Rafael Marques Soares

Inappropriate Eating Behaviors During Pregnancy: Prevalence and Associated Factors among Pregnant Women Attending Primary Care in Southern Brazil

OBJECTIVE To examine the prevalence of inappropriate eating behaviors and associated factors among pregnant women in primary care. METHOD The Eating Disorder Examination Questionnaire was used to assess eating disorders and the Primary Care Evaluation of Mental Disorders was used to examine anxiety and depressive symptoms. Body mass index (BMI) and pregestational weight were also assessed. RESULTS Prevalence of binge eating during pregnancy was 17.3% [95% confidence interval (CI) 14.5-20.0], followed by excessive shape (5.6%; 95% CI 4-8) and weight concerns (5.5%; 95% CI 4-8). Binge eating during pregnancy was significantly associated with binge eating before pregnancy [prevalence ratio (PR) = 3.1; 95% CI 2.2-4.3], current anxiety symptoms (PR = 1.8; 95% CI 1.3-2.4), and prepregnancy BMI < 19.8 kg/m(2) (PR = 1.6; 95% CI 1.1-2.5). The prevalence of eating disorders was 0.6% (95% CI 0.01-1.11). DISCUSSION Eating disorder symptoms should be routinely assessed and treated during prenatal care, along with other comorbid psychiatric symptoms such as anxiety.

Nutrition, mental health and violence: from pregnancy to postpartum Cohort of women attending primary care units in Southern Brazil - ECCAGE study

BackgroundWomans nutritional status, before and during pregnancy, is a strong determinant of health outcomes in the mother and newborn. Gestational weight gain and postpartum weight retention increases risk of overweight or obesity in the future and they depend on the pregestational nutritional status and on food consumption and eating behavior during pregnancy. Eating behavior during pregnancy may be the cause or consequence of mood changes during pregnancy, especially depression, which increases likelihood of postpartum depression. In Brazil, a study carried out in the immediate postpartum period found that one in three women experienced some type of violence during pregnancy. Violence and depression are strongly associated and both exposures during pregnancy are associated with increased maternal stress and subsequent harm to the infant. The main objectives of this study are: to identify food intake and eating behaviors patterns; to estimate the prevalence of common mental disorders and the experience of violence during and after pregnancy; and to estimate the association between these exposures and infants health and development.Methods/DesignThis is a cohort study of 780 pregnant women receiving care in 18 primary care units in two cities in Southern Brazil. Pregnant women were first evaluated between the 16th and 36th week of pregnancy at a prenatal visit. Follow-up included immediate postpartum assessment and around the fifth month postpartum. Information was obtained on sociodemographic characteristics, living circumstances, food intake, eating behaviors, mental health and exposure to violence, and on infants development and anthropometrics measurements.DiscussionThis project will bring relevant information for a better understanding of the relationship between exposures during pregnancy and how they might affect child development, which can be useful for a better planning of health actions aiming to enhance available resources in primary health care.

Validação relativa de Questionário de Freqüência Alimentar em gestantes usuárias de serviços do Sistema Único de Saúde em dois municípios no Rio Grande do Sul, Brasil

OBJECTIVES: to evaluate a Food Frequency Questionnaire (FFQ) previously designed by Sichieri and Everhart to provide information about food consumption among pregnant women attended by the Brazilian National Health Service. To compare the mean daily intakes of energy and nutrients as assessed using a FFQ and dietary recalls. METHODS: the study took place in two cities: Bento Goncalves and Porto Alegre, State of Rio Grande do Sul, Brazil. During a first interview, the FFQ was administered to pregnant women, followed by two dietary recalls. In a second interview two further food recalls were obtained. The Bland-Altman analysis was used to assess the degree of agreement between the FFQ and dietary recalls. RESULTS: the FFQ produced higher energy and nutrient intakes. The correlation coefficient between nutrient intake measured using dietary recalls and using the questionnaire, after adjusting for energy intake, ranged from 0.1 (unsaturated fat) to 0.47 (calcium). The nutrients: fiber, Vitamin C, folate, calcium and potassium showed higher coefficients (above 0.4). Thirty percent of individuals were classified by the two dietary assessment methods into the same quartile. CONCLUSION: this FFQ is a useful tool for epidemiological studies among pregnant women; although efforts need to be made to improve its performance. More studies are necessary to identify sociocultural and behavioural factors that influence its validity.

Dietary fibre intake of pregnant women attending general practices in southern Brazil – The ECCAGE Study

BACKGROUND Increase in fibre intake during pregnancy may reduce weight gain, glucose intolerance, dyslipidaemia, pre-eclampsia and constipation. Few studies have evaluated adequacy of fibre intake during pregnancy. OBJECTIVE To assess, through an FFQ, the dietary fibre intake of pregnant women receiving prenatal care from general public practices and compare it with current guidelines. DESIGN AND SETTING Cross-sectional analyses of a pregnancy cohort study (ECCAGE-Study of Food Intake and Eating Behaviour in Pregnancy) conducted in eighteen general practices in southern Brazil, from June 2006 to April 2007. SUBJECTS Five hundred and seventy-eight pregnant women with mean (SD) age of 24.9 (6.5) years and mean gestational age of 24.5 (5.8) weeks. RESULTS The mean energy intake was 11 615 kJ/d (2776 kcal/d). The mean total fibre intake (30.2 g/d) was slightly above the recommended value of 28 g/d (P < 0.001), yet 50% (95% CI 46, 54) of the women failed to meet the recommendation. Whole-grain fibre constituted only 1% of total fibre intake in the cereal group. In adjusted Poisson regression analyses, not meeting the recommendation for fibre intake was associated with alcohol intake (prevalence ratio 1.29; 95% CI 1.11, 1.50) and absence of nutritional guidance (prevalence ratio 1.22; 95% CI 1.05, 1.42) during pregnancy. CONCLUSIONS About half of the pregnant women failed to meet the recommended fibre intake, especially those not reporting nutritional guidance during pregnancy. For most women, whole-grain cereal intake was absent or trivial. Taken together, our data indicate the need, at least in this setting, for greater nutritional education in prenatal care.

Padrones alimentarios en la gestación y su asociación con características sociodemográficas en mujeres atendidas en unidades básicas de salud en el sur de Brasil: estudio ECCAGe

A avaliacao do consumo alimentar e das condicoes sociodemograficas e crucial para o desenvolvimento de politicas publicas. Este estudo examinou os padroes alimentares em gestantes e sua associacao com caracteristicas sociodemograficas. Gestantes (n = 712) atendidas em unidades basicas de saude no sul do Brasil, responderam a um questionario sobre as caracteristicas sociodemograficas e a um outro de frequencia alimentar. Foram identificados tres padroes alimentares por analise de cluster. Utilizando-se o teste qui-quadrado com residuos ajustado verificou-se a associacao dos padroes alimentares com as variaveis sociodemograficas (p < 0,05). O padrao restrito foi associado com gestantes mais jovens, que nao moram com o companheiro e so estudam; o padrao variado com mulheres mais velhas que moram com o companheiro, trabalham e tem niveis de escolaridade e renda mais altos. Mulheres que nao trabalham nem estudam e possuem niveis de renda e escolaridade mais baixos estiveram associadas ao padrao comum-brasileiro, caracterizado por alimentos tradicionais da populacao brasileira.The assessment of the relationship between food intake and sociodemographic factors is crucial for developing effective public health policies. The present study aimed to examine dietary patterns in pregnant women and the association between these patterns and sociodemographic characteristics. Pregnant women attending general practices in southern Brazil (n = 712) answered a questionnaire and a food-frequency questionnaire with 88 items. Three dietary patterns were identified using cluster analysis. The association between the dietary patterns and sociodemographic variables was analyzed using the chi-square test and adjusted standardized residuals (p < 0,05). The restricted pattern was associated with lower maternal age, not living with a partner and being a non-working student. The varied pattern was associated with older maternal age, living with a partner, being employed and higher levels of education and income. The common-Brazilian dietary pattern included traditional Brazilian food items and was associated with lower levels of education and income, being unemployed and being a non-student.As campanhas de vacinacao antiinfluenza para idosos sao realizadas anualmente no mesmo periodo nos estados brasileiros. Objetivou-se avaliar obitos decorrentes de doencas respiratorias por influenza e causas associadas em idosos do Municipio de Aracaju, Sergipe, Brasil. Avaliaram-se dados do Sistema de Informacao de Vigilância Epidemiologica da Gripe (SIVEP_GRIPE), do Sistema de Informacoes Hospitalares (SIH), do Sistema de Informacoes sobre Mortalidade (SIM) e do Departamento de Informatica do SUS (DATASUS), no periodo de 1998 a 2007, alem de registros do Laboratorio Central de Sergipe (LACEN-SE) e dados pluviometricos do Instituto Nacional de Meteorologia (INMET). O ano de 2007 apresentou a maior taxa de mortalidade por influenza e causas associadas na populacao idosa no periodo avaliado. A faixa etaria de 70 anos ou mais apresentou a maior mortalidade (p < 0,0001). No periodo de 1998 a 2007, as taxas de mortalidade de doencas respiratorias por influenza e causas associadas, em Aracaju, foram elevadas em comparacao as dos Estados brasileiros, o que indica necessidade de reformulacao no calendario de vacinacao contra gripe nos idosos desse municipio.

Padrões alimentares na gestação e associação com características sociodemográficas em mulheres atendidas em unidades básicas de saúde no Sul do Brasil: Estudo ECCAGe

A avaliacao do consumo alimentar e das condicoes sociodemograficas e crucial para o desenvolvimento de politicas publicas. Este estudo examinou os padroes alimentares em gestantes e sua associacao com caracteristicas sociodemograficas. Gestantes (n = 712) atendidas em unidades basicas de saude no sul do Brasil, responderam a um questionario sobre as caracteristicas sociodemograficas e a um outro de frequencia alimentar. Foram identificados tres padroes alimentares por analise de cluster. Utilizando-se o teste qui-quadrado com residuos ajustado verificou-se a associacao dos padroes alimentares com as variaveis sociodemograficas (p < 0,05). O padrao restrito foi associado com gestantes mais jovens, que nao moram com o companheiro e so estudam; o padrao variado com mulheres mais velhas que moram com o companheiro, trabalham e tem niveis de escolaridade e renda mais altos. Mulheres que nao trabalham nem estudam e possuem niveis de renda e escolaridade mais baixos estiveram associadas ao padrao comum-brasileiro, caracterizado por alimentos tradicionais da populacao brasileira.The assessment of the relationship between food intake and sociodemographic factors is crucial for developing effective public health policies. The present study aimed to examine dietary patterns in pregnant women and the association between these patterns and sociodemographic characteristics. Pregnant women attending general practices in southern Brazil (n = 712) answered a questionnaire and a food-frequency questionnaire with 88 items. Three dietary patterns were identified using cluster analysis. The association between the dietary patterns and sociodemographic variables was analyzed using the chi-square test and adjusted standardized residuals (p < 0,05). The restricted pattern was associated with lower maternal age, not living with a partner and being a non-working student. The varied pattern was associated with older maternal age, living with a partner, being employed and higher levels of education and income. The common-Brazilian dietary pattern included traditional Brazilian food items and was associated with lower levels of education and income, being unemployed and being a non-student.As campanhas de vacinacao antiinfluenza para idosos sao realizadas anualmente no mesmo periodo nos estados brasileiros. Objetivou-se avaliar obitos decorrentes de doencas respiratorias por influenza e causas associadas em idosos do Municipio de Aracaju, Sergipe, Brasil. Avaliaram-se dados do Sistema de Informacao de Vigilância Epidemiologica da Gripe (SIVEP_GRIPE), do Sistema de Informacoes Hospitalares (SIH), do Sistema de Informacoes sobre Mortalidade (SIM) e do Departamento de Informatica do SUS (DATASUS), no periodo de 1998 a 2007, alem de registros do Laboratorio Central de Sergipe (LACEN-SE) e dados pluviometricos do Instituto Nacional de Meteorologia (INMET). O ano de 2007 apresentou a maior taxa de mortalidade por influenza e causas associadas na populacao idosa no periodo avaliado. A faixa etaria de 70 anos ou mais apresentou a maior mortalidade (p < 0,0001). No periodo de 1998 a 2007, as taxas de mortalidade de doencas respiratorias por influenza e causas associadas, em Aracaju, foram elevadas em comparacao as dos Estados brasileiros, o que indica necessidade de reformulacao no calendario de vacinacao contra gripe nos idosos desse municipio.