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Objective: Childbirth is a natural process, and according to the World Health Organization, oral intake is recommended for patients at usual risk. However, due to rare cases of pulmonary aspiration (known as Mendelson's syndrome) during general anesthesia and the limited evidence supporting its benefits, this practice remains controversial. This systematic review summarizes evidence on interventions that recommend oral intake during labor compared to fasting, focusing on labor duration and perinatal complications., Sources: A literature search across PubMed, EMBASE, Lilacs, and Scielo identified randomized clinical trials involving habitual-risk patients, nulliparous women receiving oral diet interventions during labor. The RoB 2.0 tool was used to assess bias., Summary of the Findings: Six studies (3,333 patients) were included, with three showing low risk of bias. Patients in the intervention group were allowed to eat, while the control group only had access to water, ice chips, and non-energy drinks. Food intake was found to correlate with significantly shorter labor duration in one study (P < 0.01), while no significant differences were observed in the others. No outcome variations (such as epidural anesthesia, lower Apgar scores, vomiting, or nausea) or cases of aspiration or Mendelson's syndrome were reported., Conclusions: Only one study found a significant difference in labor duration when offering a diet during labor to patients at usual risk compared to fasting. No differences were observed in other perinatal outcomes between the intervention and control groups., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025. Published by Elsevier Ltd.)

Objective: To compare the phase angle (PhA) through bioelectrical impedance (BIA) of children with intestinal failure (IF) using prolonged parenteral nutrition (PN) followed by an Intestinal Rehabilitation Program, with a control group., Methods: Children under 10 years of age with IF using prolonged PN for >60 days (study group) were included. The control group consisted of healthy children without chronic pathologies, matched by sex and age. Anthropometric parameters evaluated were: weight, height, weight/age z-score (W/A), height/age z-score (H/A), BMI, BMI/A z-score, arm circumference, triceps skinfold, subscapular skinfold, mid-arm muscle circumference. BIA parameters were resistance (R), reactance (Xc), and phase angle (PhA)., Results: Twenty-eight children were included in the study group, median (IQR) age was 11 (8-27) months, 53.6 % were male. In the control group, 28 children were included, median (IQR) age was 12.5 (8-24.7) months, 50 % were male. Children from the study group had W/A z-scores and H/A z-scores significantly lower than controls. There was no significant difference between PhA in the study group and controls, [median (IQR) 4.3° (3.8;4.6) vs 4.0° (3.8;5.4) respectively, p = 0.980]. Prematurity was significantly higher in the study group than in the controls, but there was no significant correlation between gestational age at birth and PhA of the children from the study group., Conclusion: Children with IF using prolonged PN showed lower W/A and H/A compared to the control group, but without significant difference between the PhA of children with IF compared to controls., Competing Interests: Conflicts of interest The authors declare no conflict of interest., (Copyright © 2024 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.)

To evaluate the association between nutritional risk and functionality of children and adolescents hospitalized with COVID-19 at admission and discharge., Methods: Retrospective cross-sectional study with patients under 19 years old, positive for SARS-COV-2 by RT-PCR test, from February 2020 to May 2022. The STRONGKids screening (Screening Tool Risk On Nutritional Status and Growth) was used to assess nutritional risk on hospital admission and the Functional Status Scale (FSS-Brazil) to determine the functionality of patients on admission and discharge. Data was collected from hospital medical records. Poisson regressions with crude robust variance were used to test the association between nutritional risk and functional status at admission, with adjustments for the age, length of stay, and presence of complex chronic conditions., Results: Of the 217 patients, 55.7% (n = 121) were boys with a median age of 6 years (IQ 0-12), 58.5% (n = 127) had at least one complex chronic condition, 64% (n = 139) had medium/high nutritional risk, and 23.9% (n = 52) had some degree of dysfunctionality upon admission and 14.6% (n = 31) upon discharge. By associating STRONGKids and the FSS-Brasil of hospital admission, it was observed that children with low nutritional risk had a mean global FSS lower (6.4 ± 0.7) than children with medium/high nutritional risk (7. 7 ± 2.8; p < 0.001). Children with low nutritional risk on admission also had a lower mean (6.1 ± 0.59) on the FSS at hospital discharge than children with medium/high nutritional risk (7.1 ± 2.5; p < 0.001). After adjustments, it was identified that the addition of one STRONGKids point increases by 36% (PR 1.36; 95%CI 1.15-1.62) the probability of the patient presenting some degree of functional impairment on admission.    Conclusion: The study found a positive association between nutritional risk and functional impairment in hospitalized children and adolescents with COVID-19 on admission, even after adjusting for age, length of stay, and complex chronic conditions. Furthermore, patients with medium/high nutritional risk at admission also had worse functionality, both on admission and at discharge., What Is Known: • Children and adolescents infected with COVID-19 tend to exhibit milder symptoms and lower hospitalization rates compared to adults, although severe cases and complications can occur. • A paucity of targeted investigations exists regarding the correlation between nutritional risk and functionality in children and adolescents with COVID-19., What Is New: • Children and adolescents with COVID-19 who presented with medium to high nutritional risk upon hospital admission demonstrated functional impairments, both at admission and hospital discharge., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction : Pediatric hematopoietic stem cell transplantation requires individualized nutritional therapy, and the use of early enteral nutrition is beneficial. This study aims to analyze the use of enteral nutrition therapy in pediatric patients undergoing autologous transplantation. Methods : This is a descriptive cohort study conducted with data from electronic medical records of pediatric patients undergoing autologous transplantation from 2017 to 2022, using enteral nutrition. Nutritional and clinical variables and biochemical markers were assessed at four time points: day 0, day +5, day +10 and day +15. Results : The sample consisted of 50 patients. On average, the nasoenteral tube was inserted on D-4 and the enteral feeding started on D-3. On D0, most patients used a normocaloric polymeric enteral formula, but on D  + 10, when diarrhea ( p  = 0.017) and mucositis ( p  < 0.001) worsened, the most commonly used enteral formula was a hypocaloric pediatric semi-elemental formula. On D  + 15, 35% of patients were receiving parenteral nutrition. At discharge, the patient's nutritional status had worsened compared to admission ( p  < 0.001). Discussion : Early use of enteral nutrition was observed, as adopted in other transplant centers and recommended in the literature. Protocols and guidelines are needed to support enteral nutritional therapy in pediatric transplantation.

The purpose of this study was to translate and adapt the Feeding/Swallowing Impact Survey (FS-IS) into Brazilian Portuguese and provide a validated instrument for caregivers of children with feeding/swallowing disorders. This cross-cultural study involved initial translation, synthesis of translations, back-translation, Committee of Experts, and pre-test. The sample consisted of 95 primary caregivers of children with feeding/swallowing disorders classified by Pediatric Dysphagia Evaluation Protocol (PDEP) in mild (n = 9), moderate-severe (n = 40), or profound (n = 46) dysphagia. Reliability and evidence of validity based on test content, response processes, internal structure and the relations to other variables were investigated. Internal consistency, test-retest, exploratory and confirmatory factor analysis were performed, in addition to the correlation with PedsQL™ Family Impact Module (PedsQL TM FIM). The pre-test participants did not report any difficulties in understanding the translated version. The Brazilian Portuguese version of FS-IS (Pt-Br-FS-IS) presented Cronbach's Alpha of 0.83, Exploratory Factor Analysis verified that the instrument would not be unifactorial (KMO = 0.74 and Bartlett's sphericity test p < 0.001) and Confirmatory Factor Analysis confirmed the original model in three subscales with χ 2 /df = 1.23, CFI = 0.92, TLI = 0.90, RMSEA (90% CI) 0.049 (0.011-0.073) adjustment indexes and the ICC was excellent in all subscales and total score. The correlation with PedsQL™FIM was significant in the total score and subscales. This study successfully translated and cross-culturally adapted the FS-IS instrument to the Brazilian Portuguese language and the investigation of its reliability and validity evidence suggests that the Pt-Br-FS-IS is a reliable and valid tool to measure the impact of feeding/swallowing disorders on the quality of life of caregivers of affected children., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

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., Competing Interests: Conflicts of interest The authors declare no conflicts of interest., (Copyright © 2022 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.)

Background: Childhood obesity has been growing steadily, at an earlier age, and currently comprises a public health issue. A number of studies have pointed to perinatal factors as possible determinants in the development of childhood obesity., Objective: To evaluate the influence of perinatal factors on the development of obesity in children and adolescents in southern Brazil., Design: Retrospective cohort study in which a linkage was made between anthropometric data of children and adolescents aged 0 to 15 years who had been registered in the Food and Nutrition Surveillance System (SISVAN) from 2008 to 2016 and their perinatal data registered in the Live Birth Information System (SINASC) from 2000 to 2014. The SINASC was used to extract maternal covariables (age, schooling, marital status), prenatal variables (parity and number of prenatal visits), and perinatal variables (type of delivery, sex, and birth weight). Variables such as age, inclusion in the Bolsa Família income transfer program, and the number of anthropometric evaluations were extracted from SISVAN., Results: The sample comprised 537 children and adolescents. The median age was 8 years (interquartile range: 2-11 years). The prevalence of obesity was 15.1%. Poisson regression revealed a higher risk of obesity in children born via cesarean delivery (relative risk [RR] = 1.48; 95% CI: 1.01-2.17), children of primiparous mothers (RR = 1.72; 95% CI: 1.16-2.53), girls (RR = 1.77; 95% CI:1.21-2.60), and those aged between 5 and 9 years (RR = 26.8; 95% CI: 3.75-191.55) and older than 10 years (RR = 20.74; 95% CI: 2.89-148.61)., Conclusions: The linkage between SINASC and SISVAN allowed identification of prenatal and perinatal risk factors for the development of childhood obesity. These findings should contribute to the development of health promotion and prevention policies.

Background: Evidences suggest that early processed food (PF) consumption may cause harm to infant health. During the first 6 months of life, it is not known whether the timing and quantity of this food group can impact breastfeeding and growth. The aim of the study was to analyze the associations between time of introduction and quantity of infant PF consumption with duration of breastfeeding and infant growth at 6 months of age., Methods: Data were longitudinally collected in six interviews, from birth to 6 months, in a sample of Brazilian newborns with adverse intrauterine environments. PF consumption was calculated by gravity score of processed foods (GSPF) in relation to feeding supply quality and time. For the analysis, the scores were divided into tertiles, making scores severities: Null, Mild, Moderate, and Severe. The interaction between GSPF and breastfeeding (exclusive and non-exclusive) and growth parameters (analyzed in Z-scores, by weight for height, weight for age, and body mass index for age) was tested., Results: A total of 236 infants were included in the study. Greater GSPF were associated with better rates of breastfeeding practices and higher growth indicators scores in the sixth month of infants. These findings were confirmed after adjustment for family income, maternal age, pre-gestational body mass index, and growth z scores at birth., Conclusion: The harms of eating PF in relation to breastfeeding and infant growth are more evident the greater and earlier they are consumed. Future studies should explore interventions to reduce and delay the consumption of these foods to prevent adverse health outcomes in later life., (© 2021. The Author(s).)

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.

This article aims to evaluate the influence of parity on breastfeeding and introduction of complementary feeding in children up to six months after childbirth. Longitudinal study conducted through a convenience sample of mother-child pairs, selected at postpartum and accompanied until the sixth month of infant's life, between 2011 and 2016, in Porto Alegre, Brazil. There was an analysis of the time taken in the first feeding after birth, practice and time of breastfeeding, consumption of other types of milk and introduction of complementary feeding. The sample consisted of 161 dyads, with 74 primiparous and 87 multiparous. Multiparous women breastfed their babies sooner in the first 24 hours post-partum (p = 0.019). The offering of other kinds of milk showed no difference in relation to parity, as the moment of introduction to infant nutrition, although both primiparous and multiparous did it before the age of four months. Parity seemed to influence the timing of first breastfeeding offer, but not the introduction of complementary feeding, although this occurred in an early way. In this sense, it is necessary to disseminate more information about breastfeeding and infant feeding during prenatal and childcare, to improve maternal and child health.

Background: This study investigate the influence of domestic violence against pregnant women on early complementary feeding and associated factors., Methods: A longitudinal observational study was conducted with a convenience sample recruited from three public hospitals in Porto Alegre, Rio Grande do Sul, Brazil. Data on maternal age, education, marital status, breastfeeding, introduction of complementary feeding and domestic violence during pregnancy were investigated at four follow-ups points. Data on domestic violence was collected through a self-report questionnaire based on the Abuse Assessment Screen. The early introduction of complementary feeding, characterized as occurring before or at 3 months of life, was verified through a questionnaire prepared by the research group. Data analysis involved Student's t-test, the chi-square test and Cox regression and was carried out in Statistical Package for the Social Sciences program. The significance level was set at 5%., Results: A total of 232 mother-infant pairs participated in the analyses, and 15.1% of the mothers reported suffering some form of violence. Domestic violence was directly associated with maternal education, marital status, and health status during pregnancy. Domestic violence was not associated with maternal age or breastfeeding at 3 months after delivery. In the univariate analysis, domestic violence during pregnancy was associated with early complementary feeding (RR = 1.74; CI: 1.01-2.98). This effect disappeared after the model was adjusted in multivariate analysis., Conclusions: There was no relationship between domestic violence during pregnancy and early complementary feeding.

Background: Several studies have shown that exposure of the fetus and newborn to prenatal and perinatal events, respectively, may influence the health outcomes of the child throughout their life cycle., Objective: This study aimed to increase the knowledge on the impact of different intrauterine environments on child growth and development, as we know that pregnancy and early years are a window of opportunity for health promotion and prevention interventions of diseases., Methods: The recruitment occurred 24 to 48 hours after delivery and involved mothers and their newborns in 2 public hospitals in Porto Alegre, Brazil, from December 2011 to January 2016. The mothers-newborns dyads were allocated to 5 groups: diabetes mellitus, mothers with a clinical diagnosis of diabetes; systemic arterial hypertension (SAH), mothers with a clinical diagnosis of systematic arterial hypertensive disease during pregnancy; maternal smoking, mothers who smoked at any moment of gestation; small for gestational age (SGA), mothers with SGA newborns because of intrauterine growth restriction; and control, mothers without the clinical characteristics previously mentioned. Several protocols and anthropometric measurements were applied in the interviews at immediate postpartum and 7 and 15 days and 1, 3, and 6 months after birth. For this study, we analyzed only data collected during postpartum interviews. The statistical analyses were performed using Pearson chi-square test, Mann-Whitney test, or Kruskal-Wallis test with Dunn post hoc. The significance level was set at 5%. The Hospital Ethics and Research Committees approved the study., Results: Of the 485 eligible mothers-newborns dyads, 400 agreed to participate (82.5%, 400/485). As expected, newborns from the SGA group had significantly lower birth weight, smaller stature, and lower cephalic perimeter (P<.001). This group also had the highest percentage of primiparous women in comparison with other groups (P=.005) except for control. Mothers from the SAH group had the highest mean age, the highest percentage of cesarean sections, and presented greater gestational weight gain., Conclusions: In this study, we describe the planning and structure for the systematic follow-up of mother-newborn dyads in the first 6 months after birth, considering the important demographic and epidemiological transition scenario in Brazil. The results of this prospective longitudinal study may provide a better understanding of the causal mechanisms involved in health and life course disease related to different adverse intrauterine environments., (©Isabel Cristina Ribas Werlang, Juliana Rombaldi Bernardi, Marina Nunes, Thiago Beltram Marcelino, Vera Lucia Bosa, Mariana Bohns Michalowski, Clécio Homrich da Silva, Marcelo Zubaran Goldani. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 12.11.2019.)

Objective:  To assess the daily dietary intake and energy contribution of ultra-processed foods among women who are positive and negative for the human immunodeficiency virus (HIV) during pregnancy., Methods:  This case-control study included 77 HIV-positive and 79 HIV-negative puerperal women between 2015 and 2016. The socioeconomic and maternal demographic data were assessed, and a food frequency questionnaire (FFQ) adapted for pregnant women was applied. The Fisher exact test and the Mann-Whitney test were applied to detect differences between the groups. Linear regression was used to assess the associations between the intake of ultra-processed food and energy, macro- and micronutrients, with values of p  < 0.05 considered significant., Results:  The HIV-positive group was older ( p  < 0.001) and had lower income ( p  = 0.016) and level of schooling ( p  < 0.001) than the HIV-negative group. Both groups presented similar average food intake: 4,082.99 Kcal/day and 4,369.24 Kcal/day for the HIV-positive and HIV-negative women respectively ( p  = 0.258).The HIV-positive group consumed less protein ( p  = 0.048), carbohydrates ( p  = 0.028) and calcium ( p  = 0.001), and more total fats (p  = 0.003). Ultra-processed foods accounted for 39.80% and 40.10% of the HIV-positive and HIV-negative groups' caloric intake respectively ( p  = 0.893). The intake of these foods was associated with a higher consumption of carbohydrates ( p  < 0.001), trans fat ( p  = 0.013) and sodium ( p  < 0.001), as well as lower protein ( p  < 0.001) and fiber intake ( p  = 0.022)., Conclusion:  These findings demonstrate that the energy consumption and ultra-processed food intake were similar in both groups, which reinforces the trend toward a high intake of ultra-processed food in the general population. The intake of ultra-processed food was positively associated with the consumption of carbohydrates, trans fat and sodium, and negatively associated with the consumption of protein and fiber., Competing Interests: The authors have none to declare., (Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil.)

Objective: To verify the association of maternal and anthropometric factors with consumption of ultra-processed foods in children between 4 to 24 months., Methods: cross-sectional study with 300 children hospitalized in a tertiary hospital and their mothers. The interview took place during the first 72 hours of hospitalization to avoid interference in the responses about the child's diet. Maternal factors investigated: age, schooling, income, parity, BMI and guidance on complementary feeding. Variables related to the child investigated: age, breastfeeding, infant school, BMI/age, height/age, weight/age and introduction of ultra-processed food. The association between the factors studied and introduction of ultra-processed food was tested by linear regression. The significance level considered was 0.05., Results: . It was verified that only 21% of the children had not yet received any type of ultra-processed food, and 56.5% received any of these foods before 6 months. In the multivariate analysis, maternal schooling, family income, maternal age and parity were associated with ultra-processed food supply., Conclusions: The feeding practices of children between 4 and 24 months are inadequate when compared to the recommendations for the age group.

Objective:  Different intrauterine environments may influence the maternal prepregnancy body weight (BW) variation up to 6 months postpartum. The objective of the present study was to verify the association of sociodemographic, obstetric, nutritional, and behavioral factors with weight variation in women divided into four groups: hypertensive (HM), diabetic (DM), smokers (SM), and control mothers (CM)., Methods:  It was a convenience sample of 124 postpartum women recruited from 3 public hospitals in the city of Porto Alegre, state of Rio Grande do Sul, Brazil, between 2011 and 2016. Multiple linear regressions and generalized estimating equations (GEE) were conducted to identify the factors associated with maternal weight variation. For all GEE, the maternal weight measurements were adjusted for maternal height, parity, educational level, and the type of delivery, and 3 weight measurements (prepregnancy, preceding delivery, and 15 days postpartum) were fixed., Results:  A hierarchical model closely associated the maternal diagnosis of hypertension and a prepregnancy body mass index (BMI) classified as overweight with maternal weight gain measured up to the 6 th month postpartum (the difference between the maternal weight at 6 months postpartum and the prepregnancy weight). These results showed that the BW of the HM group and of overweight women increased ∼ 5.2 kg 6 months postpartum, compared with the other groups. Additionally, women classified as overweight had a greater BW variation of 3.150 kg., Conclusion:  This evidence supports the need for specific nutritional guidelines for gestational hypertensive disorders, as well as great public attention for overweight women in the fertile age., Competing Interests: The authors have no conflicts of interest to declare., (Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil.)

This article aims to review systematically the evidence on nutritional assessment techniques and parameters used to determine the nutritional status of children and adolescents. The literature review and the selection of publications were performed using the Medline, Lilacs, SciELO, Embase, personal files. 17 studies were identified, 7 addressed the anthropometric indices as the main outcome, 7 analyzed the growth and development of children and adolescents through growth curves, and the remainder surveyed body composition. In general, all met the quality criteria, unless 6 of the articles who did not discuss the limitations. The literature review suggests several techniques and parameters that can be applied to determine the nutritional status of children and adolescents from different countries. Growth graphs are essential to assess the health of children, but depend greatly of the growth tables used. Although BMI can be practical, it does not distinguish body fat from lean mass. The best interpretation of anthropometry will depend of valid reference values for age range of the study population. BIA is a quick feasible method, but the measurement has some various nationalities.

Objectives: To transculturally adapt and validate the Karitane Parenting Confidence Scale to the Brazilian Portuguese language and culture and verify the combination of the results with the maternal sociodemographic characteristics., Methodology: This is a validation and transcultural adaptation nestled in a longitudinal and observational study in Porto Alegre, RS, Brazil, assessing mother-infant pairs from different gestational and perinatal environments. The original authors authorized the translation into Brazilian Portuguese, unified version creation, back-translation, analysis by specialists, final version implementation, and acceptance. Cronbach's alpha analysis was performed. The Kruskal-Wallis test with post-hoc Dunn's test was used to compare the study groups. Socioeconomic and demographic characteristics, obtained through a questionnaire in the first 24-48h of the newborns' life, were associated with maternal results by the Brazilian version of the scale, using Spearman's correlation and Mann-Whitney's test., Results: The sample consisted of 251 postpartum women, with the confidence maternal questionnaire being applied at 15 days postpartum. The median score of the mothers' confidence was 40.00 (37.00-43.00). The protocol obtained a Cronbach's alpha of 0.717. There were significant weak positive correlations between maternal confidence and age (p=0.013, r=0.157) and between maternal confidence and schooling (p=0.048, r=0.125). Additionally, a significant association was observed between maternal confidence and parity (p=0.030)., Conclusion: The transcultural adaptation and validation of the confidence maternal questionnaire into Brazilian Portuguese language and culture showed good reliability for this sample. The results of its use demonstrated that maternal confidence was associated with schooling, age and parity., (Copyright © 2017 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.)

Background: Breast milk is known to contain many bioactive hormones and peptides, which can influence infant growth and development. In this context, the purpose of this study was to evaluate the influence of different clinical pregnancy conditions on hormone concentrations in colostrum and mature breast milk., Methods: An observational study was performed with mother-newborn pairs divided into five groups according to maternal clinical background: diabetes (12), hypertension (5), smoking (19), intrauterine growth restriction of unknown causes with small-for-gestational-age newborns at delivery (12), and controls (21). Socioeconomic data, anthropometric measurements and breast milk samples were collected between the first 24 and 48 h and 30 days postpartum. Leptin, adiponectin, and insulin levels in breast milk were measured by immunoassays., Results: A significant decrease in leptin (p = 0.050) and insulin (p = 0.012) levels from colostrum to mature breast milk in mothers of small-for-gestational-age infants was observed. Maternal body mass index was correlated with both leptin and insulin, but not with adiponectin. Insulin levels were negatively correlated to infant weight gain from birth to one month (p = 0.050). In addition, catch-up growth was verified for small-for-gestational-age infants throughout the first month of life., Conclusions: This study suggests that a remarkable decrease in leptin and insulin levels in mature milk of mothers of small-for-gestational-age newborns may be involved in the rapid weight gain of these newborns. The physiological and external mechanisms by which these significant decreases and rapid weight gains occur in this group remain to be elucidated.

Objective: To determine the prevalence of preeclampsia (PE) in adolescents and to evaluate its association with risk factors for, and the occurrence of, adverse maternal and fetal outcomes., Results: Of 3006 deliveries, 533 (17.7%) were from teenage mothers, with twenty-eight (5.3%) presenting PE; 17.8% of these cases were classed as severe. Vitamin and mineral supplementation was associated with the occurrence of PE (p=0.034). Puerperal complications and prematurity were more frequent in the PE group., Conclusions: Prevalence of PE among adolescents was similar to the literature data and was associated with high rates of preterm birth and puerperal complications., (Copyright © 2017 International Society for the Study of Hypertension in Pregnancy. Published by Elsevier B.V. All rights reserved.)

Objective To investigate the association between maternal caffeine intake during pregnancy and infant anthropometric measurements at age 3 and 6 months. Methods Longitudinal observational study of mother-child pairs stratified into five groups: diabetic women (DM), hypertensive women (HYP), smoking mothers (SMO), mothers of infants small for gestational age (SGA), and controls (CTL). Pairs were recruited from three public hospitals in Porto Alegre, Brazil, from 2011 to 2015, using a convenience sampling strategy. The Food Frequency Questionnaire (FFQ) was administered on postpartum day 7 to evaluate maternal caffeine intake during pregnancy. The anthropometric measurements of interest (weight, length, and skinfold thickness) were assessed at birth and at age 3 and 6 months. Linear regression was used to analyze the interaction between caffeine intake and skinfold thickness. Results Overall, 272 mother-child pairs were investigated (41 DM, 26 HYP, 68 SMO, 25 SGA, and 112 CTL). There were no differences in anthropometric measurements between infants born to mothers who had and had not consumed caffeine during pregnancy (P > 0.05). Children of mothers in the DM group had the highest adjusted average skinfold thicknesses at 3 months. An interaction between maternal caffeine intake during pregnancy and the sum of skinfolds at age 3 months was found in the DM and CTL groups (P < 0.05). However, significant differences were not observed at 6 months. Conclusions Maternal caffeine intake influenced infants skinfold thickness measurements at 3 months of age. This parameter was reduced in infants born to mothers with DM and increased in those born to healthy control mothers.

Background: Some studies suggest a relationship between maternal smoking during pregnancy and not only intrauterine fetal growth restriction or low birth weight, but also with changes in the postnatal growth and development. The objective of the present study was to investigate the effects of smoking during pregnancy on infants growth in the first 6 months of life compared with a control group and a group with idiopathic intrauterine growth restriction., Methods: Longitudinal observational study using a convenience sample of newborns divided into three groups: infants of smoking mothers (tobacco), with idiopathic intrauterine growth restriction (IUGR) and a control group. The sample was selected from two hospitals in Porto Alegre, located in southern Brazil, between 2011 and 2015. Newborns were evaluated at birth, 7 and 15 days, and in the first, third, and sixth month. Anthropometric measures were weight, length and head circumference. The growth indicators used were expressed as z-scores. The analyses were performed using the generalized estimating equation method., Results: The sample included 273 mother/newborn pairs: 86 tobacco group, 34 IUGR group, and 153 control group. In terms of weight at birth, all groups differed significantly (p < 0.001). The birth length of tobacco and control groups were similar, but the IUGR group was lower than both (p < 0.001). We found no differences in growth trajectory between tobacco and control group, but there were differences in the growth of the IUGR group when compared with the other groups. At 6 months of age, all groups had similar anthropometric measurements., Conclusion: Intrauterine growth restriction had major impact on the growth trajectory of the infants studied, regardless of other factors, such as smoking and diet.

Objective:: To identify symptoms of anxiety, depression, and feelings of hopelessness in patients in outpatient treatment for substance dependency and to test for correlations with various aspects of their quality of life., Methods:: A cross-sectional study of a sample of 25 men in recuperation from substance dependency, selected by convenience. We assessed symptoms of depression (Beck Depression Inventory-II), anxiety (Beck Anxiety Inventory), hopelessness (Beck Hopelessness Scale), and quality of life (World Health Organization Quality of Life instrument-Abbreviated version [WHOQOL-Bref]), and also analyzed sociodemographic profile, substance abuse, and family history. Categorical variables were expressed as frequencies and percentages and quantitative variables as means and standard deviations or as medians and interquartile ranges. We also analyzed Spearman correlations to a 5% significance level., Results:: The study revealed prevalence rates of 32% for depression, 24% for anxiety, and 12% for hopelessness, at a moderate/severe level. Correlations between Beck scales and WHOQOL-Bref were significant; but impacts differed in the four areas evaluated., Conclusions:: Overall, we observe global negative impacts on subjects' lives, affecting their psychiatric symptoms and quality of life and their relationships and occupational factors to a similar degree. The results show that the lower the scores on these scales, the better the quality of life in some areas, indicating that there is a negative correlation between psychiatric symptoms and quality of life.

An adverse early life environment can induce changes on behavioral and metabolic responses later in life. Recent studies in rats showed that the quality of maternal care as measured by high levels of pup licking and grooming (LG) was associated with changes in the relationship between the precursor thyroid-hormone T4 and the more active T3. Here we investigated if early exposure to childhood abuse is associated with thyroid-hormone levels in human adolescents. Given the empirical evidence from animal models showing that good maternal care was associated with increased conversion of T4 to T3, we hypothesized that early adversity would be associated with a decreased peripheral conversion of T4 to T3. A sample of 80 adolescents (10-18 years) participated in this study. We used the Childhood Trauma Questionnaire to investigate early life stress. We calculate the body mass index (BMI) assessing weight and height and sexual maturation stage was determined by self-assessment. Blood samples were collected to measure T3 and T4 levels. ANCOVA were used to evaluate the influence of the Physical Abuse domain of the Childhood Trauma Questionnaire as the early life stress variable in T3 and T4 separately, adjusted for potential confounders such as pubertal status, gender, socioeconomic status and BMI. Early life trauma was associated with reduced T3 levels in adolescents, when adjusted for potential confounders (p=0.013), but not with peripheral T4 levels (p=0.625). We extended findings from animal models showing that adverse early experience persistently impacts on the individual's responses to stress, which is marked by an abnormal metabolism of thyroid hormones. Further studies are needed to further investigate the nature of such associations., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

The objective of this study is to compare energetic expenditure in day-to-day activities among subjects with internalizing disorders (depression and anxiety), externalizing disorders (attention deficit/hyperactivity disorder and oppositional defiant disorder) and healthy children and adolescents without any psychiatric diagnosis. One hundred and five (n = 105) students from a community sample were evaluated throughout a structured psychiatric interview and categorized into three groups: internalizing (n = 54), externalizing (n = 12) and typically developing controls (TDC, n = 39). Energetic expenditure was evaluated using 3-day physical activity record. Subjects with internalizing disorders performed activities with lower energetic expenditure as compared to those with externalizing disorders and TDC. Participants with externalizing disorders had more energetic expenditure variability. Our study suggests that internalizing disorders are associated with activities of low energetic expenditure in day-to-day activities, extending previous findings with physical exercise. These findings may further contribute to the understanding of the associated morbidity previously described in patients with internalizing disorders.

The objective of this study is to investigate if a polymorphism in the NR3C2 gene moderates the association between childhood trauma on serum levels of brain derived neurothrophic factor (sBDNF). sBDNF was used here as a general marker of alteration in brain function. This is a community cross sectional study comprising 90 adolescents (54 with anxiety disorders). DNA was extracted from saliva in order to genotype the MR-2G/C (rs2070951) polymorphism using real time PCR. Blood was collected for sBDNF Elisa immunoassay. The Childhood Trauma Questionnaire (CTQ) was used to evaluate childhood abuse and neglect. Main effects and gene environment interactions were tested using linear regression models. Anxiety disorders were not associated with the MR-2G/C polymorphism or with sBDNF levels, but the number of C alleles of the MR-2G/C polymorphism was significantly associated with higher sBDNF levels (b = 8.008; p-value = 0.001). Subjects with intermediate and high exposure to physical neglect showed higher sBDNF levels if compared to subjects non-exposed (b = 11.955; p = 0.004 and b = 16.186; p = 0.009, respectively). In addition, we detected a significant physical neglect by MR-2G/C C allele interaction on sBDNF levels (p = 0.005), meaning that intermediate and high exposure to childhood neglect were only associated with increased sBDNF levels in subjects with the CC genotype, but not in subjects with other genotypes. Our findings suggest that genetic variants in NR3C2 gene may partially explain plastic brain vulnerability to traumatic events. Further studies are needed to investigate the moderating effects of NR3C2 gene in more specific markers of alteration in brain function., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Objective: To investigate whether internalizing disorders are associated with quality of life (QoL) in adolescents, even after accounting for shared risk factors., Methods: The sample comprised 102 adolescents from a community cross-sectional study with an oversampling of anxious subjects. Risk factors previously associated with QoL were assessed and divided into five blocks organized hierarchically from proximal to distal sets of risk factors., Results: Multiple regression analysis yielded a hierarchical model accounting for 72% of QoL variance. All blocks were consistently associated with QoL (p < 0.05), accounting for the following percentages of variance: 12% for demographics; 5.2% for family environment; 37.8% for stressful events; 10% for nutritional and health habits; and 64.2% for dimensional psychopathological symptoms or 22.8% for psychiatric diagnoses (dichotomous). Although most of the QoL variance attributed to internalizing symptoms was explained by the four proximal blocks in the hierarchical model (43.2%), about 21% of the variance was independently associated with internalizing symptoms/diagnoses., Conclusions: QoL is associated with several aspects of adolescent life that were largely predicted by our hierarchical model. Our findings reinforce the hypothesis that internalizing disorders and internalizing symptoms in adolescents have a high impact on QoL and deserve proper clinical attention.

Background: Although several studies have reported an association between mental disorders and serum levels of brain-derived neurotrophic factor (BDNF), this association is still poorly understood. The study of factors associated with both BDNF levels and mental disorders, such as n-3 polyunsaturated fatty acids (n-3 PUFAs), may help to elucidate the mechanisms mediating the relationship between the two variables. Therefore, the present study aimed to evaluate whether the intake n-3 PUFAs correlates with serum levels of BDNF., Findings: This study involved 137 adolescents drawn from a community sample, including a group with high levels of anxiety, assessed using the Screen for Children and Anxiety Related Emotional Disorders. Blood samples were collected and serum BDNF levels were measured. n-3 PUFAs were estimated using a food frequency questionnaire for adolescents. Correlations were performed to assess the association between n-3 PUFAs intake and BDNF levels. Effects of potential confounders (total fat consumption, age, gender and anxiety) were examined using linear regression models. There was a direct correlation between n-3 PUFAs consumption and serum BDNF levels, which remained significant even after accounting for potential confounders., Conclusions: We were able to detect a correlation between n-3 PUFAs intake and peripheral BDNF levels. Our study was limited by its small sample size, and our external validity may be restricted by the oversampling of anxious adolescents. Our findings may help determine the nature of the association between mental disorders and serum levels of BDNF. However, more studies are needed to elucidate the possible mechanisms by which n-3 PUFAs intake affects BDNF levels, and how this may lead to an increased vulnerability to psychiatric disorders.

Background: In the last twenty years, retrospective studies have shown that perinatal events may impact the individual health in the medium and long term. However, only a few prospective studies were designed to address this phenomenon. This study aims to describe the design and methods of the Impact of Perinatal Environmental Variations in the First Six Months of Life - the IVAPSA Birth Cohort., Method/design: This is a clinical study and involves the recruitment of a birth cohort from hospitals in Porto Alegre, Rio Grande do Sul, Brazil. Mothers from different clinical backgrounds (hypertensive, diabetics, smokers, having an intrauterine growth restricted child for idiopathic reasons, and controls) will be invited to join the study twenty-four hours after the birth of their child. Data on economic, social, and maternal health care, feeding practices, anthropometric measures, physical activity, and neuropsychological evaluation will be obtained in interviews at postpartum, 7 and 15 days, 1, 3 and 6 months of life., Discussion: To our knowledge, this is the first thematic cohort focused on the effects of intrauterine growth restriction to prospectively enroll mothers from different clinical backgrounds. The IVAPSA Birth Cohort is a promising research platform that can contribute to the knowledge on the relationship between perinatal events and their consequences on the children's early life.

Objective: This study aims to describe the design, methods and sample characteristics of the Multidimensional Evaluation and Treatment of Anxiety in Children and Adolescents - the PROTAIA Project., Method: Students between 10 and 17 years old from all six schools belonging to the catchment area of the Primary Care Unit of Hospital de Clínicas de Porto Alegre were included in the project. It comprises five phases: (1) a community screening phase; (2) a psychiatric diagnostic phase; (3) a multidimensional assessment phase evaluating environmental, neuropsychological, nutritional, and biological factors; (4) a treatment phase, and (5) a translational phase., Results: A total of 2,457 subjects from the community were screened for anxiety disorders. From those who attended the diagnostic interview, we identified 138 individuals with at least one anxiety disorder (apart from specific phobia) and 102 individuals without any anxiety disorder. Among the anxiety cases, generalized anxiety disorder (n = 95; 68.8%), social anxiety disorder (n = 57; 41.3%) and separation anxiety disorder (n = 49; 35.5%) were the most frequent disorders., Conclusion: The PROTAIA Project is a promising research project that can contribute to the knowledge of the relationship between anxiety disorders and anxiety-related phenotypes with several genetic and environmental risk factors.

Objective: To measure resting energy expenditure (REE) and to estimate caloric intake of asthmatic adolescents with excess body weight and compare results with those groups of eutrophic asthmatic adolescents and non-asthmatic adolescents with excess body weight., Methods: This cross-sectional study categorized 69 adolescents aged 10 to 18 y into three matched groups. Nutritional status was assessed using anthropometric and body composition measurements. Indirect calorimetry was used to measure energy expenditure, and caloric intake was estimated from dietary recalls., Results: In each group, there were 23 adolescents (10 girls) aged 12.39 ± 2.40 y. Results for each group were as follows. For asthmatic adolescents with excess body weight, body mass index (BMI) was 24.83 ± 2.73 kg/m(2), REEs were 1550.24 ± 547.23 kcal/d and 27.69 ± 11.33 kcal · kg(-1) · d(-1), and estimated caloric intake was 2068.75 ± 516.66 kcal/d; for eutrophic asthmatic adolescents, BMI was 19.01 ± 2.10 kg/m(2), REEs were 1540.82 ± 544.22 kcal/d and 36.65 ± 15.04 kcal · kg(-1) · d(-1), and estimated caloric intake was 2174.05 ± 500.55 kcal/d; and for non-asthmatic adolescents with excess body weight, BMI was 25.35 ± 3.66 kg/m(2), REEs were 1697.24 ± 379.84 kcal/d and 28.18 ± 6.70 kcal · kg(-1) · d(-1), and estimated caloric intake was 1673.17 ± 530.68 kcal/d. Absolute REE values between groups were not statistically different, even after correction for lean mass and fat mass (F = 0.186, P = 0.831). REE (kilocalories per kilogram per day) was significantly higher in the group of eutrophic asthmatic adolescents (P = 0.016). Estimated caloric intake was greater than REE only in the group of adolescents with asthma., Conclusion: The REE was not significantly different among groups, and REE (kilocalories per kilogram per day) was higher in the group of eutrophic asthmatic adolescents. Estimated caloric intake was greater than REE in the group of adolescents with asthma., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Objective: To assess the nutritional status of children and adolescents with bronchiolitis obliterans and to analyze associations with clinical and nutritional factors., Methods: The study included 57 patients. Nutritional status was assessed using z scores for weight/age, stature/age, weight/stature in children, and stature/age and body mass index percentiles in adolescents. Body composition was assessed via tricipital skin folds, subscapular skin folds, and the sum of both plus the muscular circumference of the arm; pulmonary function was also investigated in subjects over 8 years old., Results: The high percentages of malnutrition and risk for malnutrition are noteworthy: 21.7 and 17.5%, respectively. Among children, weight/age and stature/age detected higher percentages of malnutrition (21.6 and 16.2%), while weight/stature underestimated this diagnosis. Among adolescents, body mass index detected a high percentage of malnutrition (25%) and of risk for malnutrition (20%). Body composition analysis detected 51% of patients with low muscle reserves, and the majority of patients had normal fat reserves. Compromised pulmonary function was associated with poor performance at exercise (r = 0.434; p = 0.024). Malnutrition and/or nutritional risk and low muscle reserves were significantly associated with the 6-minute walk test (p = 0.032; p = 0.030). There was no association between spirometry and the nutritional variables (p > 0.05)., Conclusion: These results emphasize the need for nutritional intervention, and suggest that, in addition to using weight and height indices for nutritional assessment, it is necessary to combine these with an analysis of body composition, so that a larger number of patients with malnutrition and/or at an increased risk for developing malnutrition may be identified and correctly managed.

Introduction: Studies suggest that anxiety is an independent predictor of adverse cardiovascular events. However, few studies have investigated the association between cardiovascular risk factors (RF) and severity of anxiety disorders (AD) in childhood and adolescents., Objectives: To assess the prevalence of cardiovascular RF in children and adolescents with anxiety disorders and their association with disease severity., Method: Cross-sectional study assessing nutritional and anthropometric RF, as well as % body fat (BF), blood pressure (BP), physical activity level, anxiety symptoms and severity of the anxiety disorder of children and adolescents., Results: A total of 65 children and adolescents (8.6 } 1.7 years) took part in the study. Excess saturated fatty acid intake (52.3%), high body mass index (50.8%), high BP (50.8%) and physical inactivity (50.0%) were the most prevalent cardiovascular RF. There was a significant association between the severity of the anxiety and the presence of ≥ 6 RF per patient (p=0.026), excess abdominal body fat as assessed by waist circumference (p=0.019) and conicity index (p=0,053), and excess % BF (p=0.035). Generalized anxiety disorder was significantly associated with high BP (p=0.044)., Conclusion: A high prevalence of cardiovascular RF was found in the present sample, and individuals with more severe anxiety had greater cardiovascular risk. The characterization of the cardiovascular risk in young populations, especially in individuals with AD who are therefore more susceptible to CVD, is crucial for the development of lifestyle interventions in these patients., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)