Juliana Araujo Teixeira

O objetivo deste estudo foi analisar perspectivas de gestores e profissionais de saúde sobre concepção e implementação de uma intervenção referente à vigilância do desenvolvimento infantil (DI) com uso da Caderneta da Criança na Atenção Primária à Saúde (APS). Estudo qualitativo, com abordagem participativa de codesign de pesquisa em saúde. Foram realizadas entrevistas semiestruturadas, baseadas no Consolidated Framework for Implementation Research (CFIR), com 14 participantes de dois municípios brasileiros. Por meio de análise temática indutiva, foram identificadas barreiras e facilitadores dos serviços de saúde, vigilância do DI, caderneta da criança, gestão do cuidado infantil e processo de implementação. Dinâmicas institucionais, lacunas conceituais e possibilidades de reorganização do cuidado infantil permearam as percepções dos gestores e profissionais de saúde. A abordagem de codesign contribuiu para o planejamento da intervenção em busca de qualificar a vigilância do DI na APS.

Background: Little is currently known about adolescents’ diet quality and its determinants in New Zealand (NZ). Aims: This study described the dietary patterns (DP) of 12-year-olds in the Growing Up in NZ cohort and their associations with sociodemographics and food security. Methods: Data from a 59-item food frequency questionnaire were analysed. Principal component factor analysis was used to identify the DPs, based on the scree plot analysis and interpretability of the matrix after varimax rotation. Associations between quartiles of DP scores with food security and sociodemographic characteristics were examined using multivariate multinomial regression models. Results: Two DPs were identified, explaining 51.8% of the variance in food intake. DP ‘refined, high in sugar, salt and fat ’ was characterised by high positive loadings in foods and drinks high in sugar, energy drinks, foods high in salt and fat, processed meats, refined breads and cereals, and the protein foods group (lean animal and non-animal protein sources). Adolescents with higher adherence to this DP were more likely to identify as Pacific, Māori or Asian, have mothers with lower levels of formal education, live in food-insecure households and were less likely to live in rural areas. The ‘core food groups’ DP was characterised by high positive loadings in vegetables, fruit, milk and dairy products (whole and low-fat), bread and cereals (refined and wholegrain) and protein foods. Those with higher adherence to this DP were more likely to live in rural areas and less likely to have mothers with lower levels of formal education. Conclusion: Poorer diet quality was more likely among adolescents in disadvantaged conditions. Findings reinforce the call for government-led mandatory interventions in the NZ food environment to improve young people’s diet quality equitably to set them on trajectories of good health and well-being.

Food biodiversity is vital for human health and sustainable food systems. However, research on neglected and underutilized species is limited by funding, uneven research capacity, and the challenge of balancing ecological, cultural, and public health considerations, requiring innovative prioritization approaches. Using Brazil as a model, this study inventories 369 neglected food species across algae, aquatic fauna, wild terrestrial vertebrates, insects, mushrooms, and plants. A mixed-methods approach, combining expert knowledge and explainable AI (LightGBM and SHAP value analysis), identified key factors for prioritizing species for food composition and consumption studies. The inventory is dominated by plants (29.5%) and wild vertebrates (24.4%), with major nutritional data gaps, particularly for algae, insects, and wild vertebrates. Over 36,000 recipes using neglected species were identified. In both food composition (R²: 0.677) and consumption studies (R²: 0.782) recipe number and species occurrence across different states were the most influential features predicting prioritization. These findings emphasize the role of cultural uses and local accessibility in shaping nutritional research priorities. We urge increased research on neglected species to bridge data gaps and integrate them into food systems, promoting sustainable diets in Brazil and other tropical regions.

OBJETIVO: Identificar e mapear de forma sistemática os estudos que envolvem a Caderneta da Criança (CC) no Brasil. MÉTODOS: Revisão de escopo utilizando a metodologia proposta pelo Instituto Joanna Briggs. Foram consultadas as bases de dados PubMed, BVS Regional, Biblioteca Digital Brasileira de Teses e Dissertações, Periódicos Capes e Google Scholar. Incluíram-se estudos primários e secundários que mencionavam o uso da CC, sem restrições quanto ao delineamento, ano de publicação ou população, publicados em português, inglês ou espanhol e literatura cinzenta (teses e dissertações). RESULTADOS: Foram incluídos 129 estudos, em sua maioria descritivos, publicados como artigos científicos. A região Nordeste, a população de cuidadores das crianças e o cenário da atenção primária foram observados na maioria dos estudos; 47% dos estudos utilizou a CC como fonte de dados, a maioria sobre vacinação. Apesar dos diferentes critérios para definir adequação de preenchimento da CC, os estudos identificaram fragilidades no preenchimento de todos os seus itens, com exceção da vacinação. Características contextuais (como a disponibilidade da CC), das crianças (sexo, idade, prematuridade e consultas de puericultura), dos familiares e cuidadores (idade, escolaridade, renda, paridade, trabalho, pré-natal, ler, fazer anotações e levar a CC nas consultas) e dos profissionais (local de atuação, especialidade médica, comunicação no trabalho, conhecimentos sobre a CC, solicitar, orientar sobre e realizar anotações na CC) foram relacionadas ao uso e/ou preenchimento da CC. CONCLUSÕES: Os resultados reforçam a necessidade de melhor compreender quais fatores afetam a distribuição da CC à população, assim como apontam para a necessidade de compreender o seu uso e preenchimento pelos diversos pontos de atenção. Fica clara a necessidade de estudos de intervenção para que a implementação desse instrumento seja aprimorada e de incluir capacitações sobre a caderneta no contexto da educação permanente em saúde.

The maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) influence maternal and infant outcomes. This study identified patterns of habitual dietary intake in 385 pregnant women in São Paulo and explored their associations with excessive weight gain (EGWG). Weight at the first visit ( 35 years (p = 0.03), while subjects overweight at baseline had a higher probability of EGWG (p = 0.02), suggesting that the identification of dietary and weight inadequacies should be observed from the beginning of pregnancy, accompanied by nutritional intervention and weight monitoring throughout the gestational period to reduce risks to the mother and child’s health.

A nationally generalisable cohort (n 5770) was used to determine the prevalence of non-timely (early/late) introduction of complementary food and core food groups and associations with maternal sociodemographic and health behaviours in New Zealand (NZ). Variables describing maternal characteristics and infant food introduction were sourced, respectively, from interviews completed antenatally and during late infancy. The NZ Infant Feeding Guidelines were used to define early (≤ 4 months) and late (≥ 7 months) introduction. Associations were examined using multivariable multinomial regression, presented as adjusted relative risk ratios and 95 % confidence intervals (RRR; 95% CI). Complementary food introduction was early for 40·2 % and late for 3·2 %. The prevalence of early food group introduction were fruit/vegetables (23·8 %), breads/cereals (36·3 %), iron-rich foods (34·1 %) and of late were meat/meat alternatives (45·9 %), dairy products (46·2 %) and fruits/vegetables (9·9 %). Compared with infants with timely food introduction, risk of early food introduction was increased for infants: breastfed < 6months (2·52; 2·19–2·90), whose mothers were < 30 years old (1·69; 1·46–1·94), had a diploma/trade certificate v. tertiary education (1·39; 1·1–1·70), of Māori v. European ethnicity (1·40; 1·12–1·75) or smoked during pregnancy (1·88; 1·44–2·46). Risk of late food introduction decreased for infants breastfed < 6 months (0·47; 0.27–0·80) and increased for infants whose mothers had secondary v. tertiary education (2·04; 1·16–3·60) were of Asian v. European ethnicity (2·22; 1·35, 3·63) or did not attend childbirth preparation classes (2·23; 1·24–4·01). Non-timely food introduction, specifically early food introduction, is prevalent in NZ. Interventions to improve food introduction timeliness should be ethnic-specific and support longer breast-feeding.

Using data from a nationally generalisable birth cohort, we aimed to: (i) describe the cohort’s adherence to national evidence-based dietary guidelines using an Infant Feeding Index (IFI) and (ii) assess the IFI’s convergent construct validity, by exploring associations with antenatal maternal socio-demographic and health behaviours and with child overweight/obesity and central adiposity at age 54 months. Data were from theGrowing Up in New Zealandcohort (n6343). The IFI scores ranged from zero to twelve points, with twelve representing full adherence to the guidelines. Overweight/obesity was defined by BMI-for-age (based on the WHO Growth Standards). Central adiposity was defined as waist-to-height ratio > 90th percentile. Associations were tested using multiple linear regression and Poisson regression with robust variance (risk ratios, 95 % CI). Mean IFI score was 8·2 (sd2·1). Maternal characteristics explained 29·1 % of variation in the IFI score. Maternal age, education and smoking had the strongest independent relationships with IFI scores. Compared with children in the highest IFI tertile, girls in the lowest and middle tertiles were more likely to be overweight/obese (1·46, 1·03, 2·06 and 1·56, 1·09, 2·23, respectively) and boys in the lowest tertile were more likely to have central adiposity (1·53, 1·02, 2·30) at age 54 months. Most infants fell short of meeting national Infant Feeding Guidelines. The associations between IFI score and maternal characteristics, and children’s overweight/obesity/central adiposity, were in the expected directions and confirm the IFI’s convergent construct validity.

Objective: To identify dietary patterns associated with subclinical atherosclerosis measured as coronary artery calcification (CAC).Design: Cross-sectional analysis of data from the Brazilian Longitudinal Study of Adult Health. Dietary data were assessed using a FFQ, and a principal component factor analysis was used to derive the dietary patterns. Scree plot, eigenvalues > 1 and interpretability were considered to retain the factors. CAC was measured using a computed tomography scanner and an electrocardiography-gated prospective Ca score examination and was categorised into three groups based on the CAC score: 0, 1–100 and >100 Agatston units. Multinomial regression models were conducted for dietary patterns and CAC severity categories.Setting: Brazil, São Paulo, 2008–2010.Participants: Active and retired civil servants who lived in São Paulo and underwent a CAC exam were included (n 4025).Results: Around 10 % of participants (294 men, 97 women) had a detectable CAC (>0), 6·5 % (182 men, 73 women) had a CAC of 1–100 and 3·5 % (110 men, 23 women) had a CAC > 100. Three dietary patterns were identified: convenience food, which was positively associated with atherosclerotic calcification; plant-based and dairy food, which showed no association with CAC; and the traditional Brazilian food pattern (rice, legumes and meats), which was inversely associated with atherosclerotic calcification.Conclusions: Our results showed that a dietary pattern consisting of traditional Brazilian foods could be important to reducing the risk of atherosclerotic calcification and prevent future cardiovascular events, whereas a convenience dietary pattern was positively associated with this outcome.