A obesidade foi classificada conforme critérios da Organização Mundial da Saúde, a partir de dados diretamente aferidos de peso e da altura. Modelos de regressão brutos e ajustados foram utilizados para avaliar a associação entre adesão à alimentação escolar e indicadores de consumo alimentar e a obesidade. Resultados - A amostra foi bem distribuída entre os sexos, houve maior prevalência de adolescentes de raça/cor preta/parda (59,1%), com idade entre 11 e 15 anos (59,4%) e dos turnos da manhã (44,5%) e tarde (34,5%). Menos de 22% dos adolescentes apresentaram alta adesão às refeições ofertadas pelo PNAE (5 vezes na semana). A alta adesão foi diretamente associada com o escore de alimentação saudável (0,18 IC95% 0,07;0,30) e de qualidade global da alimentação (0,42 IC95% 0,26;0,57) e inversamente associada com o escore de alimentação não saudável (-0,23 IC95% -0,35; -0,10). Observou-se uma associação inversa e dose-resposta entre a adesão ao PNAE e a ocorrência de obesidade. Adolescentes com alta adesão ao PNAE apresentaram 24% menos risco de desenvolver obesidade do que os alunos não aderentes (Razão de prevalência 0,76, IC95% 0,62-0,93). Conclusão - A adesão à alimentação escolar foi associada a melhor qualidade da dieta e menor ocorrência de obesidade. Os resultados sugerem que o PNAE se configura como uma estratégia nacional importante de promoção da alimentação saudável e prevenção da obesidade.

Background -. Inadequate diet is one of the main risk factors for the occurrence of several diseases, including obesity. Evidence points to the school as a potential environment to promote healthy habits. The Brazilian National School Feeding Program (Programa Nacional de Alimentação Escolar - PNAE) is one of the largest programs in the world and internationally recognized. However, there is a lack of studies that explore the impact of Brazilian school meals on the diet quality and the nutritional status, especially involving a national sample that includes an ample age range of adolescence. However, the impact of school meals on diet quality and nutritional status of adolescents is controversial on the international scene, and little explored, especially in Brazil. Objective - To evaluate whether adherence to school meals served by the Brazilian School Feeding Program (Programa Nacional de Alimentação Escolar - PNAE) influences diet quality and nutritional status of adolescents from public schools. Design - Data from 12.376 public school students aged from 11 to 19 years old were evaluated, based on the 2015 National School Health Survey (PeNSE 2015). Food consumption data were obtained from a food frequency questionnaire converted into three diet quality assessment scores: consumption of healthy foods, consumption of unhealthy foods and overall healthy eating score. The obesity was classified according to WHO criteria, based on directly measured by weight and height. Crude and adjusted regression models were used to assess the association between high adherence to school meals (5x/ week) and indicators of food consumption and obesity. Results - The sample was well distributed between genders, there was a higher prevalence of adolescents of race/color black/brown (59.1%), aged between 11 and 15 years old (59.4%) and from morning (44.5%) and night shifts (34.5%). Less than 22% of the adolescents had high adherence to the meals offered by PNAE (5 times a week). High adherence was directly associated with healthy foods score (0.18 95% CI 0.07;0.30) and overall healthy eating score (0.42 95% CI 0.26;0.57) and inversely associated with unhealthy food score (-0.23 95% CI -0.35; -0.10). An inverse and dose-response association between adherence and protection related to nutritional status was observed. Highly adherent adolescents had 24% less risk of developing obesity than non-adherent students (prevalence ratio 0.76, 95%CI 0.62-0.93). Conclusion - Adherence to school meals was associated with better diet quality and lower occurrence of obesity. The results suggest that the PNAE is configured as an important national strategy for promoting healthy eating and preventing obesity.

Implementation of a Brazilian Cardioprotective Nutritional (BALANCE) Program for improvement on quality of diet and secondary prevention of cardiovascular events: A randomized, multicenter trial

Background Complex percutaneous coronary intervention (PCI) is associated with higher ischemic risk, which can be mitigated by long-term dual antiplatelet therapy (DAPT). However, concomitant high bleeding risk (HBR) may be present, making it unclear whether short- or long-term DAPT should be prioritized. Objectives This study investigated the effects of ischemic (by PCI complexity) and bleeding (by PRECISE-DAPT [PRE dicting bleeding Complications in patients undergoing stent Implantation and Sub sequent Dual Anti Platelet Therapy] score) risks on clinical outcomes and on the impact of DAPT duration after coronary stenting. Methods Complex PCI was defined as ≥3 stents implanted and/or ≥3 lesions treated, bifurcation stenting and/or stent length >60 mm, and/or chronic total occlusion revascularization. Ischemic and bleeding outcomes in high (≥25) or non-high (<25) PRECISE-DAPT strata were evaluated based on randomly allocated duration of DAPT. Results Among 14,963 patients from 8 randomized trials, 3,118 underwent complex PCI and experienced a higher rate of ischemic, but not bleeding, events. Long-term DAPT in non-HBR patients reduced ischemic events in both complex (absolute risk difference: −3.86%; 95% confidence interval: −7.71 to +0.06) and noncomplex PCI strata (absolute risk difference: −1.14%; 95% confidence interval: −2.26 to −0.02), but not among HBR patients, regardless of complex PCI features. The bleeding risk according to the Thrombolysis In Myocardial Infarction scale was increased by long-term DAPT only in HBR patients, regardless of PCI complexity. Conclusions Patients who underwent complex PCI had a higher risk of ischemic events, but benefitted from long-term DAPT only if HBR features were not present. These data suggested that when concordant, bleeding, more than ischemic risk, should inform decision-making on the duration of DAPT. (AU)

A percepção de meninas sobre as atitudes maternas e sua relação com a (in)satisfação corporal / The perception of girls about maternal attitudes and the relation with their body (dis)satisfaction / La percepción de niñas de las actitudes maternas e su relación com la (in)satisfacción corporal

Acredita-se que a preocupação com o corpo tem iniciado precocemente, principalmente nas meninas. Estudos têm sugerido uma relação importante entre a (in)satisfação corporal destas com atitudes maternas. Analisou-se a prevalência de (in)satisfação corporal em meninas de 8 a 10 anos e a relação com a sua percepção sobre as preocupações maternas com o próprio peso e com o da criança. A (in)satisfação foi obtida através da Childrens Figure Rating Scale e a influência materna, de um questionário de autopreenchimento. Dados antropométricos foram coletados para calcular o IMC. Das 97 meninas, 73,2% estavam insatisfeitas: 52,6% gostariam de emagrecer. Na análise bivariada apresentaram significância IMC, dieta, preocupação materna com o próprio peso e encorajamento materno para magreza. Os resultados mostram elevada prevalência de meninas insatisfeitas, sugerindo a necessidade de programas de prevenção já que tanto as atitudes maternas frente ao seu corpo e de sua filha, como o IMC, influenciaram na (in)satisfação.(AU)

It is believed that the concern with the body has started earlier, especially among girls. Studies have suggested an important relation between their body (dis)satisfaction and maternal attitudes. It was analyzed the prevalence of body (dis)satisfaction among 8 to10 year-old-girls and the relation between their mother’s perception of their own weight and their daughters’. The (dis)satisfation was obtained through the Children’s Figure Rating Scale and the maternal influence applying a self-administered questionnaire. Anthropometric data were collected to calculate the BMI. Out of 97 girls, 73.2% were dissatisfied, and 52.6% would like to lose weight. The bivariate analysis was significant for BMI, diet, maternal own weight concern and maternal encouragement to be thin. The results showed high prevalence of dissatisfied girls, suggesting the need for preventive programs, since the maternal attitudes towards their own body and her daughters’, as well as the BMI had influence on (dis)satisfaction.(AU)

Se cree que la preocupación con el cuerpo ha comenzado temprano, especialmente en las niñas. Estudios han sugerido una relación importante entre la (in)satisfacción corporal de ellas y las actitudes maternas. Se analizó la prevalencia de la (in)satisfacción corporal en niñas entre 8 a 10 años y la relación con su percepción de las preocupaciones maternas con su peso y el da niña. La (in)satisfacción fue obtenida a través de la Children’s Figure Rating Scale y la influencia materna de un cuestionario auto-administrado. Los datos antropometricos fueron recogidos para calcular el IMC. De las 97 niñas, 73,2% estaban no satisfechas, a 52,6% le gustaría perder peso. En el análisis bivariada mostraron significancia IMC, dieta, preocupación maternal con su proprio peso y estímulo materno para su hija estar delgada. Los resultados muestran una alta prevalencia de niñas insatisfechas, lo que sugiere una necesidad de programas de prevención, ya que tanto las actitudes de la madre frente a su cuerpo y de su hija cuanto el IMC, influenciaron la (in)satisfacción.(AU)

A percepção de meninas sobre as atitudes maternas e sua relação com a (in)satisfação corporal / The perception of girls about maternal attitudes and the relation with their body (dis)satisfaction / La percepción de niñas de las actitudes maternas e su relación com la (in)satisfacción corporal

Acredita-se que a preocupação com o corpo tem iniciado precocemente, principalmente nas meninas. Estudos têm sugerido uma relação importante entre a (in)satisfação corporal destas com atitudes maternas. Analisou-se a prevalência de (in)satisfação corporal em meninas de 8 a 10 anos e a relação com a sua percepção sobre as preocupações maternas com o próprio peso e com o da criança. A (in)satisfação foi obtida através da Childrens Figure Rating Scale e a influência materna, de um questionário de autopreenchimento. Dados antropométricos foram coletados para calcular o IMC. Das 97 meninas, 73,2% estavam insatisfeitas: 52,6% gostariam de emagrecer. Na análise bivariada apresentaram significância IMC, dieta, preocupação materna com o próprio peso e encorajamento materno para magreza. Os resultados mostram elevada prevalência de meninas insatisfeitas, sugerindo a necessidade de programas de prevenção já que tanto as atitudes maternas frente ao seu corpo e de sua filha, como o IMC, influenciaram na (in)satisfação...

It is believed that the concern with the body has started earlier, especially among girls. Studies have suggested an important relation between their body (dis)satisfaction and maternal attitudes. It was analyzed the prevalence of body (dis)satisfaction among 8 to10 year-old-girls and the relation between their mother’s perception of their own weight and their daughters’. The (dis)satisfation was obtained through the Children’s Figure Rating Scale and the maternal influence applying a self-administered questionnaire. Anthropometric data were collected to calculate the BMI. Out of 97 girls, 73.2% were dissatisfied, and 52.6% would like to lose weight. The bivariate analysis was significant for BMI, diet, maternal own weight concern and maternal encouragement to be thin. The results showed high prevalence of dissatisfied girls, suggesting the need for preventive programs, since the maternal attitudes towards their own body and her daughters’, as well as the BMI had influence on (dis)satisfaction...

Se cree que la preocupación con el cuerpo ha comenzado temprano, especialmente en las niñas. Estudios han sugerido una relación importante entre la (in)satisfacción corporal de ellas y las actitudes maternas. Se analizó la prevalencia de la (in)satisfacción corporal en niñas entre 8 a 10 años y la relación con su percepción de las preocupaciones maternas con su peso y el da niña. La (in)satisfacción fue obtenida a través de la Children’s Figure Rating Scale y la influencia materna de un cuestionario auto-administrado. Los datos antropometricos fueron recogidos para calcular el IMC. De las 97 niñas, 73,2% estaban no satisfechas, a 52,6% le gustaría perder peso. En el análisis bivariada mostraron significancia IMC, dieta, preocupación maternal con su proprio peso y estímulo materno para su hija estar delgada. Los resultados muestran una alta prevalencia de niñas insatisfechas, lo que sugiere una necesidad de programas de prevención, ya que tanto las actitudes de la madre frente a su cuerpo y de su hija cuanto el IMC, influenciaron la (in)satisfacción...