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The current study aims to describe the consumption of ultra-processed foods, from 2 to 4 years old, and evaluate its association with growth outcomes during the same period. It is a prospective cohort study using data from the 2015 Pelotas-Brazil Birth Cohort. Outcomes assessed at the 2- and 4-year-old follow-ups were BMI-for-age Z-score and length/height-for-age Z-score. The exposure was a score of ultra-processed food consumption calculated at each follow-up by summing up the positive answers for the consumption of nine specific items/subgroups of ultra-processed foods: (i) instant noodles; (ii) soft drink; (iii) chocolate powder in milk; (iv) nuggets, hamburger or sausages; (v) packaged salty snacks; (vi) candies, lollipops, chewing gum, chocolate or jelly; (vii) sandwich cookie or sweet biscuit; (viii) juice in can or box or prepared from a powdered mix and (ix) yogurt. Crude and adjusted analyses between the score of ultra-processed foods and the outcomes were run using generalised estimating equations. Prevalence of consumption of ultra-processed foods increased from 2 to 4 years old, for all evaluated items/subgroups, except yogurt. In prospective analyses, higher scores of ultra-processed food consumption were associated with higher BMI-for-age Z-score and lower length/height-for-age Z-score, after adjustment for confounders. Ultra-processed food consumption, measured using a short questionnaire with low research burden, increased from 2 to 4 years old and was related to deleterious growth outcomes in early childhood. These results reinforce the importance of avoiding the consumption of these products in childhood to prevent the double burden of malnutrition and non-communicable chronic diseases throughout the life.

Background and objectivesThe consumption of unprocessed or minimally processed whole plant foods and of ultra-processed foods, as defined by the Nova food classification system, are associated in opposite ways with diet quality and risk of diseases. However, it can be difficult to evaluate and monitor the consumption of these foods in some contexts due to lack of resources and time constraints for data collection. This study aimed to describe two simple and easily derived diet quality scores and evaluate their performance in reflecting the dietary share of unprocessed or minimally processed whole plant foods and ultra-processed foods.MethodsA total of 812 adults (18 years old or older) answered the Nova24h screener, a 2-minute self-administered questionnaire that measures the consumption of a set of foods on the day before the interview. Food items included in this tool belong to two main groups of Nova classification: unprocessed or minimally processed whole plant foods (WPF, 33 food items) and ultra-processed foods (UPF, 23 food items). Two scores are obtained from this tool by summing the number of items checked - the Nova-WPF and the Nova-UPF. We compared the Nova-WPF and the Nova-UPF scores with the dietary intake (% of total energy) of all unprocessed or minimally processed whole plant foods and all ultra-processed foods, respectively, obtained through a full self-administered web-based 24-hour recall, applied on the same day. We evaluated the relationship between the approximate quintiles or intervals of each score and the corresponding % of energy intake by linear regression, and the agreement between the intervals of each score with the intervals of the corresponding % of energy intake, using the Prevalence-Adjusted and Bias-Adjusted Kappa (PABAK).ResultsApproximate quintiles of each score presented a direct and linear relationship with the corresponding % of energy intake (p-value for linear trend ConclusionsThese two scores performed well against the dietary share of unprocessed or minimally processed whole plant foods and ultra-processed foods in Brazil and can thus be used to evaluate and monitor diet quality.

Background Ultra-processed food consumption and obesity have been highlighted as an important relationship to public health. We aimed to evaluate the association between ultra-processed food consumption and body fat from 6 to 11 years of age. Methods We assessed the association between ultra-processed food consumption (from food frequency questionnaires) and body fat (measured by air displacement plethysmography) between 6 and 11 years of age among participants of the Pelotas-Brazil 2004 Birth Cohort. The NOVA classification was used to classify foods according to the processing degree. Body fat was evaluated relative to the height using fat mass index (FMI). Generalized estimating equations were used to answer the main research question and mediation analyses were run to assess the direct and indirect effect of ultra-processed food in body fat. Results At fully adjusted analysis, an increase of 100 g in contribution from ultra-processed food to daily food intake at between 6 and 11 years of age was associated with a gain of 0.14 kg/m² in FMI in the same period; 58% of the total effect of ultra-processed food intake at 6 years (in grams) over the change in FMI from 6 to 11 years was mediated by its calorie content. Conclusions Ultra-processed food consumption was associated with an increase in body fat from childhood to early adolescence, and this association was not just due to the effect of ultra-processed food on calorie content.

OBJECTIVE: To evaluate the agreement between self-reported and measured weight among older adults living in the city of Pelotas, southern Brazil. METHODS: Cross-sectional analyses using data from the second follow-up of “COMO VAI?”, a longitudinal population-based study that included community-dwelling older adults from the urban region of Pelotas. Weight was self-reported and measured at the same visit. Standing height was estimated based on knee height, which was measured at the first follow-up (2014). Body mass index was categorized as normal (< 24.9 kg/m2), overweight (between 25.0 and 29.9 kg/m2) or obese (≥ 30 kg/m2). Agreement between self-reported and measured weight and between body mass index based on self-reported and measured weight was evaluated using Lin’s concordance correlation coefficient and a Bland-Altman plot. The kappa coefficient was used to evaluate the agreement between body mass index according to self-reported and measured weight. RESULTS: Ninety-nine participants were visited at home, where their weight was self-reported and directly measured. The mean difference between measured and self-reported weight was 1.8 kg (95%CI 0.5; 3.1) in men and -0.1 kg (95%CI -1.1; 0.8) in women. Nutritional status according to self-reported and measured weight showed good agreement (81% of the elderly correctly classified themselves) with a kappa of 0.71 in men and 0.68 in women, and a weighted kappa of 0.75 in men and 0.72 in women. CONCLUSIONS: There was good agreement between self-reported and measured weight in women, but strong agreement for nutritional status according to self-reported and measured weight in both sexes, thus self-reported weight can be used to monitor nutritional status in older adults.

Objective:To describe the consumption of ultra-processed foods according to demographic and socioeconomic characteristics in three birth cohorts.Design:Cross-sectional analysis.Setting:Data from the 2004, 1993 and 1982 Pelotas Birth Cohorts were used at 11, 22 and 30 years, respectively, collected between 2012 and 2015. Outcome was the relative contribution of ultra-processed foods from the total daily energy intake. Maternal-independent variables were self-reported skin colour, schooling, age and family income (obtained in the perinatal study), and variables of the cohort member, sex, skin colour, schooling and current family income (the last two obtained at the 11-, 22- and 30-year follow-ups of the respective cohorts). We calculated crude and adjusted means of the outcome for the whole cohorts and according to the independent variables.Participants:11-, 22- and 30-year-old individuals.Results:Daily energetic contribution from ultra-processed foods was higher in the younger cohort (33·7, 29·8 and 25·1 % at 11, 22 and 30 years, respectively). Maternal schooling and family income at birth showed an inverse dose–response relationship at 11 and 22 years, but a positive dose–response at 30 years. Female sex, lower schooling and family income at 22 years and higher schooling at 30 years were associated to a higher contribution from ultra-processed foods in the daily energy intake.Conclusions:Information from food and nutrition policies needs a higher dissemination, mostly among women and population groups of lower income and schooling, including its promotion in media and health services, aiming for a decreased consumption of ultra-processed foods.

This is a cross-sectional population-based study that describes the score of ultra-processed food consumption, applied in the Brazilian National Health Survey performed in 2019, and its association with sociodemographic factors in Brazilian adults (18 years or older). The score of ultra-processed food consumption was calculated by adding up the positive answers about the consumption on the previous day of 10 subgroups of ultra-processed foods frequently consumed in Brazil. The distribution of the score in the population was presented as a count. Poisson regression models were used to evaluate the crude and adjusted associations of scores equal to or higher than five subgroups of ultra-processed foods with urban/rural area, geographic region, sex, age group, schooling level, and wealth index. About 15% of the Brazilian adults reached scores equal to or higher than five. After adjustment for confounders, the prevalence of consuming five or more subgroups of ultra-processed foods decreased linearly with age, increased linearly with wealth quintiles and it was higher in urban areas, in the Southeast and South regions (compared to the others) and in men. Public policies that reduce the consumption of ultra-processed foods with emphasis on strata of the population at the greatest risk are essential and monitoring the score of ultra-processed food consumption across studies and populations will be important to assess the success of these policies.

To evaluate time evolution of receiving advice on healthy habits among Brazilians with hypertension and diabetes mellitus. Cross-sectional study with data from the 2013 and 2019 National Health Survey. We used linear regression weighted by least squares of variance to verify time evolution of the outcome estimating the annual percentage change (APC) presented according to sex, skin color, age group, and quintiles of wealth index. The analytical sample in 2013 was 11,129 individuals with hypertension and 3,182 individuals with diabetes, and in 2019 19,107 individuals with hypertension and 6,317 individuals with diabetes. For those with hypertension, there were statistically significant reductions in receiving advice for not smoking (APC: -1.49), not drinking excessive alcoholic beverages (APC: -1.48), ingesting less salt (APC: -0.56), and for all healthy habits (APC: -1.17). For those with diabetes, statistically significant reductions were observed only for not smoking (APC: -1.13) and not drinking excessive alcoholic beverages (APC: -1.11). The results suggest a reduction in all types of advice on healthy habits evaluated for hypertension and diabetes, with greater magnitude among individuals belonging to the richest quintiles. Resumo O objetivo foi avaliar a evolução temporal do recebimento de orientações sobre hábitos saudáveis entre brasileiros com hipertensão arterial e diabetes mellitus. Estudo transversal com dados da Pesquisa Nacional de Saúde de 2013 e 2019. Para verificar a evolução temporal das prevalências de orientações sobre hábitos saudáveis, realizadas por profissionais de saúde nos atendimentos para as morbidades, utilizou-se regressão linear ponderada pelos quadrados mínimos da variância, estimando a variação percentual anual (VPA) apresentada de acordo com sexo, cor da pele, faixa etária e quintis do índice de bens. A amostra analítica, em 2013, foi de 11.129 indivíduos com hipertensão e 3.182 com diabetes, e em 2019, de 19.107 indivíduos com hipertensão e 6.317 com diabetes. Para hipertensão, observou-se reduções nas orientações para não fumar (VPA: -1.49), não ingerir bebidas alcoólicas em excesso (VPA: -1.48), ingerir menos sal (VPA: -0.56) e, ainda, para todas as orientações (VPA: -1.17). Para diabetes, foram observadas reduções estatisticamente significativas apenas para não fumantes (APC: -1.13) e para os que não consomem bebidas alcoólicas em excesso (APC: -1.11). Os resultados sugerem redução de todas as orientações avaliadas para hipertensão e diabetes, com maior magnitude entre os indivíduos pertencentes aos quintis mais ricos.

This article aims to describe the reasons for sport participation in the Brazilian adult population according to gender, age and schooling level. This is a cross-sectional study with data from a National Household Sample Survey - 2015. The reasons to practice or not practice sports in the previous year were obtained by questionnaire with predetermined answer options. All analyses were performed in Stata 12.1 and stratified by gender. The prevalence of sports participation for men and women were 31.7% and 16.9%, respectively. The most frequent reasons for sports participation among men were: having fun, quality of life and performance. Among women, the most frequent reasons were: quality of life, performance and medical recommendation. Regarding reasons for not practicing sports, the most reported ones were: lack of time (38.8% for men and 37.8% for women), not enjoying (34.8% for men and 35.3% for women) and health problem (20.3% for men and 17.9% for women). The study findings showed the most frequent reasons for sport participation in Brazil. Understanding these reasons and how they affect different age ranges and educational levels may contribute to improve strategic planning to promote sports in middle-income countries. Resumo O objetivo deste artigo é descrever os motivos para participação esportiva da população adulta brasileira de acordo com sexo, idade e escolaridade. Trata-se de um estudo transversal com dados da Pesquisa Nacional por Amostras de Domicílios - 2015. Os motivos para praticar ou não esportes no ano anterior foram obtidos por questionário com respostas pré-determinadas. Todas as análises foram realizadas no software Stata 12.1 e estratificadas por gênero. As prevalências de participação em esportes para homens e mulheres foram 31,7% e 16,9%, respectivamente. Entre os homens, os motivos mais frequentes para participação em esportes foram: diversão, qualidade de vida e desempenho. Entre as mulheres, os motivos mais frequentes foram: qualidade de vida, desempenho e indicação médica. Quanto aos motivos para não praticar esportes, os mais relatados foram: falta de tempo (38,8% para os homens e 37,8% para as mulheres), não gostar (34,8% para os homens e 35,3% para as mulheres) e problemas de saúde (20,3% para os homens e 17,9% para as mulheres). O estudo mostrou os motivos mais frequentes para a prática esportiva no Brasil. Compreender esses motivos e como eles são influenciados pela idade e por nível de educação pode contribuir para melhorar estratégias para promover o esporte em países de renda média.

The aim of the study is: (a) investigate the racial inequalities as one specific dimension that affects dental pain in Brazilian adolescents; and (b) investigate the regional variations of dental pain. This cross-sectional study used data from Brazilian National Survey of School Health (PeNSE), carried out with adolescents in 2009, 2012 and 2015. Dental pain was evaluated through the question: “Did you have dental pain in the last six months?”. The main exposures were race and Brazilian regions, used to evaluate inequalities related to the outcome. Sex, age, school type and maternal education were used as covariables. The statistical significance of the trends in dental pain was tested using linear regression. The analysis was conducted in Stata 13.0 statistical package using the svy command. The standard prevalence of dental pain was 18.8%, 21.1% and 23.7%, showing an increasing trend over time (p < 0.001). We observed absolute inequalities in dental pain related to race and regions. A higher prevalence was found in non-white girls of public schools and in the Northern Region. The indexes of inequalities increased in the group of black girls, related to an increase of dental pain predominantly in girls whose mothers had lower educational level. It was observed that the prevalence of dental pain in Brazilian adolescents increased over time as well as its inequalities, which remained in marginalized populations and linked to Brazilian regions. Resumo: O estudo teve dois objetivos: (a) investigar as desigualdades raciais enquanto uma dimensão específica que afeta a prevalência de dor de dente em adolescentes brasileiros, e (b) analisar as variações regionais na prevalência de dor de dente. O estudo transversal usou dados da Pesquisa Nacional de Saúde do Escolar (PeNSE), realizada com adolescentes em 2009, 2012 e 2015. Dor de dente foi avaliada com a pergunta: “Nos últimos seis meses, você teve dor de dente?”. As principais exposições foram raça/cor e macrorregiões brasileiras, usadas para avaliar as desigualdades relacionadas ao desfecho. Sexo, idade, tipo de escola e escolaridade materna foram as covariáveis utilizadas. A significância estatística das tendências na prevalência de dor de dente foi testada com regressão linear. As análises foram realizadas com o programa estatístico Stata 13.0, usando o comando svy. A prevalência padrão de dor de dente foi 18,8%, 21,1% e 23,7%, com uma tendência crescente ao longo do tempo (p < 0,001). Foram observadas desigualdades absolutas na prevalência de dor de dente de acordo com raça e macrorregião. A prevalência mais alta esteve associada ao sexo feminino, raça não-branca, escola pública e Região Norte do país. Os índices de desigualdade aumentaram no grupo de meninas negras, refletidos em um aumento na prevalência de dor de dente em meninas cujas mães tinham menos escolaridade. A prevalência de dor de dente em adolescentes brasileiros aumentou ao longo do tempo, e as desigualdades em relação à dor de dente persistiram nas populações marginalizadas e de acordo com a região do país. Resumen: El objetivo del estudio fue doble: (a) investigar las desigualdades raciales, como una dimensión específica que afecta al dolor dental, en adolescentes brasileños; e (b) investigar las variaciones regionales del dolor dental. Este estudio transversal usó datos de la Encuesta Nacional de Salud del Escolar (PeNSE), llevada a cabo con adolescentes en 2009, 2012 y 2015. El dolor dental fue evaluado por la pregunta: “En los últimos seis meses, ¿sufriste dolor dental?”. Los principales factores de exposición fueron raza y regiones brasileñas, y se usaron para evaluar las desigualdades relacionadas con los resultados. Sexo, edad, tipo de escuela y educación maternal fueron las covariables usadas. La significación estadística de las tendencias en el dolor dental fue probada usando regresión lineal. El análisis se realizó con el paquete estadístico Stata 13.0, usando el comando svy. El estándar de prevalencia de dolor dental fue 18,8%, 21,1% y 23,7%, con tendencia a aumentar a lo largo del tiempo (p < 0.001). Se observaron desigualdades absolutas en el dolor dental, relacionadas con raza y regiones. Se encontró una prevalencia más alta en chicas, de raza no blanca, escuelas públicas y Región del Norte. Los índices de desigualdades se incrementaron en el grupo de chicas negras, en detrimento de un incremento en la prevalencia del dolor dental en chicas cuyas madres contaban con menos educación formal. Se observó que la prevalencia de dolor dental en adolescentes brasileñas se incrementó a lo largo del tiempo y las desigualdades, respecto al dolor dental, continuaron manteniéndose en el tiempo en poblaciones marginalizadas y acordes con determinadas regiones brasileñas.

Background: This study aims to describe changes in gender and wealth inequalities in leisure-time physical activity (PA) of Brazilians during a 6-year interval. It also aims to evaluate inequalities regarding PA public programs awareness, participation, and access to public spaces for PA. Methods: Data from 2 population-based surveys conducted in 2013 and 2019 were used. Leisure-time PA prevalence was assessed considering those reporting ≥150 minutes per week. The authors evaluated gender inequalities calculating differences and ratios, and wealth inequalities using the slope index of inequality and the concentration index— assessing changes over time. Results: National levels of leisure-time PA increased from 2013 to 2019, and an increase in inequalities was observed; women and the poorest groups still presented lower prevalence. A decline in socioeconomic inequalities was observed from 2013 to 2019 regarding the availability of public spaces and awareness about public programs. However, outcomes remained more common among the richest group. Inequalities did not vary for participation in public programs. Conclusion: Although leisure-time PA increased from 2013 to 2019 at a national level, there were no improvements in gender inequalities, and wealth inequalities worsened over time. Indicators of public strategies for PA increased for the population, but inequalities remain.

Objective To describe socio-economic inequalities in dental pain and dental caries in 5 and 12-year-old children enrolled in a birth cohort. Methods This prospective study was carried out with children enrolled in a birth cohort in Pelotas, Brazil. The main outcome was history of dental pain in the last six months, collected at 5 and 12 years of age. Dental caries was evaluated as a secondary outcome. Inequalities dimensions were investigated using maternal education and family income. The inequalities indicators used were the slope index of inequality (SII) and the concentration index (CIX). Results Some 1,114 and 990 children were included in the analyses at the 5- and 12-year follow-ups, respectively. The prevalence of dental pain was 16.5% (95% CI 14.4-18.8) at 5 years and 31.6% (95% CI 28.7-34.6) at 12 years. Regarding SII, the difference in the prevalence of dental pain was 14 and 11 percentage points at 5 and 12 years, respectively, when comparing the less to the more maternal schooled strata. Relative inequalities (CIX) were found for dental pain only at age 12, considering family income (-5.8 CI95% -11.0; -0.6). Absolute socio-economic inequalities were also observed for dental caries in both ages. Conclusion Dental pain in the last six months and dental caries was unequally distributed. Economically disadvantaged groups had the highest prevalence of dental pain and dental caries in both dentitions. Actions to tackle socio-economic inequalities must be designed throughout life.

OBJECTIVE To describe the Nova score for the consumption of ultra-processed foods (UPF) and evaluate its potential in reflecting the dietary share of UPF in Brazil. METHODS This study was conducted in São Paulo with a convenience sample of 300 adults. Using a tablet, participants answered a 3-minute electronic self-report questionnaire on the consumption of 23 subgroups of UPF commonly consumed in Brazil, regarding the day prior the survey. Each participant score corresponded to the number of subgroups reported. The dietary share of UPF on the day prior to the survey, expressed as a percentage of total energy intake, was calculated based on data collected on a 30-minute complete 24-hour dietary recall administered by trained nutritionists. The association between the score and the dietary share of UPF was evaluated using linear regression models. The Pabak index was used to assess the agreement in participants’ classification according to the fifths of Nova score and the fifths of dietary share of UPF. RESULTS The average dietary share of UPF increased linearly and significantly with the increase of the Nova score for the consumption of ultra-processed foods. We found a substantial agreement in participants’ classification according to the fifths of the distribution of scores and the fifths of the dietary share of UPF (Pabak index = 0.67). Age was inversely associated with a relatively high frequency of UPF consumption (upper fifth of the distribution) for both score and dietary share of UPF. CONCLUSION The Nova score for the consumption of ultra-processed foods, obtained in a quick and practical manner, shows a good potential in reflecting the dietary share of UPF in Brazil. RESUMO OBJETIVO Descrever o escore Nova de consumo de alimentos ultraprocessados e avaliar seu potencial para refletir, no contexto brasileiro, a participação desses alimentos na dieta. MÉTODOS Estudo realizado na cidade de São Paulo com amostra de conveniência de 300 adultos, que responderam, em cerca de três minutos, em um tablet, a um questionário eletrônico de autorrelato sobre o consumo, no dia anterior, de 23 subgrupos de alimentos ultraprocessados comumente consumidos no Brasil. O escore de cada participante correspondeu ao número de subgrupos reportados. A participação de alimentos ultraprocessados no consumo alimentar do mesmo dia, expressa como percentual da ingestão total de energia, foi calculada por meio das respostas dos participantes a recordatório alimentar completo de 24 horas aplicado em cerca de 30 minutos por nutricionistas treinados. A associação entre o escore e a participação de ultraprocessados na dieta foi estudada por modelos de regressão linear. A concordância na classificação dos participantes segundo quintos do escore e quintos da participação de alimentos ultraprocessados na dieta foi avaliada pelo índice Pabak. RESULTADOS O percentual médio de participação de alimentos ultraprocessados na dieta aumentou linear e significativamente com o aumento do escore Nova de consumo de alimentos ultraprocessados. Observou-se concordância substancial na classificação dos participantes segundo quintos da distribuição do escore e quintos da distribuição do percentual de participação de alimentos ultraprocessados na dieta (índice Pabak = 0,67). Relação inversa da idade com a frequência de consumo relativamente elevado de alimentos ultraprocessados (quinto superior da distribuição) foi observada tanto para o escore quanto para a participação de alimentos ultraprocessados na dieta. CONCLUSÃO O escore Nova de consumo de alimentos ultraprocessados, obtido de forma rápida e prática, apresenta bom potencial para refletir, no contexto brasileiro, a participação desses alimentos na dieta.

Este estudo descreve modificações no peso corporal de participantes da coorte NutriNet Brasil (n=14.259) ocorridas durante a pandemia de covid-19. Foram analisados dados de peso informados em período anterior ao início da pandemia (26/01/2020 a 18/03/2020) e cerca de 6 meses após (14/09/2020 a 19/10/2020). O ganho de peso ≥ 2 kg alcançou 19,7% dos participantes, mostrando-se diretamente associado ao sexo masculino, à menor escolaridade e à presença prévia de excesso de peso, sendo inversamente associado à idade. A perda de peso ≥ 2kg alcançou 15,2% dos participantes, mostrando-se diretamente associada ao sexo masculino e à presença prévia de excesso de peso, sendo inversamente associada à idade.

O objetivo deste trabalho foi realizar uma revisão de escopo da literatura acerca da associação entre o consumo de alimentos ultraprocessados e desfechos em saúde. A busca foi realizada nas bases PubMed, Web of Science e LILACS. Foram elegíveis os estudos que avaliaram a associação entre o consumo de alimentos ultraprocessados identificados com base na classificação NOVA e os desfechos em saúde. O processo de revisão resultou na seleção de 63 estudos, os quais foram analisados em termos de qualidade com base em ferramenta do Instituto Nacional de Saúde dos Estados Unidos. Os desfechos encontrados incluíram indicadores de obesidade, marcadores de risco metabólico, diabetes, doenças cardiovasculares, câncer, asma, depressão, fragilidade, doenças gastrointestinais e mortalidade. A evidência foi particularmente consistente para obesidade (ou indicadores relacionados a ela) em adultos, cuja associação com o consumo de ultraprocessados foi demonstrada, com efeito dose-resposta, em estudos transversais com amostras representativas de cinco países, em quatro grandes estudos de coorte e em um ensaio clínico randomizado. Grandes estudos de coorte também encontraram associação significativa entre o consumo de alimentos ultraprocessados e o risco de doenças cardiovasculares, diabetes e câncer, mesmo após ajuste para obesidade. Dois estudos de coorte demonstraram associação do consumo de alimentos ultraprocessados com depressão e quatro estudos de coorte com mortalidade por todas as causas. Esta revisão sumarizou os resultados de trabalhos que descreveram a associação entre o consumo de alimentos ultraprocessados e as diversas doenças crônicas não transmissíveis e seus fatores de risco, o que traz importantes implicações para a saúde pública.

The aim of this study was to conduct a literature scope review of the association between the consumption of ultra-processed foods and health outcomes. The search was carried out in the PubMed, Web of Science and LILACS databases. Studies that assessed the association between the consumption of ultra-processed foods, identified on the NOVA classification, and health outcomes were eligible. The review process resulted in the selection of 63 studies, which were analyzed in terms of quality using a tool from the National Institutes of Health. The outcomes found included obesity, metabolic risk markers, diabetes, cardiovascular diseases, cancer, asthma, depression, frailty, gastrointestinal diseases and mortality indicators. The evidence was particularly consistent for obesity (or indicators related to it) in adults, whose association with the consumption of ultra-processed foods was demonstrated, with dose-response effect, in cross-sectional studies with representative samples from five countries, in four large cohort studies and in a randomized clinical trial. Large cohort studies have also found a significant association between the consumption of ultra-processed foods and the risk of cardiovascular diseases, diabetes and cancer - even after adjusting for obesity. Two cohort studies have shown an association of ultra-processed foods consumption with depression and four cohort studies with all-cause mortality. This review summarized the studies' results that described the association between the consumption of ultra-processed foods and various non-communicable diseases and their risk factors, which has important implications for public health.O objetivo deste trabalho foi realizar uma revisão de escopo da literatura acerca da associação entre o consumo de alimentos ultraprocessados e desfechos em saúde. A busca foi realizada nas bases PubMed, Web of Science e LILACS. Foram elegíveis os estudos que avaliaram a associação entre o consumo de alimentos ultraprocessados identificados com base na classificação NOVA e os desfechos em saúde. O processo de revisão resultou na seleção de 63 estudos, os quais foram analisados em termos de qualidade com base em ferramenta do Instituto Nacional de Saúde dos Estados Unidos. Os desfechos encontrados incluíram indicadores de obesidade, marcadores de risco metabólico, diabetes, doenças cardiovasculares, câncer, asma, depressão, fragilidade, doenças gastrointestinais e mortalidade. A evidência foi particularmente consistente para obesidade (ou indicadores relacionados a ela) em adultos, cuja associação com o consumo de ultraprocessados foi demonstrada, com efeito dose-resposta, em estudos transversais com amostras representativas de cinco países, em quatro grandes estudos de coorte e em um ensaio clínico randomizado. Grandes estudos de coorte também encontraram associação significativa entre o consumo de alimentos ultraprocessados e o risco de doenças cardiovasculares, diabetes e câncer, mesmo após ajuste para obesidade. Dois estudos de coorte demonstraram associação do consumo de alimentos ultraprocessados com depressão e quatro estudos de coorte com mortalidade por todas as causas. Esta revisão sumarizou os resultados de trabalhos que descreveram a associação entre o consumo de alimentos ultraprocessados e as diversas doenças crônicas não transmissíveis e seus fatores de risco, o que traz importantes implicações para a saúde pública.El objetivo de este estudio fue realizar una revisión de alcance de la literatura sobre la asociación entre el consumo de alimentos ultraprocesados y los resultados de salud. La búsqueda se realizó en las bases de datos PubMed, Web of Science y LILACS. Fueron elegibles los estudios que evaluaron la asociación entre el consumo de alimentos ultraprocesados identificados según la clasificación NOVA y los resultados de salud. El proceso de revisión resultó en la selección de 63 estudios, cuya calidad se analizó con base en una herramienta delo Instituto Nacional de Salud de Estados Unidos Los resultados encontrados incluyeron indicadores de obesidad, marcadores de riesgo metabólico, diabetes, enfermedad cardiovascular, cáncer, asma, depresión, fragilidad, enfermedad gastrointestinal y mortalidad. La evidencia fue particularmente consistente para la obesidad (o indicadores relacionados con ella) en adultos, cuya asociación con el consumo de alimentos ultraprocesados se demostró, con un efecto dosis-respuesta, en estudios transversales con muestras representativas de cinco países, en cuatro grandes estudios de cohortes y en un ensayo clínico aleatorizado. Grandes estudios de cohortes también encontraron una asociación significativa entre el consumo de alimentos ultraprocesados y el riesgo de enfermedades cardiovasculares, diabetes y cáncer, incluso después de ajustar la obesidad. Dos estudios de cohortes mostraron una asociación entre el consumo de alimentos ultraprocesados y la depresión y cuatro estudios de cohortes con mortalidad por todas las causas. Esta revisión resumió los resultados de estudios que describieron la asociación entre el consumo de alimentos ultraprocesados y las diversas enfermedades crónicas no transmisibles y sus factores de riesgo, lo que tiene importantes implicaciones para la salud pública.

OBJECTIVE To describe the dietary characteristics of participants in the NutriNet Brasil cohort immediately before and during the covid-19 pandemic. METHODS Our data stem from an adult cohort created to prospectively investigate the relationship between diet and morbidity and mortality from chronic non-communicable diseases in Brazil. For this study, we selected the first participants (n = 10,116) who answered twice to a simplified questionnaire on their diet the day before, the first time when entering the study, between January 26 and February 15, 2020, and the second between May 10 and 19, 2020. The questionnaire inquiries about the consumption of healthy (vegetables, fruits and legumes) and unhealthy (ultra-processed foods) eating markers. Comparisons of indicators based on the consumption of these markers before and during the pandemic are presented for the study population and according to gender, age group, macro-region of residence and schooling. Chi-square tests and t-tests were used to compare proportions and means, respectively, adopting p < 0.05 to identify significant differences. RESULTS For all participants, we found a modest but statistically significant increase in the consumption of healthy eating markers and stability in the consumption of unhealthy food markers. This favorable pattern of dietary changes during the pandemic occurred in most sociodemographic strata. We observed a less favorable changing pattern, with a tendency to increasing consumption of healthy and unhealthy food markers, in the Northeast and North macro-regions and among people with less schooling, suggesting social inequalities in the response to the pandemic. CONCLUSIONS If confirmed, the trend of increased consumption of ultra-processed foods in underdeveloped regions and by people with less schooling is concerning, as eating these foods increases the risk of obesity, hypertension and diabetes, whose presence increases the severity and lethality of covid-19. RESUMO OBJETIVO Descrever características da alimentação dos participantes da coorte NutriNet Brasil imediatamente antes e na vigência da pandemia de covid-19. MÉTODOS Os dados deste estudo provêm de coorte de adultos criada para investigar prospectivamente a relação entre alimentação e morbimortalidade por doenças crônicas não transmissíveis no Brasil. Para este estudo, foram selecionados os primeiros participantes (n = 10.116) que responderam por duas vezes a questionário simplificado sobre sua alimentação no dia anterior, a primeira vez ao ingressar no estudo, entre 26 de janeiro e 15 de fevereiro de 2020, e a segunda entre 10 e 19 de maio de 2020. O questionário indaga sobre o consumo de marcadores de alimentação saudável (hortaliças, frutas e leguminosas) e não saudável (alimentos ultraprocessados). Comparações de indicadores baseados no consumo desses marcadores antes e na vigência da pandemia são apresentadas para o conjunto da população estudada e segundo sexo, faixa etária, macrorregião de residência e escolaridade. Testes qui-quadrado e testes t foram utilizados para comparar proporções e médias, respectivamente, adotando-se p < 0,05 para identificar diferenças significantes. RESULTADOS Para o conjunto dos participantes, identificou-se aumento modesto, porém estatisticamente significante, no consumo de marcadores de alimentação saudável e estabilidade no consumo de marcadores de alimentação não saudável. Esse padrão favorável de mudanças na alimentação com a pandemia se repetiu na maior parte dos estratos sociodemográficos. Padrão menos favorável de mudanças, com tendência de aumento no consumo de marcadores de alimentação saudável e não saudável, foi observado nas macrorregiões Nordeste e Norte e entre pessoas com menor escolaridade, sugerindo desigualdades sociais na resposta à pandemia. CONCLUSÕES Caso confirmada, a tendência de aumento no consumo de alimentos ultraprocessados nas regiões economicamente menos desenvolvidas e por pessoas com menor escolaridade preocupa, pois a ingestão desses alimentos eleva o risco de obesidade, hipertensão e diabetes, cuja presença aumenta a gravidade e a letalidade da covid-19.

Objetivo: Descrever características da alimentação dos participantes da coorte NutriNet Brasil imediatamente antes e na vigência da pandemia de COVID-19. Métodos: Os dados deste estudo provêm de coorte de adultos criada para investigar prospectivamente a relação entre alimentação e morbimortalidade por doenças crônicas não-transmissíveis no Brasil. Para este estudo, foram selecionados os primeiros participantes (n=10.116) que responderam por duas vezes questionário simplificado sobre sua alimentação no dia anterior, a primeira ao ingressar no estudo, entre 26 de janeiro e 15 de fevereiro de 2020, e a segunda entre 10 e 19 de maio de 2020. O questionário indaga sobre o consumo de marcadores de alimentação saudável (hortaliças, frutas e leguminosas) e não saudável (alimentos ultraprocessados). Comparações de indicadores baseados no consumo desses marcadores antes e na vigência da pandemia são apresentadas para o conjunto da população estudada e segundo sexo, faixa etária, macrorregião de residência e escolaridade. Testes qui-quadrado e testes t foram utilizados para comparar proporções e médias, respectivamente, adotando-se p

Objective The aim of this study was to develop new appendicular lean mass (ALM) prediction models based on ultrasound and anthropometric measurements. Methods This was a cross-sectional assessment of a subsample from a population-based study (COMO VAI?), conducted with community-dwelling individuals ≥60 y of age living in a southern Brazilian city. ALM was measured by dual-energy x-ray absorptiometry (DXA). Muscle thickness (MT) from supine participants was assessed by ultrasound on the anterior aspect of both upper and lower limbs. Such measures, along with anthropometric data, were used to develop prediction models (multivariable linear regression) through the backward stepwise method. Results The study included 190 participants composed mainly of women, white, and middle-class individuals. The best ALM predictive performance was achieved by a model based on two “lengths” (height and arm length), two circumferences (dominant arm and thigh), and two ultrasound-measured MTs (dominant arm and thigh): R2 = 0.90, limits of agreement: ±2.36 kg. Closely satisfactory results were also achieved by an “abbreviated” model composed by the two aforementioned “lengths” and MTs (R2 = 0.89, limits of agreement: ±2.51 kg). ALM estimates from both equations were unbiased and similar to DXA measurements (P = 0.13 and 0.09, respectively). Bootstrap analysis favorably suggested the validity of the models. Conclusions Based on two ultrasound assessments and a few anthropometric measurements, the developed equations produced accurate and unbiased ALM estimates in the sample. Hence: 2 MTs + 2 lengths (+ 2 circumferences) = 4 limbs' muscle mass. Such models might represent promising alternatives for muscle assessment among older individuals.

The scope of this paper was to identify patterns of food consumption and associated factors among children under two years of age in Brazil. It involved a cross-sectional, population-based study using data from the National Health Survey conducted in 2013. Food consumption was measured by dichotomous questions, listing the food ingested solely on the day prior to the interview. The patterns were identified through principal component analysis. Poisson regression was used to obtain a crude and adjusted prevalence ratio. The sample design effect was considered in the analyses that were stratified according to age. Among the 5,052 children, three patterns were identified, being defined as: a "healthy food consumption pattern," a "milk consumption pattern" and an "unhealthy food consumption pattern." There was an association between the patterns in each age group, mainly related to skin color, gender, schooling of the head of the family, area of residence and region. A quarter of the children from 12 to 23 months consumed soft drinks, more than a third drank artificial juices and almost half ate candies the day before the interview. Three dietary patterns were identified, besides observing early food ingestion among children under six months of age.Objetivou-se identificar os padrões de consumo alimentar e os fatores associados em crianças menores de dois anos no Brasil. Estudo transversal, de base populacional, utilizando dados da Pesquisa Nacional de Saúde realizada em 2013. O consumo alimentar foi mensurado por questões dicotômicas, listando os alimentos, considerando apenas o dia anterior à entrevista. Os padrões foram identificados por meio de análise de componentes principais. Utilizou-se regressão de Poisson para obtenção de razão de prevalência bruta e ajustada. Considerou-se o efeito de delineamento amostral nas análises que foram estratificadas de acordo com a idade. Dentre as 5.052 crianças, foram identificados três padrões, sendo denominados como: “padrão de consumo de alimentos saudáveis”, “padrão de consumo de leites” e “padrão de consumo de alimentos não saudáveis”. Observou-se associação entre os padrões em cada faixa etária, principalmente com cor da pele, sexo, escolaridade do chefe da família, zona de residência e região. Um quarto das crianças de 12 a 23 meses ingeriu refrigerantes, mais de um terço sucos artificiais e quase metade doces no dia anterior à entrevista. Foram identificados três padrões alimentares, além de observar introdução alimentar precoce em crianças menores de seis meses de idade.

ObjectiveTo review the available literature on the association between consumption of ultra-processed foods and body fat during childhood and adolescence.DesignA systematic review was conducted in the PubMed, Web of Science and LILACS databases. Studies that evaluated the association between consumption of ultra-processed food (exposure) and body fat (outcome) during childhood and adolescence were eligible.SubjectsHealthy children and adolescents.ResultsTwenty-six studies that evaluated groups of ultra-processed foods (such as snacks, fast foods, junk foods and convenience foods) or specific ultra-processed foods (soft drinks/sweetened beverages, sweets, chocolate and ready-to-eat cereals) were selected. Most of the studies (n15) had a cohort design. Consumption was generally evaluated by means of FFQ or food records; and body composition, by means of double indirect methods (bioelectrical impedance analysis and skinfolds). Most of the studies that evaluated consumption of groups of ultra-processed foods and soft drinks/sweetened beverages found positive associations with body fat.ConclusionsOur review showed that most studies have found positive associations between consumption of ultra-processed food and body fat during childhood and adolescence. There is a need to use a standardized classification that considers the level of food processing to promote comparability between studies.

Background The study examined the association of body size (weight and length) at birth and gain in height and weight during childhood and adolescence with areal bone mineral density (aBMD) in adulthood for women and men. Methods 756 members (335 men and 421 women) of the 1993 Pelotas (Brazil) Birth cohort were studied. Data on weight and length/height were obtained at birth and subsequent follow-ups at 1, 4, 11, 15, 18, and 22 years of age and specific z scores were calculated by sex. The outcome was whole body aBMD (g/cm²) measured at 22 years of age using dual-energy X-ray absorptiometry (DXA). The effects of exposures, weight and length/height gain, were analyzed using conditional relative weight (CWh) and conditional length/height (CH). Linear regression models were adjusted for multiple confounders, including mother’s educational level, family income, maternal smoking during pregnancy, gestational age, breastfeeding and skin color. Results In the adjusted models, among men greater height gain at 4, 11, and 18 years of age was associated with higher whole body aBMD, and the result with greatest magnitude was at 11 years of age (β 0.018 g/cm²; 95%CI 0.006; 0.030). Among women, aBMD was associated with height gain at all assessments from 1–15 years, with greatest effect size at 4 years of age (β 0.017 g/cm²; 95%CI 0.007; 0.027). Regarding to body weight, among men, greater weight at 4 and 15 years were associated with higher aBMD, with the highest coefficients for 15 years of age (β 0.015 g/cm²; 95%CI 0.003; 0.027); for women, except at birth, all weight gain variables were associated with aBMD and the highest coefficients were observed at 4 years (β 0.025 g/cm²; 95%CI 0.015; 0.035). Conclusions In this birth cohort, height and weight gain, especially from 4 to 15 years have important positive implications for aBMD to early adulthood.

to evaluate maternal intention to breastfeed, duration of breastfeeding up to 24 months-of-age and reasons for weaning in the first year of life.this was a cohort study conducted in Pelotas, RS, Brazil, with participants from the Multi-Center Body Composition Study; a life table was used to analyze duration of breastfeeding.of the 1377 mothers screened, 74.3% reported intending to exclusively breastfeed up until 6 months, while 91.1% intended to prolong breastfeeding until at least 12 months; 58.0% of children were breastfed up to at least 6 months; median breastfeeding duration was 10.8 months (IQR: 5.8 - 23.0); the main reasons reported for weaning were insufficient breast milk (57.3%), return to work/school (45.5%), and unexplained refusal by the baby (40.1%).the results show that despite the intention to breastfeed, there are still structural and social barriers that interfere with successful breastfeeding, especially those related to working mothers.

BACKGROUND Diet has been of interest for asthma; however, it remains unknown whether the consumption of ultra-processed food (UPF) increases the risk of the disease. Our objective was to investigate whether UPF consumption during childhood was associated with wheeze, asthma, and severe asthma in adolescence. METHODS We included 2190 11-year-old children from the 2004 Pelotas Birth Cohort Study, without asthma at the age of 6 years. Consumption of UPF was assessed by Food Frequency Questionnaires at 6- and 11-year follow-ups. Wheeze, asthma, and severe asthma data were assessed at 11-year follow-up. We classified foods according to the processing degree in ultra-processed food. We used logistic regression to estimate the odds ratio (OR) and 95% confidence intervals (CIs), for the association between UPF consumption and the asthma outcomes. RESULTS Cumulative incidence of wheeze and asthma between 6 and 11 years was 12.7% and 23.2%, respectively. In prospective analyses, comparing children in the highest and the lowest quintile of UPF consumption at age 6, we found no association with wheeze (OR = 0.85; 95% CI = 0.54-1.34), asthma (OR = 0.84; 95% CI = 0.58-1.21), or severe asthma (OR = 1.12; 95% CI = 0.62-2.03) in early adolescence. In cross-sectional analyses, comparing adolescents in the highest and lowest quintile of UPF consumption at 11 years, we found no association with wheeze (OR = 1.12; 95% CI = 0.72-1.75), asthma (OR = 1.00; 95% CI = 0.7-1.44), or severe asthma (OR = 1.05; 95% CI = 0.59-1.86). CONCLUSION Our study provided evidence that UPF consumption during childhood or adolescence is not associated with asthma or wheeze among adolescents.

Resumo Estudo transversal de base populacional com objetivo de medir as prevalências e identificar os fatores associados à ocorrência de obesidade geral e abdominal entre idosos residentes na área urbana de Pelotas, RS. O processo de amostragem por conglomerados foi realizado em dois estágios. A obesidade geral foi definida pelo Índice de Massa Corporal (IMC), a partir das medidas de peso e altura estimada através da altura do joelho. Considerou-se como obeso quando IMC ≥ 30 kg/m2. A obesidade abdominal foi avaliada pela circunferência da cintura, sendo considerado obeso quando > 102 cm para homens e > 88 cm para mulheres. As análises brutas e ajustadas foram realizadas por meio da regressão de Poisson. A prevalência de obesidade geral foi 29,9% (IC95%: 27,5-32,4) e de abdominal 50,4% (IC95%: 47,8-53,1). Após o ajuste, as prevalências de ambos os desfechos foram maiores em mulheres, não fumantes, hipertensos e diabéticos e menores em fisicamente ativos no lazer. Idade apresentou associação inversa com obesidade geral e abdominal. A redução da obesidade nesta população depende do planejamento de políticas de saúde que englobem o incentivo à prática de atividade física, considerando as limitações e as condições de saúde do idoso. Abstract This is a cross-sectional population-based study aimed to measure the prevalence and to identify associated factors with the occurrence of general and abdominal obesity among the elderly living in the urban area of Pelotas, State of Rio Grande do Sul. The process of cluster sampling was conducted in two stages. Overall obesity was defined by Body Mass Index (BMI) from measurements of weight and height estimated by knee height. Obesity was considered when BMI was ≥ 30 kg/m2. Abdominal obesity was evaluated by waist circumference, being considered obese when it was > 102 cm for men and > 88 cm for women. The crude and adjusted analyses were performed using Poisson regression. The prevalence of obesity was 29.9% (CI95%: 27.5-32.4) and abdominal obesity, 50.4% (CI95%: 47.8-53.1). After adjustment, the prevalence of both outcomes were higher in women, non-smokers, hypertensives and diabetics and lower in the physically active in their leisure time. Age was inversely associated with general and abdominal obesity. Reducing obesity in this population depends on the planning of health policies actively encourage physical activity, keeping in mind the limitations and health conditions of the elderly.

This study aims to measure the association between body mass index (BMI), comparing two different classifications, and mortality among community-dwelling elderly considering myopenia in Pelotas, Brazil. This is a longitudinal study started in 2014, we followed 1451 elderly people (≥ 60 years) enrolled in the “COMO VAI?” study. BMI was classified according to the World Health Organization (WHO) and the classification with specific cutoff points for older adults. Myopenia was measured by calf circumference (≤33 cm for women and ≤34 cm for men). Cox proportional-hazards models were used to test associations controlling for sociodemographic and behavioral characteristics and number of morbidities. Nearly 10% (N = 145) of the elderly died during almost three years of follow-up. We observed a L-shaped relation between BMI and mortality. Elderly with underweight had a higher mortality risk compared to those with adequate BMI in both classifications. According to the WHO classification, overweight elderly presented protection for mortality (HR: 0.58; 95% CI 0.38–0.87) when compared to those with adequate BMI. Among elderly with myopenia, overweight by WHO continued to protect against mortality, although not significantly, while those with the specific classification underweight presented a higher risk of death compared to those with normal weight (HR: 2.09; 95% CI 1.06–4.14). In conclusion the underweight increased the risk of death in community-dwelling elderly people during a follow-up of three years. The specific classification seemed to be more adequate to indicate risk of mortality in this population. Higher BMI protect against mortality when muscle mass was not considered.

Objective The aim of this study was to examine the association between early feeding practices and consumption of ultraprocessed foods in children at age 6 y. Methods This was a prospective cohort study using data from 3427 children who participated in the 2004 Pelotas Cohort Study and who had available food frequency questionnaire information at 6 y. Information about exclusive and total breastfeeding duration as well as age at introduction of semisolid and solid foods was used to define early feeding practices. Consumption of ultraprocessed foods was defined as proportion of total daily energy intake that came from ultraprocessed foods at age 6 y. Crude and adjusted linear regression models were employed to analyze the effect of early feeding practices on ultraprocessed foods consumption. Results It was determined that 40.3% of total daily energy intake at 6 y came from ultraprocessed foods. In crude linear regression models, early feeding practices (exclusive and total breastfeeding duration, and age at introduction of semisolid and solid foods) were negatively associated with ultraprocessed foods consumption. After adjustment, only exclusive breastfeeding duration and age at introduction of solid foods remained associated with consumption of ultraprocessed foods, although the observed effects size was small. Children exclusively breastfed for ≥3 mo and those who had solid foods introduced at ≥4 mo consumed a lower proportion of daily energy intake from ultraprocessed foods. Conclusion This study supports the need to promote healthy early feeding practices including the support of breastfeeding to promote healthier eating habits later in childhood., Highlights • Newborn infants from southern Brazil were followed up in infancy and childhood. • Breastfeeding duration and timing of introduction of foods were recorded. • Ultraprocessed food intake was evaluated by a food frequency questionnaire. • Introduction of solid foods was related with consumption of ultraprocessed foods. • Longer exclusively breastfed infants had lower ultraprocessed food consumption later.

Aim To evaluate the relationship between leisure-time activities at 11 years old and the incidence of school failures from 11 to 15 years in adolescents. Methods The sample comprised 4,090 adolescents from the 1993 Pelotas Birth Cohort, Brazil. The outcome was measured as the number of school failures from 11 to 15 years, based on reported information from cohort participants and their parents. The exposures were collected at 11 years old, as follows: reading; meeting friends; talking to parents; and dating. Results In the group from 11 to 15 years old, 53.3% failed at school at least once. Meeting friends 4–7 times/week (RR = 1.15) and dating 1–3 times/week (RR = 1.22) were associated with high risk for school failure. Reading showed an inverse relationship with school failures (1–3 times/week RR = 0.83; 4–7 times/week RR = 0.71). Reading at least once a week could prevent around 16% of school failures. Conclusion The context in which adolescents are inserted plays a relevant role in school performance. Understanding these factors may help to propose actions to reduce school failure rates even further.

O objetivo foi avaliar a prevalência do consumo de leite materno e os fatores associados em crianças brasileiras com menos de dois anos de idade. Estudo transversal, de base nacional, realizado em 2013. Os desfechos foram amamentação entre crianças menores de 24 meses e amamentação exclusiva entre aquelas menores de seis meses de idade. Realizou-se análise hierárquica para fatores associados. As análises foram estratificadas por idade (0-5 meses e 29 dias; 6-11 meses e 29 dias; 12-23 meses e 29 dias de idade). A prevalência de aleitamento materno foi de 56% para o total estudado e, segundo idade, foi de 80% (0-5 meses e 29 dias), 62,3% (6-11 meses e 29 dias) e 40,1% (12-23 meses e 29 dias). Nas análises ajustadas, em todas as faixas etárias, a maior prevalência de ingestão de leite materno esteve associada ao menor número de alimentos lácteos consumidos. Entre crianças de 6-11 meses e 29 dias, residir na Região Norte, ter cor da pele preta e situar-se no menor quinto de posse de bens associaram-se a maior prevalência de amamentação. Naquelas entre 12-23 meses e 29 dias, maior prevalência de consumo de leite materno foi associado à cor da pele preta, consumo de líquidos e de alimentos saudáveis, residência na zona urbana, maior escolaridade do chefe da família e posse de maior número de bens. A prevalência de aleitamento exclusivo foi de 20,6%, sendo maior na Região Sul, nos maiores níveis de escolaridade do chefe da família e naquelas crianças com maior número de bens. As prevalências de amamentação e amamentação exclusiva nas crianças brasileiras menores de dois anos podem ser consideradas baixas. As políticas já existentes para aumentar as prevalências de consumo de leite materno, em qualquer faixa etária, devem ser reforçadas.