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

This cross-sectional study employs Structural Equation Modelling (SEM) to explore both direct and indirect effects of parental level of education and child individual factors on the length-for-age outcomes in children aged 6-24 months assisted by the Bolsa Família Program in the State of Alagoas. A total of 1,448 children were analyzed by the SEM technique. A negative standardize direct effect (SED) of the children's younger age (SED: -0.06; p=0.017), the use of bottle feeding (SED: -0.11; p<0.001), and lack a minimum acceptable diet (SED: -0.09; p<0.001) on the length-for-age indicator was found. Being female (SDE: 0.08; p=0.001), the higher birth weight (SDE: 0.33; p<0.001), being ever breastfed (SED: 0.07; p=0.004) and a higher level of parental education (SDE: 0.09; p<0.001) showed a positive SDE effect on the child's length-for-age. The model also demonstrated a negative standardize indirect effect (SIE) of the sweet beverage consumption (SIE: -0.08; p=0.003) and a positive effect of being ever breastfed (SIE: 0.06; p=0.017) on the child's length-for-age through parental level of education as a mediator. This research underscores the crucial role of proper feeding practices and provide valuable insights for the development of targeted interventions, policies, and programs to improve the nutritional well-being and promote adequate linear growth and development among young children facing similar challenges.

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

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

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

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

Breastfeeding and factors associated with the neuropsychomotor development of children living in social vulnerability / Aleitamento materno e fatores associados ao desenvolvimento neuropsicomotor de crianças em vulnerabilidade social

Abstract Objective: to determine the association between breastfeeding and associated factors with neuropsychomotor development of children living in social vulnerability. Methods: cross-sectional study within a socially vulnerable community. Households with children aged seven to 72 months, and their biological mothers were included. Sociodemographic, anthropometric and breastfeeding variables were collected using questionnaires, and neuropsychomotor development was assessed using the Denver II screening test. Adjusted prevalence ratios were calculated using multivariable models, oriented by directed acyclic graphs. Results: from the 654 households visited, 224 mother-child binomials were included. The mean age of children was 28 (18.7) months, and 143 (63.8%) of them presented suspected delay in neuropsychomotor development. Mothers presented a median of 8 years of formal schooling and 64 (28.6%) had performed exclusive breastfeeding for 6 months. Exclusive breastfeeding was not associated with neuropsychomotor development (PR=0.92; CI95%=0.84-1.00). A significant association was observed only with years of formal maternal education (PR=0.98; CI95%=0.97-0.99). A mediation analysis did not show any clear mediator between maternal education and neuropsychomotor development. Conclusions: children living in social vulnerability presented a high prevalence of suspected delay in neuropsychomotor development. Maternal education was the only variable associated with such condition.

Resumo Objetivos: determinar a associação entre o aleitamento materno e fatores associados ao desenvolvimento neuropsicomotor de crianças em extrema vulnerabilidade social. Métodos: estudo transversal conduzido em uma comunidade em vulnerabilidade social, envolvendo crianças de sete a 72 meses, e suas mães biológicas. Variáveis sociodemográficas, antropométricas e de amamentação foram coletadas por meio de questionários e o desenvolvimento neuropsicomotor foi avaliado por meio do teste de triagem Denver II. Razões de prevalência ajustadas foram calculadas usando modelos multivariáveis, orientados por grafos acíclicos direcionados. Resultados: dos 654 domicílios visitados, foram incluídos 224 binômios mãe-filho, com média de idade de 28,8 (18,7) meses, em que 143 (63,8%) crianças apresentavam suspeita de atraso no desenvolvimento neuropsicomotor e 64 (28,6%) haviam realizado aleitamento materno exclusivo até o sexto mês. Aleitamento materno exclusivo por 6 meses não se associou ao desenvolvimento neuropsicomotor (RP= 0,91; IC95%=0,83-1,00). Houve associação significativa observada apenas com anos de escolaridade materna formal (RP=0,97; IC95%=0,96-0,99). Análise de mediação não mostrou nenhum mediador entre escolaridade materna e desenvolvimento neuropsicomotor. Conclusões: destaca-se a alta prevalência de crianças com suspeita de atraso no desenvolvimento neuropsicomotor. A escolaridade materna foi a única variável associada à esta condição.

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

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

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

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

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

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

Use of the activPAL® triaxial accelerometer to estimate total energy expenditure in low-income women: differences between body mass index classifications

ABSTRACT Objective: This study aimed to assess the agreement between the total energy expenditure (TEE) estimated by the activPAL® triaxial accelerometers (ACC) and the TEE measured by the doubly labeled water method (DLW), as well as to assess if these values differ between the classifications of body mass index (BMI). Materials and methods: This is a cross-sectional study. Low-income adult women (19-45y) with BMI ≥ 18.5 kg/m2 were included. Accelerometry data (activPAL®) were collected over 7 consecutive days, which were used to calculate TEE-ACC and compared with DLW data. The Bland-Altman method, concordance correlation coefficient and root mean square error were used to assess agreement between methods. Results: The sample consisted of 55 women with a mean age of 31 ± 5 years. The agreement between TEE-ACC and TEE-DLW showed a bias of -142.5 kcal (-7.1%). Among the BMI classifications, participants with normal weight show a bias of -417.1 kcal (-21.0%), participants with overweight, -87.5 kcal (-3.9%) and participants with obesity, 97.5 kcal (4.3%). Furthermore, the bias between the methods showed a significant and positive correlation with the body weight (r = 0.49; p < 0.01). Conclusion: The TEE-ACC estimates from activPAL® were reasonably accurate when compared to the TEE-DLW, especially in women with overweight and obesity, being much less accurate in individuals with normal weight.

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

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

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

Underreporting of energy intake is not associated with the reported consumption of NOVA-classified food groups in socially vulnerable women.

Few studies have investigated which types of food are least reported among underreporters of energy intake (EI). This study assessed the association between the underreporting of EI and the consumption report of food groups according to NOVA classification in women in social vulnerability. EI was measured through three 24-h dietary recalls administered by the research team. Total energy expenditure (TEE) was evaluated using the doubly labelled water method. The percentage of EI arising from each NOVA group food classification (unprocessed/minimally processed foods, culinary ingredients, processed foods and ultra-processed foods [UPF]) was calculated. The agreement between the EI and the TEE was assessed using the ratio EI:TEE. Associations were assessed with Pearson's correlation and multivariable linear regression, adjusted for age, education and body fat. The sample (63 women, age: 30.8 years, Body Mass Index: 27.6 kg/m2 ) reported an EI of 1849 kcal and a TEE of 2223 kcal, with a mean EI:TEE of 0.85. There were no significant correlations between the EI:TEE and the reported food intake according to NOVA classifications. Multivariable linear regression also did not show any significant associations (UPF: 8.47, 95% CI: [-3.65; 20.60] %kcal; Processed: -6.85, [-19.21; 7.71] %kcal; Culinary ingredients: 1.30 [-5.10; 7.71] %kcal; Unprocessed/minimally processed: -2.92 [-10.98; 5.13] %kcal). In conclusion, socially vulnerable women that underreport their EI do not report a lower intake of any specific group of foods according to NOVA classification.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Effectiveness of mussels (Mytella falcata) in malnourished children's recovery living in the slums in Maceió, Alagoas / Eficácia do sururu (Mytella falcata) na recuperação de crianças desnutridas, moradoras de favelas de Maceió, Alagoas

Abstract Objectives: to assess the efficacy of mussels (Mytella falcata) in malnourished children's recovery. Methods: 64 chronically malnourished children were accompanied for 12 months and attended at the Centro Recuperação e Educação Nutricional (Recovery Center and Educational Nutrition). The children were paired by age and malnutrition level forming three groups, which they received a balanced diet for nutritional recovery differing only on protein source. The group was offered (1) preparation of red meat, group (2) preparation of mussels and group (3) preparation of mussels in coconut milk. Results: the anthropometric assessment revealed that the children obtained a mean increase in the Z score in A-I indice of 0.70 for the group who red meat, 0.62 for the group who had mussels and 0.57 the group who had mussels cooked in coconut milk (p<0,05). An observation was made on a reduction in the prevalence of anemia with 22,8% (p=0,002), 27.8% (p=0.,007) and 42.4% (p 0.001) in groups 1, 2 and 3, respectively. Conclusion: the preparation of mussels cooked in or not in coconut milk can be an effective substitution for meat in combating child malnutrition and anemia and may be included in the children's institutions menus and in the programs that aim for children's nutritional recovery.

Resumo Objetivos: avaliar a eficácia do sururu (Mytella falcata) na recuperação de crianças desnutridas. Métodos: foram acompanhadas por 12 meses 64 crianças desnutridas crônicas atendidas no Centro Recuperação e Educação Nutricional. As crianças foram pareadas por idade e grau de desnutrição formando 3 grupos, os quais receberam dieta balanceada para a recuperação nutricional diferindo apenas na fonte de proteína. Foi ofertada ao grupo (1) preparação de carne bovina, ao grupo (2) preparação de sururu e ao grupo (3) uma preparação de sururu com leite de coco. Resultados: a avaliação antropométrica revelou que as crianças obtiveram um incremento médio em escore Z no índice A-I de 0,70 para o grupo da carne, 0,62 no grupo que recebeu sururu e 0,57 no grupo que recebeu sururu com leite de coco (pD0,05). Constatou-se ainda redução da prevalência da anemia nos grupos com percentual de redução de 22,8% (p=0,002), 27,8% (p=0,007) e 42,4% (pD0,001) nos grupos 1, 2 e 3, respectivamente. Conclusões: a preparação sururu com ou sem leite de coco pode ser um substituto eficaz da carne bovina no combate a desnutrição infantil e da anemia, podendo ser incluída no cardápio de instituições infantis e em programas que visem à recuperação nutricional de crianças.

Desempenho cognitivo de pré-escolares com baixa estatura em tratamento de recuperação nutricional / Cognitive performance of stunted pre-school children undergoing nutritional recovery treatment

RESUMO Objetivo: Determinar se o tratamento de crianças com baixa estatura, ofertado em um centro especializado, influencia seu desempenho cognitivo. Métodos: Foram analisados dois grupos de crianças advindas de famílias vulneráveis, um com crianças com baixa estatura em tratamento no Centro de Recuperação e Educação Nutricional (CREN) e outro de crianças eutróficas de uma creche municipal localizada na mesma região do CREN. No CREN, as crianças são tratadas em semi-internato (9 horas/dia, 5 dias/semana), recebendo suporte médico, nutricional e psicopedagógico. Todas foram submetidas ao Teste de Triagem do Desenvolvimento de Denver-II e avaliadas quanto ao índice de estatura-para-idade em 3 momentos distintos: no início do acompanhamento e após 6 e 12 meses. A classificação socioeconômica das crianças, de acordo com os Critérios de Classificação Econômica Brasil, foi feita no início do acompanhamento. Calcularam-se razões de prevalência para a análise transversal da linha de base, por meio de uma regressão de Poisson, e razões de prevalência agrupadas para a análise longitudinal, por meio de um modelo de estimativas de equações generalizadas, ambas ajustadas por idade, sexo e classe socioeconômica. Resultados: Ao todo, 74 crianças foram analisadas, 37 em cada grupo. Não houve diferenças de idade, sexo e classe socioeconômica entre os grupos. Na análise longitudinal, o grupo CREN apresentou melhor desempenho no domínio pessoal-social (razão de prevalência agrupada: 0,89; intervalo de confiança de 95% - IC95%: 0,82-0,95), sem diferenças significativas para os demais domínios. Conclusão: O tratamento ofertado pelo CREN melhorou satisfatoriamente as habilidades sociais das crianças tratadas, sem alterar os demais domínios.

ABSTRACT Objective: To determine if the treatment of stunted children offered at a specialized center influences their cognitive performance. Methods: Two groups of children from vulnerable families were selected, one consisting of stunted children being treated at the Nutrition Education and Recovery Center (CREN), and the other group of eutrophic children from a local, public day care center. At CREN, children are treated in a day-hospital system (9 hours/day, 5 days/week), receiving medical, nutritional and psycho-pedagogical support. All children were submitted to the Denver-II Development Screening Test and had their development and the height-for-age index assessed at 3 moments: at the beginning of the follow-up, and after 6 and 12 months. The socioeconomic status, according to the Brazilian Economic Classification Criteria, was assessed at the beginning of the follow-up. Data were treated by prevalence ratios for cross-sectional baseline analysis, using the Poisson regression, and by pooled prevalence ratios for longitudinal analysis, using a generalized equation estimation model, both adjusted by age, sex and economic status. Results: Seventy-four children were included, 37 for each group. There were no differences in age, sex and socioeconomic status between groups. In the longitudinal analysis, the CREN group showed better performance in the personal-social domain (pooled prevalence ratio: 0.89; 95% confidence interval - 95%IC 0.82-0.95), with no differences in the other domains. Conclusions: The treatment offered at CREN satisfactorily improved the social skills of the treated children, without changing other domains.

COGNITIVE PERFORMANCE OF STUNTED PRE-SCHOOL CHILDREN UNDERGOING NUTRITIONAL RECOVERY TREATMENT. / DESEMPENHO COGNITIVO DE PRÉ-ESCOLARES COM BAIXA ESTATURA EM TRATAMENTO DE RECUPERAÇÃO NUTRICIONAL.

OBJECTIVE: To determine if the treatment of stunted children offered at a specialized center influences their cognitive performance. METHODS: Two groups of children from vulnerable families were selected, one consisting of stunted children being treated at the Nutrition Education and Recovery Center (CREN), and the other group of eutrophic children from a local, public day care center. At CREN, children are treated in a day-hospital system (9 hours/day, 5 days/week), receiving medical, nutritional and psycho-pedagogical support. All children were submitted to the Denver-II Development Screening Test and had their development and the height-for-age index assessed at 3 moments: at the beginning of the follow-up, and after 6 and 12 months. The socioeconomic status, according to the Brazilian Economic Classification Criteria, was assessed at the beginning of the follow-up. Data were treated by prevalence ratios for cross-sectional baseline analysis, using the Poisson regression, and by pooled prevalence ratios for longitudinal analysis, using a generalized equation estimation model, both adjusted by age, sex and economic status. RESULTS: Seventy-four children were included, 37 for each group. There were no differences in age, sex and socioeconomic status between groups. In the longitudinal analysis, the CREN group showed better performance in the personal-social domain (pooled prevalence ratio: 0.89; 95% confidence interval - 95%IC 0.82-0.95), with no differences in the other domains. CONCLUSIONS: The treatment offered at CREN satisfactorily improved the social skills of the treated children, without changing other domains.

OBJETIVO: Determinar se o tratamento de crianças com baixa estatura, ofertado em um centro especializado, influencia seu desempenho cognitivo. MÉTODOS: Foram analisados dois grupos de crianças advindas de famílias vulneráveis, um com crianças com baixa estatura em tratamento no Centro de Recuperação e Educação Nutricional (CREN) e outro de crianças eutróficas de uma creche municipal localizada na mesma região do CREN. No CREN, as crianças são tratadas em semi-internato (9 horas/dia, 5 dias/semana), recebendo suporte médico, nutricional e psicopedagógico. Todas foram submetidas ao Teste de Triagem do Desenvolvimento de Denver-II e avaliadas quanto ao índice de estatura-para-idade em 3 momentos distintos: no início do acompanhamento e após 6 e 12 meses. A classificação socioeconômica das crianças, de acordo com os Critérios de Classificação Econômica Brasil, foi feita no início do acompanhamento. Calcularam-se razões de prevalência para a análise transversal da linha de base, por meio de uma regressão de Poisson, e razões de prevalência agrupadas para a análise longitudinal, por meio de um modelo de estimativas de equações generalizadas, ambas ajustadas por idade, sexo e classe socioeconômica. RESULTADOS: Ao todo, 74 crianças foram analisadas, 37 em cada grupo. Não houve diferenças de idade, sexo e classe socioeconômica entre os grupos. Na análise longitudinal, o grupo CREN apresentou melhor desempenho no domínio pessoal-social (razão de prevalência agrupada: 0,89; intervalo de confiança de 95% - IC95%: 0,82-0,95), sem diferenças significativas para os demais domínios. CONCLUSÃO: O tratamento ofertado pelo CREN melhorou satisfatoriamente as habilidades sociais das crianças tratadas, sem alterar os demais domínios.

Consumption of minimally processed food is inversely associated with excess weight in adolescents living in an underdeveloped city.

BACKGROUND: The consumption of ultra-processed foods may be associated with the development of chronic diseases, both in adults and in children/adolescents. This consumption is growing worldwide, especially in low and middle-income countries. Nevertheless, its magnitude in small, poor cities from the countryside is not well characterized, especially in adolescents. This study aimed to assess the consumption of minimally processed, processed and ultra-processed foods by adolescents from a poor Brazilian city and to determine if it was associated with excess weight, high waist circumference and high blood pressure. METHODS: Cross-sectional study, conducted at a public federal school that offers technical education together with high school, located in the city of Murici. Adolescents of both sexes and aged between 14-19 years old were included. Anthropometric characteristics (weight, height, waist circumference), blood pressure, and dietary intake data were assessed. Associations were calculated using Poisson regression models, adjusted by sex and age. RESULTS: At total, 249 adolescents were included, being 55.8% girls, with a mean age of 16 years-old. The consumption of minimally processed foods was inversely associated with excess weight (Adjusted Prevalence Ratio: 0.61, 95% Confidence Interval: [0.39-0.96], P = 0.03). Although the consumption of ultra-processed foods was not associated with excess weight, high blood pressure and high waist circumference, 46.2% of the sample reported eating these products more than weekly. CONCLUSION: Consumption of minimally processed food is inversely associated with excess weight in adolescents. Investments in nutritional education aiming the prevention of chronic diseases associated with the consumption of these foods are necessary.