Improving the Nutritional Status of Socially Vulnerable Children in Manaus, Brazilian Amazon, through a Food Supplementation Programme.

Information on the effects of government nutrition programmes provided to socially vulnerable children to improve their nutritional status is scarce. We analysed the effectiveness of a nutritional programme, including food supplementation with infant formula, on the evolution of the weight and height of socially vulnerable children from Manaus in the Brazilian Amazon. This study included 7752 children aged 12-24 months admitted to the programme between 2017 and 2020. Weight and height measurements at admission and every three months thereafter were extracted from the programme database. Weight-for-age, weight-for-height, body mass index-for-age (BMI/A), and height-for-age z-scores were analysed using a multilevel linear regression model, which showed a statistically significant decrease in nutritional deficits toward nutritional recovery at follow-up. The programme's effectiveness was evaluated in 1617 children using a paired analysis comparing data from between 12 and 15 months of age at admission and follow-up after 6-9 months. Children admitted with wasting presented an increase in the BMI/A z-score, whereas children admitted with a risk of being overweight and obese had a statistically significant decrease in the BMI/A z-score. Children admitted with stunted growth also showed increased height-for-age z-scores. The nutrition programme was effective for children experiencing wasting and reducing excess weight.

Assessing the relationship between nutrition literacy and eating behaviors among nursing students: a cross-sectional study.

BACKGROUND: Eating behavior is an essential aspect of life that can have long-term effects on health outcomes. Nutrition literacy is crucial for better health and well-being. It empowers individuals to make informed decisions about their nutrition and take control of their eating habits. OBJECTIVES: This study aimed to assess the relationship between nutritional literacy and eating behavior among nursing students at the nursing faculties of Ardabil University of medical sciences. METHODS: A cross-sectional correlational study was conducted in Ardabil province, northwest Iran. The study collected data through simple random sampling at nursing schools in Ardabil province, with 224 nursing students participating. The study collected data from a demographic information form, the nutritional literacy self-assessment questionnaire for students (NL-SF12), and the adult eating behavior questionnaire (AEBQ). The data were analyzed using SPSS version 14.0 software. RESULTS: Based on the results, nutritional literacy explains 44% of the variance in eating behavior and shows significant explanatory power in two sub-scales of eating behavior. The adjusted R2 values for food approach and food avoidance scales were 0.33 and 0.27, respectively. CONCLUSION: Given the significant relationship between nutritional literacy and eating behaviors among nursing students, nursing faculty managers and health policymakers should develop new public health strategies to increase nutritional literacy among nursing students.

Mothers' sociodemographic factors and use of health professionals for child feeding advice.

This study examined sociodemographic factors associated with mothers seeking child feeding advice from health professionals (HPs). Cross-sectional analysis of survey data from linked randomized controlled trials was conducted. Surveys asked which sources of feeding information mothers used when their child was 6 months and 5 years old. Logistic regression was used to examine associations between sociodemographic characteristics and use of information from HPs. Here, 947 and 405 mothers completed 6-month and 5-year surveys, respectively. At 6 months, multiparous mothers were less likely to seek advice from child and family health nurses (CFHNs) (adjusted odds ratio [AOR]: 0.558, 95% confidence interval [95% CI]: 0.416-0.749) and other HPs (AOR: 0.706, 95% CI: 0.542-0.919), unmarried mothers were less likely to seek advice from other HPs (AOR: 0.582, 95% CI: 0.342-0.990). At 5 years, mothers with household income ≥$80,000 p.a. were less likely to seek advice from CFHNs (AOR: 0.514, 95% CI: 0.302-0.875) and working mothers less likely to seek advice from general practitioners (GPs) (AOR: 0.581, 95% CI: 0.374-0.905). Mothers born in Australia were less likely to seek information from CFHNs (AOR: 0.462, 95% CI: 0.257-0.833) and GPs (AOR: 0.431, 95% CI: 0.274-0.677). There was a greater likelihood that multiparous mothers (AOR: 2.114, 95% CI: 1.272-3.516) and mothers of children whose fathers had not attended university (AOR: 2.081, 95% CI: 1.256-3.449) had never sought advice from CFHNs, and that mothers who had not attended university (AOR: 1.769, 95% CI: 1.025-3.051), multiparous (AOR: 1.831, 95% CI: 1.105-3.035) and employed (AOR: 2.058, 95% CI: 1.135-3.733) mothers had never sought advice from other HPs. Understanding sociodemographic factors associated with seeking child feeding advice from HPs may inform priorities for engaging families in health promotion.

Encuesta a profesionales sobre la nueva base de datos de composición de alimentos de Uruguay / Survey of professionals on the new database of food composition in Uruguay

Introducción. El Capítulo Nacional URUGUAYFOODS, perteneciente a la Red Latinoamericana de Composición de Alimentos (LATINFOODS, INFOODS, FAO), realizó recientemente una investigación para identificar cuáles tablas/bases de datos de composición de alimentos (TCA/ BDCA) utilizan los profesionales nacionales, así como la percepción de sus limitaciones, con el fin de ser tenidos en cuenta en la creación de la nueva BDCA nacional. Objetivo. Caracterizar el uso de las TCA/BDCA de composición de alimentos y describir las características y limitaciones de las mismas, mediante el análisis de la encuesta realizada a profesionales del área de salud, nutrición y alimentos de Uruguay en el año 2022. Materiales y métodos. Se trató de un estudio cuantitativo, descriptivo y transversal. La información fue obtenida a través de una encuesta de participación voluntaria. La muestra estuvo conformada por 94 profesionales nacionales. Se analizó la variable uso y frecuencia de uso de dichas herramientas respecto a la edad y población específica con la que trabaja el profesional encuestado. Resultados. La preferencia de uso fue la base de datos USDA y CENEXA, antes que la TCAU, resultando en una debilidad importante en todas las áreas en donde se utilicen estos datos, pues no refleja los hábitos ni costumbres de la población. Conclusiones. Los potenciales usuarios de la nueva BDCA nacional pretenden que sea de acceso fácil y gratuito, en idioma español, en formato digital, con información actualizada y con posibilidad de elección de datos en porción o cada 100 gramos(AU)

Introduction. The URUGUAYFOODS National Chapter, belonging to the Latin American Food Composition Network (LATINFOODS, INFOODS, FAO), recently carried out an investigation to identify which food composition tables and databases (TCA and BDCA) are used by national professionals, as well as the perception of their limitations, in order to be taken into account in the creation of the new national BDCA. Objective. Characterize the use of TCAs and BDCAs for food composition and describe their characteristics and limitations through the analysis of the survey carried out among professionals in the area of health, nutrition, and food in Uruguay in 2022. Materials and methods. It was a quantitative, descriptive, and cross-sectional study. The information was obtained through a voluntary participation survey. The sample consisted of 94 national professionals. The variable use and frequency of these tools were analyzed with respect to the age and specific populations with which the surveyed professional works. Results. The preference for use was the USDA and CENEXA databases rather than the TCAU, resulting in a significant weakness in all areas where these data are used since they do not reflect the habits and customs of the population. Conclusions. Potential users of the new national BDCA want it to be easily and freely accessible, in Spanish, in digital format, with up-to-date information, and with the possibility of choosing data in portions or every 100 grams(AU)

Digestive perianastomotic ulcerations after intestinal resection in children.

Digestive perianastomotic ulceration (DPAU) is a rare complication after intestinal resection and anastomosis occurring at or near the anastomosis site. The purpose of this review is to summarize the characteristics of DPAU, including the etiology, diagnosis and differential diagnosis, clinical manifestations, treatment, and future research. All recent literature on DPAU was searched in PubMed, Embase, and Cochrane and then reviewed. The clinical manifestations of DPAU are mainly gastrointestinal symptoms such as bloody stool and chronic anemia. The diagnosis of DPAU is difficult. Specific diseases, such as Crohn's disease, must be ruled out before a diagnosis can be made. In addition, there are no clear treatment guidelines due to the high degree of heterogeneity in response to drugs and surgery. It is recommended to adjust medication in time and combine various treatment methods. In addition, the mechanism that causes DPAU is not well understood; however, several possible mechanisms have been proposed, such as scar tissue ischemia and underlying diseases. Moreover, there is a high risk of relapses, and a long-term follow-up is necessary. Numerous issues remain to be solved in this area; therefore, more randomized controlled trials and studies should be carried out to further understand this disease.

Dietary assessment of 101 para-athletes from team and individual sports.

Assessing the usual food intake of para-athletes enables knowledge and description of nutrient intakes, providing insight into the potential nutritional status of para-athletes and may help tailor dietary intake to their specific training needs. This study aimed to evaluate the usual intake of macronutrients and food groups and meal food patterns of athletes with a disability. We also compared dietary intake data between team and individual sport para-athletes. One hundred and one athletes with a disability from 13 Paralympic disciplines living in Brasília, Federal District, Brazil were included. Food intake was estimated from two or four non-consecutive 24-h food recalls in which para-athletes reported all food, beverages, and supplements consumed in the previous 24-h. Dietary intake analysis was performed by implementing the National Cancer Institute (NCI) method to calculate the macronutrient and food group usual intake. Macronutrient intakes were compared to Acceptable Macronutrient Distribution Ranges for the general population and food group intakes were compared to the 2008 Brazilian National Dietary Guidelines. Para-athletes consumed a low-carbohydrate, adequate protein, high-fat diet. There was no significant difference in macronutrient intake distribution between team sport and individual sport para-athletes. Most para-athletes had three main meals during the day. The prevalence of inadequate fruit servings in the middle and highest energy intake tertiles was significantly higher in team sport para-athletes (92.5% and 98.4%) than in individual sport para-athletes (90.8% and 65.5%), respectively. The prevalence of inadequate vegetable servings was significantly higher between team and individual para-athletes for the middle energy intake tertiles. Para-athletes generally consumed an imbalanced diet, which is a cause for concern given their additional physiological demands and specific training needs.

Enseñanza y aprendizaje sobre nutrición en estudiantes de enfermería: revisión de alcance / Teaching and learning methods for nursing students on nutrition: scoping review

Introducción: La ingesta de alimentos puede determinar el estado individual de salud y bienestar de la persona. El abordaje de contenido relevante sobre nutrición en el curriculum de enfermería resulta clave a la hora de proporcionar conocimientos, actitudes y habilidades sobre prevención, tratamiento y promoción de la salud. Objetivo: Revisar el tipo de evidencia en relación a la enseñanza y aprendizaje sobre nutrición en estudiantes de grado en enfermería. Método: Se llevó a cabo una búsqueda en MEDLINE (PubMed/Ovid), Web of Science (WOS), EMBASE (a través de OvidSP), CINAHL (a través de EBSCO Publishing), ERIC (Educational Resource Information Center) y Scopus. La búsqueda incluyó publicaciones en inglés y español desde el lanzamiento de las bases de datos hasta enero de 2021. En esta revisión se incluyeron estudios empíricos primarios y que contuvieran en la muestra estudiantes de enfermería, y estudios cuyos resultados informaran sobre la enseñanza y aprendizaje en nutrición. Resultados: 22 trabajos cumplieron los criterios de inclusión, identificándose cuatro temas relevantes; 1) Revisión de programas y curriculum; 2) Diseños de enseñanza; 3) Evaluación del aprendizaje; 4) Percepción de los estudiantes sobre la metodología de enseñanza. Conclusiones: Las publicaciones incluidas presentan una gran heterogeneidad entre los programas implementados, los resultados de aprendizaje explicitados y los métodos de evaluación, lo que imposibilitó la comparación. Sin embargo, todos destacaron los beneficios de la enseñanza de la nutrición en estudiantes de enfermería. Estos resultados sugieren la necesidad de seguir investigando sobre el diseño, implementación y evaluación de las secuencias de aprendizaje. (AU)

Introduction: Food intake can determine a person's individual state of health and well-being. Addressing relevant nutrition content in the nursing curriculum is the key to providing knowledge, attitudes and skills on prevention and treatment and to promoting health. Objective: To review the evidence concerning teaching and learning methods on nutrition for undergraduate nursing students. Methods: A search was carried out in MEDLINE (PubMed/Ovid), Web of Science (WOS), EMBASE (through OvidSP), CINAHL (through EBSCO Publishing), ERIC (Educational Resource Information Center) and Scopus. The search included publications in English and Spanish from the launch of the databases until January 2021. Primary empirical studies, studies with nursing students in the sample and studies that reported on teaching and learning about nutrition were included in this review. Results: 22 articles met the inclusion criteria, identifying four relevant themes: 1) Review of nursing programs and curricula; 2) Teaching designs; 3) Assessment of learning; 4) Student perceptions of the teaching methodology. Conclusions: This scoping review highlights the benefits of teaching nursing students about nutritional care programmes. The publications included show great heterogeneity across programmes, explicit learning outcomes and evaluation methods. Our findings suggest the need to further expand and strengthen research on design, implementation and evaluation of learning sequences. (AU)

Cost-effectiveness of infant hypoallergenic formulas to manage cow's milk protein allergy in France.

Background: Clinician's choice of hypoallergenic formulas in the first-line management of cow's milk protein allergy (CMPA) should be informed by evidence on clinical efficacy and cost-effectiveness. Objective: We compare the cost-effectiveness of amino acid-based formula (AAF), extensively hydrolyzed casein formula with Lactobacillus rhamnosus Gorbach Goldin (EHCF+LGG), extensively hydrolyzed whey formula (EHWF), and rice hydrolyzed formula (RHF) in non-breastfed children in France. Methods: Immunotolerance and atopic manifestations' prevalence were based on a prospective non-randomized study with a 36-month follow-up. Resource utilization was sourced from a survey of French clinicians, and unit costs were based on national data. Costs and health consequences were discounted at 2.5% annually. Results were reported using the Collective and French National Health Insurance perspectives. Results: Children receiving EHCF+LGG were predicted to require less healthcare resources, given their reduced prevalence of CMPA symptoms at 3 years. In the base case, EHCF+LGG led to savings of at least €674 per child compared to AAF, EHWF, and RHF at 3 years, from both perspectives. Nutrition had the highest economic burden in CMPA, driven by hypoallergenic formulas and dietetic replacements costs. Results were robust to one-way and probabilistic sensitivity analyses. Conclusions: EHCF+LGG was associated with more symptom-free time, higher immune tolerance, and lower costs.

The association between plasma choline, growth and neurodevelopment among Malawian children aged 6-15 months enroled in an egg intervention trial.

Choline is an essential micronutrient that may influence growth and development; however, few studies have examined postnatal choline status and children's growth and development in low- and middle-income countries. The aim of this observational analysis was to examine associations of plasma choline with growth and development among Malawian children aged 6-15 months enrolled in an egg intervention trial. Plasma choline and related metabolites (betaine, dimethylglycine and trimethylamine N-oxide) were measured at baseline and 6-month follow-up, along with anthropometric (length, weight, head circumference) and developmental assessments (the Malawi Developmental Assessment Tool [MDAT], the Infant Orienting with Attention task [IOWA], a visual paired comparison [VPC] task and an elicited imitation [EI] task). In cross-sectional covariate-adjusted models, each 1 SD higher plasma choline was associated with lower length-for-age z-score (-0.09 SD [95% confidence interval, CI -0.17 to -0.01]), slower IOWA response time (8.84 ms [1.66-16.03]) and faster processing speed on the VPC task (-203.5 ms [-366.2 to -40.7]). In predictive models, baseline plasma choline was negatively associated with MDAT fine motor z-score at 6-month follow-up (-0.13 SD [-0.22 to -0.04]). There were no other significant associations of plasma choline with child measures. Similarly, associations of choline metabolites with growth and development were null except higher trimethylamine N-oxide was associated with slower information processing on the VPC task and higher memory scores on the EI task. In this cohort of children with low dietary choline intake, we conclude that there were no strong or consistent associations between plasma choline and growth and development.

Patterns in Mothers' Recollection of Health Care Providers' Young Child Feeding Recommendations.

OBJECTIVE: Characterize feeding guidance mothers recall receiving from their child's health care provider (HCP). DESIGN: Cross-sectional study of mothers participating in the 2017-2019 National Survey of Family Growth. PARTICIPANTS: US mothers reporting (n = 1,302) information about their youngest child (aged 6 months to 5 years). VARIABLES MEASURED: Weighted percentage of mothers who recalled their child's HCP discussing 6 different feeding topics by demographic characteristics. ANALYSIS: Logistic regression assessing the relationship between recall of feeding guidance and demographics. RESULTS: In this sample, 36.9% of mothers (95% confidence interval, 32.3-41.4) recalled HCPs recommending solid food before 6 months old (34.6% at 4-5 months, and 2.3% before 4 months). Mothers who were older or had a higher education level were more likely than their counterparts to recall their HCP discussing several of the feeding topics examined. CONCLUSION AND IMPLICATIONS: Mothers reported high recollection of early childhood nutrition guidance from their HCP; however, certain topics (eg, appropriate timing of solid food introduction) could be prioritized, and some subpopulations may need additional focus to improve receipt of messages. A better understanding of variability in recall of feeding guidance could provide information for interventions to address barriers to receiving and retaining guidance.

Determinants of exclusive breastfeeding among Haitian children under 6 months of age.

Objective: To identify the determinants of exclusive breastfeeding (EBF) among children under 6 months of age from three regions in the South and Grand'Anse Departments of Haiti. Methods: Data were pooled from three cross-sectional surveys conducted yearly from 2017 to 2019 with the guardians of 638 children under 6 months of age. A non-quantitative 24-hour dietary recall was used to assess EBF the day before the survey. Using unadjusted and adjusted prevalence ratios, associations were assessed between EBF and several explanatory factors: infant's age and sex; maternal age, educational attainment, mid-upper arm circumference (MUAC), dietary diversity, number of children under 5 years of age, responsibility for the main or secondary source of income of the household, initiation of breastfeeding within one hour, knowledge of EBF duration; household severe food insecurity, socioeconomic status, dependency ratio, region, and residential zone (urban/rural). Results: Prevalence of EBF was 68% in the study sample. From the fully adjusted model, prevalence of EBF was statistically significantly higher among younger infants, mothers with larger MUAC, who met or exceeded Minimum Dietary Diversity for Women (MDD-W), who initiated breastfeeding within one hour, who were knowledgeable of the recommendations for EBF duration, and living in the Jérémie region. Conclusions: The main determinants of EBF identified in this study attest to the importance of breastfeeding mothers' access to nutritious food for the practice and maintenance of EBF and the need for geographically equitable access to health services and education that support breastfeeding.

Association between dietary and suicidal behaviors in adolescents in Korea based on the Youth Risk Behavior Survey (2015-2020).

OBJECTIVES: This study explored the association between dietary and suicidal behaviors of Korean adolescents and investigated differences in this association in children of immigrant parents. METHODS: The sample (n=368,138) was collected from the Korea Youth Risk Behavior Survey from 2015 to 2020. Participants who agreed to provide family information (n=313,689) were classified according to their parents' nationality. The study variables were 11 self-reported dietary behaviors, and their composite dietary behaviors (i.e., nutrient deprivation and unhealthy food consumption) that resulted from principal component analysis. The association between study variables and suicide-related outcomes (i.e., suicidal ideation, suicide planning, and suicide attempts) was analyzed by multiple logistic regression with adjustment for covariates. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated. RESULTS: Participants who skipped key meals and foods were more likely to have attemped suicide (aOR [95% CI]: skipping breakfast ≥5 days/wk, 1.28 [1.21 to 1.35]; consuming fruits <1 times/wk: 1.42 [1.32 to 1.52]; consuming vegetables <1 times/wk: 1.72 [1.53 to 1.93]; consuming milk <3 times/wk: 1.07 [0.99 to 1.16]). The associations were prominent in third culture kids (TCKs) (aOR [95% CI]: 2.23 [1.61 to 3.09]; 2.32 [1.61 to 3.35]; 2.63 [1.50 to 4.60]; 1.69 [1.09 to 2.63], respectively). Participants who consumed unhealthy foods (fast food, caffeinated and sugary drinks) more frequently were more likely to have attempted suicide (aOR, 1.55; 95% CI, 1.38 to 1.73). This association was also more prominent in TCKs (aOR, 2.08; 95% CI, 1.08 to 4.01). CONCLUSIONS: Our findings indicate a positive association between unfavorable dietary behaviors and outcomes related to suicide, and this association appears to be notable in adolescents with immigrant parents.

Obesity prevention practices in early care and education settings: an adaptive implementation trial.

BACKGROUND: Despite the potential for Early Care and Education (ECE) settings to promote healthy habits, a gap exists between current practices and evidence-based practices (EBPs) for obesity prevention in childhood. METHODS: We will use an enhanced non-responder trial design to determine the effectiveness and incremental cost-effectiveness of an adaptive implementation strategy for Together, We Inspire Smart Eating (WISE), while examining moderators and mediators of the strategy effect. WISE is a curriculum that aims to increase children's intake of carotenoid-rich fruits and vegetables through four evidence-based practices in the early care and education setting. In this trial, we will randomize sites that do not respond to low-intensity strategies to either (a) continue receiving low-intensity strategies or (b) receive high-intensity strategies. This design will determine the effect of an adaptive implementation strategy that adds high-intensity versus one that continues with low-intensity among non-responder sites. We will also apply explanatory, sequential mixed methods to provide a nuanced understanding of implementation mechanisms, contextual factors, and characteristics of sites that respond to differing intensities of implementation strategies. Finally, we will conduct a cost effectiveness analysis to estimate the incremental effect of augmenting implementation with high-intensity strategies compared to continuing low-intensity strategies on costs, fidelity, and child health outcomes. DISCUSSION: We expect our study to contribute to an evidence base for structuring implementation support in real-world ECE contexts, ultimately providing a guide for applying the adaptive implementation strategy in ECE for WISE scale-up. Our work will also provide data to guide implementation decisions of other interventions in ECE. Finally, we will provide the first estimate of relative value for different implementation strategies in this setting. TRIAL REGISTRATION: NCT05050539 ; 9/20/21.

Simple anthropometry-based calculations to monitor body composition in athletes: Scoping review and reference values.

BACKGROUND: Kinanthropometry offers to exercise and health professionals a standardized procedure of acquiring surface anatomical measurements that might be used to track changes in body composition. AIM: To describe simple anthropometric indices to monitor body composition changes in amateur and elite athletes, and to provide reference values during the competition phase. METHODS: A search of articles indexed in PubMed/MEDLINE, ScienceDirect, Cochrane, and SciELO databases using the string body composition AND (anthropometric OR skinfolds OR circumferences OR girth OR estimation equation) AND "body fat". Inclusion criteria were: quantitative and/or qualitative research published between 2009 and 2020, written in English or Spanish, reporting simple anthropometric indices that included skinfolds, girths, or basic measures in amateur and elite athletes. RESULTS: A total of 51 studies (Price's index = 66.4%) met all the inclusion criteria and were included in this scoping review. Contrary to the frequent practice, the use of a regression equation might not be accurate to evaluate body composition. To avoid this, anthropometrists should base their analysis on the absolute values of the sum of skinfolds (∑S) and related variables, such as skinfold-corrected girths and lean mass index. While not definitive, because further research is required, the practical recommendations and updated reference values in competition phase provided by this review would contribute to the accurate identification of body composition changes. CONCLUSIONS: ∑S and lean mass index have been shown to be valid for monitoring changes in fat mass and fat-free mass, respectively. More research is needed to derive the lean mass index-specific coefficient for each sports population.

Determinants of exclusive breastfeeding among Haitian children under 6 months of age / Los determinantes de la lactancia materna exclusiva en menores de 6 meses de edad en Haití / Determinantes do aleitamento materno exclusivo entre crianças haitianas com menos de 6 meses de idade

ABSTRACT Objective. To identify the determinants of exclusive breastfeeding (EBF) among children under 6 months of age from three regions in the South and Grand'Anse Departments of Haiti. Methods. Data were pooled from three cross-sectional surveys conducted yearly from 2017 to 2019 with the guardians of 638 children under 6 months of age. A non-quantitative 24-hour dietary recall was used to assess EBF the day before the survey. Using unadjusted and adjusted prevalence ratios, associations were assessed between EBF and several explanatory factors: infant's age and sex; maternal age, educational attainment, mid-upper arm circumference (MUAC), dietary diversity, number of children under 5 years of age, responsibility for the main or secondary source of income of the household, initiation of breastfeeding within one hour, knowledge of EBF duration; household severe food insecurity, socioeconomic status, dependency ratio, region, and residential zone (urban/rural). Results. Prevalence of EBF was 68% in the study sample. From the fully adjusted model, prevalence of EBF was statistically significantly higher among younger infants, mothers with larger MUAC, who met or exceeded Minimum Dietary Diversity for Women (MDD-W), who initiated breastfeeding within one hour, who were knowledgeable of the recommendations for EBF duration, and living in the Jérémie region. Conclusions. The main determinants of EBF identified in this study attest to the importance of breastfeeding mothers' access to nutritious food for the practice and maintenance of EBF and the need for geographically equitable access to health services and education that support breastfeeding.

RESUMEN Objetivo. Determinar cuáles son los determinantes de la lactancia materna exclusiva en menores de 6 meses de edad de tres regiones de los departamentos Sur y Grand'Anse de Haití. Métodos. Se agruparon los datos de tres encuestas transversales realizadas anualmente entre 2017 y 2019 a representantes de 638 bebés menores de 6 meses de edad. Se empleó una descripción no cuantitativa de los alimentos consumidos en las últimas 24 horas para evaluar la lactancia materna exclusiva el día anterior a la encuesta. Mediante cocientes de prevalencia ajustados y no ajustados, se evaluó la relación entre la lactancia materna exclusiva y varios factores explicativos: sobre el lactante: edad y sexo; sobre la madre: edad, nivel educativo, circunferencia del brazo media, diversidad alimentaria, número de hijos menores de 5 años y responsabilidad como fuente principal o secundaria de ingresos del hogar; inicio de la lactancia materna en un plazo de una hora después del nacimiento y conocimiento sobre la duración de la lactancia materna exclusiva; inseguridad alimentaria grave en el hogar, situación socioeconómica y tasa de dependencia; y región y zona residencial (urbana/rural). Resultados. La prevalencia de la lactancia materna exclusiva fue de 68 % en la muestra del estudio. A partir del modelo totalmente ajustado, la prevalencia de la lactancia materna exclusiva fue significativamente mayor desde un punto de vista estadístico en los bebés más pequeños, las madres con una mayor circunferencia del brazo media, la que cumplieron o excedieron la Diversidad Alimentaria Mínima para las Mujeres, las que iniciaron la lactancia materna dentro de una hora después del parto, las que conocían bien las recomendaciones sobre la duración de la lactancia materna exclusiva y las que vivían en la región de Jérémie. Conclusiones. Los principales determinantes de la lactancia materna exclusiva identificados en este estudio confirman la importancia de que las madres lactantes tengan acceso a alimentos nutritivos para la práctica y el mantenimiento de la lactancia materna exclusiva, así como la necesidad de disponer de un acceso geográfico equitativo a los servicios de salud y la educación que respaldan la lactancia materna.

RESUMO Objetivo. Identificar os determinantes do aleitamento materno exclusivo (AME) entre crianças com menos de 6 meses de idade de três regiões dos departamentos Sul e Grand'Anse do Haiti. Métodos. Agruparam-se dados de três pesquisas transversais realizadas anualmente, de 2017 a 2019, com pais e responsáveis de 638 crianças com menos de 6 meses de idade. Um recordatório alimentar não quantitativo de 24 horas foi utilizado para avaliar o AME no dia anterior à pesquisa. Usando taxas não ajustadas e ajustadas de prevalência, avaliou-se a associação entre AME e diversos fatores explicativos: idade e sexo do bebê; idade da mãe, seu nível de escolaridade, circunferência do braço (CB), diversidade da dieta, número de filhos com menos de 5 anos, responsabilidade pela fonte primária ou secundária de renda da família, início do aleitamento materno na primeira hora, conhecimento sobre a duração do AME; insegurança alimentar domiciliar grave, status socioeconômico, índice de dependência, região e zona residencial (urbana/rural). Resultados. A prevalência de AME na amostra do estudo foi de 68%. Com base no modelo totalmente ajustado, a prevalência do AME foi maior, de forma estatisticamente significante, entre bebês mais jovens, mães com maior CB, que atendiam ou excediam a Diversidade Alimentar Mínima para Mulheres (MDD-W), que começaram a amamentar na primeira hora, que estavam familiarizadas com as recomendações sobre a duração do AME e que moravam na região de Jérémie. Conclusões. Os principais determinantes de AME identificados neste estudo atestam a importância do acesso das lactantes a alimentos nutritivos para a prática e a continuidade do AME, e a necessidade de acesso geograficamente equitativo a educação e serviços de saúde que apoiem o aleitamento materno.

Potential health risks surrounding ingredients of pre-workout and post-workout dietary supplements: a thorough label analysis / Potenciais riscos de saúde relacionados com ingredientes de suplementos alimentares de pré-treino e pós-treino: análise meticulosa de rótulos

ABSTRACT Objective Dietary supplements use is increasing. Dietary supplements may contain high doses of substances or dangerous ingredient combinations. This article aims to investigate, by analyzing dietary supplements labels, if there are any doping substances or dangerous amounts of any other component in the reviewed dietary supplements. Methods Several brands which possessed their supplements sorted in pre-workout and post-workout were analyzed. 40 dietary supplements with all ingredients described were included. The minimum and maximum dosages of dietary supplements were statistically described as Mean±SD. Results Citrus aurantium extract, Yohimbe extract, Garcinia cambogia extract and Maca root extract were reported in some of the analyzed dietary supplements. Regarding caffeine, the pre-workout group displayed higher mean caffeine (241±86mg) than the post-workout group (183±68mg), and the minimal mean dose was 226±84mg; meanwhile, the maximal mean dose was 242±88mg. Concerning creatine, the pre-workout group displayed lower mean creatine (3106±1079mg) than the post-workout group (4137±4177mg), and the minimal mean dose was 3167±1728mg; meanwhile, the maximal mean dose was 3917±3643mg. The salt content in the post-workout group displayed a much higher mean (2155±4486mg) than the pre-workout group (464±605mg), and the minimal mean dose was 1635±3930mg; meanwhile, the maximal mean dose was 1708±3926g. Conclusions No doping substances were reported in the dietary supplements, but consumption recommendations on the label could lead to excessive consumption of some not yet fully tested ingredients.

RESUMO Objetivo O uso de suplementos alimentares está a aumentar. Estes podem conter altas doses de substâncias ou combinações de ingredientes perigosas. Este artigo procura encontrar, analisando os rótulos dos produtos, se existem substâncias dopantes ou nocivas. Métodos Foram analisadas várias marcas cujos respectivos suplementos foram classificados em pré e pós-treino. Foram incluídos 40 suplementos com todos os ingredientes descritos. A respectiva dose mínima e máxima foi descrita estatisticamente como média ± DP. Resultados Extratos de Citrus aurantium, Yohimbe, Garcinia cambogia e raiz de Maca foram encontrados nos suplementos analisados. O grupo pré-treino apresentou maior média de cafeína (241±86mg) do que o grupo pós-treino (183±68mg), e a dose média mínima foi de 226±84mg, enquanto a dose média máxima foi de 242±88 mg. O grupo pré-treino apresentou menor média de creatina (3106±1079mg) do que o grupo pós-treino (4137±4177mg), e a dose média mínima foi de 3167±1728mg, enquanto a dose média máxima foi de 3917±3643mg. O grupo pós-treino apresentou uma maior média de sal (2155±4486mg) do que o grupo pré-treino (464±605mg), e a dose média mínima foi 1635±3930mg, enquanto a dose média máxima foi de 1708±3926mg. Conclusão Não foram encontradas substâncias dopantes nos suplementos, mas algumas recomendações de consumo nos rótulos poderão levar à sobredose de certos ingredientes menos testados.

Association of Diet, Physical Activity Guidelines and Cardiometabolic Risk Markers in Children.

The aim was to identify different dietary and physical activity (PA) patterns in 5- to 14-year-old children with a high prevalence of overweight and obesity using cluster analysis based on their adherence to the Spanish Society of Community Nutrition dietary guidelines and levels of PA, and to determine their associations with age, sex, body composition, and cardiometabolic risk markers. In 549 children, hierarchical cluster analysis was used to identify subgroups with similar adherence to dietary recommendations and level of PA. Three clusters were identified: Cluster 1, with the lowest level of vigorous PA and adherence to dietary recommendations; Cluster 2, with the lowest levels of moderate and vigorous PA and the highest adherence to dietary recommendations; and Cluster 3, with the highest level of PA, especially vigorous PA and a medium level adherence to dietary recommendations. Cluster 3 had lower total body fat and higher lean body mass percentages than Cluster 2. Cluster 2 had lower high-density lipoprotein cholesterol and higher low-density lipoprotein cholesterol levels than Cluster 1. The results from our study suggest that it is important to consider adherence to PA recommendations together with adherence to dietary guidelines to understand patterns of obesogenic habits in pediatric populations with high prevalence of overweight and obesity.

Measuring the sports nutrition knowledge of elite Australian athletes using the Platform to Evaluate Athlete Knowledge of Sports Nutrition Questionnaire.

AIMS: To evaluate the nutrition knowledge of elite Australian athletes, and to obtain feedback from sports dietitians on the Platform to Evaluate Athlete Knowledge of Sports Nutrition Questionnaires' (PEAKS-NQ) suitability. METHODS: Sports dietitians from the National Institute Network across Australia recruited athletes to complete the online, 50-item PEAKS-NQ which contained two sections (General Nutrition and Sports Nutrition). Sports dietitians provided feedback on the PEAKS-NQ using a 14-item questionnaire (with two open-ended items). The main outcome measures were nutrition knowledge score and tool suitability (usefulness, acceptability and feasibility) scores. For knowledge scores, independent t-tests, ANOVA and Chi-square tests were used to evaluate differences between groups. Suitability was evaluated using descriptive statistics. RESULTS: Twelve sports dietitians from the National Institute Network in Australia recruited a convenience sample of 240 athletes (21.3 ± 4.3 years, 63.5% female, 63.3% competed internationally). Athletes scored 70.7 ± 10.5%, with better general vs sports nutrition knowledge. Females had higher overall scores (P < .001) with no differences for age or sport played. University-educated athletes scored higher than non-tertiary educated athletes (P = .004). Knowledge gaps were identified in fats (role and food sources), recovery nutrition and managing body composition. Sports dietitians rated suitability of PEAKS-NQ positively with complete agreement on 8 of 12 items. CONCLUSIONS: Athletes have greater understanding of general nutrition compared to sports nutrition concepts and may benefit from education on applying nutrition in sports-specific contexts. Sports dietitians' responses showed PEAKS-NQ was a highly acceptable, feasible and useful measure.

Basal metabolic rate for high-performance female karate athletes / Tasa metabólica basal de deportistas de karate femenino de alto rendimiento

Introduction: karate is a millennial martial art, currently inserted in the context of Olympic Combat Sports. However, important scientific gaps still persist in monitoring high-performance athletes, including the basal metabolism measurement of female karate athletes. Aim: to contribute to understanding the applicability of equations for predicting basal metabolic rate in this population. Methods: this is a cross-sectional study with a retro-analytical component, in which data were obtained from the medical records of seven athletes participating in the project "Karate São Paulo Olímpico" (São Paulo Olympic Karate) (KSPO) during their nutrition counseling, including body composition and indirect calorimetry testing, with the aim of comparing these data to basal metabolic rate prediction equations. Results: only one out of the five evaluated equations did not have a significant statistical difference relative to the value obtained by open-circuit indirect calorimetry. Conclusion: in case basal metabolism cannot be measured through standard methodology (calorimetry), Cunningham's prediction equation (1980) would be appropriate to obtain total energy expenditure for high-performance female karate athletes. (AU)

Introducción: el karate es un antiguo arte marcial que actualmente encaja en el contexto de los deportes olímpicos de combate. Sin embargo, aún quedan importantes lagunas científicas para el seguimiento de los deportistas de alto rendimiento, una de las cuales es la determinación del metabolismo basal de las deportistas de karate. Objetivo: contribuir al conocimiento de la aplicabilidad de las ecuaciones predictivas para obtener la tasa metabólica basal de esta población. Métodos: el estudio se caracteriza por ser transversal con un componente retroanalítico, donde se obtuvieron los datos de siete atletas de la historia clínica de cuidado nutricional del proyecto Karate São Paulo Olímpico (KSPO), referidos a la composición corporal y el examen de calorimetría indirecta, con el propósito de compararlos con las ecuaciones predictivas de la tasa metabólica basal. Resultados: solo una de las cinco ecuaciones evaluadas no mostró ninguna diferencia estadísticamente significativa con respecto al valor medido mediante calorimetría indirecta de circuito abierto. Conclusión: sería conveniente, si no existe la posibilidad de obtener un metabolismo basal mediante la metodología de referencia (la calorimetría), utilizar la ecuación predictiva de Cunningham (1980) con el fin de obtener el gasto energético total de las deportistas karatecas de alto rendimiento. (AU)

Toddler milk perceptions and purchases: the role of Latino ethnicity.

OBJECTIVES: Toddler milk (i.e. a nutrient-fortified milk-based drink marketed for children 12-36 months old) is increasingly being marketed in the USA despite not being recommended for young children. There is evidence of targeted toddler milk marketing to Latinos in the USA. This study aimed to explore toddler milk perceptions and behaviours among Latino and non-Latino parents. DESIGN: An online survey assessed toddler milk perceptions, behaviours and interpretations of nutrition-related claims. Multivariable logistic and linear regression explored socio-demographic correlates of parent reported past purchases and perceived healthfulness. SETTING: Online. PARTICIPANTS: National convenience sample of 1078 US parents of children aged 2-12 years (48 % Latino). RESULTS: About half of parents (51 %) had previously purchased toddler milk and few (11 %) perceived toddler milk as unhealthy. Latino parents were more likely to have purchased toddler milk than non-Latino parents (P < 0·001), but there were no differences in perceived product healthfulness (P = 0·47). Compared to parents born in the USA, parents living in the USA 10 years or less were more likely to have purchased toddler milk (P < 0·001) and perceive toddler milk as healthier (P = 0·002). Open-ended interpretations of claims were primarily positive, suggesting 'health halo' effects. CONCLUSIONS: Common misperceptions about toddler milk healthfulness suggest stronger labelling regulations are needed. Greater reported purchases by Latino parents and recent immigrants warrant further investigation.