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This cross-sectional study employs structural equation modelling (sEM) to explore both direct and indirect effects of parental level of education and child individual factors on the length-for-age outcomes in children aged 6-24 months assisted by the Bolsa Família Program in the State of Alagoas. A total of 1448 children were analysed by the sEM technique. A negative standardised direct effect (sDE) of the children's younger age (sDE: -0·06; P = 0·017), the use of bottle feeding (sDE: -0·11; P < 0·001) and lack of a minimum acceptable diet (sDE: -0·09; P < 0·001) on the length-for-age indicator was found. Being female (SDE: 0·08; P = 0·001), a higher birth weight (SDE: 0·33; P < 0·001), being ever breastfed (sdE: 0·07; P = 0·004) and a higher level of parental education (SDE: 0·09; P < 0·001) showed a positive SDE effect on the child's length-for-age. The model also demonstrated a negative standardised indirect effect (SIE) of the sweet beverage consumption (SIE: -0·08; P = 0·003) and a positive effect of being ever breastfed (SIE: 0·06; P = 0·017) on the child's length-for-age through parental level of education as a mediator. This research underscores the crucial role of proper feeding practices and provides valuable insights for the development of targeted interventions, policies and programmes to improve nutritional well-being and promote adequate linear growth and development among young children facing similar challenges.

This study aims to assess the association between economic class, race/skin color, and food consumption among Brazilian college students. A cross-sectional web-based survey was conducted with college students from all over Brazil. Demographic data, economic class, self-reported race/skin color, anthropometry, and food consumption markers from the Brazilian Food and Nutrition Surveillance System were collected. The final sample comprised 5843 participants with a mean age of 24.1 (SD: 6.3) years, 4292 (73.5%) were female, and 810 (13.9%) in the highest economic stratum. We observed a progressive decrease in the frequency of fresh fruits and vegetables consumption from higher to lower economic classes (p < 0.01 for both). Contrarily, there was a progressive increase in the frequency of consumption of beans from higher to lower economic classes (p < 0.01). The frequency consumption of vegetables was also associated with race/skin color (p < 0.01), being lower in brown (PR: 0.94; CI 95%: 0.90; 0.98), and black (PR: 0.91; 95% CI: 0.85; 0.98) individuals, compared to white individuals. Brown individuals showed higher frequency consumption of beans (PR: 1.10; 95% CI: 1.05; 1.15) than whites. When compared to individuals of white race/skin color, brown (PR: 1.07; 95% CI: 1.01; 1.13) and black (PR: 1.15; 95% CI: 1.07; 1.23) individuals showed higher frequency consumption of sweetened beverages. Economic class and race/skin color were independent factors associated with the food consumption of Brazilian college students., (© 2022. W. Montague Cobb-NMA Health Institute.)

Objective: This study aimed to verify the association between socio-economic and demographic characteristics and dietary patterns (DP) of children assisted by the Conditional Cash Transfer Program, Bolsa Família Program (BFP)., Design: This is a cross-sectional study. DP were defined using a principal component analysis. The association of the predictive variables and DP was modelled using multilevel linear regression analysis., Setting: This study was conducted in six municipalities from the State of Alagoas, Brazil., Participants: The participants were children aged 6-24 months who were assisted by the BFP., Results: A total of 1604 children were evaluated. Four DP were identified (DP1, DP2, DP3 and DP4). DP1 is composed of traditional Brazilian food. DP2 is formed mostly from ultra-processed foods (UPF). DP3 consists of milk (non-breast) with added sugar, while DP4 consists of fresh and minimally processed foods. Caregivers with higher age and education (β = -0·008; (95 % CI -0·017, -0·000); β = -0·037; (95 % CI -0·056, -0·018), respectively) were negatively associated with DP2. We observed a negative association between households with food insecurity (β = -0·204; (95 % CI -0·331, -0·078)) and DP4 and a positive association between caregivers with higher age and education (β = 0·011; (95 % CI (0·003; 0·019); β = 0·043; (95 % CI 0·025, 0·061), respectively) and DP4., Conclusion: This study identified the association between socio-economic inequities and DP early in life, with an early introduction of UPF, in children assisted by BFP in the State of Alagoas.

Objective: To evaluate the association between Fe deficiency anaemia (IDA) and complementary feeding in children under 2 years old assisted by the Conditional Cash Transfer programme, Bolsa Família (BFP)., Design: Cross-sectional study. Data were obtained through a standardised form, questionnaire to assess the eating habits of children under 2 years of age, capillary Hb (HemoCue®) and the Brazilian Household Food Insecurity Measurement Scale. Associations were calculated using hierarchical Poisson regression, adjusted at the last level by socio-economic, demographic and environmental variables from previous hierarchical levels., Setting: Six municipalities from the State of Alagoas, Brazil., Participants: Children aged 6-24 months assisted by BFP., Results: A total of 1604 children were evaluated, among whom 58·1 % had anaemia. A higher number of food groups consumed (prevalence ratio (PR) = 0·97; 95 % CI 0·95, 0·99; P = 0·009), the consumption of dairy (PR = 0·86; 95 % CI 0·79, 0·84; P = 0·001) and meat (PR = 0·90; 95 % CI 0·83, 0·99; P = 0·030) in addition to bottle feeding (PR = 0·88; 95 % CI 0·82, 0·96; P = 0·004) were associated with a lower prevalence of IDA., Conclusions: IDA is still a serious public health problem in children under 2 years old assisted by BFP in Alagoas. We highlight the importance of promoting complementary feeding based on a diversified dietary intake, as well strengthening prophylactic supplementation programmes to increase children's adherence in conjunction with the implementation of food and nutrition education to help reduce the prevalence of this condition.

Objective: To evaluate the association between the consumption of ultra-processed foods (UPF) and the practice of breast-feeding in children under 2 years of age assisted by the conditional cash transfer programme, Bolsa Família Programme (PBF)., Design: A cross-sectional study. The consumption of UPF and the practice of breast-feeding were assessed using a structured 24-h recall. Associations were calculated using hierarchical Poisson regression, adjusted at the last level by socio-economic, demographic and environmental variables from previous hierarchical levels., Setting: Six counties from the state of Alagoas, Brazil., Participants: Children aged 6-24 months, assisted by PBF., Results: A total of 1604 children were evaluated, 11·7% of whom were overweight, and most had consumed UPF (90·6%) in the last 24 h. The most consumed UPF were biscuits, chocolate milk and baby food with 74·8, 66·8 and 24·9%, respectively. Through multivariable analysis, an association was found between lower consumption of UPF in the continuation of breast-feeding until the second year of life (prevalence ratio (PR) 0·91, 95 % CI 0·86, 0·96) and in the first year of life (PR 0·93, 95 % CI 0·88, 0·99)., Conclusions: It was found that the studied population had a high consumption of UPF, which harmed continued breast-feeding. We highlight the importance of strengthening public policies aimed at the promotion, protection and support of breast-feeding and healthy complementary feeding aimed at populations that have difficulties in physical and economic access to a healthy and adequate diet.

This ecological study aimed to analyze the trend of the nutritional status of pregnant adolescent beneficiaries of the Brazilian Bolsa Família conditional cash transfer program in the 2008-2018 period. We evaluated secondary data of pregnant adolescent beneficiaries of the Bolsa Família Program from January 2008 to December 2018, extracted from the public reports of the WEB Food and Nutrition Surveillance System. We accessed the monitoring reports on the consolidated public-access health conditionalities of the Bolsa Família Program, always considering the second validity. An annual variation of -1.2% (95%CI: [-1.6; -0.8] p<0.01) was observed in the prevalence of underweight in Brazil in the studied sample. The prevalence of overweight and obesity in the country had annual variations of 2.9% (95%CI: [2.0; 3.7] p<0.01) and 7.5% (95%CI: [5.7; 9.3] p<0.01), respectively. We conclude by saying, that, in the evaluated period, the prevalence of underweight among pregnant adolescent beneficiaries of the Bolsa Família Program showed a decreasing trend, while the prevalence of overweight and obesity increased throughout Brazil.

The clinical and nutritional status of pregnant women are important variables for birth-weight risk inadequacies. Thus, this study sought to evaluate the nutritional status of high-risk pregnant women and its association with birth weight of their offspring. It involved a cross-sectional study with high-risk pregnant women assisted at the university hospital of Maceio in the State of Alagoas and their newborns. The nutritional status of pregnant women and their offspring was evaluated according to body mass index for gestational age and birth weight, respectively. The association between maternal factors (comorbidities and nutritional status) and birth weight was assessed by the chi-square test and Pearson correlation, by adopting a confidence level of 95%. One hundred and forty-nine pregnant women were studied, 19.7% of whom were of normal weight; 32% were underweight; and 48.3% were overweight. Among newborns, 39.6% referred to as small for gestational age (SGA); 26.8% appropriate for gestational age (AGA) and 33.6% large for gestational age (LGA). LGA offspring were associated with overweight and the presence of metabolic comorbidities and SGA offspring were associated with insufficient gestational weight gain, whereby interventions are needed to reduce these outcomes.

Objectives: Obesity is a multifactorial disease characterized by the presence of the pro-inflammatory state associated with the development of many comorbidities, including bone turnover marker alterations. This study aimed to investigate the role of the inflammatory state on bone turnover markers in obese adolescents undergoing interdisciplinary weight loss treatment for one year., Subjects and Methods: Thirty four post-pubescent obese adolescents with primary obesity, a body mass index (BMI) greater than > 95th percentile of the CDC reference growth charts, participated in the present investigation. Measurements of body composition, bone turnover markers, inflammatory biomarkers and visceral and subcutaneous fat were taken. Adolescents were submitted to one year of interdisciplinary treatment (clinical approach, physical exercise, physiotherapy intervention, nutritional and psychological counseling)., Results: Reduction in body mass, body fat mass, visceral and subcutaneous fat, as well as, an increase in the body lean mass and bone mineral content was observed. An improvement in inflammatory markers was seen with an increase in adiponectin, adiponectin/leptin ratio and inteleukin-15. Moreover, a positive correlation between the adiponectin/leptin ratio and osteocalcin was demonstrated. Further, both lean and body fat mass were predictors of osteocalcin. Negative associations between leptin with osteocalcin, adiponectin with Beta CTX-collagen, and visceral fat with adiponectin were observed., Conclusions: It is possible to conclude that the inflammatory state can negatively influence the bone turnover markers in obese adolescents. In addition, the interdisciplinary weight loss treatment improved the inflammatory state and body composition in obese adolescents. Therefore, the present findings should be considered in clinical practice.

Objective: Leptin is an adipokine released mainly by adipose tissue, with many functions including regulation of energy balance. However, little is known about the effect of LEPR polymorphism on orexigenic and anorexigenic neuropeptides. Thus, the aim of the present study is to verify the influence of LEPR polymorphism (rs2767485) on serum orexigenic (NPY, MCH and AgRP) and anorexigenic (Leptin and α-MSH) neuropeptides levels among obese adolescents submitted to 1year of multicomponent weight loss therapy., Methods: Seventy-six adolescents with obesity were enrolled in 1year of weight loss therapy including clinical, nutritional, psychological and exercise-related. Blood samples were collected to analyze neuropeptides (NPY, MCH, AgRP and leptin) and LEPR genotyping. Visceral fat was measured by ultrasound and body composition was measured by plethysmography. The parameters were measured at baseline and after one year. Adolescents were grouped according to genotype (TT or CT+CC group). Effect of the weight loss therapy was analyzed through ANOVA and Wilcox, according to normality. Statistic value was set at <0.05., Results: C-allele carriers have the orexigenic neuropeptides (NPY, AgRP and MCH) levels statistically higher when compared with TT group, at baseline. Furthermore, TT group seems to respond better to the therapy by a greater delta on BMI. Indeed, the data suggest a concomitant increased of AgRP levels in CT+CC genotypes, after weight loss therapy., Conclusion: Both groups responded to the weight loss intervention, however wildtypes (TT) appear to respond to the intervention most optimally with C carries, where post intervention reduction in BMI was significantly greater in wildtypes. The leptin receptor polymorphism seems to affect neuroendocrine regulation of energy balance among adolescents with obesity., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Objective: To determine if the treatment of stunted children offered at a specialized center influences their cognitive performance., Methods: Two groups of children from vulnerable families were selected, one consisting of stunted children being treated at the Nutrition Education and Recovery Center (CREN), and the other group of eutrophic children from a local, public day care center. At CREN, children are treated in a day-hospital system (9 hours/day, 5 days/week), receiving medical, nutritional and psycho-pedagogical support. All children were submitted to the Denver-II Development Screening Test and had their development and the height-for-age index assessed at 3 moments: at the beginning of the follow-up, and after 6 and 12 months. The socioeconomic status, according to the Brazilian Economic Classification Criteria, was assessed at the beginning of the follow-up. Data were treated by prevalence ratios for cross-sectional baseline analysis, using the Poisson regression, and by pooled prevalence ratios for longitudinal analysis, using a generalized equation estimation model, both adjusted by age, sex and economic status., Results: Seventy-four children were included, 37 for each group. There were no differences in age, sex and socioeconomic status between groups. In the longitudinal analysis, the CREN group showed better performance in the personal-social domain (pooled prevalence ratio: 0.89; 95% confidence interval - 95%IC 0.82-0.95), with no differences in the other domains., Conclusions: The treatment offered at CREN satisfactorily improved the social skills of the treated children, without changing other domains.

Objective: To assess the relationship between the degree of waist circumference (WC) and nonalcoholic fatty liver disease (NAFLD) in obese adolescents of both genders, analyzed according to quartiles of WC., Methods: Cross-sectional study that involved 247 obese adolescents aged 12-19 years. Mean values of the nutritional parameters and serum analyses were compared with the groups using the independent t-test. Pearson correlation coefficient was used to determine the relationship of the parameters studied. Chi-square test for trend was used to determine the relationship between the prevalence of the NAFLD and WC quartile by gender., Results: NAFLD were presented in 60% of the study participants. Obese adolescents in the 3rd and 4th quartiles of WC presented higher prevalence of NAFLD when compared with that in the 1st quartile in both genders. The NAFLD patients had significantly higher values for body weight, BMI (body mass index), BAZ-score (BMI-for-age z-scores), total fat (% and kg), WC, visceral fat, insulin, insulin resistance index (HOMA-IR), aspartate aminotransferase and alanine aminotransferase, when compared with non-NAFLD obese adolescents., Conclusions: The results presented here suggest that an increase in WC can reliably predict the risk of NAFLD in obese adolescents. This is a low cost and easy-to-use tool that can help in screening in adolescents., (Copyright © 2015 Sociedade de Pediatria de São Paulo. Publicado por Elsevier Editora Ltda. All rights reserved.)

Background: Perinatal undernutrition may lead to important metabolic adaptations in adult life, short stature being the most visible. The present study aimed to evaluate the association between stature and total energy expenditure of low-income women., Method: Women aged 19-45 years from low-income communities in Maceió-AL were recruited. A sample of 67 volunteers was selected and divided into either short stature (≤ 152.4 cm; n = 34) or non-short stature (≥ 158.7 cm; n = 33) group. Data on socioeconomic status, anthropometric variables, and hormonal profiles was collected. Total energy expenditure and body composition were assessed by the doubly labeled water technique with multiple points over 14 days. In addition, physical activity levels were measured with triaxial accelerometers and dietary intake data were collected using three 24-hour food records., Results: The mean subject age was 30.94 years. Women of short stature had lower body weight and lean body mass compared to non-short women, but there were no differences in thyroid hormone concentrations or daily energy intake between the two groups. Short-stature women showed lower total energy expenditure (P = 0.01) and a significantly higher physical activity level (P = 0.01) compared to non-short women. However, the difference in total energy expenditure was no longer significant after statistical adjustment for age, lean body mass, and triiodothyronine concentrations., Conclusion: Women with short stature present the same energy intake, but lower total energy expenditure than non-short women, even with a higher physical activity level, which suggests that they are more prone to weight gain.

Background: The low-grade inflammatory state in obesity leads to insulin resistance and endothelial dysfunction, which promote cardiovascular diseases in individuals with obesity. The purpose of this study was to evaluate the early effects of weight loss achieved through bariatric surgery on the inflammatory and prothrombotic states. This study also aimed to identify the role of hyperleptinemia on the prothrombotic state., Methods: The sample was composed of 41 extremely obese who underwent Roux-en-Y gastric bypass (RYGB). Anthropometric and clinical data, and biochemical markers of inflammation were collected prior to surgery and 6 months post-RYGB., Results: It was found that plasminogen activator inhibitor-1 (PAI-1) concentrations were higher among extremely obese individuals with hyperleptinemia than in those without hyperleptinemia (p < 0.01).In relation to the baseline, post-surgery body mass index (BMI) was reduced by 12.9 kg/m(2), corresponding to 63.50 % of excess weight loss. Additionally, waist circumference was found to decrease significantly from 126.2 to 101.4 cm. Plasma total cholesterol (p < 0.01), LDL cholesterol (p = 0.02), triglycerides (p < 0.01), and glucose (p = 0.01) were also found to decrease. Pro-inflammatory biomarkers were observed to decrease: PAI-1 by 55.9 ± 6.0 % (p < 0.01), C-reactive protein (CRP) by 18.8 ± 3.4 % (p < 0.01), intercellular adhesion molecule-1 (ICAM-1) by 89.9 ± 5.7 % (p < 0.01), leptin by 27.9 ± 3.2 % (p < 0.01), and resistin by 69.3 ± 5.8 % (p < 0.01). Additionally, significant decreases of tumor necrosis factor alpha (TNF-α) and leptin/adiponectin ratio were observed. Anti-inflammatory cytokines adiponectin and interleukin-10 (IL-10) were significantly increased (170.7 ± 82.5 %, p < 0.01; 122.7 ± 55.1 %, p = 0.02). CRP levels were predictive of ICAM-1 (p = 0.04), and changes in leptin concentrations were associated with decreased PAI-1 levels (p = 0.03)., Conclusions: We observed that individuals with obesity that have hyperleptinemia have higher circulating PAI-1 levels, which could indicate increased risk for cardiovascular disease. The biomarkers of inflammation and thrombosis measured in this study decreased after RYGB, suggesting that the surgery may be effective in reducing pro-inflammatory and thrombotic risk in individuals with extreme obesity.

Objective: Augmented waist circumference (WC) is associated with non-communicable diseases and could represent a valuable marker in screening for metabolic dysfunctions in subjects with insufficient linear growth. The objective of the present study was to determine whether biochemical and hemodynamic parameters and waist circumference vary between mildly-stunted and non-stunted adolescents from impoverished communities of São Paulo, Brazil., Methods: The cross-sectional study involved 206 subjects, aged between 9 and 19 years and living in impoverished areas of São Paulo, Brazil. The sample population was divided according to height-for-age Z-score (HAZ) into stunted (-1 > HAZ ≥ -2) and non-stunted (HAZ ≥ -1) groups, and was sub-divided according to gender. Logistic regression analysis was employed to compare individuals with elevated (> 75th percentile) insulin concentrations. The receiver operating characteristic curves were constructed to determine WC cut-off points that could be used to identify stunted and non-stunted individuals with elevated insulin concentrations., Results: WC cut-off points of 58.25cm and 67.2cm allowed for correct classification of 90.7% of stunted and 88.7% of non-stunted individuals in the studied population. While the sensitivity of the model was high for stunted and non-stunted subjects (98.8% and 97.2%, respectively), the specificity was modest (57.1% and 41.2%, respectively)., Conclusion: The results presented herein suggest that an increase in plasma insulin is one of the primary metabolic modifications in stunted individuals, and that this alteration could be identified at a lower WC cut-off point than in non-stunted counterparts., (Copyright © 2014 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.)

Background: The regulation of energy balance is influenced by physical exercise. Although some studies show a stimulation of hormones related to food intake, others show that exercise provides satiety., Aim: The aim of this study was to compare the effects of aerobic training (AT) and aerobic plus resistance training (AT+RT) on anorexigenic and orexigenic factors in obese adolescents undergoing interdisciplinary weight loss therapy., Methods: A total of 26 obese adolescents, aged 15-19 years with BMI≥P95 were submitted to 12 months of interdisciplinary intervention (clinical support, nutrition, psychology and physical exercise) and divided into two groups, aerobic training (AT) (n=13) or aerobic plus resistance training (AT+RT) (n=13), which were matched according to gender and body mass. Blood samples were collected to analyze orexigenic factors (AgRP, NPY, MCH) and the anorexigenic factor alpha-MSH., Results: The AT and AT+RT groups significantly reduced body mass, body mass index and body fat mass (kg) during the therapy. The AT group showed no significant changes in body lean mass (kg), whereas the AT+RT group showed an increase in body lean mass (kg) during the interdisciplinary intervention. There was an increase in AgRP levels (ng/ml) only in the AT+RT group after 6 months of interdisciplinary intervention compared with baseline condition. Conversely, α-MSH levels (ng/ml) increased only in the AT group after 12 months of interdisciplinary intervention compared with baseline condition., Conclusion: Aerobic training (AT) as part of an interdisciplinary therapy is more effective than aerobic plus resistance training (AT+RT) to improve secretion of anorexigenic/orexigenic factors in obese adolescents., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Background: Studies have shown that pre/postnatal undernutrition leads to higher risk of non communicable diseases such as diabetes, hypertension and obesity in adulthood., Objective: To determine whether overweight adolescents with mild stunting [height-for-age Z scores (HAZ) in the range <-1 to ≥ -2] have higher blood pressure than overweight individuals with normal stature (HAZ ≥ -1)., Methods: Participants were classified as mildly stunted or of normal stature, and further stratified according to body mass index-for-age percentiles as overweight, normal or underweight. Systolic (SBP) and diastolic (DPB) blood pressures were determined according to guidelines, and abdominal fat was analyzed by dual energy X-ray absorptiometry., Results: Mild stunted overweight individuals showed higher DBP values (p=0.001) than their underweight counterparts (69.75 ± 12.03 and 54.46 ± 11.24 mmHg, respectively), but similar to those of normal BMI. No differences were found in DBP values of normal, overweight and underweight individuals among the normal stature groups. An increase in SBP (p=0.01) among mild stunted individuals was found when those with overweight were compared to their underweight and normal BMI counterparts (114.70 ± 15.46, 97.38 ± 10.87 and 104.72 ± 12.24 mmHg, respectively). Although no differences were observed in the means of SBP between mild stunting and normal stature groups, a significant intercept was found (p=0.01), revealing higher SBP among stunted individuals. There was a correlation between SBP and abdominal fat (r=0.42, ρ=0.02) in the stunted group., Conclusion: Stunted individuals with overweight showed higher SBP than those of normal stature and overweight. These findings confirm that mild stunting increase the risk of future hypertension and alterations are evident at early age.

Objective: To test if individuals having height-for-age z scores between -2 and -1 present higher body fat percentage and, therefore, should not be categorized as having normal nutritional status., Methods: The study involved 96 individuals (52 boys and 44 girls); 57% of whom had already attained puberty. Body composition was analyzed by dual energy X-ray absorptiometry., Results: The percentage of abdominal body fat in pre-pubertal stunted girls was higher (27.4%; p = 0.01) in comparison with their non-stunted counterparts (20.6%). Similar differences in abdominal fat content (%) were observed for pubertal stunted and non-stunted girls and boys (37.6 and 29.8%, respectively, p = 0.01; 24.6 and 15.7%, p = 0.01, respectively). The percentages of total body fat percent in pre-pubertal stunted girls and pubertal stunted boys (29.9 and 24.5%, p = 0.03; 26.3 and 18.1%, p = 0.01, respectively) were higher than those of their non-stunted counterparts. Non-stunted groups showed lower waist circumferences., Conclusion: Adolescents with mild stunting exhibit alterations in body composition indicating increased risk of metabolic diseases.

Purpose. To evaluate glucose and insulin profiles in adolescents with mild stunting and overweight in order to assess the possibility of increased predisposition to diabetes. Subjects and Methods. The study population consisted of 66 pubertal adolescents classified as mildly stunted (height-for-age z scores ≥-2 and <-1) or of normal stature, as well as overweight (body mass index ≥85th percentile) or normal weight. Beta-cell function and insulin resistance were evaluated according to the homeostasis model assessment (HOMA). Results. In the group with mild stunting, glucose, insulin, and HOMA-IR levels were significantly higher in overweight adolescents compared with those of normal weight, whereas HOMA-B levels were significantly lower. Adolescents with mild stunting showed significantly higher accumulations of body and abdominal fat than their normal stature counterparts. Conclusions. The presence of mild stunting was associated with higher levels of glucose and insulin, diminished function of beta cells, and increased insulin resistance. These results reinforce the need for intervention in adolescents with mild stunting.

Incidence of work-related accidents in Botucatu, São Paulo, Brazil, was estimated according to gender, age, employment status, occupation, and type of work. A household survey was conducted by systematic random group sampling (195 census tracts). Information was collected from all residents 10 years or older in each household. Of those who had worked during the 90 days prior to the interview, we obtained information on occupation, job position, and employment contract. The study included 9,626 households (sample fraction 0.26). The proportion of non-fatal work accidents in the municipal area was 3.3% (95%CI: 2.7-3.9), higher for men 4.5% (95%CI: 3.6-5.5) and varying with type of employment contract and occupation. Compared to results from previous studies, we observed a decline in work-related accident risk.

Objective: To assess whether exposure to occupational noise is an important risk factor for work-related injuries., Methods: A population-based case-control study was performed. Data collection was carried out from May 16, 2002 to October 15, 2002 in the city of Botucatu, southeast Brazil. Cases were defined as workers who had suffered typical work-related injuries in a 90-day period previously to the study, and who identified through systematic random sampling of their households. Controls were non-injured workers randomly sampled from the same population, matched on 3:1 ratio according to sex, age group and census track. A multiple logistic regression model was adjusted, where the independent variable was exposure to occupational noise, controlled for covariates of interest., Results: A total of 94 cases and 282 controls were analyzed. An adjusted multiple regression model showed that "work always exposed to high-level noise" and "work sometimes exposed to high-level noise" were associated to a relative risk for work-related injuries of about 5.0 (95% CI: 2.8-8.7; p<0.001) and 3.7 (95% CI: 1.8-7.4; p=0.0003) respectively, when work not exposed to noise was taken as a reference, controlled for several covariates., Conclusions: Based on the study findings, investing in hearing conservation programs, particularly those for controlling noise emission at its source, is justifiable aiming at both hearing health maintenance and reduction of work-related injuries.

Objective: The implementation of work-related injury prevention policies has been hindered by underreporting of incidents among formal workers, and substantial underreporting among informal workforce. This study aimed at estimating the underreporting of work-related injury in a median-sized city., Methods: A random survey was carried out among residences in the urban area of Brazil. Residents were interviewed about the occurrence of work-related injury to people aged more than nine years in the last 90 days. All incidents reported were double checked in the National Social Security Institute (INSS) records., Results: There were 9,626 residences visited. It was estimated 79.5% (CI 95%: 78.8%-80.3%) of underreporting of work-related injury., Conclusions: Work-related injury reporting is poor in the study location and this may be occurring in other cities. Data suggest the need to build up information systems on Brazilian workers' health. It should incorporate methods, materials and human recourses necessary to recognize, store, analyze, and spread information to support injury prevention policies and promote workers' health programs.