Frequency of breakfast consumption and its associations with food consumption by degree of industrial processing and with indicators of overweight in Brazilian adolescents (EVA-JF Study).

OBJECTIVE: The aim of this study was to investigate the frequency of breakfast consumption and estimate its associations with the consumption of food at different degrees of industrial processing and with overweight indicators in Brazilian adolescents. METHODS: This cross-sectional study involved a probabilistic sample of 14- to 19-y-old adolescents enrolled in 29 public schools in the municipality of Juiz de Fora, MG, Southeast Brazil (n = 805). The frequency of breakfast consumption was evaluated via a questionnaire (classified into "do not consume", "sometimes consume", and "regularly consume"). The evaluation of food consumption involved two 24-h dietary recalls, the items of which were analyzed according to the NOVA classification system. Overweight indicators (waist circumference, body mass index for age (BMI-for-age), and body fat percentage) were evaluated according to a standard protocol. Linear regression models were performed, first without and then with adjustments for sociodemographic characteristics. RESULTS: We found that 20% of adolescents skipped breakfast, and ∼46% of the caloric intake came from ultra-processed foods. Breakfast omission was associated with a mean increase of 3.02% (95% confidence interval [CI], 0.52-5.53) in energy intake from ultra-processed foods, in addition to a mean increase of 0.28 z-score (95% CI, 0.05- 0.52) of BMI-for-age and of 1.64% (95% CI, 0.21-3.08) in body fat. CONCLUSIONS: We verified that the omission of breakfast was associated with higher consumption of ultra-processed foods, as well as a higher BMI-for-age and higher percentage of body fat, reinforcing the importance of actions to encourage the consumption of this meal and the adoption of healthy eating practices in adolescents.

Involvement of Brazilian adolescents in home cooking: An exploratory analysis (EVA-JF Study).

OBJECTIVE: The aim of this study was to investigate the involvement of Brazilian adolescents in home cooking, estimating its associations with sex and socioeconomic status. METHODS: This cross-sectional study involved a probabilistic sample of 14- to 19-y-olds enrolled in 29 public schools in the municipality of Juiz de Fora, MG, Southeast Brazil (n = 835). To assess involvement in home cooking, a 12-question questionnaire was used. The content was based on the Brazilian Food Guide, which encourages the acquisition, development, and sharing of culinary skills. Pearson's χ test and Poisson regression models were carried out, without and with adjustments. RESULTS: Most of the adolescents did not usually participate in meal planning (61%), and in the choice/purchase of food and culinary ingredients (67%). Boys were less likely to know how to cook "from scratch", positively self-evaluate their culinary skills, enjoy cooking, wish to learn more about cooking and meal preparation, and to participate frequently in the planning and preparation of meals. Belonging to a lower socioeconomic status represented a greater probability of preparing meals alone for the family. CONCLUSIONS: We verified an alarming prevalence of adolescents with behaviors unaligned with Brazilian Food Guide recommendations; that is, most of them, especially boys, were not involved in home cooking. Adolescence may present a window of opportunity for the development of culinary skills, resulting in long-term benefits for the population's diet quality. Furthermore, to change a historical pattern that overloads women's daily lives, it is necessary to encourage, from an early age, the presence of boys in the kitchen.

Consumer food environment assessment and its association with socioeconomic factors in a midsize city in Brazil / Avaliação do ambiente alimentar do consumidor e suas associações com fatores socioeconômicos em uma cidade brasileira de médio porte

ABSTRACT Objective To assess the consumer food environment and its associations with socioeconomic factors in a midsize Brazilian city. Methods An ecological study that assessed the consumer food environment through audits in a stratified and proportional sample of food stores. The ESAO-S and the ESAO-R instruments were used. Access to healthy food was assessed using the Healthy Food Store Index and the Healthy Meal Restaurant Index. Socioeconomic and demographic characteristics and the Health Vulnerability Index were obtained from the 2010 Demographic Census. Statistical analyses were performed using the IBM®SPSSNo-Break®No-Break software. Result A total of 280 food stores were assessed. Only 47.1% of food stores for home consumption had fruits, vegetables, or legumes. High availability of ultra-processed food was identified, such as sugar-sweetened beverages (85.0%) and chocolate sandwich cookies (77.8%). The prices of some unprocessed foods and the availability of snacks were different according to socioeconomic characteristics. In food stores for immediate consumption, low availability of healthy options was identified, and, in most of them, natural juices had higher prices than sugar-sweetened beverages (87.1%). The mean Healthy Food Store Index score was 5.1 (SD=3.6), and the Healthy Meal Restaurant Index was 2.4 (SD=1.2). Conclusion These findings allow us to expand the knowledge about the consumer food environment, helping to implement public policies related to food supply.

RESUMO Objetivo Avaliar o ambiente alimentar do consumidor e suas associações com fatores socioeconômicos em uma cidade brasileira de médio porte. Métodos Estudo ecológico, no qual avaliou-se o ambiente alimentar do consumidor por meio de auditorias em uma amostra estratificada e proporcional de estabelecimentos que comercializam alimentos. Utilizaram-se os instrumentos ESAO-S e ESAO-R. O acesso a alimentos saudáveis foi avaliado por meio do Healthy Food Store Index e do Healthy Meal Restaurant Index. As características socioeconômicas, demográficas e o índice de vulnerabilidade da saúde foram obtidos a partir do Censo Demográfico de 2010. As análises estatísticas foram realizadas no software IBMNo-Break®No-BreakSPSSNo-Break®No-Break. Resultados Avaliaram-se 280 estabelecimentos, onde apenas 47,1% dos comércios de alimentos para consumo em domicílio possuíam frutas, verduras ou legumes. Foi identificada uma elevada disponibilidade de alimentos ultraprocessados, como refrigerantes (85,0%) e biscoitos (77,8%). Os preços de alguns alimentos in natura e a disponibilidade de salgadinhos foram diferentes segundo as características socioeconômicas. Nos comércios de alimentos para consumo imediato, foi identificada baixa disponibilidade de opções saudáveis e, na maioria deles, os sucos naturais apresentaram preços superiores a refrigerantes (87,1%). A pontuação média do Healthy Food Store Index foi 5,1 (DP=3,6) e do Healthy Meal Restaurant Index de 2,4 (DP=1,2). Conclusão Os resultados permitem ampliar o conhecimento sobre o ambiente alimentar do consumidor, auxiliando na implantação de políticas públicas relacionadas ao abastecimento alimentar.

Dificuldades financeiras, aspectos alimentares e de saúde em estudantes universitários, durante a pandemia de Covid-19 / Financial difficulties, dietary and health aspects in university students during the Covid-19 pandemic

Introdução: As dificuldades financeiras advindas da pandemia, em virtude de mudanças econômicas do país, além de refletirem no estado de segurança alimentar e nutricional e no estado de saúde dos indivíduos, acarretaram o aumento da evasão dos cursos superiores. Objetivo: Verificar a associação entre as dificuldades financeiras, durante a pandemia de Covid-19, com os aspectos alimentares e de saúde dos graduandos da Universidade Federal de Juiz de Fora (UFJF). Método: Estudo transversal com graduandos da UFJF. Os dados foram coletados entre setembro de 2020 e março de 2021, através de questionário on-line. Utilizou-se Teste Qui-quadrado (p<0,05) para avaliar os fatores associados às dificuldades financeiras durante a pandemia. Verificou-se a razão de chances (Odds Ratio - OR) das associações encontradas. Resultados: Avaliaram-se 584 graduandos, dentre os quais se constatou que 31,7% passaram por dificuldades financeiras durante a pandemia. Notou-se que a presença de dificuldades financeiras no período pandêmico se associou positivamente à presença de Insegurança Alimentar e Nutricional (INSAN), à autopercepção negativa de saúde, à má qualidade do sono e às alterações de depressão, ansiedade e estresse. Além disso, os indivíduos caracterizados com dificuldades financeiras tinham maiores chances de apresentarem INSAN, percepção negativa de saúde, má qualidade do sono, bem como alterações nos níveis de depressão, ansiedade e estresse, quando comparados à sua contraparte. Conclusão: Conclui-se que as dificuldades financeiras durante o período pandêmico são associadas à presença de INSAN e aspectos de saúde alterados. Assim, ressalta-se a necessidade de criação de estratégias que visem à assistência financeira e psicológica dos graduandos.

Introduction: The financial difficulties caused by the pandemic due to economic changes in the country, in addition to affecting food and nutrition security and the state of health of individuals, resulted in greater evasion from higher education courses. Objective: To check the association between financial difficulties during the COVID-19 pandemic with the dietary and health aspects of undergraduate students from Universidade Federal de Juiz de Fora (Federal University of Juiz de Fora ­ UFJF). Methods: Transversal study with UFJF undergraduate students. The data were collected between September 2020 and March 2021, via an online survey. The chi-square test (p<0.05) was used to evaluate the factors associated with financial difficulties during the pandemic. We also checked the odds ratio (OR) for the associations found. Results: We assessed 584 undergraduate students, 31.7% of which were found to have gone through financial difficulties during the pandemic. We observed that the presence of financial difficulties in that period was positively associated with Food and Nutrition Insecurity (INSAN, Portuguese acronym), negative self-perception of health, bad sleep quality, and changes in depression, anxiety, and stress levels. Moreover, individuals characterized as having financial difficulties had a higher chance of having INSAN, negative perception of health, bad sleep quality, as well as changes in the levels of depression, anxiety, and stress, when compared to their counterparts. Conclusion: We concluded that financial difficulties during the pandemic period are associated with INSAN and affected health aspects. Therefore, we highlight that there is a need for the development of strategies which aim to provide financial and psychological assistance to undergraduate students.

Tradução e adaptação transcultural do Questionário de Escolhas Alimentares para Adolescentes Brasileiros (FCQ-A-BR) / Translation and cross-cultural adaptation of the Food Choice Questionnaire for Brazilian Adolescents (FCQ-A-BR)

Resumo Introdução Instrumentos que busquem conhecer os motivos que propiciam as escolhas alimentares em adolescentes são inexistentes no Brasil até o momento. O Food Choice Questionnaire (FCQ) para adolescentes é um questionário de fácil aplicação e que pode ser utilizado não somente em pesquisas, mas também nos serviços de atenção à saúde. Objetivo Descrever as etapas iniciais - validade de face e de conteúdo - do processo de tradução e adaptação transcultural do FCQ para adolescentes da versão em espanhol para o português do Brasil. Método Trata-se de um estudo metodológico de tradução e adaptação transcultural, em conformidade com as normas internacionais para tradução de instrumentos para validação. Foram seguidas quatro etapas: tradução, retradução, avaliação por comitê de especialistas e dois pré-testes, que foram realizados com adolescentes com idades entre 14 e 19 anos. Resultados Os itens e o título do instrumento foram traduzidos para o português. Alguns itens necessitaram de ajustes para melhor compreensão do público-alvo. O tempo médio de aplicação foi de sete minutos. Um item foi eliminado do questionário e modificou-se a escala de resposta para melhor adequação do instrumento. Conclusão O processo inicial de tradução e adaptação transcultural do Questionário de Escolhas Alimentares para Adolescentes Brasileiros (FCQ-A-BR) atestou as validades de face e conteúdo. No entanto, faz-se necessária a complementação das análises psicométricas, para utilização do instrumento, caso elas se mostrem satisfatórias.

Abstract Background Instruments that seek to find out the reasons that lead to food choices among adolescents are not yet available in Brazil so far. The Food Choice Questionnaire (FCQ) for adolescents is a simple questionnaire that can be used not only in research, but also in healthcare. Objective To describe the initial steps - face and content validity - of the process of translation and cross-cultural adaptation of the FCQ for adolescents from the Spanish version into Brazilian Portuguese. Method This is a methodological study of translation and cross-cultural adaptation, in accordance with international standards for translation of instruments for validation. Four steps were followed: translation, back-translation, evaluation by an expert committee and two pre-tests, which were carried out with adolescents aged between 14 and 19 years. Results The items and the instrument title were translated to Portuguese. Some items needed adjustments to better understand the target audience. The average application time was seven minutes. One item was eliminated from the questionnaire and the response scale was modified to better suit the instrument. Conclusion The initial process of translation and cross-cultural adaptation of the Food Choice Questionnaire for Brazilian Adolescents (FCQ-A-BR) attested to the face and content validity. However, it is necessary to complement the psychometric analyses, to use the instrument, if they are satisfactory.

Eating contexts and their associations with socio-demographic factors in Brazilian adolescents (EVA-JF Study).

OBJECTIVE: To describe the eating contexts and estimate their associations with socio-demographic factors in a sample of Brazilian adolescents. DESIGN: Cross-sectional study. We used an exploratory questionnaire about eating contexts (encompassing regularity of meals, places where they occur and if they take place with attention and in company), which was submitted to cluster analysis. Subsequently, three clusters were identified: cluster 1, 'appropriate eating contexts at breakfast, lunch and dinner'; cluster 2, 'inappropriate eating context at breakfast' and cluster 3, 'inappropriate eating context at dinner'. Multinomial logistic regression models were performed, without and with adjustments, using cluster 1 as reference. SETTING: Twenty-nine public schools of Juiz de Fora, MG, Southeast Brazil. PARTICIPANTS: Adolescents, 14-19-year-olds (n 835). RESULTS: We observed relevant prevalence of adolescents omitting breakfast (52·9 %) and dinner (39·3 %), and who had the habit of eating sitting/lying on the couch/bed or standing/walking, and in front of screens. Breakfast usually occurred unaccompanied (70·8 %); around half (47·5 %) and little over a third (36·1 %) of the sample also would usually have lunch and dinner unaccompanied, respectively. Furthermore, through multivariate analysis, we found associations of eating contexts clusters with female sex (more likely in clusters 2 and 3), age range 14-15-year-olds (less likely in cluster 2) and higher mother's schooling (more likely in cluster 3). CONCLUSIONS: We verified an alarming prevalence of adolescents with eating contexts unaligned with healthy eating recommendations. Additionally, inappropriate eating contexts at breakfast and/or at dinner were associated with socio-demographic factors (sex, age range and mother's schooling).

Eating contexts at breakfast, lunch, and dinner: Associations with ultra-processed foods consumption and overweight in Brazilian adolescents (EVA-JF Study).

This cross-sectional study estimated associations of eating contexts (including regularity of meals, places where they occur, and if they take place with attention and in company) with food consumption by degree of industrial processing and overweight indicators in a sample of Brazilian adolescents (14-19 years old) enrolled in 29 public schools in Juiz de Fora, MG (n = 805). We used an exploratory questionnaire, which was submitted to cluster analysis. Three clusters were identified: cluster 1 (n = 572), "appropriate eating contexts at breakfast, lunch, and dinner"; cluster 2 (n = 139), "inappropriate eating context at breakfast"; and cluster 3 (n = 94) "inappropriate eating context at dinner". The evaluation of food consumption involved two 24-h dietary recalls, whose items were analyzed according to the NOVA classification system. Linear regression models were performed, using cluster 1 as reference. Clusters 2 and 3 were associated with an increase in the energy fraction from ultra-processed foods [respectively, ß = 2.55% (IC 95%: 0.50; 5.05) and ß = 4.18% (IC 95%: 1.21; 7.14)]; and cluster 2 was associated with a reduction in the energy fraction from unprocessed or minimally processed foods and processed culinary ingredients [ß = -3.61% (IC 95%: -6.40; -0.82)]. Additionally, clusters 2 and 3 were associated with an increase of body mass index for age [respectively, ß = 0.23 z-score (IC 95%: 0.01; 0.46) and ß = 0.27 z-score (IC 95%: 0.02; 0.54)]; and cluster 2 was associated with an increase of body fat [ß = 1.21% (IC 95%: 0.23; 2.64)]. In conclusion, inappropriate eating contexts at breakfast and dinner were associated with higher ultra-processed food intake, higher body mass index and higher body fat percentage.

Factors associated with non-frequent breakfast consumption in adolescents (EVA-JF Study) / Fatores associados ao consumo não frequente de café da manhã em adolescentes (Estudo EVA-JF)

ABSTRACT Objective To estimate the association of infrequent breakfast consumption with socioeconomic, behavioral, and individual factors in a sample of Brazilian adolescents from public schools. Methods Cross-sectional study with adolescents aged from 14 to 19 from public schools in Juiz de Fora, state of Minas Gerais. The frequency of consumption of breakfast, snacks, soft drinks, industrialized drinks, the usual food consumption, body mass index, body fat percentage, and waist circumference were evaluated. Other socioeconomic, behavioral, and individual data were obtained through questionnaires. Logistic regression analysis and hierarchical selection of variables were used to verify the associated factors. Results The sample consisted of 805 adolescents; 53.4% reported infrequent breakfast consumption. Through hierarchical logistic regression analysis, it was evidenced that the house occupancy status (OR: 0.618; 95%CI: 0.4410.865; p=0.005) was the distal factor associated with infrequent breakfast consumption; the intermediate factors were the consumption of industrialized beverages (OR: 0.658; 95%CI: 0.486-0.890; p=0.007) and percentage of energy from processed foods (OR: 0.935; 95%CI: 0.907-0.964; p<0.001); and the proximal factors were the male gender (OR: 0.696; 95%CI: 0.520-0.932; p=0.0015) and being nonwhite (OR: 1.529; 95%CI: 1.131-2.069; p=0.006). Conclusion Male adolescents who lived in owned houses, with occasional consumption of industrialized beverages and a higher percentage of energy derived from processed foods, had lower chances of infrequent breakfast consumption, while non-white adolescents had higher chances.

RESUMO Objetivo Estimar as associações do consumo não frequente de café da manhã com fatores socioeconômicos, comportamentais e individuais em uma amostra de adolescentes de escolas públicas. Métodos Estudo transversal realizado com adolescentes de 14 a 19 anos matriculados em escolas públicas de Juiz de Fora (MG). Foram avaliadas a frequência de consumo de café da manhã, lanches, refrigerantes e bebidas industrializadas, consumo alimentar usual, IMC, percentual de gordura corporal e perímetro da cintura. Demais dados socioeconômicos, comportamentais e individuais foram obtidos através de questionários. A análise de regressão logística e seleção hierárquica das variáveis foram usadas para verificar fatores associados. Resultados A amostra foi composta por 805 adolescentes e 53,4% deles relataram consumo não frequente de café da manhã. Através da análise de regressão logística hierarquizada, evidenciou-se que a ocupação em domicílio próprio (OR: 0,618; IC95%: 0,441-0,865; p=0,005) foi o fator distal associado ao consumo não frequente de café da manhã, além dos fatores intermediários "consumo não frequente de bebidas industrializadas" (OR: 0,658; IC95%: 0,486-0,890; p=0,007) e "percentual de energia proveniente de alimentos processados" (OR: 0,935; IC95%: 0,907-0,964; p<0,001) e dos fatores proximais "sexo masculino" (OR: 0,696; IC95%: 0,520-0,932; p=0,0015) e "cor da pele não branca" (OR: 1,529; IC95%: 1,131-2,069; p=0,006). Conclusão Adolescentes que residiam em domicílios próprios, com consumo não frequente de bebidas industrializadas, com maior percentual de energia proveniente de alimentos processados e do sexo masculino apresentaram menores chances de consumo não frequente de café da manhã, enquanto, adolescentes com cor da pele não branca apresentaram maiores chances.

Consumption of differently processed food by public school adolescents / Consumo alimentar de adolescentes de escolas públicas segundo grau de processamento industrial dos alimentos

ABSTRACT Objective To characterize food consumption, considering the degree of industrial food processing by public schools' adolescents. Methods Cross-sectional study involving adolescents aged 14 to 19 years, of both genders, attending public schools in Juiz de Fora, MG. Food consumption was assessed using two 24-hour dietary recalls. Foods were classified into three groups according to the degree of industrial processing: (1) unprocessed foods or minimally processed foods, culinary ingredients and preparations based on these foods; (2) processed foods; (3) ultra-processed foods. In addition, weight and height information was collected, with subsequent calculation of body mass index/age to assess the individuals' nutritional status according to the gender. Pearson's chi-square, Mann-Whitney and Kruskal-Wallis tests were performed, adopting a value of p<0.05. Results The sample consisted of 804 adolescents, with a predominance of females (57.5%). In the sample, 29.9% and 26.1%, of girls and boys, respectively, were overweight. There was a difference in the daily consumption of ready-made sweet-tasting foods, being higher in females (26.2%) when compared to males (18.1%), whereas the consumption of soft drinks (one to four times a week) was 47.2% and 55.6% in girls and boys, respectively (p<0.05). Higher consumption of ultra-processed foods was observed in females (p=0.02) and processed foods in males (p=0.008). Conclusion There was a high contribution of ultra-processed foods in the diet of adolescents in public schools; a high prevalence of overweight was observed in both genders.

RESUMO Objetivo Caracterizar o consumo alimentar através do grau de processamento industrial dos alimentos consumidos por adolescentes matriculados em escolas públicas. Métodos Estudo transversal com adolescentes de 14 a 19 anos de ambos os sexos matriculados em escolas públicas de Juiz de Fora, MG. O consumo alimentar foi avaliado através de dois recordatórios de 24h. Os alimentos foram classificados em três grupos de acordo com o grau de processamento industrial: (1) alimentos in natura ou minimamente processados, ingredientes culinários e preparações a base desses alimentos; (2) alimentos processados; (3) alimentos ultraprocessados. Ademais, foram coletadas informações de peso e altura dos estudantes, com posterior cálculo de índice de massa corporal/idade para avaliação do estado nutricional conforme o sexo. Foram realizados os testes Qui-quadrado de Pearson, Mann-Whitney e Kruskal-Wallis, adotando o valor de p<0,05. Resultados A amostra foi composta por 804 adolescentes, com predomínio do sexo feminino (57,5%). Entre os adolescentes, 29,9% das meninas e 26,1% dos meninos apresentaram excesso de peso. Observou-se diferença no consumo diário de alimentos prontos de sabor doce, sendo maior no sexo feminino (26,2%) quando comparado ao masculino (18,1%), ao passo que o consumo de refrigerantes de uma a quatro vezes na semana foi de 47,2% e 55,6% nas meninas e meninos, respectivamente (p<0,05). Maior consumo de alimentos ultraprocessados foi observado no sexo feminino (p=0,02) e de alimentos processados no sexo masculino (p=0,008). Conclusão Verificou-se elevada contribuição proveniente do grupo dos alimentos ultraprocessados na dieta dos adolescentes de escolas públicas, com altas prevalências de excesso de peso em ambos os sexos.

Brazilian health professionals' perception about the Baby-Led Weaning (BLW) method for complementary feeding: an exploratory study / Percepções de profissionais de saúde brasileiros acerca da prática do método Baby-Led Weaning (BLW) para alimentação complementar: um estudo exploratório

Abstract Objective: To describe Brazilian health professionals' perception about the Baby-Led Weaning (BLW) method use for complementary feeding. Methods: Cross-sectional, descriptive study including 458 health professionals graduated in Nursing, Speech Therapy, Medicine, Nutrition or Dentistry and working in Pediatrics, being directly or indirectly involved with pediatric nutrition. We used a convenience non-probability sampling. The questionnaire applied to participants addressed demographic characteristics, academic degree, workplace, knowledge about clinical practice and perceptions about the possible advantages of the BLW method. Results: Participants had a mean age of 34.5±8.5 years, 64.6% of them working in Southeast Brazil and 65.3% being nutritionists. Most participants reported being acquainted with the BLW method (82.0%). Regarding clinical practice, 38.3% mentioned having recommended the BLW some times, 37.5% often and 20.5% always. Most participants fully agreed that the BLW method could have advantages for babies, for example, having them more likely to share family meals, facilitating adaptation to food flavors and consistencies, enhancing chewing and favoring the development of motor skills. On the other hand, important disagreements were also expressed regarding the BLW convenience and the possibility to create less concerns or anxiety in parents. Conclusions: The BLW method reported as advantageous, but disagreements were also raised, probably because scientific evidences on the suject are scarse. Further investigation is needed so we can better understand the risks and benefits and health care professionals can feel effectively assisted to offer support and advice to parents and caretakers.

Resumo Objetivo: Descrever as percepções de profissionais de saúde brasileiros acerca do método baby-led weaning (BLW) para alimentação complementar. Métodos: Estudo de corte transversal conduzido com 458 profissionais de saúde graduados em Enfermagem, Fonoaudiologia, Medicina, Nutrição ou Odontologia e que atuavam em pediatria, estando direta ou indiretamente envolvidos com nutrição infantil. A amostragem foi não probabilística, de conveniência. O questionário englobou características demográficas, titulação e local de trabalho dos participantes, além do conhecimento, da prática clínica e das percepções sobre possíveis vantagens do BLW. Resultados: Os profissionais de saúde tinham idade média de 34,5±8,5 anos, 64,6% atuavam no sudeste do Brasil e 65,3% eram nutricionistas. A maioria relatou conhecer o BLW (82,1%). Quanto à prática clínica, 38,3% mencionaram que costumavam recomendar o BLW às vezes, 37,5%, frequentemente, e 20,5%, sempre. Grande parte declarou que concordava totalmente que o método poderia trazer vantagens, tornando os bebês mais propensos a compartilharem refeições em família, facilitando a adaptação aos sabores e às consistências dos alimentos, potencializando a mastigação e favorecendo o desenvolvimento de habilidades motoras, porém manifestaram-se discordâncias importantes em relação à comodidade/conveniência e ao argumento de gerar menos preocupação ou ansiedade para os pais/cuidadores. Conclusões: Em geral, o BLW foi relatado como vantajoso, mas foram evidenciadas discordâncias, que são um provável reflexo da escassez de evidências científicas factuais sobre essa temática. São necessários mais estudos, para a melhor compressão de seus riscos e benefícios. Só assim os profissionais de saúde se sentirão efetivamente respaldados para fornecer suporte ou aconselhamento aos pais/cuidadores.

Brazilian health professionals' perception about the Baby-Led Weaning (BLW) method for complementary feeding: an exploratory study.

OBJECTIVE: To describe Brazilian health professionals' perception about the Baby-Led Weaning (BLW) method use for complementary feeding. METHODS: Cross-sectional, descriptive study including 458 health professionals graduated in Nursing, Speech Therapy, Medicine, Nutrition or Dentistry and working in Pediatrics, being directly or indirectly involved with pediatric nutrition. We used a convenience non-probability sampling. The questionnaire applied to participants addressed demographic characteristics, academic degree, workplace, knowledge about clinical practice and perceptions about the possible advantages of the BLW method. RESULTS: Participants had a mean age of 34.5±8.5 years, 64.6% of them working in Southeast Brazil and 65.3% being nutritionists. Most participants reported being acquainted with the BLW method (82.0%). Regarding clinical practice, 38.3% mentioned having recommended the BLW some times, 37.5% often and 20.5% always. Most participants fully agreed that the BLW method could have advantages for babies, for example, having them more likely to share family meals, facilitating adaptation to food flavors and consistencies, enhancing chewing and favoring the development of motor skills. On the other hand, important disagreements were also expressed regarding the BLW convenience and the possibility to create less concerns or anxiety in parents. CONCLUSIONS: The BLW method reported as advantageous, but disagreements were also raised, probably because scientific evidences on the suject are scarse. Further investigation is needed so we can better understand the risks and benefits and health care professionals can feel effectively assisted to offer support and advice to parents and caretakers.

Fatores associados ao tempo e à frequência do aleitamento materno / Factors associated with time and frequency of breast-feeding

Objetivos: Avaliar os fatores que determinam o tipo e o tempo de aleitamento materno, bem como delinear sobre a situação social e nutricional de mulheres atendidas na rede de atenção primária à saúde no município de Juiz de Fora (MG). Métodos: Realizaram-se quatro avaliações: a primeira no terceiro trimestre da gestação, e as outras, nos 1o, 3o e 6o meses pós-parto. Inicialmente, aplicou-se um questionário sobre amamentação e um Recordatório 24 horas, também aplicado no 6o mês pós-parto. Posteriormente, questionou-se sobre a frequência, tipo de aleitamento e dificuldades no manejo. Resultados: As variáveis que influenciaram significativamente no aleitamento materno exclusivo nos 1°, 3° e 6° meses foram: maior consumo mediano de Vitamina C e B9, maior desempenho no teste sobre amamentação, idade da mãe entre 20 e 35 anos, consumo adequado de carboidratos e suplementação de complexo vitamínico. Os fatores protetores do aleitamento materno exclusivo ou predominante foram: apresentar alguma dificuldade para amamentar e dieta inadequada em relação aos lipídios. Já os fatores de risco foram: fumo na gestação, não saber responder sobre o correto manejo da lactação e renda familiar menor que um salário mínimo. Conclusões: Variáveis maternas, dietéticas, socioeconômicas e conhecimentos sobre o manejo da lactação influenciaram no tempo e tipo do aleitamento materno.

Objectives: To evaluate the factors determining the type and maternal breastfeeding time and report on the social and nutritional status of women at the local network of primary health care in the city of Juiz de Fora (MG). Methods: There were four evaluations: the first in the third trimester of pregnancy and the others in the first, third, and sixth months following delivery. At first, we applied a questionnaire about breastfeeding and 24-hour dietary recall, also applied in the sixth month postpartum. Subsequently, they were asked about the frequency, type of feeding, and difficulties in management. Results: The variables that significantly influenced the exclusive breastfeeding in the first, third, and sixth months were higher mean intake of vitamins C and B9, higher scores in the test on breastfeeding, mother aged between 20 and 35 years old, adequate intake of carbohydrates and supplementation of vitamin complex. Protective factors in exclusive or predominant breastfeeding were having some difficulty in breastfeeding and inadequate diet in relation to lipids. However, the risk factors were smoking during pregnancy, being unable to correctly answer about lactation management, and family income lower than one minimum wage. Conclusions: Maternal variables, diet, socioeconomic, and knowledge about lactation management influenced the time and type of breastfeeding.

Cardiovascular Risk Factors in Patients with Chronic Kidney Disease Under Conservative Treatment

Abstract Background Cardiovascular disease (CVD) is commonly associated with chronic kidney disease (CKD). These diseases have a significant impact on life expectancy. Individuals with CKD are more likely to die from CVD than to progress to end-stage kidney disease. Objective To assess cardiovascular risk factors of patients with CKD under conservative treatment. Methods This was an observational, cross-sectional study. Socioeconomic, anthropometric, biochemical, and physical inactivity data were assessed, and 10-year risk for CVD were estimated using the Framingham Score in patients with CKD under conservative treatment. For statistical analysis, the Student's t-test and Pearson's chi-square test were performed. Results A total of 172 individuals were evaluated, 57% of whom were male, with an average age of 68.85 ± 11.41 years. The prevalence of hypertension and diabetes were 87.2% and 53.5%, respectively; 62.2% were physically inactive; 9.9% of men were smokers and 12.8% consumed alcohol. According to BMI, 82.4% of adults <60 years old and 60.6% of those older than 60 years were overweight. High waist circumference and a high waist-hip ratio were highly prevalent in females (91.9% and 83.8%, respectively) and males (64.3% and 39.8%, respectively); 92.4% had a high body fat percentage and 73.3% high uric acid levels. According to the Framingham score, 57% have a medium or high risk of developing CVD in 10 years. Conclusion There was a high prevalence of cardiovascular risk factors in the population studied. The assessment of cardiovascular risk factors in patients with CKD makes it possible to guide the conduct of health professionals to prevent mortality from cardiovascular causes. Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0

Availability and access to food in supermarkets before and during the Covid-19 pandemic in a mid-size city / Disponibilidade e preço de alimentos em supermercados antes e durante a pandemia de Covid-19 em uma cidade de médio porte

ABSTRACT Objective To investigate the availability and price of fresh and ultra-processed foods in supermarkets before and during the Covid-19 pandemic in a mid-size city in the Brazilian state of Minas Gerais. Methods Ecological and longitudinal study. A proportionate stratified random sampling method was applied to supermarkets in the municipality. To assess the availability, variety, and price of fresh and ultra-processed foods, we applied the Estudo do Ambiente Obesogênico em São Paulo (ESAO, Obesogenic Environment Study in São Paulo, Brazil) Food Store Observation Tool questionnaire and calculated the Healthy Food Store Index. The audits took place from December 2019 to January 2020, and we returned to the establishments in September 2020. Descriptive analyzes, McNemar tests, paired Student's T or Wilcoxon tests were performed using the SPSS software, version 20.0, with a 5% significance level. Results Ten supermarkets were evaluated. The prices of oranges (p=0.012), bananas (p=0.043), apples (p=0.004), and onions (p=0.004) were significantly increased during the time frame. Sugar-free soft drinks (p=0.044), powdered drinks (p=0.032), and corn snacks (p=0.015) showed a greater variety of brands and flavors during the pandemic. The Healthy Food Store Index score was 9.50±0.85 before the pandemic and 9.00±1.15 during it. Conclusion The prices of some fruits and vegetables increased, and supermarkets sold a greater variety of ultra-processed foods. Such findings highlight the importance of assessing the consequences of the Covid-19 pandemic on the food environment.

RESUMO Objetivo Investigar a disponibilidade e preço de alimentos in natura e ultraprocessados em supermercados no período anterior e durante a pandemia de Covid-19 em uma cidade de médio porte de Minas Gerais. Métodos Estudo ecológico e longitudinal. Realizou-se amostragem aleatória estratificada proporcional dos supermercados do município. Foi aplicado o questionário ESAO Food Store Observation Tool, o qual avalia a disponibilidade, variedade e preço de alimentos in natura e ultraprocessados, e calculou-se o índice Healthy Food Store Index. As auditorias ocorreram nos meses de dezembro de 2019 e janeiro de 2020 e retornou-se aos estabelecimentos em setembro de 2020. Foram realizados análises descritivas, testes de McNemar, T de Student pareado ou Wilcoxon utilizando-se o software SPSS, versão 20.0, com nível de significância de 5%. Resultados Foram avaliados dez supermercados. Os preços da laranja (p=0,012), banana (p=0,043), maçã (p=0,004) e cebola (p=0,004) apresentaram aumento significativo, e uma variedade maior de marcas e sabores de refrigerantes sem açúcar (p=0,044), refresco em pó (p=0,032) e salgadinhos de milho (p=0,015) foram encontradas durante a pandemia. A pontuação do índice Healthy Food Store Index antes da pandemia foi de 9,50 ± 0,85 e durante a pandemia foi de 9,00 ± 1,15. Conclusão Foram verificados aumentos nos preços de frutas e legumes e uma maior variedade de alimentos ultraprocessados disponíveis na auditoria feita durante a pandemia. Esses achados contribuem para salientar a importância da avaliação das consequências da pandemia de covid-19 no ambiente alimentar.

Associação de estado nutricional e maturação sexual com insatisfação com a imagem corporal / Assossiation of nutritional status and sexual maturation with dissatisfaction with body image

Objetivo: Avaliar a associação do estado nutricional e maturação sexual com a insatisfação corporal em adolescentes. Métodos: Trata-se de estudo transversal, realizado com adolescentes de 10 a 14 anos de escolas públicas. Avaliaram-se peso, altura, IMC para idade, perímetro da cintura, percentual de gordura corporal, maturação sexual (escala de Tanner) e insatisfação corporal, por meio da pontuação na Escala de Evaluación de Insatisfación Corporal para Adolescentes (EEICA). Para as análises estatísticas, utilizou-se o programa SPSS versão 17.0 e realizaram-se os testes de Kolmogorov-Smirnov, Qui-quadrado de Pearson, t de Student ou Anova, considerando-se nível de significância de 5%. Resultados: A amostra foi composta por 345 adolescentes, sendo 53,6% do sexo feminino. A maioria (63,6 % meninas e 66,7% dos meninos) são eutróficos. A pontuação média da EEICA no sexo feminino (11,46 ± 5,90) foi superior ao masculino (9,29 ± 4,71) (p<0,001). Em ambos os sexos, o IMC para idade, percentual de gordura corporal e razão cintura/estatura associaram-se a uma maior pontuação na EEICA (p<0,001). No sexo feminino, as pós-puberes foram mais insatisfeitas que as púberes. Conclusão: Observou-se maior pontuação no sexo feminino, assim como associação entre insatisfação corporal e o estado nutricional em ambos os sexos e com a maturação sexual no sexo feminino. Tais achados reforçam a importância da abordagem do tema e suas possíveis consequências, estimulando a reflexão sobre os padrões de beleza. (AU)

Objective: To evaluate the association of nutritional status and sexual maturation with body dissatisfaction in adolescents. Methods: This is a crosssectional study carried out with adolescentes aged 10 to 14 from public schools. Weight, height, BMI for age, waist circumference, percentage of body fat,sexual maturation (Tanner's scale) and body dissatisfaction were assessed using the Scale for Assessment of Body Dissatisfaction for Adolescents (EEICA). For the statistical analysis, the SPSS version 17.0 program was used and the Kolmogorov-Smirnov, Pearson's Chi-square, Student's T or Anova tests were used, considering a significance level of 5%. Results: The sample consisted of 345 adolescents, 53.6% female. The majority (63.6% girls and 66.7% boys) are eutrophic. The mean EEICA sco ,302r for females (11.46 ± 5.90) was higher than for males (9.29 ± 4.71) (p <0.001). In both sexes, the BMI for age, percentage of body fat and waist-toheight ratio were associated with a higher score in the EEICA (p <0.001). In the female, the post-puberals were more dissatisfied than the pubescent ones. Conclusion: It was observed a higher score in the female, as well as an association between body dissatisfaction and nutritional status in both sexes and sexual maturation in females. Such findings reinforce the importance of approaching the theme and its possible consequences, stimulating reflection on beauty standards. (AU)

Medidas antropométricas para avaliação da massa muscular em portadores de doença renal crônica em tratamento conservador / Anthropometric measurements for muscle mass assessment in chronic kidney disease patients under conservative treatment

INTRODUÇÃO: Portadores da doença renal crônica (DRC) apresentam aumento do catabolismo proteico, levando a pior qualidade de vida, complicações cardiometabólicas e maior risco de hospitalizações. Sendo importante a avaliação nutricional, embora essa apresente limitações devido a alterações de água corporal e massa óssea. O objetivo do estudo foi identificar a correlação de medidas antropométricas com a massa muscular em portadores da DRC. MÉTODOS: Estudo epidemiológico, transversal. Avaliou-se portadores da DRC em tratamento conservador, a partir de 60 anos. Coletou-se: peso, altura, IMC, circunferência braquial (CB), circunferência muscular braquial (CMB), circunferência da panturrilha (CP), espessura do músculo adutor do polegar (EMAP), massa muscular obtida por bioimpedância bipolar e tetrapolar (LTM). Realizou-se analises descritivas e as medidas foram correlacionadas com o LTM pela Correlação de Pearson. A concordância entre o métodos foram testadas pelo teste Kappa. RESULTADOS: A amostra foi composta por 137 indivíduos, sendo 60,6% do sexo masculino, com média de idade de 72,89 ± 7,66 anos. No sexo feminino, apenas a EMAP da mão dominante apresentou correlação com o LTM (r = 0,33), já no sexo masculino, todas medidas (IMC, CP, CB, CMB, massa muscular e EMAP) apresentaram correlação moderada. Avaliando-se as concordâncias entre a classificação de acordo com o índice de LTM e as medidas antropométricas, obtevese concordâncias pobre ou leves. DISCUSSÃO: As medidas antropométricas apresentam como vantagens: baixo custo, rápidas, fácil avaliação e aplicabilidade clínica. Dentre as medidas avaliadas destaca-se a EMAP, que apresentou correlação moderada e concordância leve com a massa muscular. Tal medida é promissora para avaliação do estado nutricional. CONCLUSÃO: A utilização das medidas antropométricas para avaliação da massa muscular em idosos portadores de doença renal crônica em tratamento conservador deve ser realizada e interpretada com cautela e de forma complementar na avaliação da composição corporal

INTRODUCTION: Patients with chronic kidney disease (CKD) have increased protein catabolism, leading to worse quality of life, cardiometabolic complications and increased risk of hospitalizations. Nutritional assessment is important, although it has limitations due to changes in body water and bone mass. The aim of the study was to identify the correlation of anthropometric measurements with muscle mass in patients with CKD. METHODS: Epidemiological cross-sectional study. Patients with CKD under conservative treatment from 60 years of age were evaluated. We collected: weight, height, BMI, arm circumference (BC), arm muscle circumference (AMC), calf circumference (CC), adductor pollicis muscle thickness (APMT), muscle mass obtained by bipolar and tetrapolar bioimpedance (LTM). Descriptive analyzes were performed and the measurements were correlated with the LTM by Pearson Correlation. The agreement between the methods were tested by the Kappa test. RESULTS: The sample consisted of 137 individuals, 60.6% male, with a mean age of 72.89 ± 7.66 years. In females, only the dominant hand EMAP correlated with the LTM (r = 0.33), whereas in males, all measurements (BMI, CC, BC, AMC, muscle mass and EMAP) showed a moderate correlation. Evaluating the agreement between the classification according to the LTM index and the anthropometric measurements, poor or light agreement was obtained. DISCUSSION: Anthropometric measurements have the following advantages: low cost, fast, easy evaluation and clinical applicability. Among the evaluated measures, the EMAP stands out, which presented a moderate correlation and slight agreement with the muscle mass. Such measure is promising for assessment of nutritional status. CONCLUSION: The use of anthropometric measurements to assess muscle mass in elderly patients with chronic kidney disease under conservative treatment should be performed and interpreted with caution and in a complementary manner in the assessment of body composition

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Thumb adductor muscle thickness used in the nutritional assessment of chronic kidney disease patients under conservative treatment / Espessura do músculo adutor do polegar para avaliação nutricional de portadores de doença renal crônica em tratamento conservador

Abstract Introduction: Evaluate the association between the thumb adductor muscle thickness and the patient's nutritional status, and propose cutoff points for muscle mass depletion in elderly patients with chronic kidney disease (CKD) under conservative treatment. Epidemiological and cross-sectional study, including patients with CKD stages 3 to 5, older than 60 years. Socioeconomic, clinical, physical activity and anthropometric data was obtained. TAMT was described and compared according to CKD stage, socioeconomic data, physical activity, nutritional status and correlated with age, glomerular filtration rate and anthropometric variables. Receiver Operating Characteristic (ROC) curves were produced, considering the lean tissue index classification as reference. The cut-off point was defined by the Youden index. Results: We evaluated 137 individuals. The TAMT was lower in malnourished and/or depleted muscle mass individuals; among males it was higher among those who practiced physical activities (p <0.05). This measure was moderately correlated with BMI, calf and brachial circumferences, lean body tissue, lean tissue index and body cell mass (r <0.7); negatively with age (r = -0.34). The ROC curve analysis determined cut points of 15.33 mm for females and 20.33 mm for males, with 72.22% and 62.50% accuracy, respectively. Conclusion: TAMT is used to estimate muscle mass and we suggest the cutoff point is useful to rule out the likelihood of muscle mass depletion. It is recommended that it be used in a complementary way in nutritional assessment.

Resumo Introdução: Avaliar a associação da espessura do músculo adutor do polegar (EMAP) com o estado nutricional e propor pontos de corte para depleção de massa muscular em idosos portadores da doença renal crônica (DRC) em tratamento conservador. Metodologia: Estudo epidemiológico, delineamento transversal, incluindo portadores de DRC estágios 3 a 5, acima de 60 anos. Obteve-se dados socioeconômicos, clínicos, prática de atividade física e antropométricos. A EMAP foi descrita e comparada de acordo com o estágio da DRC, dados socioeconômicos, atividade física e estado nutricional e correlacionada com idade, taxa de filtração glomerular e variáveis antropométricas. Foram produzidas curvas Receiver Operating Characteristic (ROC), considerando como padrão de referência a classificação do índice de tecido magro. O ponto de corte foi definido pelo índice Youden. Resultados: Avaliou-se 137 indivíduos. A EMAP foi inferior nos desnutridos e/ou com depleção de massa muscular; no sexo masculino foi superior nos praticantes de atividade física (p<0,05). A medida se correlacionou moderadamente com IMC, circunferência da panturrilha e braquial, tecido de massa magra, índice de tecido magro e massa celular corporal (r<0,7), e negativamente com a idade (r=-0,34). A análise da curva ROC determinou pontos de corte de 15,33 mm para o sexo feminino e 20,33 mm para o masculino, com acurácia de 72,22% e 62,50%, respectivamente. Conclusão: A EMAP serve para estimar a massa muscular, e o ponto de corte sugerido é útil para afastar a probabilidade de depleção de massa muscular. Recomenda-se que seja utilizada de forma complementar na avaliação nutricional.

Fatores associados à insatisfação corporal de crianças e adolescentes de escola pública em município da Zona da Mata mineira / Factors associated with body dissatisfaction among children and teenagers enrolled in a public school in a city in the Zona da Mata Mineira area

Objetivos: determinar os fatores associados à insatisfação corporal entre estudantes de uma escola pública de um município da Zona da Mata mineira. Métodos: foi realizado um estudo transversal, descritivo, analítico e exploratório. A amostra foi constituída por escolares entre oito e doze anos. Utilizou-se uma escala de figuras de silhuetas para avaliar a insatisfação corporal. Os dados foram analisados através do Statistical Software for Professional (STATA), versão 12.0. A medida de associação utilizada foi a Razão de Prevalência (RP), determinada através da regressão de Poisson com estimador de variância robusta. Foi considerado um nível de significância de 5% para definição do modelo final. Resultados: observou-se frequência de insatisfação corporal de 86,5% e sua associação significativa com a porcentagem de gordura corporal, duração da atividade física, escolaridade materna e trabalho materno. Conclusões: a infância e a adolescência são períodos em que se adquirem hábitos que poderão ser levados por toda a vida, além de representarem um público propenso a atitudes inadequadas. Assim, destaca-se a importância em se realizar pesquisas com esses indivíduos, especialmente relativas à imagem corporal, já que a insatisfação com o corpo traz pensamentos e sensações negativas, influenciando a saúde emocional, a qualidade de vida e o convívio social.

Objectives: to determine the factors associated with body dissatisfaction among students of a public school in a city in the Zona da Mata Mineira area. Methods: a cross-sectional, descriptive, analytical and exploratory study was performed. The sample consisted of students between eight and twelve years, and a body shape figures scale was used to assess body dissatisfaction. The data was analyzed using the Statistical Software for Professional (STATA) version 12.0. The measure of association used was the prevalence ratio (PR), determined by the Poisson regression with robust variance estimator. A significance level of 5% for the definition of the final model was considered. Results: it was observed a frequency of body dissatisfaction of 86.5% and it's significant association with body fat percentage, duration of physical activity, maternal literacy and maternal employment. Conclusions: childhood and adolescence are periods in which people acquire habits that may be carried forever, and they represent a grouo of people prone to inadequate attitudes. Thus, it is important to conduct research with these individuals, especially relating to body image, as body dissatisfaction brings negative thoughts and feelings, influencing emotional health, quality of life and social interaction.

Food environment, social deprivation and obesity among students from Brazilian public schools.

OBJECTIVE: To investigate the relationship between social deprivation and the food environment. Furthermore, to evaluate if the food environment is associated with the prevalence of obesity among students in Brazilian public schools. DESIGN: Cross-sectional. For the classification of obesity, weight and height were measured, and the cut-off point of BMI-for-age Z-score >+2 was adopted. Social deprivation level was determined from the Health Vulnerability Index (HVI). To assess the food environment, the density of food establishments in urban residential areas was calculated. Associations between the food environment and the presence of obesity were estimated by binary logistic regression through a generalized estimating equations model. SETTING: Juiz de Fora, Minas Gerais, Brazil. SUBJECTS: Children and adolescents (n 661) aged 7-14 years. RESULTS: The lowest social deprivation level showed a higher density of all types of establishments that sold predominantly unhealthy foods. An inverse association was found between the density of supermarkets and hypermarkets and the presence of obesity (OR=0·58; 95 % CI 0·36, 0·93). For the other categories of food retailers, no significant differences were found. CONCLUSIONS: The findings reinforce the need for public policies that promote equality in the food environments of the city. Also, further investigations into the influence of the presence of supermarkets on the nutritional status of children and adolescents are required.

Thumb adductor muscle thickness used in the nutritional assessment of chronic kidney disease patients under conservative treatment.

INTRODUCTION: Evaluate the association between the thumb adductor muscle thickness and the patient's nutritional status, and propose cutoff points for muscle mass depletion in elderly patients with chronic kidney disease (CKD) under conservative treatment. Epidemiological and cross-sectional study, including patients with CKD stages 3 to 5, older than 60 years. Socioeconomic, clinical, physical activity and anthropometric data was obtained. TAMT was described and compared according to CKD stage, socioeconomic data, physical activity, nutritional status and correlated with age, glomerular filtration rate and anthropometric variables. Receiver Operating Characteristic (ROC) curves were produced, considering the lean tissue index classification as reference. The cut-off point was defined by the Youden index. RESULTS: We evaluated 137 individuals. The TAMT was lower in malnourished and/or depleted muscle mass individuals; among males it was higher among those who practiced physical activities (p <0.05). This measure was moderately correlated with BMI, calf and brachial circumferences, lean body tissue, lean tissue index and body cell mass (r <0.7); negatively with age (r = -0.34). The ROC curve analysis determined cut points of 15.33 mm for females and 20.33 mm for males, with 72.22% and 62.50% accuracy, respectively. CONCLUSION: TAMT is used to estimate muscle mass and we suggest the cutoff point is useful to rule out the likelihood of muscle mass depletion. It is recommended that it be used in a complementary way in nutritional assessment.