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This study aimed to evaluate the early introduction of ultra-processed foods (UPF) and identify its association with overweight and anaemia in Brazilian children living in a situation of social vulnerability. A population-based cross-sectional study was conducted in a Brazilian capital. Children aged 12-59 months were included. The presence of overweight and anaemia was evaluated, as well as the introduction of twelve different UPF in children's first year of life. Association analysis was performed using Poisson regression, with robust estimates of variances. A total of 561 children were studied; 85·5 % had consumed at least one UPF evaluated in the first year of life; 19·1 % were overweight and 52·0 % were anaemic. Adjusted multivariate analyses identified that the early introduction of soft drinks (Prevalence Ratio (PR) = 1·18, 95 % CI (1·02, 1·38)), packaged snacks (PR = 1·17, 95 % CI (1·05, 1·30)) and powdered soft drinks (PR = 1·36, 95 % CI (1·16, 1·60)) increased the likelihood of children being overweight, and the early introduction of chocolate drink (PR = 1·25, 95 % CI (1·02, 1·53)) increased the likelihood of them being anaemic, when comparing children who consumed these UPF before reaching 1 year of age with those who consumed these foods at 12 months of age or older. From the results found, one can see the existing relationship between the early introduction of UPF with overweight and anaemia, being necessary to intensify public health policies to combat malnutrition, focusing on the promotion of proper and healthy eating, especially during the phase of food introduction, focusing on the population living in socially vulnerable situations. [ABSTRACT FROM AUTHOR]

To analyse the association of socio-demographic and health factors with vitamin D insufficiency and 25-hydroxyvitamin D (25(OH)D) concentration in Brazilian children aged 6–59 months. Data from 8145 children from the Brazilian National Survey on Child Nutrition (ENANI-2019) were analysed. The serum concentration of 25(OHD)D was measured using a chemiluminescent immunoassay. The prevalence of vitamin D insufficiency (25(OH)D < 50 nmol/l) and 95 % CI was calculated. Logistic and linear regression models were used to identify the variables associated with vitamin D insufficiency and serum 25(OH)D concentrations, respectively. The mean 25(OH)D concentration was 98·6 ± 36·0 nmol/l, and 4·3 % of the children presented vitamin D insufficiency. Children aged 6–23 months (OR = 2·23; 95 % CI 1·52, 3·26); belonging to Southeast (OR = 5·55; 95 % CI 2·34, 13·17) and South (OR = 4·57; 95 % CI 1·77, 11·84) regions; the second tertile of the National Wealth Score (OR = 2·14; 95 % CI 1·16, 3·91) and winter (OR = 5·82; 95 % CI 2·67, 12·71) and spring (OR = 4·84; 95 % CI 2·17, 10·80) seasons of blood collection were associated with a higher chance of vitamin D insufficiency. Female sex (β = −5·66, 95 % CI − 7·81, −3·51), urban location (β = −14·19, 95 % CI −21·0, −7·22) and no vitamin D supplement use (β = −6·01, 95 % CI −9·64, −2·39) were inversely associated with serum 25(OH)D concentration. The age of children and the Brazilian geographical region of household location were the main predictors of vitamin D insufficiency. In Brazil, vitamin D insufficiency among children aged 6–59 months is low and is not a relevant public health problem. [ABSTRACT FROM AUTHOR]

The double burden of malnutrition (DBM) is a condition in which malnutrition coexists with overweight, reflecting a new layer of malnutrition. Our objectives were to assess prevalence; test associations between DBM and 24-hour movement behaviors; and investigate whether DBM is associated with clusters of social determinants. Methods: This multicenter cross-sectional study included 1152 adolescents (12 to 17 years old) from four Brazilian cities. Body mass index (BMI, kg/m2) was used to estimate overweight, and the adopted cutoff points took into account the curves established for age and sex: Z-score > 1 and ≤2 (overweight) and Z-score > 2 (obesity). The serum concentration of 25-hydroxyvitamin D [25(OH)D] was stratified into three levels: vitamin D deficiency ≤ 20 ng/mL; vitamin D insufficiency = 21–29 ng/mL; optimal vitamin D ≥ 30 ng/mL. We used multilevel Poisson regression models to estimate prevalence ratios (PRs) and their respective 95% confidence intervals (95%CI) and to analyze the association between DBM and covariates. A significance level of p < 0.05 was considered. Cluster analyses were performed by applying a combination of hierarchical and non-hierarchical methods. Results: A population prevalence of DBM of 7.3% (95% CI: 5.9–8.9) was revealed. A percentage of 19.2% (95% CI: 17.0–21.6) of adolescents were overweight, and 8.3% (95% CI: 6.8–10.1) were obese. A total of 41.5% (95% CI: 38.7–44.4) had vitamin D deficiency, and 25.8% (95% CI: 23.4–28.4) had vitamin D insufficiency. However, 24-hour movement behaviors were not associated with DBM. Adolescents living in the southern region of the country, from public schools whose mothers have higher education, have a 1.94 [PR = 2.94 (95% CI: 1.20–7.23)] times greater chance of developing DBM. These results highlight the importance of specific factors to improve the nutritional health of adolescents, considering the specific social determinants identified in this study. [ABSTRACT FROM AUTHOR]

Despite advances in neonatology, neonatal mortality from preventable causes remains high in the North and Northeast regions of Brazil. This study aimed to analyze the determinants associated with neonatal and postneonatal mortality in newborns admitted to a neonatal intensive care unit. A cohort study was carried out in a capital in the Brazilian Northeast from 2013 to 2018. The outcome studied was death. Poisson regression was performed in the multivariate analysis of variables. Four hundred and eighty newborns were eligible, and 8.1% (39 newborns) died. Among them, 34 died in the neonatal period. The determinants that remained significantly associated with neonatal and postneonatal mortality in the final adjustment model (p < 0.05) were history of abortion, perinatal asphyxia, early neonatal sepsis and umbilical venous catheterization. All causes of this outcome were preventable. The neonatal mortality rate, although it did not include twins, neonates with malformations incompatible with life and other conditions, was 3.47 deaths per thousand live births (95% CI:1.10−8.03‰), well below the national average. In this study, pregnant women from different social classes had in common a private plan for direct access to health services, which provided them with excellent care throughout pregnancy and postnatal care. These results indicate that reducing neonatal mortality is possible through public policies with strategies that promote improvements in access to health services. [ABSTRACT FROM AUTHOR]

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Introduction: This study reports the evaluation of the short-term effects of the Strengthening Families Program (SFP 10–14), adapted as Famílias Fortes (Strong Families) in Brazil, on preventing adolescent drug use and improving parenting behaviors. Methods: A two-arm, parallel cluster randomized controlled trial was conducted in 60 Social Assistance Reference Centers (SARC) from 12 Brazilian municipalities. In each city, the SARC were randomly assigned to the intervention or control group. A total of 805 families participated in the study, each contributing data from one parent or legal guardian and one adolescent totaling 1,610 participants. Data collection occurred before intervention implementation and 6 months after baseline collection. Data were analyzed using multilevel mixed-effects modeling with repeated measures in two different paradigms: Intention to Treat (ITT) and Per protocol (PP). The study was registered in the Brazilian Ministry of Health Register of Clinical Trials (REBEC), under protocol no. RBR-5hz9g6z. Results: Considering the ITT paradigm, the program reduced the chance of parents and legal guardians being classified as negligent by 60% (95%CI 0.21; 0.78), increased the use of nonviolent discipline by caregivers (Coef 0.33, 95%CI 0.01; 0.64) and decreased the chance of adults exposing adolescents to their drunken episodes by 80% (95%CI 0.06; 0.54). No program effects were observed on outcomes related to adolescent drug use. Similar results were found for the PP paradigm. Conclusion: The positive effects on family outcomes suggest preventive potential of the program among the Brazilian population. Long-term evaluations are necessary to verify if the program can also achieve the drug use reduction goals not observed in the short term. [ABSTRACT FROM AUTHOR]

BACKGROUND: The potential health benefits of exposure to vegetation, or greenness, are well documented, but there are few nationwide studies in Brazil, a country facing challenges related to land-use planning, deforestation, and environmental health risks. OBJECTIVES: In this study, we investigated the association between greenness and hospitalizations for cardiorespiratory diseases in Brazil. METHODS: We accessed hospital admissions data from 967,771 postal codes (a total of 26,724,624 admissions) covering Brazil for the period between 2008 and 2018. We used Normalized Difference Vegetation Index (NDVI) data from the Moderate Resolution Imaging Spectroradiometer (MODIS) to measure greenness at the postal-code level. First, we applied a quasi-Poisson regression model to estimate the association between greenness and hospitalizations for circulatory and respiratory diseases, adjusted for air pollution, weather variables, and area-level socioeconomic status. We stratified the analyzes by sex, age group, health outcome, and Brazilian regions. In the second stage, we performed a meta-analysis to estimate pooled effects across the Brazilian regions. RESULTS: The national meta-analysis for the whole population, incorporating both urban and nonurban areas, showed that higher levels of greenness were associated with a lower risk of hospitalizations for circulatory diseases. An interquartile range (IQR=0.18) increase in average NDVI was associated with a 17% (95% confidence interval: 8%, 27%) lower risk of cardiovascular admissions. In contrast, there was no association found between greenness and respiratory admissions. When specifically examining urban areas, the results remained consistent with the overall findings. However, the analyses of nonurban areas revealed divergent results, suggesting that higher levels of greenness in rural regions are associated with a lower risk of hospital admissions for both circulatory and respiratory diseases. DISCUSSION: The findings emphasize the importance of prioritizing the preservation and creation of green spaces in urban areas as a means of promoting cardiovascular health in Brazil. [ABSTRACT FROM AUTHOR]

This study evaluated changes in the use of sweeteners over one decade and the relationship between socio-demographics, diet and weight status with the type of sweetener. Data came from the Brazilian National Dietary Surveys of 2008–2009 and 2017–2018, including ≥ 10-year-old individuals (n 32 749; n 44 744, respectively, after excluding pregnant and lactating women). The use of table sugar, non-caloric sweeteners (NCS), both or none was reported through a specific question. Food consumption was assessed using two non-consecutive food records (2008–2009) and 24-h recalls (2017–2018). For the last survey, means of energy, macro and micronutrient intake, food groups' contribution (%) to daily energy intake and age- and energy-adjusted nutrient intake were estimated according to the type of sweetener used. Differences in means and proportions across the categories of sweeteners used were evaluated based on the 95 % CI. All analyses were stratified by sex and considered sample design and weights. Over 10 years, the use of table sugar decreased by 8 %, while the habit of not using any sweetener increased almost three times, and the use of NCS remained stable. Larger reductions in the use of table sugar were observed in the highest income level and among men. Regardless of sex, compared with NCS users, table sugar users had greater mean intake of energy, carbohydrates and added sugar and lower micronutrient intake means. Although table sugar is still the most used sweetener, the increased choice of 'no sweetener' is noteworthy in Brazil. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to predict adolescents with untreated dental caries through a machine-learning approach using three different algorithms Methods: Data came from an epidemiological survey in the five largest cities in Mato Grosso do Sul, Brazil. Data on sociodemographic characteristics, consumption of unhealthy foods and behaviours (use of dental floss and toothbrushing) were collected using Sisson's theoretical model, in 615 adolescents. For the machine learning, three different algorithms were used: (1) XGboost; (2) decision tree and (3) logistic regression. The epidemiological baseline was used to train and test predictions to detect individuals with untreated dental caries, through eight main predictor variables. Analyzes were performed using the R software (R Foundation for Statistical Computing, Vienna, Austria). The Ethics Committee approved the study.. Results: For the 615 adolescents, xgboost performed better with an area under the curve (AUC) of 84% versus 81% for the decision tree algorithm. The most important variables were the use of dental floss, unhealthy food consumption, self-declared race and exposure to fluoridated water. Conclusions: Family health teams can improve the work process and use artificial intelligence mechanisms to predict adolescents with untreated dental caries, and, in this way, schedule dental appointments for the treatment of adolescents earlier. [ABSTRACT FROM AUTHOR]

Colorectal cancer (CRC) is one of the most common cancer types worldwide. Its increasing mortality trends, especially in emerging countries, are a concern. The aim of this study was to analyse mortality trends and spatial patterns of CRC in the state of Sergipe, Brazil, from 1990 to 2019. Trends were calculated using data from the Online Mortality Atlas and Joinpoint Regression Program 4.8.0.1. Spatial analyses were performed using the empirical Bayesian model and Moran indices calculated by TerraView 4.2.2 between 1990 to 1999, 2000 to 2009 and 2010 to 2019. A total of 1585 deaths were recorded during the study period, with 58.42% among females. Trends were increasing and constant for both sexes and all age groups studied. The highest mean annual percent change was 6.2 {95% Confidence interval (CI) 3.4;9.0} for males aged +65 years and 4.5 (95% CI 3.2;5.8) for females aged 50–64 years. There was positive spatial autocorrelation for both sexes in all periods studied when using the Moran index for Bayesian rates. In summary, a consistent trend of increasing colorectal cancer (CRC) mortality has been observed overall. Nevertheless, an altered spatial distribution among males has emerged over the studied period. [ABSTRACT FROM AUTHOR]