Autor: projetomina

We analyzed the association between birthweight, nutritional status and transverse maxillary growth in 7- to 9-year-old schoolchildren. We undertook a cross-sectional survey nested in a population-based cohort study of 158 schoolchildren. The participants lived in the urban area of a small town within the Western Brazilian Amazon. The outcome was represented by the upper intermolar distance given in millimeters (mm), as an indicator of the degree of maxillary bone growth in its transverse dimension. The exposures were sex, birthweight, the bottle-feeding pattern operationalized by a scale corresponding to the age of introduction of the bottle and Body Mass Index-for-age z-score (BAZ) at 4 to 6 ys. Path analysis was employed to estimate standardized direct, indirect and total effects of exposures on the outcome using structural equations model (SEM) supported by Mplus 7 program. The values of standardized coefficients (SC) showed significant direct positive effects of sex (SC = 0.203; p = 0.006), birth weight (SC = 0.155; p = 0.030) and BAZ (SC = 0.165; p = 0.014) on transverse maxillary growth. The indirect effects (SC = 0.057; p = 0.012) and the total effect (SC = 0.261; p<0.001) of sex on the outcome were statistically significant. The indirect effects of birth weight on the outcome were not significant (SC = 0.018; p = 0.488), however, the total effect was significant (SC = 0.174; p = 0.011). In conclusion, sex, birthweight, bottle beginning age and BAZ showed association with the transverse growth of the maxillary bone. In addition to contributing to an adequate birth weight of the child, policies and programs that favor prenatal care and conditions to guarantee a full-term birth can positively affect transverse growth of the maxilla. From a Public Health Surveillance point of view, children with reduced birthweight, inadequate breastfeeding pattern and nutritional deficit for age may be more likely to develop atrophy of the jaws which, depending on the severity, may result in malocclusion with an important impact on quality of life. Read the article.

We investigated linear growth and weight attained among 772 children at 10–15 months of age in the first population-based birth cohort in the Brazilian Amazon. Sociodemographic, maternal and birth characteristics were collected in interviews soon after birth at baseline. Anthropometric evaluation was conducted at 10–15 months. Multiple linear regression models were fitted for length-for-age (LAZ) and body mass index (BMI)-for-age Z scores (BAZ), considering a hierarchical conceptual framework with determinants at distal, intermediate and proximal levels, with adjustment for the child’s sex and age. Mean LAZ and BAZ were 0.31 (SD: 1.13) and 0.35 (SD: 1.06), respectively. Overall, 2.2% of children were stunted and 6.6% overweight. Among socioeconomic factors, household wealth index was positively associated with LAZ (p for trend = 0.01), while children whose families received assistance from the Bolsa Famı´lia conditional cash transfer program were 0.16 Z score thinner (95% CI: -0.31, -0.00). Maternal height and BMI were positively associated with both LAZ and BAZ at 10–15 months of age (p for trend <0.001). Child’s size at birth was positively related with LAZ (p<0.001 for both birth weight and length). BAZ was 0.34 (95% CI: 0.24, 0.44) higher, but 0.11 lower (95% CI: -0.21, -0.02), for each increase in 1 Z score of birth weight and length, respectively. Children with at least one reported malaria episode within the first year of life were 0.58 (95% CI: -1.05, -0.11) Z score shorter. Socioeconomic and intergenerational factors were consistently associated with LAZ and BAZ at 10–15 months of age. The occurrence of malaria was detrimental to linear growth. In a malaria endemic region, reduction of inequalities and disease burden over the first 1,000 days of life is essential for taking advantage of a critical window of opportunity that can redirect child growth trajectories toward better health and nutrition conditions in the long term. Read the article.

To evaluate whether weekly gestational weight gain is associated with anemia, vitamin A insufficiency, and blood pressure levels in the third trimester of pregnancy. A prospective study with 457 pregnant women attending primary care in Cruzeiro do Sul, Acre. The weekly gestational weight gain rate measured between the second and third trimesters was classified as insufficient, adequate, and excessive according to the recommendations of the Institute of Medicine 2009. The outcomes at the beginning of the third gestational trimester were: anemia (Hb < 110 g/L), vitamin A insufficiency (serum retinol<1.05 μmol/L) and blood pressure levels (continuous values, in mmHg). Age-adjusted prevalence ratios, schooling, and use of vitamin and mineral supplements were calculated in Poisson regression models with robust variance. A total of 18.6% of pregnant women had insufficient weekly weight gain, and 59.1% had excessive weight gain. The frequencies of anemia, vitamin A insufficiency and hypertension (systolic blood pressure ≥ 140 mmHg or diastolic ≥ 90 mmHg) were 17.5%, 13.4%, and 0.6%, respectively. The prevalence ratios for anemia among pregnant women with insufficient and excessive weight gain were 0.41 (95%CI 0.18–0.93) and 1.00 (95%CI 0.63–1.59), respectively, when compared to pregnant women with adequate weight gain. For vitamin A insufficiency, the adjusted prevalence ratio was significantly higher among pregnant women with insufficient weight gain (2.85, 95%CI 1.55–5.24) and no difference for excessive weight gain (1.53, 95%CI 0.84–2.74) when compared to pregnant women with adequate weight gain. Pregnant women with excessive weight gain had higher mean systolic blood pressure (111.10; 95%CI 109.9–112.2) when compared to pregnant women with insufficient weight gain (107.50; 95%CI 105.4–109.6) and adequate (106.20; 95%CI 104.3–108.20). Insufficient weekly gestational weight gain was associated with the risk of vitamin A insufficiency. Excessive weight gain, in turn, was associated with higher blood pressure values at the beginning of the third gestational trimester. Read the article.

Early life feeding practices can directly affect the growth, development, and survival of a child. This study aimed to estimate the frequency of and factors associated with exclusive breastfeeding (EBF) in the first month of life among Amazonian infants. We used data of 1,523 mother-child pairs of the MINA-Brazil birth cohort study. Mothers were interviewed soon after delivery at baseline and by telephone at 30–45 days postpartum (n = 962, 63.2% of those eligible). Kaplan-Meier survival analysis and accelerated failure-time (AFT) models were used to estimate the probability of EBF and the factors associated with EBF duration in the first month. At 30 days of age, 36.7% of the studied population (95% confidence interval [CI] 33.6–39.8) were exclusively breastfed, with a median duration of 16 days. Considering all eligible children for follow-up, the probability of EBF in the first month was 43.7% (95% CI 40.4–46.8), and the median duration was 30 days. The duration of EBF (time-ratio, TR) was 28% longer among multiparous mothers (TR 1.28; 95% CI 1.11–1.48). The use of a pacifier and the occurrence of wheezing were associated with a reduced EBF duration by 33% (TR 0.67; 95% CI 0.58–0.77) and 19% (TR 0.80; 95% CI 0.70–0.93), respectively. These results highlight that EBF among children in the Brazilian Amazon is considerably below international recommendations, and indicate the immediate need to plan and implement actions to promote and support breastfeeding early in life. Read the article.

Nutrition during pregnancy is one of the key elements to good maternal and child health, as well as to lifetime landmarks. However, many pregnant women go undernourished in less developed settings. The purpose of this study was to estimate the prevalence and factors associated with gestational night blindness (GXN) and maternal anemia in a cross-sectional population-based study in Cruzeiro do Sul, Acre State, Western Brazilian Amazon. All women living in the municipality admitted at the only maternity-hospital in the city to delivery of a singleton infant were eligible to this study (n = 1,525). Recruitment of participants took place between July 2015 to June 2016. GXN was assessed in the postpartum period by WHO standardized interview. Maternal anemia was defined as hemoglobin at delivery < 110.0 g/L. We estimated prevalence rates and adjusted prevalence ratios (aPR), alongside 95% confidence intervals (95% CI), of the factors associated with the outcomes through multiple Poisson regression models with robust variance. Alarming prevalence of GXN (11.5%; 95% CI, 9.97–13.25) and maternal anemia (39.4%; 95% CI, 36.84–41.95) were found. Factors associated with GXN were (aPR; 95% CI): � 5 residents in the household (2.06; 1.24–3.41), smoking during pregnancy (1.78; 1.15–2.78), and attending < 6 antenatal care visits (1.61; 1.08–2.40). Factors associated with maternal anemia were (aPR; 95% CI): maternal age < 19 years (1.18; 1.01–1.38), gestational malaria (1.22; 1.01–1.49), not taking micronutrient supplements during pregnancy (1.27; 1.01–1.62), and attending < 6 antenatal care visits (1.40; 1.15–1.70). High prevalence rates of GXN and maternal anemia in these postpartum women may reflect poor assistance during antenatal care, underlying the importance of rethinking current protocols related to nutrition in pregnancy. Read the article.

Inadequate Vitamin A (VA) status during pregnancy has been associated with maternal anemia and suboptimal newborn birth weight (BW). We assessed the effect of gestational serum retinol and β-carotene (µmol/L), in different moments during pregnancy, on maternal hemoglobin (Hb, g/L) and anemia (Hb<110.0 g/L) at delivery, and newborn BW (kg). In a prospective cohort study in Cruzeiro do Sul, Western Brazilian Amazon, biomarkers of the VA status were assessed in the second and third trimesters in pregnancy. Serum retinol and β-carotene were analyzed considering their effects in each and in both assessments (combined VA status), and the difference of serum values between assessments. Multiple linear and Poisson regression models were used with a hierarchical selection of covariates. A total of 488 mother–newborn pairs were surveyed. Combined VA deficiency status increased the risk for maternal anemia (adjusted prevalence ratio: 1.39; 95% CI 1.05–1.84), and was negatively associated with maternal Hb (β − 3.30 g/L; 95% CI − 6.4, − 0.20) and newborn BW (β − 0.10 kg; 95% CI − 0.20, − 0.00), adjusted for socioeconomic, environmental, obstetric, and antenatal characteristics, and nutritional indicators. However, the association for newborn BW was no longer significant after further adjustment for plasma ferritin. There were no significant associations between serum β-carotene and the outcomes studied. Poor serum retinol status throughout pregnancy was associated with maternal anemia at delivery in Amazonian women. The current World Health Organization protocols for supplementation during antenatal care should consider VA status for planning recommendations in different scenarios. Read the article.

Determining the predictors of serum retinol at mid-pregnancy is relevant for planning interventions aimed at improving vitamin A status of pregnant women and their offspring. This prospective study assessed predictors of serum retinol at the beginning of the third trimester of pregnancy. We enrolled 442 pregnant women living in the urban area of Cruzeiro do Sul, Western Brazilian Amazon. Demographic, socioeconomic, environmental and clinical characteristics as well as obstetric history, anthropometric, dietary and biochemical data, including serum retinol, were gathered between 16 and 20 gestational weeks. Serum retinol also measured at the beginning of the third trimester of pregnancy (approximately 28 gestational weeks) was the outcome of interest. Multiple linear regression models were used to evaluate associations with the outcome. Overall, the following variables explained serum retinol at the beginning of the third trimester of pregnancy in the adjusted model (R2 = 11·1 %): seasonality (winter season – November to April; β =0·134; 95 % CI 0·063, 0·206), weekly consumption of Amazonian fruits (β =0·087; 95 % CI 0·012, 0·162) and retinol concentrations between 16 and 20 gestational weeks (β =0·045; 95 % CI 0·016, 0·074) were positively associated, whereas having a smoker in the house was negatively associated (β =–0·087; 95 % CI: –0·166, –0·009). Consumption of pro-vitamin A-rich fruits by pregnant women should be encouraged. Passive smoking may play a role in decreasing vitamin A status as a proxy of smoking exposure during pregnancy. Read the article.

Os primeiros 1.000 dias de vida compreendem desde o momento da concepção até os dois anos de idade da criança, sendo 270 dias da gestação mais 365 dias do primeiro ano de vida somado aos 365 dias do segundo ano de vida. É um período conhecido como “janela de oportunidades” uma vez que tanto os hábitos atitudes adotadas neste período repercutirão em indicadores de saúde e doença durante todo o ciclo de vida. Os Odontopediatras podem contribuir realizando orientações às gestantes sobre como prevenir e tratar agravos de saúde bucal e, também realizar orientações para promover a saúde bucal do bebê, principalmente em relação ao aleitamento materno, hábitos de sucção, higiene dentária, e a importância da nutrição e escolha de práticas alimentares saudáveis neste período para o adequado desenvolvimento da saúde bucal e geral. Frente a importância da saúde bucal no contexto dos primeiros 1.000 primeiros dias de vida, este trabalho teve por objetivo revisar a literatura e indicar caminhos para os novos estudos a respeito de condições nutricionais e práticas alimentares relacionadas aos principais agravos em saúde bucal que acometem crianças nesse período de vida, tais como cárie dentária, desgaste dentário erosivo, maloclusões e defeitos de desenvolvimento do esmalte dentário (DDE). Para isso, foi realizada uma revisão narrativa. Estudos de melhor força de evidência científica são referentes à associação entre fatores nutricionais, cárie dentária e DDE. Ainda há escassez de estudos longitudinais bem delineados sobre condições nutricionais e práticas alimentares e sua relação com agravos bucais no período de primeiros 1.000 dias de vida. Leia o artigo.