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The association between dairy products consumption in adults and the likelihood of type 2 diabetes mellitus (T2DM) has been described, but more information on the adolescent population is needed. This nationally representative, cross-sectional school-based study aimed to describe the consumption of dairy products and their subtypes and to evaluate their association with prediabetes and T2DM in adolescents. The Study of Cardiovascular Risks in Adolescents (ERICA) includes adolescents aged 12–17 years. Dairy products consumption was evaluated by 24-h food recall. Associations with fasting glucose, glycated hemoglobin (HbA1c) and insulin resistance, as measured by homeostatic model assessment-insulin resistance (HOMA-IR), were evaluated by multivariate linear regression. Poisson regression was also used to assess the association between dairy products consumption and the combined prevalence of prediabetes and T2DM. Models were adjusted for sociodemographic, nutritional, behavioural and anthropometrics. The final sample analysed consisted of 35 614 adolescents. Total intake of dairy products was inversely associated with fasting blood glucose levels after adjusting for all covariates (β = −0·452, 95 % CI −0·899, −0·005). The associations were stronger for overweight and obese adolescents. Findings were similar for full-fat dairy products and yogurt. Higher consumption of low-fat dairy products and cheese were associated with a 46 % (prevalence ratio, PR 1·46, 95 % CI 1·18, 1·80) and 33 % (PR 1·33, 95 % CI 1·14, 1·57) higher combined prevalence of prediabetes and T2DM, respectively. The total consumption of dairy products and full-fat dairy products was associated with a lower combined prevalence of prediabetes and T2DM, while the consumption of cheese and low-fat dairy products was associated with higher combined prevalence of prediabetes and T2DM in Brazilian adolescents. [ABSTRACT FROM AUTHOR]

Objective: Evaluate the association between breastfeeding, exclusive breastfeeding at six months and the introduction of complementary feeding during the pre-pandemic and the COVID-19 pandemic periods. Methods: Cohort study conducted with puerperal women and their newborns in the immediate postpartum period at a reference maternity hospital in Southern Brazil between 2018-2020. The COVID-19 pandemic period and the need to work outside the home during restricted circulation were the factors of exposure. The outcome evaluated was the weaning in the first six months (breastfeeding and exclusive breastfeeding) and the introduction of complementary feeding before the sixth month of life. Results: 547 puerperal women and their newborns were included. During the COVID-19 pandemic, there was a higher risk to weaning of exclusive breastfeeding up until six months (RR 1.16; 95%CI 1.03-1.31) and introducing complementary feeding early (RR 1.40; 95%CI 1.01-1.96). The need to work outside the home during the COVID-19 pandemic increased the risk of not breastfeeding exclusively at the sixth month (RR 1.27; 95%CI 1.08-1.49). Conclusions: The difficulties of the pandemic did reflect negatively on breastfeeding and complementary feeding practices. The pandemic was a risk factor for the early weaning of exclusive breastfeeding and the introduction of complementary feeding. However, not having to work outside the home during the pandemic period was a protective factor for exclusive breastfeeding at six months. [ABSTRACT FROM AUTHOR]

This randomised clinical trial aimed to evaluate the effect of a pro-breast-feeding (BF) and healthy complementary feeding intervention performed during infants' first months of life on ultraprocessed food (UPF) consumption at 4–7 years. We enrolled 323 teenage mothers and their infants from South Brazil, 163 allocated to the intervention group and 160 to the control group. Intervention consisted of sessions on BF and healthy complementary feeding promotion and was carried out in the maternity ward and at home after delivery. Food consumption was assessed using three 24-h food recalls at child's age of 4–7 years. Foods were classified according to NOVA classification. Dietary contribution of UPF was adjusted for intra-individual variability by the SPADE method and categorised into tertiles. We used Poisson regression models with robust variance, adjusted for confounders, to estimate the effect of the intervention and duration of BF on the risk of high consumption of UPF. Our final analysis included 194 children, with mean age of 6·1 (sd 0·5) years. Mean dietary contribution of UPF was 38 % in the intervention group and 42·7 % in the control group, from total daily intakes. Results adjusted for BF duration, propensity score, income and total energy content demonstrated that the intervention reduced the risk of high consumption of UPF by 35 % (relative risk 0·65, 95 % CI 0·43, 0·98). BF duration was not associated with UPF consumption. The intervention was effective in reducing the risk of high UPF consumption at the age of 4–7 years. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to assess the dietary patterns of adolescents using a food-based diet quality index and their compliance with a healthy dietary guideline Methods: Participants included 71,553 Brazilian adolescents (12–17 years old) from the Study of Cardiovascular Risks in Adolescents (ERICA), a cross-sectional school-based multicenter study.. Dietary intake was measured by one 24-h recall. A second recall was collected in a random subsample (~ 10%) to correct within-person variability. The Diet Quality Index for Adolescents adapted for Brazilians (DQIA-BR) was used to measure the overall quality of the dietary intake. The National Cancer Institute method was applied to estimate usual dietary intake. The DQIA-BR and the distribution of its components (quality, diversity, and equilibrium) were analyzed according to sex, geographical area, and type of school Results: The mean (SD) DQIA-BR scores were 14.8% (6.1%) for females and 19.0% (6.3%) for males. All analyzed strata revealed low scores of DQIA-BR and its components. The median usual intake was five to sevenfold below the recommendations for vegetables and fruits and approximately twofold below the recommendations for dairy. The highest DQIA-BR mean scores were found in the northern region [17.0% (6.4%), females; 20.7% (6.3%), males]. Adolescents in both types of schools had relatively similar median intakes of snacks (~ 85 g) and sugared drinks (~ 600 ml) Conclusions: The overall diet quality of Brazilian adolescents is inadequate based on evaluated parameters in all regions and socioeconomic backgrounds. [ABSTRACT FROM AUTHOR]

Background: Gestational diabetes mellitus (GDM), a hyperglycemic state detected during pregnancy, is an established risk factor for diabetes. However, treatment during pregnancy in and of itself is not able to eliminate this risk, and a considerable fraction of women with GDM will develop frank diabetes in the decade following pregnancy. Our aim is to conduct a multicenter randomized controlled trial to investigate the effectiveness of a lifestyle intervention program implemented after a pregnancy complicated by GDM in delaying or preventing the development of type 2 diabetes.Methods: Women aged 18 or older identified as having recent GDM are recruited and followed by telephone to assess eligibility for the trial. To be eligible, women must have used insulin during pregnancy or present intermediate hyperglycemia postpartum. Women are encouraged to enter the trial as early as 10 weeks, and are permitted to do so up to 2 years after a pregnancy with GDM. An estimated 740 women will be randomized to either conventional care or to coach-based interventions focused on breastfeeding, weight loss, healthy eating, and increased physical activity, and predominantly delivered by telephone. Women are followed annually to detect new onset diabetes, the primary outcome, and additional secondary outcomes which include reversion to normoglycemia, weight loss, physical activity and fitness, and insulin resistance.Discussion: Though previous studies have demonstrated that type 2 diabetes can be delayed or prevented, no study has yet demonstrated the feasibility and effectiveness of similar interventions implemented in the postpartum period for women with recent GDM. If shown to be successful, this approach could become an important means of preventing diabetes in primary care settings.Trial Registration: ClinicalTrials.gov Identifier: NCT02327286; Registered 23 December 2014. [ABSTRACT FROM AUTHOR]

Background: Growing evidence suggests that dairy products may have beneficial cardiometabolic effects. The current guidelines, however, limit the intake of full-fat dairy products.Objective: We investigated the association of dairy consumption, types of dairy products, and dairy fat content with metabolic syndrome (MetSyn).Methods: We analyzed baseline data of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a multicenter cohort study of 15,105 adults aged 35-74 y. We excluded participants with known diabetes, cardiovascular diseases, or other chronic diseases, and those who had extreme values of energy intake, leaving 9835 for analysis. Dairy consumption was assessed by a food-frequency questionnaire. We computed servings per day for total and subgroups of dairy intake. We computed a metabolic risk score (MetScore) as the mean z score of waist circumference, systolic blood pressure, HDL cholesterol (negative z score), fasting triglycerides, and fasting glucose. We performed multivariable linear regression to test the association of servings per day of dairy products with MetScore.Results: In analyses that adjusted for demographics, menopausal status, family history of diabetes, dietary intake, nondietary lifestyle factors, and body mass index, we observed a graded inverse association for MetScore with total dairy (-0.044 ± 0.01, P = 0.009 for each additional dairy servings per day) and full-fat dairy (-0.126 ± 0.03, P < 0.001) but not with low-fat dairy intake. Associations were no longer present after additional adjustments for dairy-derived saturated fatty acids.Conclusions: Total and especially full-fat dairy food intakes are inversely and independently associated with metabolic syndrome in middle-aged and older adults, associations that seem to be mediated by dairy saturated fatty acids. Dietary recommendations to avoid full-fat dairy intake are not supported by our findings. [ABSTRACT FROM AUTHOR]

Background: Inverse associations between dairy intake and the risk of type 2 diabetes have been shown, but more studies are needed, especially from low- and middle-income countries. Objective: The objective was to describe the association between dairy products and direct measures of glycemic status in adults without known diabetes. Design: The Brazilian Longitudinal Study of Adult Health (ELSABrasil) includes 15,105 adults, aged 35-74 y, enrolled from universities and research institutions in 6 Brazilian capital cities. We excluded participants with a known diabetes diagnosis, cardiovascular diseases, and cancer. Dairy consumption was assessed by a food-frequency questionnaire, and we computed servings per day for total and subgroups of dairy. Associations with fasting blood glucose (FG) and fasting insulin, 2-h postload glucose (PG), 2-h postload insulin (PI), glycated hemoglobin (Hb A1c), and homeostasis model assessment of insulin resistance (HOMA-IR) were assessed through multivariable linear regression analysis with adjustment for demographic characteristics, behavioral risk factors, other dietary factors, and anthropometric measurements. Results: The sample size after exclusions was 10,010. The intake of total dairy was inversely associated with FG (linear b for dairy servings/d = -0.46 ± 0.2 mg/dL), PG (-1.25 ± 0.5 mg/dL), PI (-1.52 ± 0.6 mg/dL), Hb A1c (-0.02 ± 0.0%), and HOMA-IR (-0.04 ± 0.0) after adjustment for all covariates (P < 0.05 for all). The findings were consistent across categories of sex, race, obesity status, and dairy fat amount (reduced-fat vs. full-fat dairy). Fermented dairy products showed particularly strong inverse associations with the outcomes, with adjusted differences for a 1-serving/ d increment of -0.24 (95% CI: -0.46, -0.02) mg/dL for FG, -0.86 (-1.42, -0.30) mg/dL for PG, and -0.01% (-0.02%, 0.00%) for Hb A1c. Myristic acid was the only nutrient that appeared to mediate the association between dairy intake and glycemia. Conclusion: Dairy intake, especially fermented dairy, was inversely associated with measures of glycemia and insulinemia in Brazilian adults without diagnosed diabetes. This trial was registered at clinicaltrials.com as NCT02320461. Am J Clin Nutr 2015;101:775-82. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background Breastfeeding seems to be inversely related to postpartum weight retention (PPWR), but this relationship is unclear in women with GDM. We aimed to describe the association between breastfeeding and PPWR at 1 year postpartum in women with GDM. Methods Multicentre cohort study of 524 women with GDM enrolled in prenatal clinics of the Brazilian National Health System and followed by telephone up to one year postpartum. Socio-demographics and pre-gestational weight were obtained during recruitment. Breastfeeding and post-partum maternal weight through telephone calls. PPWR was defined as 1-year postpartum weight minus pre-pregnancy weight and categorized as above and below the 80th sample percentile of retention. Breastfeeding was categorized as duration greater or less than 6 months. Adjusted Poisson regression was performed to assess relative risks (RR). Results Most women were 30 to 39 years old (50.6%), multiparous (71.0%), 39.5% completed high school, 60.1% were non-white (60.1%). Mean pre-gestational BMI was 30.42 (± 6.7) kg/m² and the mean weight gain during pregnancy was 9.5 (± 7.1) kg. After adjustments for previous variables, breastfeeding for 6 months or more reduced by 35% (RR 0.65; 95% CI 0.47; 0.90, p < 0.01) the incidence of 1-year PPWR up to 80th percentile (≥7Kg) compared to breastfeeding less than 6 months. Conclusions Breastfeeding up to 6 months might be encouraged in women with GDM to help preventing higher levels of 1-year PPWR. Key messages Breastfeeding up to 6 months was associated with less PPWR at 1 year after delivery in women with GDM. [ABSTRACT FROM AUTHOR]

Objectives: to evaluate and identify the prevalence of interruption of breastfeeding (BF) in the period of up to 45 days postpartum and the associated sociodemographic and obstetric factors.. Methods: cohort of 622 puerperal women, selected between 2018 and 2019 in a reference maternity hospital in the South Brazil. Data collection was carried out in two phases, the first in the maternity hospital during hospitalization of the puerperal woman and the newborn and the second through a telephone call, which occurred 60 days after birth. Poisson regressions with robust variance were performed to identify the factors associated with interruption of BF in the first 45 days of life. The variables that presented p<0.20 in the crude analysis were included in the adjusted analysis.. Results: the interruption of BF at 45 days was identified in 14% of the sample. Higher maternal age (PR= 0.46; CI95%= 0.22-0.93), eight years or less of education (PR= 2.11; CI95%= 1.05-4.25), support from the maternal grandmother (PR= 1.91; CI95%= 1.20-3.06) and receiving complement at the maternity hospital (PR= 1.53; CI95%= 1.04-2.25) were factors related to the interruption of BF in the 45-day postpartum period. Conclusion: maternal age =35 was a protective factor, and less education, the support of the maternal grandmother and receiving complement at the maternity hospital were predictors of early breastfeeding abandonment. [ABSTRACT FROM AUTHOR]

To assess whether using a Dietary Approaches to Stop Hypertension (DASH) diet recommendation application increases primary care physicians' knowledge and dietary counseling skills. A randomized controlled trial. Brazilian public primary care service. Two hundred and twenty-two physicians (intervention group: n = 111; control group: n = 111). Thirty days of using the Dieta Dash application. The application provides information about nutritional recommendations for hypertension management. Nutrition knowledge score. Secondary outcomes: self-assessment of knowledge, self-confidence, assessment of eating habits, and barriers to dietary counseling. Linear mixed-effects models for repeated measures and generalized estimating equations for comparing changes between groups. A total of 66.2% of participants completed the follow-up. There was no significant difference between the groups regarding the mean knowledge score (P = 0.15). The prevalence of high knowledge increased by 12% (prevalence ratio [PR] = 1.12; 95% confidence interval [CI], 1.00–1.25) in the intervention group and showed an improvement in the self-confidence assessment (PR = 1.21; 95% CI, 1.02–1.44), and increased assessment of eating habits (PR = 1.26; 95% CI, 1.10–1.55). The Dieta Dash application helped address dietary counseling, improving knowledge and self-confidence. However, innovative strategies are needed to minimize the primary care barriers. [ABSTRACT FROM AUTHOR]

Background: The Life's Essential 8 (LE8) is an official cardiovascular health (CVH) assessment tool, however, its use remains limited within the adolescent population. We aim to describe the prevalence of CVH in Brazilian adolescents using the LE8 framework and to analyze its distribution considering sociodemographic factors., Methods: The sample comprised 36,956 adolescents aged 12 to 17 years, who participated in the Study of Cardiovascular Risks in Adolescents, a nationwide, cross-sectional, school-based study. CVH was assessed by the LE8 score (0-100 points), comprising eight metrics categorized into two domains: health behaviors (diet, physical activity, nicotine exposure, and sleep) and health factors (body mass index, non-HDL cholesterol, blood glucose, and blood pressure). Sociodemographic factors were sex, age, type of school, skin color, and region of residence. The results were expressed as means with 95 % confidence intervals (95 % CI)., Results: The overall average score was 75.8 points (95 % CI: 75.3-76.3), classified as moderate CVH. The general score was higher among males (76.8; 95 % CI: 76.6-77.7) and younger adolescents (12-14 years old) (78.5; 95 % CI: 77.7-79.4). The health factors had a higher mean than behavioral factors (87.6, 95 % CI: 87.3-87.9 vs. 64.0, 95 % CI: 63.3-64.7). The best score was blood glucose (94.7; 95 % CI: 94.2-95.2), while the diet score was the lowest (48.5; 95 % CI: 46.3-50.6)., Conclusion: The CVH of Brazilian adolescents is classified as moderate and varied according to sociodemographic characteristics. Intervention actions should prioritize behavioral factors to improve the LE8 score and consequently prevent cardiovascular events in adulthood., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objectives: To evaluate the effectiveness of a nutrition counseling intervention on food consumption according to the Nova classification that reflects levels of food processing., Methods: Controlled community trial was conducted in quilombola communities in the South of Brazil. Four communities were allocated to the control group (CG) and the intervention group (IG), two communities comprised each group. A total of 158 individuals (CG = 87; IG = 68) were included in the study. The intervention consisted of six theoretical and practical workshops on food and nutrition education, conducted over a 4-month period. We used a 24-hour recall at baseline and another post-intervention., Results: There was an increase in the consumption of traditional quilombola food as an effect of the intervention (from 14.5% to 20.7% in the IG, and from 12.7% to 16.0% in the CG, p = 0.05). There was no significant variation in the other Nova food groups according to time and intervention., Conclusion: An increase in traditional quilombola food indicates a resumption of traditional food intake and appreciation of local culture as an effect of this intervention at the community level. Clinical Trial Registration: www.clinicaltrials.gov, identifier NCT02489149., Competing Interests: The authors declare that they do not have any conflicts of interest., (Copyright © 2024 Pacheco, Bairros, Neutzling, Nunes, Knauth, dos Santos and Drehmer.)

Background/objectives: Vitamin and/or mineral supplements are designed to correct micronutrient deficiencies or maintain adequate intake. However, evidence suggests the indiscriminate use of these products, particularly among populations that already meet their micronutrient requirements through diet. This study aims to estimate the prevalence of vitamin and/or mineral supplement use and assess the dietary intake of micronutrients among users and non-users in the Brazilian adult and elderly populations., Methods: The prevalence of vitamin and/or mineral supplement use was estimated from a sample of 37,364 individuals who participated in the Brazilian National Food Survey, a module of the 2017-2018 Household Budget Survey. The average dietary intake of micronutrients-including calcium, magnesium, phosphorus, iron, copper, zinc, vitamin A, thiamine, riboflavin, niacin, cobalamin, pyridoxine, vitamin D, vitamin E, vitamin C, and folate-was calculated for both users and non-users of these supplements, based on 24 h dietary recalls collected during the survey. Analyses of dietary intake were stratified by sex and age group., Results: The estimated overall prevalence of supplement use was 16.0% (95% CI: 15.4-16.6), with a higher prevalence among women (19.5% [95% CI: 18.7-20.5]) and the elderly (27.9% [95% CI: 26.4-29.4]). Women who used vitamin and/or mineral supplements showed higher average intakes for a greater number of dietary micronutrients compared to non-users., Conclusions: The findings from the analysis of average micronutrient intake from food sources, particularly among women and elderly women who used supplements, support the paradox of the "inverse supplement hypothesis", which suggests that individuals who use dietary supplements are often those with the least need for them.

Objectives: To evaluate a postpartum telephone-based lifestyle intervention to prevent diabetes in high-risk women with recent gestational diabetes mellitus (GDM)., Design: Multicentre parallel randomised clinical trial., Setting: Specialised antenatal clinics in the Brazilian National System., Methods: Lifestyle Intervention for Diabetes Prevention After Pregnancy compared (1:1) postpartum telephone support for lifestyle changes with conventional care in women with recent GDM at substantial risk for diabetes. Randomisation started on 28 March 2015 and ended on 13 March 2020, with the onset of the COVID-19 pandemic. We used Cox regression to estimate HRs for diabetes and analysis of covariance adjusted for follow-up time to assess weight change., Outcomes: The primary outcome was incident diabetes ascertained with blinded measurements of oral glucose tolerance tests. The secondary outcome was a change in measured weight., Results: We enrolled 5323 women with GDM, 2735 (51%) being at high risk. After invitations, baseline assessment and exclusions, we assigned 466 women to intervention (231) or control (235) groups. Attendance was satisfactory (≥7/20 phone sessions) in 75%. Over an average follow-up of 29.7 (15.6) months, 142 (30.5%) women progressed to diabetes, 75 (32%) in the control and 67 (29%) in the intervention group. There was no reduction in the incidence of diabetes (HR=0.84; 0.60-1.19) and only a non-significant 0.97 kg less weight gain (p=0.09). Among the 305 women randomised more than 1 year before the COVID-19 pandemic, the intervention did not reduce the incidence of diabetes (HR=0.71; 0.48-1.04) despite a 2.09 kg (p=0.002) lesser weight gain., Conclusion: The strategy to identify women with GDM at high risk proved valid, as women often gained weight and frequently developed diabetes. Over a 30-month follow-up, telephone support for lifestyle changes at postpartum did not reduce weight gain or diabetes incidence, although only 75% attended the minimum number of telephone sessions. The COVID-19 pandemic negatively impacted trial conduction., Trial Registration Number: NCT02327286., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

We verified the prevalence of adequacy in prenatal care considering nutritional assistance and associated factors. It is a cross-sectional study, part of Maternar Cohort Study, conducted between 2018-2019 in Southern Brazil. Women were interviewed during hospitalization in the immediate postpartum period and data were collected from the prenatal chart. Prenatal adequacy and nutritional care were assessed according to criteria from the Brazilian Ministry of Health. Two outcome models were constructed. Outcome 1 consisted of minimal coverage (early prenatal start and minimum number of visits) and exams, and Outcome 2 comprised minimal coverage, exams, and nutritional assistance. Poisson regression was used to estimate prevalence ratios. A total of 802 women were analyzed, and we identified 57% of adequacy of Outcome 1. Unplanned pregnancy (PR = 0.76; 95%CI: 0.68-0.86), parity (PR = 0.88; 95%CI: 0.83-0.94) and prenatal care outside Porto Alegre, Rio Grande do Sul State (PR = 0.80; 95%CI: 0.69-0.92), were associated with lower prenatal adequacy frequencies. Outcome 2 was considered adequate for 10.2% of women. Follow-up by different professionals during prenatal care was associated with lower adequacy (PR = 0.49; 95%CI: 0.28-0.86). Women with high-risk pregnancies had a higher frequency of adequacy in Outcome 1 (PR = 1.21; 95%CI: 1.07-1.37) and in Outcome 2 (PR = 1.75; 95%CI: 1.16-2.64). General adequacy was considered low in both outcomes. There was a lack of nutritional assistance during prenatal care. Characteristics such as pregnancy planning, lower parity, prenatal care in Porto Alegre, follow-up by the same professional and high-risk pregnancy were predictors for the adequacy of prenatal care.

Objective: This study aimed to evaluate gestational weight gain and birth weight in women with gestational diabetes mellitus of two Brazilian cohorts enrolled three decades apart., Methods: The authors compared data of 2362 women from the Lifestyle INtervention for Diabetes Prevention After Pregnancy study (LINDA-Brasil, 2014-2017) to those of 359 women from the Estudo Brasileiro de Diabetes Gestacional study (EBDG, 1991-1995). Gestational weight gain was classified by the 2009 Institute of Medicine criteria; large and small for gestational age newborns, by the Intergrowth-21 st chart. Differences in birth weight means between pregestational BMI and gestational weight gain categories were evaluated by ANOVA; the associations of gestational weight gain and birth weight, through multivariable Poisson regression., Results: In LINDA-Brasil, women presented higher pregestational body mass index (30.3±6.5 vs. 24.6±4.4kg/m 2 ) and were frequently obese (46.4 vs. 11.1%) compared to those of the EBDG. In the EBDG, gestational weight gain was larger (11.3±6.1 vs. 9.2±7.6kg) and rates of small for gestational age higher (7.5 vs. 4.5%) compared to LINDA-Brasil. In LINDA-Brasil, excessive gestational weight gain was associated to macrosomia (adjusted relative risk [aRR]: 1.59, 95% CI 1.08-2.35) and large for gestational age (aRR: 1.40; 95% CI 1.05-1.86); less gain increased the risk of low birth weight (aRR: 1.66; 95% CI 1.05-2.62) and small for gestational age (aRR: 1.79; 95% CI 1.03-3.11). These associations were similar in the EBDG, although not statistically significant., Conclusions: Improvements in gestational weight gain and rates of small for gestational age occurred over time in gestational diabetes mellitus pregnancies, accompanied by a worsening in maternal weight profile. This highlights the nutritional transition during this period and the importance of avoiding excessive gestational weight gain as well as promoting adequate weight before conception., (Copyright © 2020 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.)

Background: Hypertension remains widely undetected, undertreated, and poorly controlled. Appropriate dietary changes can prevent and treat hypertension effectively. Primary care physicians (PCPs) have the opportunity to counsel patients about their diets and are able to facilitate long-term adherence to changes. However, they encounter several barriers to delivery of evidence-based counseling in daily medical practice. m-Health can make important contributions. Objective: To describe the development and assessment of a Brazilian mobile app for nutritional management of hypertension supported by evidence-based. Materials and Methods: App development used a user-centered approach that seeks to solve problems in a collective and collaborative way. The app was developed in Apache Cordova ® (Adobe Systems, San Jose, CA) for iOS and Android mobile phone platforms. Beta testing was performed with a sample of Brazilian PCPs ( n  = 62), who were asked to use the app in routine practice and evaluate it. Results: The process involved researchers, government, PCPs, nutritionists, and designers. Dieta Dash ® (Universidade Federal do Rio Grande do Sul-UFRGS, Porto Alegre, Brazil) app was divided into following sections: meal evaluation, Healthy meals, Healthy choices, and a database of Healthy recipes. The mean perceived usefulness and ease-of-use scores were 23.3 and 32.3 out of 42, respectively. Conclusions: It is a great source of up-to-date and summary guidelines, usable, acceptable, and positively impact clinical care. PCPs have identified improvements that could make the user experience better. The Dieta Dash app can be incorporated into Brazilian primary care practice.

Background: Breastfeeding offers benefits to mother and child but is frequently not practiced among women whose pregnancy is complicated by gestational diabetes mellitus. Factors associated with not initiating or not maintaining breastfeeding among these women have been little investigated., Research Aims: (1) To evaluate the frequency of breastfeeding for 30 days among women with a recent pregnancy complicated by gestational diabetes and (2) to determine factors associated with not initiating or not maintaining breastfeeding., Methods: Between January 2014 and July 2017 we enrolled women with gestational diabetes at high-risk prenatal services in three Brazilian cities. We collected baseline sociodemographic and health data and followed up with participants by telephone. Using Kaplan-Meier curves, we calculated the proportions of participants not initiating breastfeeding or not maintaining it for at least 30 days. We used Poisson regression with robust variance to identify factors related to this outcome., Results: Of the 2328 participants with complete information, 2236 (96.1%) initiated breastfeeding, and 2166 (93.1%) maintained breastfeeding for 30 days. Not having breastfed the previous infant (relative risk [RR] = 5.02, 95% CI [3.39, 7.45]), smoking during pregnancy (RR = 2.37, 95% CI [1.48, 3.80]), infant with health problems (RR = 2.25, 95% CI [1.27, 3.99]), early preterm birth (RR = 2.49, 95% CI [1.07, 5.77]), and not intending to breastfeed (RR = 3.73, 95% CI [1.89, 7.33]) were related to not maintaining breastfeeding for at least 30 days., Conclusions: Breastfeeding initiation was nearly universal among participants, and most maintained breastfeeding for 30 days. Factors relating to not breastfeeding at 30 days were easily identifiable.

Objective: To investigate the association between weekly weight gain, during the second and third trimesters, classified according to the 2009 Institute of Medicine (IOM/NRC) recommendations, and maternal and fetal outcomes., Methods: Gestational weight gain was evaluated in 2,244 pregnant women of the Brazilian Study of Gestational Diabetes (Estudo Brasileiro do Diabetes Gestacional--EBDG). Outcomes were cesarean delivery, preterm birth and small or large for gestational age birth (SGA, LGA). Associations between inadequate weight gain and outcomes were estimated using robust Poisson regression adjusting for pre-pregnancy body mass index, trimester-specific weight gain, age, height, skin color, parity, education, smoking, alcohol consumption, gestational diabetes and hypertensive disorders in pregnancy., Results: In fully adjusted models, in the second trimester, insufficient weight gain was associated with SGA (relative risk [RR] 1.72, 95% confidence interval [CI] 1.26-2.33), and excessive weight gain with LGA (RR 1.64, 95% CI 1.16-2.31); in third trimester, excessive weight gain with preterm birth (RR 1.70, 95% CI 1.08-2.70) and cesarean delivery (RR 1.21, 95% CI 1.03-1.44). Women with less than recommended gestational weight gain in the 2nd trimester had a lesser risk of cesarean deliveries (RR 0.82, 95% CI 0.71-0.96) than women with adequate gestational weight gain in this trimester., Conclusion: Though insufficient weight gain in the 3rd trimester was not associated with adverse outcomes, other deviations from recommended weight gain during second and third trimester were associated with adverse pregnancy outcomes. These findings support, in part, the 2009 IOM/NRC recommendations for nutritional monitoring during pregnancy.

Aim: To estimate the prevalence of violence, depressive symptoms, and associated factors during pregnancy in women attending antenatal care in Brazil., Methods: Violence was assessed using a modified version of the abuse assessment screen (ASS), and depressive symptoms were evaluated using the primary care evaluation of mental disorders (PRIME-MD). Participants were pregnant women attending 18 primary care units in Rio Grande do Sul, Brazil, between June 2006 and April 2007. A total of 712 pregnant women participated, but only 627 of them responded the ASS., Results: Experience of any lifetime violence was reported by 273 (43.4%) women and 114 (18.2%) reported violence during the current pregnancy. One-third of them (n = 211) reported lifetime domestic violence and 100 (15.9%) women reported this type of violence during the current pregnancy. Experience of domestic violence during pregnancy was more common in unemployed women, among those with two or more children, with a higher consumption of alcohol, and who had not planned their current pregnancy. Of the total of sample (n = 712), 198 (27.8%) women reported six or more depressive symptoms. The presence of depressive symptoms during pregnancy was associated with low educational levels, living in a household with five or more people, and with higher consumption of alcohol during pregnancy., Conclusion: Pregnant women attending primary care are exposed to high rates of domestic violence, and many have clinically relevant depressive symptoms. Appropriate interventions to avoid or minimize the effects of violence and mental disorders to the well-being of the mothers and their babies are urgently required. Primary care services play an important role in identifying and supporting women at risk.

Background: Woman's 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 infant's health and development., Methods/design: This 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 infant's development and anthropometrics measurements., Discussion: This 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.

In order to describe adequacy of weight gain during pregnancy and its association with pre-pregnancy nutritional status and other factors, a cohort study of pregnant women enrolled at 16-36 weeks of gestation and followed up until delivery was carried out in prenatal care in primary care services in Rio Grande do Sul State, Brazil. Maternal weight was recorded at each prenatal care visit. Weight gain was classified as "adequate," "insufficient" or "excessive" (Institute of Medicine). Poisson regression was used to measure the associations. The sample was comprised of 667 women, and insufficient and excessive weight gain incidences were 25.8% and 44.8%, respectively. Overweight and obese before pregnancy had a significant increased risk of excessive weight gain in pregnancy (RR: 1.75; 95%CI: 1.48-2.07, RR: 1.55; 95%CI: 1.23-1.96, respectively). Women with fewer than six prenatal visits had a 52% increased risk for weight gain below recommended values. Although insufficient weight gain may still be a public health problem, excessive gain is becoming a concern that needs immediate attention in prenatal care.

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.