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Taste perception plays a key role in determining individual food preferences and dietary habits and may influence nutritional status. This study aimed to investigate the association of TAS1R2 (Ile191Val - rs35874116) and TAS1R3 (-1266 C/T - rs35744813) variants with food intake and nutritional status in children followed from birth until 7.7 years old. The nutritional status and food intake data of 312 children were collected at three developmental stages (1, 3.9 and 7.7 years old). DNA was extracted from blood samples and the polymorphisms were analyzed by real-time polymerase chain reactions (qPCR) using hydrolysis probes as the detection method. Food intake and nutritional status were compared among individuals with different single nucleotide polymorphism (SNP) genotypes. At 3.9 years old, children homozygous (Val/Val) for the TAS1R2 Ile191Val polymorphism ingested less sugar and sugar-dense foods than children who were *Ile carriers. This finding demonstrated that a genetic variant of the T1R2 taste receptor is associated with the intake of different amounts of high sugar-content foods in childhood. This association may provide new perspectives for studying dietary patterns and nutritional status in childhood.

Background Early-life dental service utilization could improve child dental health. Aim Identify contextual, socioeconomic, and child characteristics associated with dental visitation by age 3 years. Design Within a Brazilian birth cohort (N = 435), multivariable regression models were fitted to identify independent predictors of having made a dental visit at age 3 years. Contextual variables considered included health center type (Traditional vs. Family Health Strategy, which perform home visits) and composition of oral health teams at the heath center where mothers accessed prenatal care. Results Dental visitation was positively associated with Family Health Strategy health centers (36% vs. 23%) and with higher maternal education and family social class. Visitation was lowest among families served by a health center without a dentist, but number of dentists and oral health team composition were not associated with visitation among facilities with ≥1 dentists. Dental visitation was not statistically significantly associated with caries experience but was higher if parents reported worse oral health-related quality of life. The vast majority of dental decay remained untreated. Conclusions Dental visits were underutilized, and socioeconomic inequalities were evident. Dental visitation was more common when mothers received prenatal care at Family Health Strategy health centers, suggesting a possible oral health benefit.

The reward sensation after food intake may be different between individuals and variants in genes related to the dopaminergic system may indicate a different response in people exposed to the same environmental factors. This study investigated the association of Taq IA (rs1800497) and -141C InsDel (rs1799732) variants in DRD2/ANKK1 gene with food intake and adiposity parameters in a cohort of children. The sample consisted of 270 children followed until 7 to 8 years old. DNA was extracted from blood and polymorphisms were detected by PCR-RFLP analysis. Food intake and nutritional status were compared among individuals with different SNP genotypes. Children carrying the A1 allele ( Taq IA) had higher energy of lipid dense foods (LDF) when compared with A2/A2 homozygous children at 7 to 8 years old (GLM p =0.004; Mann Whitney p =0.005). No association was detected with -141C Ins/Del polymor- phism. To our knowledge, this is the first association study of the DRD2 Taq IA and -141C Ins/Del polymorphism with food intake and anthropometric parameters in children. DRD2 Taq IA polymorphism has been associated with a re- duction in D 2 dopamine receptor availability. Therefore, the differences observed in LDF intake in our sample may oc - cur as an effort to compensate the hypodopaminergic functioning

Objective: To investigate the impact of excessive maternal weight on the early discontinuation of exclusive breastfeeding Methods: This is a longitudinal study including mother-infant dyads of low socioeconomic status receiving prenatal care in Health Care Centers in Porto Alegre, Rio Grande do Sul, Brazil. A structured questionnaire was administered to women in the last trimester of pregnancy, including weight measurements. Another interview was conducted six months after delivery, and data on infant feeding practices were collected and maternal height was measured. Maternal nutritional status was assessed using body mass index values according to gestational age. Discontinuation of exclusive breastfeeding before 4 months was considered a low duration rate Results: A total of 619 mother-infant dyads were evaluated. The prevalence of maternal overweight in the third trimester of pregnancy was 51%. The median duration of exclusive breastfeeding was 2.0 months. After adjustment for possible confounding factors, no association between maternal overweight and early discontinuation of exclusive breastfeeding was identified. Maternal smoking was identified as a risk factor (1.23, 95%CI=1.13-1.35) for early discontinuation of exclusive breastfeeding Conclusion: Excessive maternal weight was not confirmed as a risk factor for early discontinuation of exclusive breastfeeding. However, women who reported being smokers had a higher risk of early discontinuation of exclusive breastfeeding than those who did not smoke. This indicates the need for public health interventions to promote smoking cessation during pregnancy and in the postpartum period because of the deleterious effects of this habit on maternal and infant health.

BackgroundDiet- and physical activity-based interventions in pregnancy have the potential to alter maternal and child outcomes.ObjectivesTo assess whether or not the effects of diet and lifestyle interventions vary in subgroups of women, based on maternal body mass index (BMI), age, parity, Caucasian ethnicity and underlying medical condition(s), by undertaking an individual patient data (IPD) meta-analysis. We also evaluated the association of gestational weight gain (GWG) with adverse pregnancy outcomes and assessed the cost-effectiveness of the interventions.Data sourcesMEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects and Health Technology Assessment database were searched from October 2013 to March 2015 (to update a previous search).Review methodsResearchers from the International Weight Management in Pregnancy Collaborative Network shared the primary data. For each intervention type and outcome, we performed a two-step IPD random-effects meta-analysis, for all women (except underweight) combined and for each subgroup of interest, to obtain summary estimates of effects and 95% confidence intervals (CIs), and synthesised the differences in effects between subgroups. In the first stage, we fitted a linear regression adjusted for baseline (for continuous outcomes) or a logistic regression model (for binary outcomes) in each study separately; estimates were combined across studies using random-effects meta-analysis models. We quantified the relationship between weight gain and complications, and undertook a decision-analytic model-based economic evaluation to assess the cost-effectiveness of the interventions.ResultsDiet and lifestyle interventions reduced GWG by an average of 0.70 kg (95% CI –0.92 to –0.48 kg; 33 studies, 9320 women). The effects on composite maternal outcome [summary odds ratio (OR) 0.90, 95% CI 0.79 to 1.03; 24 studies, 8852 women] and composite fetal/neonatal outcome (summary OR 0.94, 95% CI 0.83 to 1.08; 18 studies, 7981 women) were not significant. The effect did not vary with baseline BMI, age, ethnicity, parity or underlying medical conditions for GWG, and composite maternal and fetal outcomes. Lifestyle interventions reduce Caesarean sections (OR 0.91, 95% CI 0.83 to 0.99), but not other individual maternal outcomes such as gestational diabetes mellitus (OR 0.89, 95% CI 0.72 to 1.10), pre-eclampsia or pregnancy-induced hypertension (OR 0.95, 95% CI 0.78 to 1.16) and preterm birth (OR 0.94, 95% CI 0.78 to 1.13). There was no significant effect on fetal outcomes. The interventions were not cost-effective. GWG, including adherence to the Institute of Medicine-recommended targets, was not associated with a reduction in complications. Predictors of GWG were maternal age (summary estimate –0.10 kg, 95% CI –0.14 to –0.06 kg) and multiparity (summary estimate –0.73 kg, 95% CI –1.24 to –0.23 kg).LimitationsThe findings were limited by the lack of standardisation in the components of intervention, residual heterogeneity in effects across studies for most analyses and the unavailability of IPD in some studies.ConclusionDiet and lifestyle interventions in pregnancy are clinically effective in reducing GWG irrespective of risk factors, with no effects on composite maternal and fetal outcomes.Future workThe differential effects of lifestyle interventions on individual pregnancy outcomes need evaluation.Study registrationThis study is registered as PROSPERO CRD42013003804.FundingThe National Institute for Health Research Health Technology Assessment programme.

Objective: To evaluate factors associated with low consumption of fruits and vegetables among preschoolers from families treated at basic health centers in Porto Alegre, RS, Brazil. Methods: This was a cohort study nested in a randomized field trial. Data collection was performed through structured questionnaires to obtain demographic and dietary data, combined with two 24-hour recalls in the age groups 12–16 months and again at 2–3 years of age. Data on the consumption of one daily serving of fruits (80 g) and vegetables (60 g) were evaluated, as well as consumption of non-recommended foods such as candy, chocolate, and soft drinks. Statistical analyses were performed using Poisson regression with robust estimation. Results: A total of 388 children aged 2-3 years were evaluated; of these, 58% and 87.4% did not consume one daily serving of fruits and vegetables, respectively. The following factors were negatively associated with fruit consumption: family income higher than four minimum wages, (p = 0.024), lower paternal educational level (p = 0.03), and lower fruit consumption at 12–16 months (p = 0.002). Factors negatively associated with the consumption of vegetables were low paternal educational level (p = 0.033) and consumption of high-sugar content beverages at 12–16 months (p = 0.014). Conclusion: This study demonstrated a high prevalence of children who consumed less than one daily serving of fruit and vegetables; early feeding practices, parental education, and family income were associated with this process. Resumo: Objetivo: Avaliar os fatores associados ao baixo consumo de frutas e verduras entre pré-escolares de famílias usuárias da rede básica de saúde de Porto Alegre, RS, Brasil. Métodos: Estudo de coorte aninhado a ensaio de campo randomizado. A coleta de dados foi feita por meio de questionários estruturados para obtenção de dados dietéticos e sociodemográficos, além de dois recordatórios de 24 horas nas faixas etárias de 12–16 meses e novamente aos 2-3 anos de idade. Foram avaliados os dados de consumo de uma porção diária de frutas (80 g) e verduras (60 g), além de consumo de alimentos não recomendados, como balas, chocolates e refrigerantes. As análises estatísticas foram feitas por regressão de Poisson com estimativa robusta. Resultados: Foram avaliadas 388 crianças de 2-3 anos, destas 58% e 87,4% não consumiram uma porção de frutas e verduras, respectivamente. Os fatores que se mostraram negativamente associados ao consumo de frutas foram: renda familiar superior a 4 salários mínimos, (p = 0,024), menor escolaridade paterna (p = 0,03) e menor consumo de frutas aos 12–16 meses (p = 0,002). Os fatores negativamente associados à ingestão de verduras foram a menor escolaridade paterna (p = 0,033) e consumo de refrigerante aos 12–16 meses (p = 0.014). Conclusão: Os resultados deste estudo mostraram alta prevalência de crianças que consumiram menos de uma porção de frutas e verduras ao dia e sugerem que práticas alimentares precoces, escolaridade paterna e renda estão associadas a esse processo. Keywords: Preschooler, Food consumption, Fruits, Vegetables, Palavras-chave: Pré-escolar, Consumo de alimentos, Frutas, Verduras

OBJETIVO: Avaliar se a mudança no escore Z do índice de massa corpórea por idade >0,67 no primeiro ano de vida se associou ao excesso de peso na idade pré-escolar. MÉTODOS: Estudo de coorte aninhado a ensaio de campo randomizado realizado na cidade de São Leopoldo, no Rio Grande do Sul. Foram coletados dados de peso e estatura das crianças ao nascimento, dos seis aos oito meses e dos 12 aos 16 meses. Aos três e aos quatro anos, além destes dados aferiu-se a circunferência da cintura. Calculou-se o ganho de peso pela diferença no escore Z do índice de massa corpórea/idade dos 12 até os 16 meses em relação ao índice de massa corpórea/idade ao nascimento, adotando-se ponto de corte >0,67 para ganho de peso excessivo. A relação cintura/estatura foi realizada, considerando-se excesso de adiposidade central se valores >0,5. Utilizou-se a análise multivariada para o teste da associação entre os desfechos e as variáveis independentes. RESULTADOS: A prevalência do ganho de peso excessivo no primeiro ano de vida foi de 29,5% de um total de 338 crianças. Após ajuste para as variáveis sexo, grupo, peso ao nascer, tempo de aleitamento materno exclusivo e índice de massa corpórea da mãe, a mudança no escore Z >0,67 do nascimento até os 12 a 16 meses apresentou-se como fator de risco para o excesso de peso (RR 2,81; IC95% 1,53-5,16) e elevada relação cintura/altura na idade pré-escolar (RR 2,10; IC95% 1,19-3,72). CONCLUSÕES: O ganho de peso excessivo no primeiro ano de vida está associado ao excesso de peso e à elevada adiposidade abdominal na idade pré-escolar.OBJETIVO: Evaluar si el cambio en el escore Z del Índice de Masa Corporal (IMC) por edad >0,67 en el primer año de vida se asoció al exceso de peso en la edad pre-escolar. MÉTODOS: Estudio de cohorte aunado a ensayo de campo aleatorio realizado en la ciudad de São Leopoldo (Rio Grande do Sul). Se recogieron datos de peso y estatura de los niños al nacer, 6 a 8 y 12 a 16 meses. A los 3 a 4 años de edad, se verificó también la circunferencia de la cintura. Se calculó la ganancia de peso por la diferencia en el escore Z de IMC/Edad a los 12 a 16 meses respecto al IMC/Edad al nacer, adoptando punto de corte >0,67 para ganancia de peso excesiva. Relación cintura/estatura fue realizada, considerando exceso de adiposidad central valores >0,5. Se utilizó el análisis multivariado para probar la asociación entre los desenlaces y las variables independientes. RESULTADOS: La prevalencia de ganancia de peso excesiva en el primer año de vida fue de 29,5% de un total de 338 niños. Después del ajuste para las variables sexo, grupo, peso al nacer, tiempo de lactancia materna exclusiva e IMC de la madre, el cambio en el escore z >0,67 del nacimiento hasta los 12 a 16 meses se presentó como factor de riesgo para excesos de peso (RR 2,81; IC95% 1,53-5,16) y elevada relación cintura/altura en la edad pre-escolar (RR 2,10; IC95% 1,19-3,72). CONCLUSIÓN: Ganancia de peso excesivo en el primer año de vida está asociada a exceso de peso y elevada adiposidad abdominal en la edad pre-escolar.OBJECTIVE: To assess whether the change in body mass index Z-score for age >0.67 in the first year of life was associated with overweight at preschool age. METHODS: A cohort study nested in a randomized field trial conducted in São Leopoldo, Rio Grande do Sul, Southern Brazil. Data on weight and height of children at birth, from six to eight, and from 12 to 16 months were collected. From ages three to four, besides these data, waist circumference was measured. Weight gain was calculated by the difference in body mass index/age Z-score from 12 to 16 months in relation to that at birth, adopting as cutoff >0.67 Z-score for weight gain. Waist-to-height ratio was calculated, and the excess of central adiposity was considered for values >0.5. Multivariate analysis to test the association between outcomes and independent variables was applied. RESULTS: The prevalence of excessive weight gain in the first year of life was 29.5% out of the 338 studied children. After adjustment for gender, origin group, birth weight, duration of exclusive breastfeeding and mother's body mass index, the change in >0.67 Z-score from birth to 12 to 16 months was an independent risk factor for overweight (RR 2.81, 95%CI 1.53-5.16) and for elevated waist-to-height ratio (RR 2.10, 95%CI 1.19-3.72) in preschool age. CONCLUSIONS: Excessive weight gain in the first year of life was associated with overweight and high abdominal adiposity at preschool age.

OBJETIVO: Investigar a adequação das práticas alimentares no primeiro ano de vida e seus fatores associados na cidade de Porto Alegre (RS). MÉTODOS: Este estudo transversal foi realizado durante a Campanha Nacional de Imunização no ano de 2008. Utilizou-se amostragem por conglomerados em dois estágios e foram avaliadas 1.099 crianças menores de um ano de idade, em 31 postos de vacinação. A coleta de dados consistiu da aplicação de questionário estruturado sobre características maternas, uso de chupeta, consumo de leite materno, de leites artificiais, chá, água, alimentos complementares e de alimentos de baixo valor nutricional pelas crianças. Para estimar a associação entre variáveis maternas, uso de chupeta e práticas alimentares, foram utilizadas análises de regressão logística. RESULTADOS: A prevalência de aleitamento materno exclusivo foi de 47,1% entre as crianças com até quatro meses de vida e de 21,4% entre as crianças entre quatro e seis meses. A frequência de aleitamento materno exclusivo foi maior entre as crianças que não usavam chupeta, que não eram primogênitas e cujas mães não trabalhavam fora de casa ou estavam em licença maternidade. Melhores práticas de alimentação complementar foram observadas em crianças cujas mães tinham maior nível de escolaridade e trabalhavam fora de casa. CONCLUSÃO: Este estudo mostrou a existência de fatores de risco para a interrupção precoce do aleitamento materno exclusivo e o consumo de alimentos inadequados aos lactentes. OBJECTIVE: The present study aimed to investigate the adequacy of feeding practices in the first year of life and associated factors in the city of Porto Alegre (RS). METHODS: This cross-sectional study was performed during the national vaccination campaign in 2008. Two-stage cluster sampling was used and 1,099 children under one year of age were evaluated at 31 vaccination sites. Maternal and breastfeeding data and the use of pacifiers, infant formulas, tea, water, complementary foods and low-nutrient foods were investigated using a structured questionnaire. Logistic regression analyses were used to estimate the association between maternal characteristics, use of pacifiers and infant feeding practices. RESULTS: The prevalence of exclusive breastfeeding was 47.1% in children aged up to four months and 21.4% in children aged four to six months. The prevalence of exclusive breastfeeding was higher in children who did not use pacifiers, who were not firstborns and whose mothers were on maternity leave or not employed. Better complementary feeding practices were observed among employed mothers with higher education level. CONCLUSION: This study evidenced the existence of risk factors for early discontinuation of exclusive breastfeeding and inappropriate feeding practices.

OBJETIVO: Avaliar a prevalência de anemia, deficiência de ferro e anemia por deficiência de ferro em uma coorte de crianças. MÉTODOS: Estudo de coorte aninhado a um ensaio de campo randomizado. As crianças foram selecionadas ao nascimento na maternidade do único hospital público da cidade de São Leopoldo (RS), Brasil. O presente estudo avaliou o estado nutricional de ferro (hemoglobina e ferritina sérica) quando essas crianças apresentavam idade de 12-16 meses e, posteriormente, na idade de 3-4 anos. A anemia foi definida pela concentração de hemoglobina < 11,0 g/dL; a deficiência de ferro, por ferritina sérica < 15,0 µg/L; e a anemia por deficiência de ferro, pela presença de concentrações de hemoglobina < 11,0 g/dL com deficiência de ferro. RESULTADOS: Na idade de 12-16 meses, a prevalência geral de anemia, deficiência de ferro e anemia por deficiência de ferro foi de 63,7, 90,3 e 58,8%, respectivamente. Esses valores, para a faixa etária de 3-4 anos, foram de 38,1, 16,1 e 7,4%, respectivamente. Na idade de 12-16 meses, 95% dos casos de anemia foram associados à deficência de ferro, e na idade de 3-4 anos, apenas 19,3% dos casos. CONCLUSÕES: Observou-se que a deficiência de ferro foi a principal causa da anemia no segundo ano de vida, porém não na idade de 3-4 anos. Assim, enfatiza-se que a anemia em crianças de idade pré-escolar pode ter outras etiologias e merece avaliações cuidadosas.

A reconhecida relevância da anemia por deficiência de ferro, em termos de saúde pública, decorre não apenas da magnitude de sua ocorrência, mas, principalmente, dos efeitos deletérios que ocasiona à saúde da criança. Com o objetivo de investigar as práticas alimentares no primeiro ano de vida e sua associação com a deficiência de ferro, realizou-se revisão da literatura científica nacional e internacional sobre a questão, selecionando os artigos mais relevantes. Crianças que nascem atermo e com peso adequado, ao receberem o leite materno de forma exclusiva suprem suas necessidades de ferro, sendo desnecessário qualquer complemento nos primeiros seis meses de vida. Próximo aos seis meses de idade ocorre gradualmente o esgotamento das reservas de ferro e a alimentação complementar passa a ter papel predominante no atendimento às necessidades desse nutriente. O papel do aleitamento materno na ocorrência da deficiência de ferro é ainda controverso e parece depender do país, região e tipo de leite utilizado em substituição ao leite materno. Na impossibilidade da continuidade do aleitamento materno, a substituição deste por leite de vaca aumenta o risco de a criança apresentar deficiência de ferro. Práticas complementares que comprovadamente contribuem com a prevenção da deficiência de ferro são: alimentação complementar com alta biodisponibilidade de ferro, alimentos fortificados e suplemento de ferro em doses profiláticas. Dieta com alta biodisponibilidade de ferro é aquela que contém os alimentos básicos da família, desde que saudáveis, com a presença de carne, vitamina A e vitamina C. A alimentação no primeiro ano de vida tem papel importante na prevenção da anemia por deficiência de ferro e, para sua adequada implementação, é necessário que suas diretrizes sejam adotadas como rotina nas unidades básicas de saúde.The well-known relevance of iron deficiency anemia for public health derives not only from its prevalence, but mainly from its harmful effects on child health. In order to investigate feeding practices in the first year of life and their association with iron deficiency, domestic and international scientific articles were reviewed and the most relevant articles were selected. Children born at term and with appropriate birth weight get all the iron they need from exclusive breastfeeding, with complementary foods of any kind being unnecessary in the first six months of life. At about six months of life, the iron reserves are gradually depleted and complementary foods take on a predominant role in meeting the iron requirement. The role of breastfeeding in the occurrence of iron deficiency is still debated, and appears to depend on the country, region and type of milk used to replace breast milk. The replacement of breast milk with cow's milk increases the risk of the child developing iron deficiency. Complementary practices that have been proven to contribute to the prevention of iron deficiency are complementary foods high in bioavailable iron, enriched foods and iron supplementation in prophylactic doses. A diet high in iron bioavailability is that which contains the staple foods of the family, as long as they are healthy, with the presence of meat, vitamin A and vitamin C. The foods consumed in the first year of life have an important role in the prevention of iron deficiency anemia, and their correct implementation depends on guidelines that should be adopted as standard practice by primary healthcare units.

OBJETIVO: Avaliar a freqüência com que os adolescentes assistem televis��o na região Sul do Brasil e quais fatores estão associados a esse comportamento. MÉTODOS: Estudo transversal, com 722 adolescentes entre 10 e 19 anos. Foi calculado a média de horas diárias que os adolescentes assistiam televisão. Foi realizada análise de regressão logística para analisar possível associação entre fatores sociodemográfico, antropométricos, atividade física, sexo e idade, com o hábito de assistir mais do que 4 horas diárias de televisão. RESULTADOS: Entre os adolescentes estudados, 41,1% assistiam mais do 4 horas de TV por dia. A prevalência de adolescentes que assistiam > 4h de TV foi maior entre aqueles com menos de 16 anos. Ser filho de mãe com escolaridade maior do que 8 anos (OR 1,9; IC 1,25-2,89) e possuir circunferência da cintura maior do que o percentil 80 (OR 2,77; IC 1,33-5,77) foi positivamente associado ao hábito de assistir televisão mais do que 4 horas diárias. CONCLUSÕES: Maior escolaridade materna e circunferência da cintura maior do que o percentil 80 estão associados ao comportamento de assistir TV em excesso entre os adolescentes. Esses achados devem ser utilizados para direcionar a elaboração de programas de saúde pública, especialmente por meio das escolas, enfocando adolescentes com faixa etária entre 10 e 15 anos, assim como devem servir de alerta para os profissionais de saúde e educadores.OBJECTIVE: to evaluate the frequency adolescents watch TV in southern Brazil and which factors are associated with this behavior. METHODS: This was a cross-sectional study. The sample consisted of 722 adolescents between 10 and 19 years of age. Logistic regression analysis was used to verify association between socio-demographic and anthropometric factors, physical activity, age and sex with the adolescents who watched TV for more than four daily hours. RESULTS: Forty-one percent of the adolescents watched more than four daily hours of TV. The prevalence of adolescents who excessively watched TV was higher among those under 16 yr of age (PR 1.92; CI 1.33-2.78). Having a mother with higher educational background (PR 1.51; CI 1.08-2.11), and having waist circumference above 80 percentile (PR 1.63; CI 1.09-2.44) were positively associated with the habit of watching more than 4 hours/day of television. CONCLUSIONS: Higher mother educational background and higher waist circumference are associated with excessive television watching. These results can be useful to create health programs at schools, focusing adolescents between 19 and 15 years old.

Pregnant women who gain excess weight are at risk of complications during pregnancy and in the long term. Interventions based on diet and physical activity minimise gestational weight gain with varied effect on clinical outcomes. The effect of interventions on varied groups of women based on body mass index, age, ethnicity, socioeconomic status, parity, and underlying medical conditions is not clear. Our individual patient data (IPD) meta-analysis of randomised trials will assess the differential effect of diet- and physical activity-based interventions on maternal weight gain and pregnancy outcomes in clinically relevant subgroups of women.Randomised trials on diet and physical activity in pregnancy will be identified by searching the following databases: MEDLINE, EMBASE, BIOSIS, LILACS, Pascal, Science Citation Index, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects, and Health Technology Assessment Database. Primary researchers of the identified trials are invited to join the International Weight Management in Pregnancy Collaborative Network and share their individual patient data. We will reanalyse each study separately and confirm the findings with the original authors. Then, for each intervention type and outcome, we will perform as appropriate either a one-step or a two-step IPD meta-analysis to obtain summary estimates of effects and 95% confidence intervals, for all women combined and for each subgroup of interest. The primary outcomes are gestational weight gain and composite adverse maternal and fetal outcomes. The difference in effects between subgroups will be estimated and between-study heterogeneity suitably quantified and explored. The potential for publication bias and availability bias in the IPD obtained will be investigated. We will conduct a model-based economic evaluation to assess the cost effectiveness of the interventions to manage weight gain in pregnancy and undertake a value of information analysis to inform future research.PROSPERO 2013: CRD42013003804.

Efeitos de uma intervenção baseada na implementação dos Dez Passos para uma Alimentação Saudável: Guia Alimentar para Crianças Menores de Dois Anos sobre as condições nutricionais e de saúde de lactentes em famílias de baixa renda. Randomizou-se duzentos recém-nascidos para o grupo intervenção e trezentos para o grupo controle. O grupo intervenção recebeu orientações dietéticas no primeiro ano de vida. Os dois grupos receberam visitas aos 6 e 12 meses e acompanhamento de rotina pelos seus pediatras. Os resultados (n = 397) mostraram que a intervenção associou-se a maior proporção de aleitamento materno exclusivo aos 4 meses (RR = 1,58; IC95%: 1,21-2,06) e 6 meses (RR = 2,34; IC95%: 1,37-3,99) e amamentadas aos 12 meses (RR = 1,26; IC95%: 1,02-1,55) e a menor proporção de crianças que apresentaram diarréia (RR = 0,68; IC95%: 0,51-0,90), problemas respiratórios (RR = 0,63; IC95%: 0,46-0,85), uso de medicamentos (RR = 0,56; IC95%: 0,34-0,91) e cárie dental (RR = 0,56; IC95%: 0,32-0,96) na faixa etária de 12 a 16 meses. Não houve efeito da intervenção sobre a ocorrência de anemia, internações hospitalares e estado nutricional. Os resultados sugerem que o programa de orientações dietéticas promoveu modificações positivas nas práticas alimentares e nas condições de saúde da criança, porém foi insuficiente para prevenir a anemia ferropriva.This study assesses the impact of an intervention known as the Ten Steps to Healthy Feeding: A Nutritional Guide for Children under Two on nutritional conditions and infant health in low-income families. Two hundred newborns were randomized to the intervention group and three hundred to the control group. Parents of the intervention group received nutritional orientation during the child's first year of life. Both groups received visits at 6 and 12 months and routine follow-up by their pediatricians. The results (n = 397) showed that the intervention was associated with a higher proportion of exclusive breastfeeding at 4 months (RR = 1.58; 95%CI: 1.21-2.06) and 6 months (RR = 2.34; 95%CI: 1.37-3.99) and breastfeeding at 12 months (RR = 1.26; 95%CI: 1.02-1.55) and a lower proportion of children with diarrhea (RR = 0.68; 95%CI: 0.51-0.90), respiratory problems (RR = 0.63; 95%CI: 0.46-0.85), use of medication (RR = 0.56; 95%CI: 0.34-0.91), and dental caries (RR = 0.56; 95%CI: 0.32-0.96) in the 12-16 month bracket. The intervention had no effect on the occurrence of anemia, hospitalization, or nutritional status. The results suggest that the nutritional orientation program led to positive changes in infant feeding practices and health conditions, but that it was insufficient to prevent iron deficiency anemia.

A obesidade é uma doença de alta prevalência no mundo e é responsável por sérias repercussões orgânicas e psicossociais, desde a infância até a vida adulta. O comportamento alimentar tem bases biológicas e sociais e, associado, à obesidade, torna-se um processo ainda mais complexo pelos aspectos psicológicos envolvidos, os quais se expressam por meio de humor depressivo, ansiedade, sentimento de culpa e, também, por mecanismos fisiológicos, como a resistência ao jejum na vigência de dietas restritivas. Há evidências de que, em indivíduos obesos, comportamentos de compulsão alimentar e ou restrição são mais freqüentes e parecem ser, em parte, responsáveis pelos fracassos observados no tratamento da obesidade. As restrições e auto-imposições das pessoas que fazem dieta, parecem ter um efeito rebote, resultando em compulsão alimentar, a qual pode associar-se a conseqüências psicológicas, como a perda da auto-estima, mudanças de humor e distração. As reflexões desta revisão sugerem que os programas para redução de peso corporal devem enfocar as bases do comportamento alimentar e desenvolver, efetivamente, ações interdisciplinares que permitam obter resultados eficazes no tratamento da obesidade.Obesity is a widespread disease in the world, responsible for serious organic and psychosocial repercussions, from infancy to adulthood. Eating behavior has biological as well as social bases. Associated to obesity, it becomes an even more complex process, since it is accompanied by psychological aspects showing symptoms such as depressive moods, anxiety, feelings of guilt, and physiological mechanisms as, for instance, the resistance to fast during restrictive diets. Obese individuals prevalently present behaviors such as binge or restrained eating, both leading to failure in the treatment of obesity. Restrained eating refers to the tendency to restrict food intake consciously, in order to prevent weight gain or to promote weight loss, which may be associated to episodes of overeating and have psychological consequences as, for example, the loss of self-steam, mood distress and distraction. The results of this review suggest that weight control programs should focus on the bases of eating behaviors, and, effectively, develop interdisciplinary courses of action in order to obtain positive results in the treatment of obesity.

A prevenção e o tratamento do excesso de peso são particularmente complexos, reforçando a importância de estudos que visem esclarecer sua rede de causas e efeitos. Assim, o objetivo desse estudo foi avaliar a relação entre horas de sono noturnas e medidas antropométricas. Realizou-se uma análise transversal realizada a partir de dados de 348 crianças de 3 e 4 anos da cidade de São Leopoldo/ RS. As horas de sono noturnas foram relatadas pelas mães e as medidas de índice de massa corporal, circunferência da cintura e dobras cutâneas foram medidas de acordo com protocolo padrão. As análises foram ajustadas para consumo energético e horas de televisão assistidas. As crianças com excesso de peso apresentaram, em média, 0,39 horas a menos de sono em relação àquelas com peso adequado (9,77 ± 1,44 versus 10,17 ± 1,34; IC95% 0,03-0,76). Observou-se associação inversa entre horas de sono noturnas e valores de escore z de índice de massa corporal para idade (B = -0,12 IC95% -0,22--0,02). A circunferência da cintura e as dobras cutâneas apresentaram relação inversa com as horas de sono, porém sem diferença estatística. Em pré-escolares do sul do Brasil, menos horas de sono noturnas foram associadas com maiores valores de índice de massa corporal. Prevention and treatment of overweight are particularly complex, reinforcing the importance of studies aimed at clarifying their range of causes and effects. Thus, the objective of this study was to evaluate the relationship between night sleep duration and anthropometric measurements. A cross-sectional analysis was performed from data from 348 children aged 3 and 4 years in São Leopoldo/RS. Night sleep duration was reported by their mothers and body mass index, waist circumference and skinfold thickness were measured according to standard protocol. The analyses were adjusted for energy intake and hours of television watching. Overweight children had, on average, 0.39 hours less sleep than those with normal weight (9.77 ± 1.44 versus 10.17 ± 1.34; 95% CI 0.03 to 0, 76). We observed an inverse association between night sleep duration and z score values of body mass index for age (B = -0.12 95% CI -0.22--0.02). Waist circumference and skinfold thickness showed an inverse relationship with sleep duration, but without any statistic differences. Among preschool children in southern Brazil, smaller night sleep duration was associated with higher body mass index

Objetivo: estudar a associação entre tipo de aleitamento, consumo de fibra alimentar e ocorrência de constipação em lactentes. Métodos: foram estudados 275 lactentes atendidos consecutivamente em unidade básica de saúde. O tipo de aleitamento foi classificado como predominante, misto e artificial. Constipação foi caracterizada pela eliminação de fezes duras, associada a uma das seguintes características: dor ou dificuldade ao evacuar, fezes em cíbalos ou cilíndrica, com rachaduras, e intervalo entre as evacuações maior ou igual a 3 dias. Pseudoconstipação foi caracterizada quando ocorria a eliminação de fezes amolecidas, sem dor ou dificuldade, em intervalo maior ou igual a 3 dias. Resultados: constipação foi observada em 25,1% dos lactentes. Pseudoconstipação ocorreu exclusivamente nos primeiros 6 meses de vida, em 5,1% dos 159 lactentes desta faixa etária. Constipação entre os 6 e 24 meses (38,8%; 45/116) foi mais freqüente do que no primeiro semestre de vida (15,1%, p=0,0000). A análise de regressão logística evidenciou que, no primeiro semestre, os lactentes em aleitamento artificial demonstram chance 4,5 vezes maior de apresentar constipação do que os em aleitamento predominante. Entre os de 6 a 24 meses, a estimativa de consumo de fibra alimentar (gramas/dia) foi semelhante (p=0,57) nos lactentes com constipação (mediana=9,0g; percentis 25 e 75: 6,9-13,1g) e naqueles com hábito intestinal normal (mediana=8,8; percentis 25 e 75: 6,1-12,9g). Conclusões: o consumo de fibra alimentar por crianças menores de dois anos foi semelhante entre os grupos com e sem constipação intestinal. O aleitamento natural predominante é fator de proteção contra constipação no primeiro semestre de vida.Objective: To study the relationship between breast-feeding, dietary fiber intake and constipation in infants. Methods: The study population consisted of 275 infants consecutively enrolled in two Primary Care Clinic in the city of Embu, in the Great São Paulo. The feeding pattern were classified in predominantly breast-feeding, partially breast and cow’s milk feeding and artificial feeding. Constipation was defined by the elimination of hard stool associated with one of the following: painful or difficult defecation, hard or round cracked stools and less than three defecations a week. False constipation was defined by the elimination of soft stools without pain or difficulty but with less than three defecations a week. Results: Constipation was found in 25.1% (69/275). False constipation was found only in the first semester of life in 5.1% of 159 infants. The prevalence of constipation was higher between 6 and 24 months (38.8%, 45/116) than in the first semester of life (15.1%, p=0.000). A model of logistic regression demonstrated that infants under artificial feeding were 4.53 times more liable to develop constipation than infants who were predominantly breastfed. The daily dietary fiber intake (g/day) was similar (p=0.57) among the constipated (median=9.0 g; 25th and 75th percentiles: 6.9-13.1g) and non-constipated (median = 8.8 g; 25th and 75th percentiles: 6.1-12.9 g). Conclusions: Dietary fiber intake was similar in constipated and non-constipated infants. Breast-feeding serves as a protection factor against the development of constipation in the first semester of life.

A freqüência da obesidade na infância e adolescência aumentou nos últimos anos. Essa situação tem preocupado a área da saúde, não só pelas conseqüências promovidas pela obesidade na população em geral, mas pela imposição de prejuízos biopsicossociais, ainda na infância. O tratamento é bastante complexo, pois sua causa é multifatorial, exigindo atenção interdisciplinar. O presente trabalho teve como objetivo relatar o papel do professor de educação física na equipe de atendimento ambulatorial de crianças e adolescentes obesos. A atividade física, depois da taxa metabólica basal, é considerada o segundo maior componente do gasto energético diário. Diversos estudos demonstraram que a atividade física associada ao controle alimentar leva a melhores resultados do que essas ações isoladas. O aumento da atividade física é muito benéfico no tratamento de crianças e adolescentes obesos, pois permite maior ingestão alimentar e auxilia a preservar a massa magra. Entretanto, o exercício físico deve ser adaptado às condições de excesso de peso e de crescimento ósseo. Além desses cuidados, o profissional depara-se com a dificuldade de manter crianças e adolescentes em programa de exercício regular. Desse modo, a prescrição do aumento de movimento corporal após a anamnese da rotina diária de cada paciente foi a solução encontrada para, inicialmente, colocá-los em contato com o próprio corpo. Paralelamente, o professor de educação física auxilia a criança a encontrar um tipo de esporte que mais lhe agrade, dentro daqueles permitidos pelo seu excesso de peso e fase de crescimento. Geralmente, recomendam-se atividades que tenham baixo impacto, como nadar, caminhar e andar de bicicleta. O professor de educação física, como educador, deve fazer parte do atendimento multidisciplinar de crianças e adolescentes obesos. The prevalence of childhood and adolescent obesity has increased in recent years. This fact has raised concern in the health care field because obesity in general causes many health problems in the population at large, and also because obesity has many bio-psycho-social implications during childhood. The treatment of obesity is very complex since this disease has multifactorial causes, requiring an interdisciplinary response from health care professionals. This study was conducted to evaluate the role of physical education teachers in a group of professionals treating obese children and adolescents. Physical activity, after basal metabolic rate, is considered the second largest component of daily energy expenditure. Various studies have shown that physical activity with control of food intake produces the best results in treating weight loss compared to either of these treatments used independently. The increase of physical activity is very beneficial in the treatment of obese children and adolescents since it allows for a greater intake of food and at the same time maintains lean body mass. However, the type of physical activity should be adapted to the conditions of each child given that the obese person has an excess amount of weight along with the presence of active bone growth. Besides these precautions, the professional often has to deal with the difficulty of keeping the child or adolescent in an active, regular program of physical activity. It was found that promoting an increase in overall physical activity through a detailed, personal evaluation of his/her daily routine allows each patient to become more in touch with his/her own body. At the same time physical education teachers assist the child to find a type of sport that is enjoyable to him/her, but within the constraints of his/her excess weight and period of growth. It is generally recommended that the activities of the obese child or adolescent be low impact, such as swimming, walking, or riding a bicycle. The physical education teacher is an educator and thus should used his/her abilities in the multidisciplinary treatment of obese children and adolescents.

OBJECTIVE: To assess the association of single nucleotide polymorphisms (SNPs) in five genes - leptin, leptin receptor (LEPR), adiponectin (APM1), peroxisome proliferator-activated receptor gamma (PPARG) and uncoupling protein 1 - with anthropometric, metabolic, and dietary parameters in a Southern Brazilian cohort of 325 children followed up from birth to 4 years old. MATERIALS AND METHODS: SNPs were analyzed using polymerase chain reaction-based procedures, and their association with phenotypes was evaluated by t-test, analysis of variance, and general linear models. RESULTS: LEPR223Arg allele (rs1137101) was associated with higher daily energy intake at 4 years of age (P = 0.002; Pcorrected = 0.024). PPARG 12Ala-carriers (rs1801282) presented higher glucose levels than Pro/Pro homozygotes (P = 0.007; Pcorrected = 0.042). CONCLUSIONS: Two of the six studied SNPs presented consistent associations, showing that it is already possible to detect the influences of genetic variants on susceptibility to overweight in 4-year-old children. OBJETIVO: Avaliar a associação de polimorfismos de nucleotídeo único (SNPs) em cinco genes: leptina, receptor da leptina (LEPR), adiponectina (APM1), receptor ativado por proliferadores de peroxissomas gama (PPARG) e proteína desacopladora 1 com parâmetros antropométricos, metabólicos e dietéticos em uma coorte sul-brasileira composta por 325 crianças acompanhadas desde o nascimento até os 4 anos. MATERIAIS E MÉTODOS: Os SNPs foram analisados por meio da reação em cadeia da polimerase e sua associação com os fenótipos foi avaliada utilizando teste T, análise de variância e análise fatorial. RESULTADOS: O alelo LEPR223Arg (rs1137101) foi associado a uma maior ingestão energética diária aos 4 anos (P = 0,002; Pcorrigido = 0,024). Os portadores do alelo PPARG12Ala (rs1801282) apresentaram maior glicemia em relação aos homozigotos Pro/Pro (P = 0,007; Pcorrigido = 0,042). CONCLUSÕES: Dois dos seis SNPs estudados apresentaram associações consistentes, mostrando que aos 4 anos de idade já é possível detectar as influências de variantes genéticas sobre a suscetibilidade ao excesso de peso.

RACIONAL: Distúrbios na mastigação, deglutição e motilidade digestiva podem predispor pacientes com síndrome de Rett à ocorrência de anormalidades nutricionais. OBJETIVOS: Avaliar as práticas alimentares, o estado nutricional e a prevalência de constipação na síndrome de Rett clássica. MÉTODOS: Estudaram-se 27 pacientes do sexo feminino, com idade entre 2,6 e 21,8 anos. Avaliaram-se os seguintes parâmetros: registros alimentares, peso, estatura, características do hábito intestinal. Peso e estatura foram comparados com os valores do Centro Nacional para Estatísticas da Saúde (EUA). RESULTADOS: Incapacidade para ingerir alimentos sólidos foi observada em 80,8% das pacientes. Déficit de estatura foi observado em 13 (48,1%) meninas, sendo mais intenso nas pacientes no estágio IV. Déficit de estatura para a idade foi observado em 13 (48,1%) pacientes. Em 10 (37,0%) pacientes encontrou-se déficit de peso para a estatura, 15 (55,6%) apresentaram peso normal e duas (7,4%) sobrepeso para a estatura. A ingestão mediana de energia, segundo o peso para a estatura foi igual a 106,6%. Ingestão insuficiente de ferro foi observada em 63% e de cálcio em 55,6% das pacientes. Constipação foi verificada em 74,1% das pacientes e não apresentou relação com a quantidade de fibra alimentar na dieta. CONCLUSÃO: Observou-se elevada ocorrência de problemas nutricionais e de constipação intestinal, que devem ser considerados no planejamento terapêutico multidisciplinar destinado às pacientes com síndrome de Rett. BACKGROUND: Disturbance in chewing, swallowing and digestive motility may predispose to feeding and nutritional abnormalities in patients with Rett syndrome. OBJECTIVE: To evaluate the dietary habits, nutritional status and the prevalence of constipation in patients with classical Rett syndrome. METHODS: Twenty seven female patients between the ages of 2.6 and 21.8 years were studied. The following parameters were evaluated: food register, weight, height and intestinal movement characteristics. Weight and height were compared with the National Center for Health Statistics standards. RESULTS: The inability to ingest solid foods was observed in 80.8% of the patients. A height-to-age deficit was observed in 13 (48.1%) of the girls, being more intense in patients at stage IV. Weight-for-height deficit was found in 10 (37.0%) patients, 15 (55.6%) showed normal weight and 2 (7.4%) were overweight for their height. The median ingestion of energy, according to weight-for-height, was equal to 106.6%. Insufficient iron ingestion was observed in 63.0% and insufficient calcium in 55.6% of the patients. Constipation was verified in 74.1% of the patients and did not show a relationship with the quantity of fiber in the diet. CONCLUSION: Various nutritional problems, as well as, intestinal constipation were observed in these patients with Rett syndrome, and they must be considered in the multidisciplinary therapeutic planning of these individuals. Federal University of São Paulo Paulista School of Medicine Federal Faculty of Medical Sciences Department of Public Health Mackenzie Presbyterian University Program on Development Disorders Federal University of São Paulo EPM UNIFESP, EPM SciELO

OBJECTIVE: the study was designed to evaluate the impact of a multidisciplinary program on children and adolescents' weight control.DESIGN: Retrospective study regarding changes in relative weight of all patients treated regularly in an out-patient care public service between January 1992 and December 1993.SUBJECTS: 198 children and adolescents (108 girls and 90 boys; mean age: 9.25 y; mean body mass index (BMI): 24.26 kg/m(2), range 19.1-40.31).MEASUREMENTS: Anthropometric data collected at the visits were obtained until June 30 1994. BMI compared to reference data was used. Dual Photon X-ray Absorptiometry (DEXA) was used for 64 patients, to determine percent body fat.RESULTS: Relative weight at the last visit was significantly lower when compared with initial relative weight for the whole sample. Significantly better outcome of relative weight was obtained when six or more visits occurred for the whole sample, and for girls when the days' interval between visits was shorter than 52d. Variables such as percent body fat, body shape at the first visit, family obesity pattern, length of obesity and pubertal stage, did not significantly influence the outcome of relative weight for the subjects during the treatment.CONCLUSION: Results obtained indicated that good outcomes can be obtained in a program using nutrition education focused on small modifications of eating habits in order to avoid excess energy intake. the best predictors of weight improvement for children and adolescents participating in the program were the higher frequency of visits and shorter intervals between them. Universidade Federal de São Paulo, Dept Pediat, BR-04040032 São Paulo, Brazil Universidade Federal de São Paulo, Dept Pediat, BR-04040032 São Paulo, Brazil Web of Science