Autor: projetomina

This study conducts a systematic literature review and meta-analysis regarding the potential influence of serum uric acid levels on cerebral small vessel diseases and the cognitive status in the prodromal stages of dementia. We identified four different cerebral small vessel diseases and three specific domains of cognitive performance to be considered in the literature search. The analysis contained 14 studies (13 cross-sectional design and one longitudinal design) with 11,502 participants measuring the relationship between uric acid and cerebral small vessel disease. In both continuous and categorical analyses, significant associations were found between hyperuricemia and cerebral small vessel diseases (continuous data: pooled OR: 1.00, 95%CI: 1.00–1.01 and categorical data: pooled OR: 1.42, 95%CI: 1.15–1.75). For the relationship between uric acid and cognitive performance, 19 studies with 49,901 participants were considered, including eight cohort studies, and 11 cross-sectional studies. The cross-sectional data showed that a marginal relationship existed between uric acid and global cognition (β: 0.00, 95%CI: -0.01–0.00). The pooled analysis of cohort studies indicated that higher uric acid had a deleterious effect on attention and executive function (continuous data: β: -0.02, 95%CI: -0.04–0.00 and categorical data: β: -0.03, 95%CI: -0.07–0.00). Conclusion: Our study indicated that a higher level of uric acid had an adverse effect on brain health. Furthermore, a high level of uric acid is related to cognitive decline in attention and executive function, which may exist a long time before the diagnosis of dementia. Read the article.

Vitamin D insufficiency has been related to metabolic complications during pregnancy, including insulin resistance. There is evidence that excessive weight gain can negatively influence 25-hydroxyvitamin D (25(OH)D) concentrations. We aimed to investigate the association of vitamin D insufficiency during pregnancy (25(OH)D₃ < 75 nmol/L in the second and third trimesters) with insulin resistance, and explore whether excessive gestational weight gain (GWG) could modify such relationship. A prospective longitudinal analysis was conducted within the MINA-Brazil Study among 444 pregnant women enrolled in antenatal care and with complete data on 25(OH)D₃, weight gain, insulin, and homeostatic model assessment of insulin resistance (HOMA-IR). Quantile and logistic regression models were conducted with adjustment for sociodemographic, obstetric, and lifestyle characteristics, as well as gestational age and seasonality at outcome assessment. Predicted probabilities for insulin resistance (HOMA-IR>2.71) were estimated according to excessive GWG. Persistent vitamin D insufficiency was associated with increasing insulin concentrations (p for trend = 0.04); pregnant women with vitamin D insufficiency in the second or third trimester had an odds ratio of 1.83 (95% confidence interval (95% CI) = 1.03, 3.27) for insulin resistance, with significant modification by GWG (p = 0.038). Among participants without excessive GWG, the predicted probability for insulin resistance was 0.345 (95% CI = 0.224, 0.467) for those with persistent vitamin D insufficiency, and 0.134 (95% CI = 0.046, 0.221) for those who were sufficient in vitamin D. Probabilities for insulin resistance did not vary according to vitamin D status among participants with excessive GWG. Vitamin D insufficiency was associated with insulin resistance in the third trimester of pregnancy, dependent on excessive GWG. Read the article.

We estimated risk factors associated with suspected neuropsychomotor developmental delay at age 2 years, in a birth cohort in the Brazilian Amazon. The Maternal and Child Health and Nutrition in Acre (MINA-Brasil) study is a population-based birth cohort involving children born between July 2015 and June 2016 in the municipality of Cruzeiro do Sul, in the Brazilian state of Acre. We assessed neuropsychomotor development in 735 and 819 children at one and 2 years of age, respectively, using the Denver II screening test. Multivariate Poisson regression models were used to investigate the factors associated with suspected developmental delay at age 2 years. The frequency of suspected developmental delay was 29.5 and 51.0% at one and 2 years of age, respectively, with a cumulative incidence of 41.6% and a persistence of 60.6% between the first and second years of life. After adjustment, the risk of developmental delay at 2 years of age was found to be higher for children born to women with fewer years of education and whose mothers had urinary tract infection during pregnancy. Other risk factors included male sex, low height for age at 2 years, malaria at childhood, pacifier use and limited child stimulation at age 2 years. Read the article.

The prevalence of immunity to Chikungunya virus (CHIKV) in pregnant women and newborns in the Western Brazilian Amazon was assessed at a time when previous studies did not report chikungunya fever in the area. In 435 asymptomatic pregnant women and 642 healthy unrelated newborns, the presence of IgM and IgG antibodies to CHIKV were determined by a commercial ELISA. All participants were negative to IgM anti-CHIKV. Anti-CHIKV IgG was identified in 41 (9.4%) pregnant women and 66 (10.3%) newborns. The presence of anti-CHIKV IgG was positively associated with the lowest socioeconomic status in pregnant women (OR 2.54, 95% CI 1.15-5.62, p=0.021) and in the newborns’ mothers (OR 5.10, 95% CI 2.15-12.09, p< 0.001). Anti-CHIKV IgG was also associated with maternal age in both, the pregnant women (OR 1.06, 95% CI 1.00-1.11, p=0.037) and the newborns’mothers (OR 1.08, 95% CI 1.03-1.12, p=0.001). Pregnancy outcomes in which the mother or the newborn was anti-CHIKV IgG positive proceeded normally. Negative CHIKV serology was associated with being positive for DENV antibodies and having had malaria during pregnancy. These findings showed that there was already a silent circulation of CHIKV in this Amazon region before the first outbreak of chikungunya fever. Furthermore, seropositivity for CHIKV was surprisingly frequent (10%) in both, pregnant women and newborns, affecting mainly low-income women. Read the article.

The objective of this study was to promote healthy and adequate complementary feeding practices in Acre, a state located in the Western Brazilian Amazon, through qualification of primary healthcare (PHC) professionals. Specific aims were to: (1) develop educational materials based on the Brazilian Food Guidelines for Young Children; and (2) conduct and evaluate an online asynchronous workshop among professionals. Educational materials were developed by a multiprofessional team. Participants were invited through messages from Secretariats of Health in the state of Acre. During the workshop, communication with the participants took place through email, Instagram and WhatsApp. Activities were developed to track the participants’ accomplishments throughout the course. Summative assessment was carried out through a final questionnaire and evaluation was performed based on reach parameters previously defined by the workshop coordinators, based on indicators for the fulfillment of the project’s aims (table 1). The workshop materials consisted of 55 videos divided in eight themes: (1) Complementary feeding: scenario and challenges, (2) Reflections on healthcare and nutrition education, (3) Food processing and conflicts of interest, (4) Importance and promotion of breastfeeding, (5) Foundations for the complementary feeding, (6) Evolution of complementary feeding: from 6 months to 2 years, (7) Child health: overcoming challenges, (8) Family meals. Contents were presented as recorded classes (interactive or not), animations (interactive or not), interviews, podcasts, movie session with synchronous discussion, and cooking videos. A total of 30 hours of learning materials were available on an online learning platform. 170 participants (67% from Acre), with a mean age of 33 years (SD 8) participated in the workshops. Most were female (90%), and nurses (45%). Other professionals included dietitians (28%), dentists (5%), and social workers (3%). Main barriers to promote adequate complementary feeding were lack of training in the subject (reported by 54% of participants) and lack of supporting materials (reported by 43%). The Project had a high reach of PHC facilities and participants registered in the workshop, and medium reach concerning meetings with PHC coordinators and participants completing the workshop. Participants preferred contents in the format of animations and video lessons up to ten minutes long. Contents considered the most important were anthropometric evaluation of children, food processing and classification), prenatal diets and breastfeeding challenges. The Project’s workshops thus addressed the main challenge to promoting complementary feeding in the Western Brazilian Amazon: the lack of training. Maintaining high levels of synchronous interaction with participants remains a challenge of future workshops. Read the article.

Compelling evidence supports the current international recommendation of at least 150 min/week of leisure-time physical activity (LTPA) during pregnancy. However, the potential relationship between LTPA and birth weight (BW) remains unclear in low- and middle-income countries. The purpose of this study was to examine the association between LTPA during pregnancy and offspring BW in an Amazonian population. Prospective cohort study was carried-out with 500 pregnant women and their offspring followed-up in the MINA-Brazil study, which was conducted in Cruzeiro do Sul, Western Brazilian Amazon. LTPA was assessed in the second (mean 19.6, SD 2.4 weeks) and third (mean 27.8, SD 1.6 weeks) gestational trimesters by a standardised interview and categorised according to the recommended cut-off of at least 150 min/week. We calculated offspring BW z-scores by sex and gestational age. We then explored the effect of LTPA during pregnancy on offspring BW, the association between LTPA and small-for-gestational-age (SGA) or large-for-gestational-age (LGA) births, and the mediating role of excessive and insufficient gestational weight gain (GWG). At least 150 min/week of LTPA during the third gestational trimester was associated with an offspring BW decrease of -0.35 z-score (95% CI: -0.65, -0.05) or -147.9 grams (95% CI: -260.9, -14.8), without increasing the frequency of SGA foetuses either in the second or third gestational trimester (p > 0.05). Excessive GWG mediated the effect of LTPA on the offspring BW (indirect effect = -0.05 z-score [95% CI: -0.10, -0.00] or -34.7 grams (95% CI: -66.1, -3.3]). This mediation effect was not observed for insufficient GWG. LTPA in the third, but not in the second, trimester of pregnancy was inversely associated with offspring BW without increasing the frequency of SGA, an effect that was partly mediated by excessive GWG. Read the article.

To determine predictors of 25-hydroxyvitamin D₃ (25(OH)D₃) concentrations (25^th, 50^th, and 75^th percentiles) in the third trimester of pregnancy. Data on sociodemographic, obstetric, lifestyle and pregnancy characteristics, including serum 25(OH)D₃ and retinol, were collected among 448 pregnant women who participated in the Maternal and Child Health and Nutrition in Acre, Brazil (MINA-Brazil Study) in Cruzeiro do Sul, Brazilian Amazon (latitude 7°S). Simultaneous-quantile regression was fitted to prospectively assess predictors at the 25^th, 50^th and 75^th percentiles of 25(OH)D₃ concentrations. In the third trimester, 25(OH)D₃ <50 nmol/L was observed in 26% of pregnant women. Exposure to the Amazonian dry season during follow-up and vitamin D status ≥75 nmol/L in the second trimester of pregnancy were positively associated with 25(OH)D₃ concentrations in the third trimester. Pregnant women who were the main providers of family income presented lower 25(OH)D₃ concentrations (50^th and 75^th percentiles: −15 nmol/L, 95%CI −24; −3, p = 0.02, and −22 nmol/L, 95%CI −36; −7, p = 0.004, respectively), as well as those with sustained vitamin A insufficiency (25^th and 50^th percentiles: −27 nmol/L, 95%CI −40; −15, p < 0.001, and −17 nmol/L, 95%CI −33; −1, p = 0.04, respectively). Sun protection practices had a smaller negative impact on 25(OH)D₃, restricted to participants whose concentrations were at the 25^th percentile of the distribution. Seasonality and vitamin A status were important predictors of 25(OH)D₃ concentrations in the third trimester. Adequate exposure to sunlight and dietary sources of vitamin A within safe intake levels may help ensuring a good nutritional status of vitamin D during pregnancy. Read the article.

Este estudo investigou como as condições socioeconômicas de mães que residem na área urbana de Cruzeiro do Sul, Acre, interagem com o acesso a alimentos, tendo como foco as motivações envolvidas nas escolhas dos locais de aquisição de alimentos e dos tipos de alimentos adquiridos. Os métodos de produção de dados empregados foram a entrevista em profundidade e observação participante com 20 mulheres, posteriormente classificadas em diferentes grupos socioeconômicos. A partir de análise de conteúdo identificamos quatro principais fatores considerados pelas participantes para pensar os alimentos e seus locais de aquisição: preço, variedade, praticidade e estratégias. Nossos resultados apontam que disparidades socioeconômicas influenciam o acesso a alimentos por meio da valorização de alguns aspectos em detrimento de outros no processo de escolha alimentar, culminando em distintas motivações e formas de aquisição de alimentos. Logo, em um nível local, o acesso aos locais de compra e a aquisição de alimentos são fortemente influenciados pelas condições socioeconômicas, fazendo com que as práticas alimentares de grupos socioeconômicos díspares se diferenciem de forma polarizada, como a valorização de alimentos regionais e a distinção destes em relação aos alimentos “de fora”. Leia o artigo.

Approximately 40% of women experience their first depressive episode during the postpartum period. In Brazil, several maternal health outcomes are affected by profound social inequalities. Investigating inequalities in maternal depressive symptomatology in two different regions of the country in the first 24 months after childbirth may help clarify these patterns and appropriate support services. Data from three birth cohorts from two Brazilian cities (Cruzeiro do Sul, North region, and Pelotas, South region) were analysed. The baseline of each cohort consisted of 4,231 (2004 Pelotas), 4,275 (2015 Pelotas), and 1,246 (MINA-Brazil) live births. Depressive symptomatology was repeatedly measured using the Edinburgh Postnatal Depression Scale (EPDS) at 3, 12, and 24 months postpartum. Socioeconomic status and skin colour inequalities in depressive symptomatology were analysed at each point. Between the 3rd and 24th months postpartum, maternal depressive symptomatology increased amongst women from the south, but decreased amongst women in the north. Black/brown women and those belonging to the lowest socioeconomic stratum showed the highest frequency of depressive symptomatology. Absolute and relative inequalities remained stable throughout the study period. Depressive symptomatology was most common amongst women with few years of schooling, multiparae, and amongst those who smoked during pregnancy. There was no information regarding any psychological/psychiatric treatment at the time the EPDS was evaluated, and economic status was assessed differently amongst the cohorts. Marked social inequalities were found in postpartum depressive symptoms. Actions aimed at early detection and reducing social inequalities in maternal postpartum depressive symptomatology are vital. Read the article.

To assess how mothers classify foods and how their eating practices interact with these classifications, with special attention to meanings and uses given to ultra-processed foods. Qualitative research with in-depth interviews and pile sorts. Content analysis for in-depth interviews and multidimensional scaling and cluster analysis for pile sorts. Classifications were based on context (ie, a time or a situation in which the food is eaten) and foods’ healthiness. Five food groupings based on mothers’ classifications were defined: (1) main meal foods, (2) fruits and fruit juices, (3) convenient foods, (4) leisure foods, and (5) canned sardines. Ultra-processed foods were classified differently from non-ultra-processed foods and considered unhealthy, consumed on special occasions or when there was no time or desire to cook. Results highlight the potential of incorporating context-based categories and personal experiences to guide nutrition interventions and the potential of pile sorts to tailor messages to target populations. Read the article.