Antônio Augusto Schäfer

Fatores associados ao tipo de parto em mulheres brasileiras: PNDS 2006

The scope of this paper was to analyze the prevalence of the types of delivery and associated factors in Brazilian women of childbearing age studied in the last National Demographics and Health Survey (NDHS). The study is a national domicile-based cross-sectional analysis, seeking to establish the characteristics of the female population of child-bearing age and of children under 5 years of age. The prevalence of the type of delivery was described according to the following exposition variables: Brazilian macro-regions, location of residence, age, skin color, nutritional status, education, prenatal health unit and place of delivery. The statistical significance (p<0,05) was evaluated using the chi-square test. The population studied consisted of 6.125 women. It was revealed that 42.9% of the women had a caesarean section. Significantly, the prevalence of caesarean section was smaller, irrespective of macro-regions, location of residence, age, skin color, nutritional status, prenatal health unit and place of delivery. The need for further investigation into the factors behind the increase in caesarean sections in Brazil is required in order to reverse this situation, since caesarean section can lead to a series of health complications for both mother and child.

The influence of birth order and number of siblings on adolescent body composition: evidence from a Brazilian birth cohort study

The aim of this study was to estimate the association between birth order and number of siblings with body composition in adolescents. Data are from a birth cohort study conducted in Pelotas, Brazil. At the age of 18 years, 4563 adolescents were located, of whom 4106 were interviewed (follow-up rate 81·3 %). Of these, 3974 had complete data and were thus included in our analysis. The variables used in the analysis were measured during the perinatal period, or at 11, 15 and/or 18 years of age. Body composition at 18 years was collected by air displacement plethysmography (BOD POD®). Crude and adjusted analyses of the association between birth order and number of siblings with body composition were performed using linear regression. All analyses were stratified by the adolescent sex. The means of BMI, fat mass index and fat-free mass index among adolescents were 23·4 (sd 4·5) kg/m2, 6·1 (sd 3·9) kg/m2 and 17·3 (sd 2·5) kg/m2, respectively. In adjusted models, the total siblings remained inversely associated with fat mass index (β = − 0·37 z-scores, 95 % CI − 0·52, − 0·23) and BMI in boys (β = − 0·39 z-scores, 95 % CI − 0·55, − 0·22). Fat-free mass index was related to the total siblings in girls (β = 0·06 z-scores, 95 % CI − 0·04, 0·17). This research has found that number of total siblings, and not birth order, is related to the fat mass index, fat-free mass index and BMI in adolescents. It suggests the need for early prevention of obesity or fat mass accumulation in only children.

Birth order and number of siblings and their association with overweight and obesity: a systematic review and meta-analysis

Context The effect of both birth order and number of siblings on overweight and/or obesity has not been determined. Birth order and sibsize have been mathematically coupled to overweight and/or obesity, but thus far their respective effects have been estimated separately. Objective The aim of this systematic review was to evaluate the effects of both birth order and number of siblings on the risk of overweight/obesity. Data Sources The electronic databases MEDLINE, Social Science, SocINDEX, PsycINFO, CINAHL Plus, and Academic Search Complete were searched systematically. Study Selection Titles and abstracts of 1698 records were examined. After 1504 records were excluded, 2 authors independently assessed the full text of all remaining papers (n = 194); disagreements were resolved by discussion. Data Extraction A standardized form for assessment of study quality and evidence synthesis was used to extract data from the included studies. Results Twenty studies were included in the systematic review, 14 of which were included in the meta-analysis. Meta-analyses showed that lower (vs higher) birth order and smaller (vs greater) number of siblings were associated with overweight and/or obesity, with ORs of 1.47 (95%CI, 1.12–1.93) and 1.46 (95%CI, 1.17–1.84), respectively. However, among the 9 studies that attempted to separate the effects of birth order and number of siblings in the same analysis, a higher risk of overweight/obesity was consistently found among individuals without siblings than among those with 1 or more siblings, rather than among firstborns more generally. Conclusion The results show that both lower birth order and lower number of siblings are associated with risk of overweight/obesity, which suggests that only children are at a slightly increased risk of overweight/obesity. Systematic Review Registration PROSPERO registration number CRD42014015135.

Food consumption of children younger than 6 years according to the degree of food processing

OBJECTIVE To evaluate food intake according to the degree of processing, stratified by family income and age, in a representative sample of children younger than 6 years in the city of Pelotas, RS, Brazil. METHODS Cross-sectional population-based study carried out with 770 children aged 0-72 months of age living in the urban area of Pelotas. The dietary intake of children was assessed by 24-h recall administered to mothers or guardians. The energy intake was estimated and each food item was classified according to the food processing degree. Food consumption was stratified by age (younger than 24 months; 24 months or older) and associations between quintiles of family income and relative contribution of each food to total energy were performed by linear regression. The Wald test was applied to test linear trend across groups. RESULTS The mean energy intake was 1725.7kcal/day. The mean contribution of processed and ultraprocessed foods was 19.7% among children younger than 24 months and 37% in those aged 24 months or older, while the mean consumption of natural and minimally processed food was 61% and 44%, respectively. Among children aged 24 months or older, a greater consumption of canned foods, cheese and sweets was observed as family income quintiles increased, while breads were more consumed by those children belonging to the lower income quintiles. CONCLUSION A high caloric contribution of ultraprocessed foods in detriment to a lower consumption of natural and minimally processed foods was observed in the diet of children younger than 6 years.

Sleep Duration Trajectories and Body Composition in Adolescents: Prospective Birth Cohort Study.

We aimed to estimate the association between sleep duration trajectories and body composition in adolescents. We used data from participants of the 1993 Pelotas (Brazil) Birth Cohort Study who were later followed up at age 18 years (response rate of 81.3%). At the time, 3974 adolescents had complete data on body composition, which was assessed by air displacement plethysmography. Sleep duration was self-reported by participants at ages 11 and 18 years. Analyses were sex-stratified. The mean sleep duration at 11 years was 9.7 (SD 1.4) and 8.4 (SD 1.9) at 18 years. Sleep duration was dichotomized as inadequate (<8 hours/day) or adequate (≥8 hours/day). Mean body mass, fat mass, and fat-free mass indices at 18 years were 23.4 kg/m2 (SD 4.5), 6.1 kg/m2 (SD 3.9) and 17.3 kg/m2 (SD 2.5), respectively. Girls who reported inadequate sleep duration at 11 years of age, but adequate sleep duration at 18, on average experienced an increase in body mass index (β = 0.39 z-scores; 95% CI 0.13, 0.65), fat mass index (β = 0.30 z-scores; 95% CI 0.07, 0.53), and fat-free mass index (β = 0.24 z-scores; 95% CI 0.08, 0.39) compared to those who had adequate sleep duration at both time points. The results suggest that changes in sleep duration across adolescence may impact body composition in later adolescence and that this may differ by sex.

Associação entre circunferência da cintura e índice de massa corporal de mulheres brasileiras PNDS 2006

O objetivo do estudo foi analisar a associacao entre a circunferencia da cintura (CC) e o indice de massa corporal (IMC) de mulheres brasileiras em idade fertil, estudadas na ultima Pesquisa Nacional de Demografia e Saude (PNDS), no ano de 2006. Este estudo e um recorte da PNDS, a qual e um estudo seccional, de base domiciliar. O estado nutricional foi avaliado atraves do IMC e da CC, considerando-se excesso de peso IMC > 25 Kg/m2e CC de risco > 80 cm. Para a avaliacao da significância estatistica foi usada Regressao de Poisson, que identificou os fatores associados a CC de risco em mulheres com e sem excesso de peso, apresentando-se o valor p correspondente ao teste de Wald para heterogeneidade ou tendencia linear. Das 14.101 mulheres estudadas, 45,8% apresentaram excesso de peso e 55,5% CC de risco. Em relacao a associacao entre IMC e CC, constatou-se que 23,5% das mulheres sem excesso de peso apresentavam CC de risco. Apos analise estratificada pelo IMC, a prevalencia de CC de risco entre as mulheres sem excesso de peso foi maior nas regioes Nordeste, 26,0%, e Sudeste, 24,5%, e menor na regiao Sul, 18,5%. Conclui-se que as medidas antropometricas IMC e CC devem ser empregadas concomitantemente, uma vez que a utilizacao isolada dessas medidas pode desprezar individuos com risco para varias patologias.The scope of this study was to evaluate the association between waist circumference (WC) and body mass index (BMI) of Brazilian women of childbearing age studied in the most recent National Demographic and Health Survey (NDHS), in 2006. This study is an excerpt of the NDHS, which is a home-based cross-sectional study. The nutritional status of women was assessed by WC and BMI, considering excess weight to be BMI = 25 Kg/m2 and WC risk to be = 80 cm. To evaluate the statistical significance, Poisson Regression was applied to identify factors associated with WC risk in women with or without excess weight, presenting the p-value corresponding to the Wald test for heterogeneity or linear trend. Of the 14,101 women studied, 45.8% were overweight and 55.5% at WC risk. Regarding the association between BMI and WC, it was found that 23.5% of women who were not overweight showed WC risk. After a stratified analysis by BMI, the prevalence of WC risk among women without excess weight was greatest in the Northeast, 26.0%, and the Southeast, 24.5%, while the South region presented the lowest prevalence at 18.5%. It follows that the anthropometric WC and BMI measures should be used concomitantly since the use of only one of these measures may overlook individuals at risk for various diseases.

Validity assessment of the nutrition screening initiative checklist in older adults

OBJECTIVE To ascertain whether the NSI (Nutrition Screening Initiative Checklist) is a valid screening instrument for diagnosing nutritional risk in an older population from a medium-size city in the south of Brazil. METHODS The study population comprised individuals aged 60 years or older selected from a population-based cross-sectional survey. Data collection was carried out at two different timepoints: first, the NSI (instrument under test) was applied and later a dietary recall (gold standard) based on the previous day. Validity analyses were performed based on sensitivity and specificity as well as the Receiver Operating Characteristic Curve. RESULTS A total of 183 older adults were studied. Agreement between the dietary recall and the NSI for positive and negative results was 54.6%.The sensitivity and specificity values were low for all cut-off points of the instrument. The area under the curve was 0.52 (95%CI: 0.44-0.62) for the cut-off point ≥6. CONCLUSION Based on sensitivity and specificity values, the NSI proved ineffective for application in the population studied.

Tornar-se obeso na adolescência pode trazer consequências à saúde mental?

O estudo avaliou a associacao entre trajetoria de obesidade e dificuldades emocionais e comportamentais em adolescentes. Foram estudados 4.325 jovens, aos 11 e 15 anos de idade, pertencentes a coorte de nascimentos de 1993 de Pelo-tas, Rio Grande do Sul, Brasil. Informacoes sobre indice de massa corporal (IMC), avaliacao materna da saude emocional e comportamental do adolescente (Strengths and Difficulties Questionnaire - SDQ) e caracteristicas sociodemograficas e comportamentais foram utilizadas. As analises, estratificadas por sexo, foram conduzidas por meio de regressao linear simples e multipla. A trajetoria de obesidade mostrou associacao com o escore total do SDQ, nas analises ajustadas, apenas entre os meninos. Entre esses, tornar-se obeso no periodo esteve relacionado com maior escore na subescala de problemas de relacionamento com os colegas. Diante do conhecimento atual sobre as implicacoes futuras da obesidade na saude mental e em se tratando de adolescentes, sugere-se que estudos que avaliem as diferencas de genero na adolescencia possam contribuir para o entendimento da associacao encontrada.

Is the number of siblings associated with dietary patterns in adolescents? The 1993 birth cohort of Pelotas (Brazil)

Our study aimed to estimate the association between number of siblings and dietary patterns in adolescents. Prospective longitudinal study was developed using data from the birth cohort of the city of Pelotas, Brazil, which included 5249 participants. At the 18-year-old follow-up, from 4563 individuals located, 4106 were interviewed (follow-up rate 81.3%). Of these, 3751 were included in our principal component analysis of dietary patterns. Regular dietary intake of 45 food groups over the previous year was measured with a food frequency questionnaire. We identified four patterns, which accounted for 40% of the total variance in food group consumption. These were labeled “Protein and fast food”, “Fruit and vegetables”, “Common Brazilian”, and “Sweets, soft drinks, and dairy products”. Crude and adjusted analyses of the association between number of siblings and dietary patterns were performed using linear regression. The number of siblings was positively associated with a higher adherence to each dietary pattern, with the exception of the “Common Brazilian” patterns, for which there was no apparent relationship with number of siblings. The findings showed that a greater number of siblings is related to a more diverse diet in the later adolescence, which may predict better nutrient adequacy and health outcomes.

Association between waist circumference and body mass index of Brazilian women: NDHS 2006

O objetivo do estudo foi analisar a associacao entre a circunferencia da cintura (CC) e o indice de massa corporal (IMC) de mulheres brasileiras em idade fertil, estudadas na ultima Pesquisa Nacional de Demografia e Saude (PNDS), no ano de 2006. Este estudo e um recorte da PNDS, a qual e um estudo seccional, de base domiciliar. O estado nutricional foi avaliado atraves do IMC e da CC, considerando-se excesso de peso IMC > 25 Kg/m2e CC de risco > 80 cm. Para a avaliacao da significância estatistica foi usada Regressao de Poisson, que identificou os fatores associados a CC de risco em mulheres com e sem excesso de peso, apresentando-se o valor p correspondente ao teste de Wald para heterogeneidade ou tendencia linear. Das 14.101 mulheres estudadas, 45,8% apresentaram excesso de peso e 55,5% CC de risco. Em relacao a associacao entre IMC e CC, constatou-se que 23,5% das mulheres sem excesso de peso apresentavam CC de risco. Apos analise estratificada pelo IMC, a prevalencia de CC de risco entre as mulheres sem excesso de peso foi maior nas regioes Nordeste, 26,0%, e Sudeste, 24,5%, e menor na regiao Sul, 18,5%. Conclui-se que as medidas antropometricas IMC e CC devem ser empregadas concomitantemente, uma vez que a utilizacao isolada dessas medidas pode desprezar individuos com risco para varias patologias.The scope of this study was to evaluate the association between waist circumference (WC) and body mass index (BMI) of Brazilian women of childbearing age studied in the most recent National Demographic and Health Survey (NDHS), in 2006. This study is an excerpt of the NDHS, which is a home-based cross-sectional study. The nutritional status of women was assessed by WC and BMI, considering excess weight to be BMI = 25 Kg/m2 and WC risk to be = 80 cm. To evaluate the statistical significance, Poisson Regression was applied to identify factors associated with WC risk in women with or without excess weight, presenting the p-value corresponding to the Wald test for heterogeneity or linear trend. Of the 14,101 women studied, 45.8% were overweight and 55.5% at WC risk. Regarding the association between BMI and WC, it was found that 23.5% of women who were not overweight showed WC risk. After a stratified analysis by BMI, the prevalence of WC risk among women without excess weight was greatest in the Northeast, 26.0%, and the Southeast, 24.5%, while the South region presented the lowest prevalence at 18.5%. It follows that the anthropometric WC and BMI measures should be used concomitantly since the use of only one of these measures may overlook individuals at risk for various diseases.