Maria Claret Costa Monteiro Hadler

Purpose This study evaluated tympanometric cutoff points (tympanometric peak pressure and static compliance) for transient evoked otoacoustic emissions (TEOAEs) and determined their diagnostic accuracy. Methods This analytical study, based on a randomized clinical trial, included 84 children (6–42 months; median 24 months) from public childcare centers in Brazil. Associations between cutoff points and TEOAEs were verified by Fisher’s exact test and Chi-square. Kappa assessed agreement between ears, and the correlation between tympanometric peak pressure and static compliance was analyzed by Spearman. Diagnostic accuracy was determined using ROC (Receiver Operating Characteristic) curves and confirmed with EpiDat 3.1. Results In the 84 children, 66 right ears and 73 left ears were examined; however, 42 ears were randomly selected from each side for the final analysis. A significant correlation was found between peak pressure and static compliance. ROC analysis identified -180 daPa as the most accurate cutoff (AUC = 0.781; 95% CI: 0.656–0.905; p < 0.001). EpiDat indicated a specificity of 93.9%, a sensitivity of 55.6%, and an overall accuracy of 85.7%. Static compliance <0.2 mL showed comparable performance (specificity = 98.5%, sensitivity = 50.0%, accuracy = 88.1%). Conclusion The cutoff point of –180 daPa combined with static compliance <0.2 mL improved screening accuracy and reduced unnecessary referrals. It provided the best balance between specificity, sensitivity, and accuracy, aligning more closely with TEOAEs results and supporting updating this tympanometric criterion in infant hearing screening.

This study aimed to assess the prevalence and factors associated with lipid profile abnormalities of children aged 6 to 42 months in a Central-West Brazilian capital city. This cross-sectional study used data from the baseline of a cluster-randomized clinical trial conducted in parallel. It evaluated the lipid profile, usual nutrients intake (direct food-weighing method and 24-hour dietary recall), anthropometric parameters, and socioeconomic aspects of 169 children from early childhood education centers. Poisson regression with robust variance analysis was conducted. Of the total sample, 85% had dyslipidemia, 72% had high-density lipoproteins (HDL-c) levels below the desired range, 49% had increased triglycerides (TG), 17% exhibited elevated low-density lipoproteins (LDL-c), and 15% showed high total cholesterol (TC). An increase in the body mass index (BMI) for age z-score was associated with a higher prevalence of increased TG (PR = 1.22; 95%CI: 1.05-1.41; p = 0.009). Higher age in children was associated with an increased prevalence of high LDL-c (PR = 1.037; 95%CI: 1.01-1.07; p = 0.022) and TC (PR = 1.036; 95%CI: 1.00-1.07; p = 0.037), however it was a protective factor against low HDL-c (PR = 0.991; 95%CI: 0.98-1.00; p = 0.042). High energy intake was associated with low HDL-c (PR = 1.001; 95%CI: 1.00-1.00; p = 0.023). A higher prevalence of increased LDL-c (PR = 1.005; 95%CI: 1.00-1.01; p = 0.006) and decreased HDL-c (PR = 1.002; 95%CI: 1.00-1.00; p < 0.001) were associated with dietary cholesterol intake. Most of the children presented at least one alteration in serum lipids. Lipid profile abnormalities were associated with higher BMI, older age, and increased caloric and cholesterol intake.

Fe-deficiency anaemia is a major public health concern in children under 5 years of age. TMPRSS6 gene, encoding matriptase-2 protein, is implicated in Fe homoeostasis and has been associated with anaemia and Fe status in various populations. The aim of this cross-sectional study was to investigate the associations between the single nucleotide polymorphism (SNP) TMPRSS6 rs855791 and biomarkers of anaemia and Fe deficiency in Brazilian children attending day care centres. A total of 163 children aged 6–42 months were evaluated. Socio-economic, demographic, biochemical, haematological, immunological and genotype data were collected. Multiple logistic and linear regressions with hierarchical selection were used to assess the effects of independent variables on categorised outcomes and blood marker concentrations. Minor allele (T) frequency of rs855791 was 0·399. Each copy of the T allele was associated with a 4·49-fold increased risk of developing anaemia (P = 0·005) and a 4·23-fold increased risk of Fe deficiency assessed by serum soluble transferrin receptor (sTfR) (P < 0·001). The dose of the T allele was associated with an increase of 0·18 mg/l in sTfR concentrations and reductions of 1·41 fl and 0·52 pg in mean corpuscular volume (MCV) and mean corpuscular haemoglobin (MCH), respectively. In conclusion, the T allele of SNP TMPRSS6 rs855791 was significantly associated with anaemia and Fe deficiency assessed by sTfR in Brazilian children attending day care centres. The effect was dose dependent, with each copy of the T allele being associated with lower MCV and MCH and higher concentrations of sTfR.

The aim goal is to know the frequency, distribution, development and monitoring of the factors associated to the excess weight and chronic non-communicable diseases (NCDs) is essential to qualify policies and surveillance and health promotion actions for the execution of the Care Policy Health and Safety of the Federal Civil Servants (PASS). This study aimed to analyze the association between risk factors for NCDs and food consumption with excess weight in federal civil servants. Methods: cross-sectional population-based analytical study, conducted in the period from September to November 2014, in the rectory and 10 campus of the Instituto Federal de Goiás (IFG) in the capital and cities in the interior of Goiás. The sample was stratified by campus and professional category. In the analysis we used the Chi-square test. A multivariable analysis was performed using Poisson regression with a robust variance estimative to obtain prevalence ratios. Results: 429 servers participated in the research, and 55.7% 44.3% technical administrative and teaching staff with an average age of 36.3 ± 9.2 years, 59.7% were women, 68.8% had less than 40 years and 69.9 percent were sedentary. As for the nutritional state, 55.0% showed no excess weight, but realized with 74.8% overweight. There was no significant difference between the gender, 62.5% women had lower prevalence of overweight men 43.9% (p < 0001). In relation to food consumption, women follow more healthy eating recommendations for frying 27.7% (p < 0.003), vegetables 64.1% (p < 0.033), soft drinks 46.1% (p < 0.001) and embedded 31.6% (p < 0.028) than men. In multivariate analysis associated to overweight: being a docent (PR = 1.32; 95% CI = 1.066 – 1.647) male (PR = 1.40; IC =1.133 -1.732), have more than 40 years of age (PR =1.35; 95% CI = 1.104 – 1.667), be sedentary (PR= 1.41; 95% CI = 1.070 -1.604) and perform meals outside the home (PR =1.31; 95% CI=1.005-1.505). Conclusions: the factors associated with the prevalence of overweight were be teacher, male, age 40 years or more, sedentary and meals away from home.

Vitamin D deficiency and insufficiency as well as low serum calcium levels can trigger negative health outcomes in women of childbearing age. Therefore, we aimed to estimate the prevalence of serum vitamin D and calcium deficiencies and insufficiencies and associated risk factors in Brazilian women of childbearing age and to assess whether there are differences in prevalence according to regions of the country and the presence or absence of pregnancy. The systematic literature review was performed using the following databases: PubMed, LILACS, Embase, Scopus, and Web of Science. Cross-sectional, cohort, and intervention studies were included. Among pregnant women, the prevalence of vitamin D deficiency ranged from 0% to 27% and of vitamin D insufficiency from 33.9% to 70.4%. Among non-pregnant women, the prevalence of vitamin D deficiency ranged from 0% to 41.7% and of vitamin D insufficiency from 38.5% to 69.3%. We found a high prevalence of vitamin D deficiency and insufficiency in women of childbearing age, with insufficiency affecting more than half of these women. The highest prevalence of vitamin D deficiency and insufficiency was observed in the South region. It was not possible to assess the prevalence and factors associated with calcium deficiency.

Vitamin E is an important nutrient from the earliest stages of life. It plays key roles as an antioxidant and in the maintenance of the immune system, among others. Vitamin E deficiency (VED), which occurs more frequently in children, is rarely addressed in the literature. This narrative review aims to summarise the chemistry, biology, serum indicators and clinical trials that have evaluated the impact of fortification and other relevant aspects of vitamin E, in addition to the prevalence of its deficiency, in children worldwide. Vitamin E intake in recommended amounts is essential for this nutrient to perform its functions in the body. Serum α-tocopherol is the most widely used biochemical indicator to assess the prevalence of VED. VED has been associated with symptoms secondary to fat malabsorption and may lead to peripheral neuropathy and increased erythrocyte haemolysis. Reduced concentrations of α-tocopherol may be caused by the combination of diets with low amounts of vitamin E and inadequate consumption of fats, proteins and calories. The lowest prevalence of VED was found in Asia and the highest in North America and Brazil. High proportions of VED provide evidence that this nutritional deficiency is a public health problem in children and still little addressed in the international scientific literature. The planning, evaluation and implementation of health policies aimed at combatting VED in the paediatric population are extremely important.

Fortification with multiple micronutrient powder has been proposed as a public health intervention able to reduce micronutrient deficiencies in children. Our objective was to compare the effectiveness of fortification with multiple micronutrient powder with drug supplementation in the prevention and treatment of iron deficiency and anaemia. This was a cluster trial with anemic and non-anaemic children between six and 42 months old, in randomization data. Non anaemic children received fortification with multiple micronutrient powder or standard drug supplementation of ferrous sulfate associated with folic acid in a prevention dose. Anaemic children who were randomized to receive multiple micronutrient powder also received the recommended iron complementation for anaemia treatment. A total of 162 children were evaluated. The prevalence of anaemia decreased from 13.58 to 1.85%. Iron deficiency decreased from 21.74% to 7.89% (by serum ferritin) and iron deficiency decreased from 66.81 to 38.27% (by soluble transferrin receptor). No difference was identified between interventions for hemoglobin (p = 0.142), serum ferritin (p = 0.288), and soluble transferrin receptor (p = 0.156). Fortification with multiple micronutrient powder was effective in preventing iron deficiency and anaemia in children aged six to 48 months. In anaemic children; it was necessary to supplement the dose of multiple micronutrient powder with ferrous sulfate.

Multiple micronutrient powder supplementation is a health promotion strategy, but data on its effectiveness regarding vitamin E are rare. The objective was to evaluate the impact of home fortification with powdered micronutrients on α-tocopherol concentrations, growth, and inflammation in Brazilian children aged 6–15 months. This is a pragmatic, controlled clinical trial, in which the intervention group received micronutrient powder sachets for up to 3 months. Vitamin E deficiency was considered when α-tocopherol was less than 11.6 µmol/L. The Poisson regression model was used to estimate adjusted values for prevalence ratios (PR) for the outcome variable. A total of 224 children participated in the study. The intervention group had a higher median α-tocopherol level (17.2 versus 3.6 µmol/L; p < 0.001) and an 82.0% reduction in the prevalence of vitamin deficiency (PR = 0.18; 95% CI 0.11–0.30) when compared with the control group. Consumption of multiple micronutrients in powder increases serum α-tocopherol concentrations, promotes better linear growth, and reduces morbidity in children.