Ultra-processed food consumption during pregnancy and newborn weight / Consumo de alimentos ultraprocessados durante a gestação e peso ao nascer do recém-nascido

Abstract Objectives: to assess the association between pregnant women's consumption of ultra-processed foods and newborn body weight. Methods: prospective study with pregnant women (n=214) selected from all Basic Health Units in the city of Pinhais, Paraná. Socioeconomic, demographic, and health data were collected. Food consumption data were assessed using a 24-hour dietary recall and tabulated with GloboDiet software. Daily relative energy intake of ultra-processed food was estimated and logistic regression analysis was utilized. The infuence of covariates on the association analysis was also explored (e.g., income and education). Results: ultra-processed foods contributed to 26.9% of pregnant women's total energy intake. About 5.7% of newborns were classifed as small-for-gestational-age and 10.7% as large-for-gestational-age. A borderline statistically signifcant association was observed between large-for-gestational-age newborn weight and maternal consumption of ultra-processed foods (OR= 1.027; p=0.048). Additionally, family income was associated with the consumption of ultra-processed foods (OR= 0.144; p=0.008). With each additional 1% consumption of ultra-processed foods, mothers' likelihood of having large-for-gestational-age babies increased by about 2.7%. Conclusions: the study reveals a trend of positive association between the weight of large-for-gestational-age newborns and the consumption of ultra-processed foods by pregnant women, but not for small-for-gestational-age children.

Resumo Objetivos: avaliar a associação entre o consumo de alimentos ultraprocessados por gestantes e o peso de recém-nascidos. Métodos: estudo prospectivo com gestantes (n=214) selecionadas em Unidades Básicas de Saúde em Pinhais, Paraná. Dados socioeconômicos, demográfcos e de saúde foram coletados. Dados de consumo alimentar foram coletados por recordatório de 24-horas físico e entrados no software GloboDiet. O consumo diário relativo de energia proveniente de alimentos ultraprocessados foi estimado e a análise de regressão logística foi utilizada, considerando covariáveis como renda familiar e escolaridade. Resultados: o consumo de alimentos ultraprocessados pelas gestantes representou 26,9% da energia total. Cerca de 5,7% de recém-nascidos foram classifcados como pequenos para idade gestacional (PIG) e 10,7% como grandes para idade gestacional (GIG). Foi observada uma associação estatisticamente signifcativa limítrofe entre o peso dos recém-nascidos GIG e o consumo materno de alimentos ultraprocessados (OR= 1,027; p=0,048). Além disso, a renda familiar esteve associada com o consumo de alimentos ultraprocessados (OR=0,144; p=0,008). A cada 1% adicional de consumo de alimentos ultraprocessados, a probabilidade de as mães terem recém-nascidos GIG aumentou cerca de 2,7%. Conclusões: o estudo revela uma tendência de associação positiva entre o peso de recém-nascidos GIG e o consumo de alimentos ultraprocessados por mulheres grávidas, mas não para crianças PIG.

Iodine Intake and its Interindividual Variability in Brazilian Pregnant Women: EMDI Brazil Study.

Data on pregnant women's iodine intake are limited in Brazil. The aim of the study was to evaluate the contribution of foods, food groups, and food subgroups to the Brazilian pregnant women's iodine intake, and identify which food items explain the interindividual variability of their intake. A cross-sectional study with food consumption data of 2247 pregnant women from 24-h recalls was developed. Food items were classified according to the FAO/WHO GIFT classification, and their contribution to iodine intake and interindividual variability was assessed by the proportion of means method and linear regression, respectively. The mean usual iodine intake was 163.1 mcg (95% CI: 162.9-163.2). The food groups "spices and condiments," "cereals and their products," and "milk and milk products"; and the food subgroups "herbs and spices," "wheat and wheat-based products," "milk: fresh and processed," "dough-based sweets," and "eggs: fresh and processed" contributed to at least 80% of the iodine intake. Of these, only the food subgroups "milk," "dough-based sweets," and "eggs" did not explain the higher proportion (> 80%) of the interindividual variability. The contribution of "salt," "white French bread," "fluid whole milk," and "rice" to the iodine intake and its interindividual variability is highlighted. This study confirms the importance of "salt" as a dietary source of iodine and that few food groups and subgroups explained the difference in the iodine intake among pregnant women. Despite that, Brazilian staple foods, such as "rice," "beans," "eggs," "milk," and "bread" were identified as important for iodine intake and could be included in nutritional guidelines targeted to Brazilian pregnant women.

Effects of iodine supplementation on thyroid function parameter: Systematic review and meta-analysis.

BACKGROUND: Supplementation is an alternative with potential benefits for the prevention of iodine deficiency in pregnancy. OBJECTIVE: To evaluate the effects of iodine supplementation on maternal thyroid hormone concentrations and iodine status during and/or before pregnancy. METHODS: The review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). The search was conducted in the databases: Cochrane, Embase, Pubmed/MEDLINE and Scopus. Studies involving pregnant women of all trimesters who received oral iodine supplementation were included. Study selection was performed in the Rayyan program. Risk of bias was assessed by the Joanna Briggs Institute tool. Meta-analysis was performed in R software version 4.0.4. RESULTS: Eleven articles with low and moderate risk of bias were included. According to the results of the meta-analysis, supplementation of 200 µg/day of iodine was able to change urinary iodine concentration during pregnancy, thus contributing to adequate intake. When evaluating the period when the intervention started, the best time to start supplementation was prior to pregnancy or in early pregnancy. CONCLUSION: Daily iodine supplementation had satisfactory effects on iodine status and maternal thyroid hormone concentrations. Although supplementation with 200 µg showed positive effects on iodine status in pregnancy, some studies showed no effect. Prospero Registration: CRD42021249307 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=249307).

Food insecurity and its socioeconomic and health determinants in pregnant women and mothers of children under 2 years of age, during the COVID-19 pandemic: A systematic review and meta-analysis.

Background: The COVID-19 pandemic has reduced access to adequate food in terms of quality and quantity, especially for the most vulnerable population groups. The objective of this study was to evaluate the prevalence of Food Insecurity and its main socioeconomic and health determinants in pregnant women and mothers of children under 2 years of age, during the COVID-19 pandemic. Methods: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42021278033). The descriptors "Pregnant Woman", "Postpartum Women", "Breastfeeding Women", "COVID-19", "Food Insecurity", "Food Security" were combined in Scopus (Elsevier), Medline/PubMed (via National Library of Medicine), Embase (Elsevier), Web of Science and Science Direct independently by two researchers in September 2022. Original articles about Food Insecurity in households with pregnant women and mothers of children under 2 years of age during the COVID-19 pandemic were included. The meta-analysis of the prevalence of Food Insecurity was conducted using the RStudio software (4.0.4). Results: The initial search resulted in 539 records, and 10 articles met the proposed criteria and were included in this review. The prevalence of Food Insecurity ranged from 11.5 to 80.3% and in the meta-analysis it was 51% (IC: 30-71) (I 2 = 100.0%). The main socioeconomic and health determinants were ethnicity, domain language, low education, low income, informal employment, unemployment, occurrence of mental disorders, domestic violence, in addition to the unavailability of food in markets and lack of transport. The inclusion of studies with data collection by telephone stands out as a limitation, due to the non-inclusion of vulnerable groups without access to this means of communication. Conclusion: It is necessary to implement and strengthen specific public policies for the maternal and child group with the objective of protecting and strengthening the rights of women to maintain the physical and mental integrity of this group and guarantee Food Security.

Individual and contextual predictors of children's hemoglobin levels from Southern Brazilian municipalities in social vulnerability.

Few studies have investigated the simultaneous effect of individual and contextual factors on the occurrences of anemia. This study aims to evaluate the variability of children's hemoglobin levels from municipalities in social vulnerability and its association with factors of individual and municipal nature. This is a cross-sectional, multi-center study, with children data (12-59 months) collected from 48 municipalities of the Southern region of Brazil, that were included in the Brazil Without Poverty Plan. Individuals' data were collected using a structured questionnaire, and secondary and ecological data of children's municipalities were collected via national surveys and institutional websites. The outcome was defined as the hemoglobin level obtained by HemoCue. A multilevel analysis was performed using Generalized Linear Models for Location Scale and Shape using R, with a 5% significance level. A total of 1,501 children were evaluated. The mean hemoglobin level was 12.8g/dL (95%CI: 12.7-12.8), with significant variability between municipalities. Lower values of hemoglobin were observed in children who lived in municipalities with a higher urbanization rate and a lower number of Community Health Agents, in relation to the reference categories. At the individual level, lower hemoglobin values were identified for children under 24 months, not enrolled at daycares, who were beneficiaries of the conditional cash transfer program and diagnosed with underweight. The results shed light on important factors at the municipal and the individual levels that were associated to the hemoglobin levels of children living in municipalities in social vulnerability.

Individual and contextual predictors of children's hemoglobin levels from Southern Brazilian municipalities in social vulnerability / Preditores individuais e contextuais dos níveis de hemoglobina em crianças de municípios do Sul do Brasil com vulnerabilidade social / Predictores individuales y contextuales de los niveles de hemoglobina en niños socialmente vulnerables de municipios del Sur de Brasil

Abstract: Few studies have investigated the simultaneous effect of individual and contextual factors on the occurrences of anemia. This study aims to evaluate the variability of children's hemoglobin levels from municipalities in social vulnerability and its association with factors of individual and municipal nature. This is a cross-sectional, multi-center study, with children data (12-59 months) collected from 48 municipalities of the Southern region of Brazil, that were included in the Brazil Without Poverty Plan. Individuals' data were collected using a structured questionnaire, and secondary and ecological data of children's municipalities were collected via national surveys and institutional websites. The outcome was defined as the hemoglobin level obtained by HemoCue. A multilevel analysis was performed using Generalized Linear Models for Location Scale and Shape using R, with a 5% significance level. A total of 1,501 children were evaluated. The mean hemoglobin level was 12.8g/dL (95%CI: 12.7-12.8), with significant variability between municipalities. Lower values of hemoglobin were observed in children who lived in municipalities with a higher urbanization rate and a lower number of Community Health Agents, in relation to the reference categories. At the individual level, lower hemoglobin values were identified for children under 24 months, not enrolled at daycares, who were beneficiaries of the conditional cash transfer program and diagnosed with underweight. The results shed light on important factors at the municipal and the individual levels that were associated to the hemoglobin levels of children living in municipalities in social vulnerability.

Resumo: Poucos estudos investigaram o efeito simultâneo dos fatores individuais e contextuais sobre a ocorrência da anemia. O estudo procura avaliar a variabilidade dos níveis de hemoglobina em crianças de municípios com vulnerabilidade social e a associação com fatores individuais e municipais. Foi realizado um estudo transversal com dados de crianças de idade pré-escolar (12-59 meses) de um estudo multicêntrico em 48 municípios do Sul do Brasil, incluídos no Plano Brasil Sem Miséria. Os dados dos indivíduos foram coletados com um questionário estruturado, e os dados secundários e ecológicos dos municípios das crianças foram obtidos através de inquéritos nacionais e websites institucionais. O desfecho foi definido como o nível de hemoglobina, obtido com o sistema HemoCue. Foi realizada análise multinível usando modelos lineares generalizados para posição, escala e forma, no R, com nível de 5% de significância . Foram avaliadas 1.501 crianças. O nível médio de hemoglobina foi 12,8g/dL (IC95%: 12,7-12,8), com variabilidade significativa entre os municípios. Níveis de hemoglobina mais baixos foram observados nas crianças em municípios com taxas de urbanização mais altas e menor número de agentes comunitários de saúde, comparado com as categorias de referência. Em nível individual, níveis de hemoglobina mais baixos foram identificados em crianças abaixo de 24 meses, não matriculadas em creches, beneficiárias do Programa Bolsa Família e diagnosticadas com baixo peso. Os resultados destacam fatores importantes nos níveis municipal e individual que estão associados com os níveis de hemoglobina em crianças de municípios com vulnerabilidade social.

Resumen: Pocos estudios han investigado el efecto simultáneo de los factores individuales y contextuales en la incidencia de anemia. El objetivo de este estudio fue evaluar la variabilidad de los niveles de hemoglobina en niños socialmente vulnerables en municipios del sur de Brasil y su asociación con factores en el nivel individual y municipal. Se trata de un estudio trasversal con datos de niños (12-59 meses), procedentes de un estudio multicéntrico, realizado en 48 municipios de la región sur de Brasil, incluidos en el Plan Brasil sin Pobreza. Se recogieron los datos de los participantes, usando un cuestionario estructurado, así como datos secundarios y ecológicos de los municipios de los niños, a través de encuestas nacionales y sitios web institucionales. El resultado se definió como el nivel de hemoglobina obtenido por HemoCue. Se realizó un análisis multinivel, usando modelos lineales generalizados para la escala de localización y forma usando R, con un nivel de un 5% de significancia. Un total de 1.501 niños fueron evaluados. La media de nivel de hemoglobina fue 12,8g/dL (95%CI: 12,7-12,8), con una significativa variabilidad entre municipios. Los valores más bajos de hemoglobina se observaron en niños que vivían en municipios con unas tasas más altas de urbanización, y un número de agentes de salud comunitario más bajo, en relación con las categorías de referencia. En el nivel individual, los valores de hemoglobina más bajos fueron identificados en niños con menos de 24 meses, no matriculados en guarderías, beneficiarios de ayudas económicas, enmarcadas en programas de ayuda económica, y diagnosticados como con bajo peso. Los resultados aclararon importantes factores en el nivel municipal e individual que estaban asociados a los niveles de hemoglobina de niños residentes en municipios, así como vulnerables socialmente.

Nutritional composition of school meals serving children from 7 to 36 months of age in municipal day-care centres in the metropolitan area of Curitiba, Paraná, Brazil.

The Brazilian National School Feeding Program (PNAE) seeks to meet student's nutritional needs during the period they remain in school. This study aimed to determine the nutritional composition of meals provided in municipal day-care centres serving children of 7-11 months (group A) and 12-36 months (group B) of age and to compare observed values with the PNAE's and dietary reference intakes' (DRI) recommendations. This cross-sectional study was conducted in 4 day-care centres in the metropolitan area of Curitiba, Paraná, Brazil, between June and November 2013. Food samples of six daily meals were collected during 20 non-consecutive days, totalling 120 samples. For each meal, average served and consumed portions were submitted for laboratory analysis of moisture, ash, proteins, lipids, carbohydrates, dietary fibre, Na, Ca and Fe and compared with the PNAE's and DRI's values. No statistically significant difference was found between age groups (P=0·793) regarding portion sizes and nutritional composition. The same menu was offered to both groups in 95 % of the meals (n 114), although the groups' nutritional needs were different. For group A, served meals met PNAE's recommendations for energy, carbohydrates, proteins, Na and Ca content, and consumed portions provided 70 % of the nutritional needs for carbohydrates, proteins and Ca. For group B, served portions complied with the PNAE's values for proteins, Na and Ca. Proteins and Na reached 70 % of the nutritional needs when consumed food was evaluated. School feeding in day-care centres partially meet PNAE's guidelines and children's nutritional requirements, contradicting the primary objective established by the national programme.

Oferta de sódio na alimentação em crechesmunicipais: um risco à saúde / Sodium offer in public child daycare centers: a health risk

O objetivo da pesquisa foi determinar a quantidade de sódio oferecida nas refeições de crianças de 12 a 36 meses emcreches municipais, por meio de análises laboratoriais. O estudo transversal foi realizado em quatro creches de um municípioda Região Metropolitana de Curitiba/PR, sorteadas aleatoriamente por amostragem estratificada por conglomerados.De junho a novembro/2013 foram coletadas amostras das seis refeições diárias servidas às crianças, durante cinco diasnão consecutivos nas quatro creches, totalizando 20 dias e 120 amostras analisadas. O teor de sódio foi determinado pelométodo de cloretos por volumetria e os resultados foram comparados a quatro parâmetros: 1) quantidade máxima diáriapreconizada para o sódio na alimentação escolar, 2) limite superior tolerável de ingestão do nutriente para a idade, 3)atendimento máximo de 70% da recomendação nutricional e 4) teor máximo de sódio recomendado para uma refeição,na alimentação escolar. O teor médio de sódio oferecido foi 1251mg/dia (n=20), atendendo ao preconizado para a alimentaçãoescolar e correspondendo a 83,4% do limite superior de ingestão para a idade. Cem por cento dos almoços e60% dos jantares apresentaram valores de sódio acima do recomendado para uma refeição, indicando um fator de riscopara a hipertensão arterial infantil e necessidade de intervenção nessa população.

This paper aimed to determine sodium amount in meals offered to children from 12 to 36 months old, in municipal childdaycare centers, using laboratorial analysis. The study was conducted in 4 child daycare centers from a city in the metropolitanregion of Curitiba/PR, Brazil, randomly selected after complex sampling techniques. From June to November/2013,samples of the 6 daily meals served to children were collected in 4 child daycare centers, for 5 non-consecutive days, totaling20 days and 120 samples analyzed. Sodium content was determined by the method of chlorides by volumetry and theresults were compared to 4 parameters, as follows: 1) maximum sodium value recommended by PNAE to full-time schoolfeeding, 2) tolerable upper intake level (UL) for the age group, 3) compliance to maximum 70% of tolerable upper intakelevel (UL) for the age group, and 4) maximum sodium value recommended by PNAE to a single meal. The average amountof sodium offered to children was 1251mg/day, which met PNAE’s guidelines and corresponded to 83.4% of UL for age. Asto sodium content in a single meal, 100% of lunches and 60% of dinners exceeded the maximum recommended by PNAE,indicating risk factor to hypertension in childhood and highlighting intervention required in this population.