Míriam Carmo Rodrigues Barbosa

There is a gap in knowledge regarding the school food environment in small-sized municipalities. Thus, this study aims to analyze the anthropometric status of schoolchildren and the school and community food environments in a small Brazilian municipality. This is a cross-sectional, exploratory, and ecological study conducted in elementary schools and food retail outlets in Jerônimo Monteiro, Espírito Santo, Brazil. Anthropometric indicators were assessed using the students’ weight and height. The school food environment was analyzed by evaluating the National School Feeding Program (PNAE) menu using the IQ-COSAN index, classifying foods brought in lunchboxes and sold at schools according to the Brazilian Dietary Guidelines, and auditing food retailers outside schools using the ESAO-S and ESAO-R instruments. Food establishments were categorized according to the Locais-Nova classification and scored using the Healthy Food Store Index (HFSI) and Healthy Meal Restaurant Index (HMRI). The study included 2 schools and 266 schoolchildren (5–11 years), of whom 33.1% had excess weight. The PNAE menu was classified as “needing improvement,” and 81% of schoolchildren’s lunchboxes contained processed/ultra-processed foods. In the external food environment around schools, low levels of access to healthy foods and predominance of ultra-processed food sales were observed.

Objectives: to develop and validate a breastfeeding flip chart based on the Interactive Theory of Breastfeeding. Methods: cross-sectional, observational, quantitative study conducted in three phases: 1) organization of the theoretical content; 2) flip chart development; 3) evaluation by experts and the target audience. Results: the breastfeeding flip chart was organized into 27 pages presented as double-sided sheets. Sixteen experts rated it positively, with agreement exceeding 95.5%. In face validation with 101 pregnant and postpartum women, the technology was deemed appropriate, yielding a total Face Validity Index of 0.94, considered excellent. Final Considerations: experts and the target audience evaluated and approved the breastfeeding flip chart. This dialogue-based educational tool utilizes simple, clear language and features attractive illustrations and layout. It can be used to support health education delivered by healthcare professionals who care for pregnant and postpartum women.

RESUMO Objetivos: elaborar e validar um álbum seriado sobre amamentação baseado na Teoria Interativa de Amamentação. Métodos: estudo transversal, observacional, de abordagem quantitativa, que seguiu as etapas: 1) Organização do conteúdo teórico; 2) Desenvolvimento do álbum seriado; 3) Avaliação por especialistas e público-alvo. Resultados: o Álbum Seriado sobre Amamentação foi organizado em 27 páginas, dispostas em lâminas frente e verso. Os 16 especialistas aprovaram o álbum com mais de 95,5% de concordância. Na avaliação da aparência com as 101 gestantes e puérperas, a tecnologia foi considerada adequada, obtendo um Índice de Validade de Aparência total de 0,94, considerado excelente. Considerações Finais: o Álbum Seriado sobre Amamentação foi avaliado e aprovado pelos especialistas e pelo público-alvo. É uma ferramenta dialógica, com linguagem simples e clara; desenhos e layout atrativos. Pode ser utilizado na promoção da educação em saúde por profissionais de saúde envolvidos na assistência a gestantes e puérperas.

Background: Recent studies have expanded our understanding of the functions of vitamin D beyond bone health and calcium homeostasis. Limited data exists on the prevalence of vitamin D insufficiency in Brazil, particularly in children, but studies have shown deficiencies in a significant percentage of the population. Some studies have suggested a potential interaction between vitamin D and platelets, as they share common metabolic pathways, and alterations in platelet levels have been observed in individuals with vitamin D insufficiency. Objective: This study aimed to verify if serum levels of 25(OH)D, platelet count, and mean platelet volume (MPV), are associated in children and adolescents aged 6 to 17 years old. Methods: This is a cross-sectional study in children and adolescents aged 6 to 17 years (first sentence) Serra, Espírito Santo, a metropolitan city in Southeast Brazil. In total, 659 children and adolescents aged 6 to 17 years old and registered in a social project called “Estação do Conhecimento” in Serra, Espírito Santo, Brazil. Socioeconomic data were collected in the first interview using a semi-structured questionnaire. Blood was collected after 12 h of fasting, 25-hydroxyvitamin D [25(OH)D] levels were assessed using a chemiluminescence method, blood cells were analyzed using the counting method by impedance, and the cell analysis were performed by continuous flow cytometry. Results: Vitamin D insufficiency was highly prevalent among children and adolescents. Vitamin D levels and platelets were positively correlated and independently associated. Surprisingly, insufficient and deficient vitamin D were associated with higher mean platelet volume. Conclusion: Our findings suggest that vitamin D’s influence on platelet parameters is likely indirect, possibly mediated by its role in modulating low-grade inflammation.

Background/Objectives: Iodine is an important nutrient for the human body, used in the production of thyroid hormones. During pregnancy, a deficiency can cause miscarriage and hypothyroidism, while an excess can cause thyroid dysfunction. Therefore, the objective of this study was to evaluate the factors associated with the iodine nutritional status of pregnant Brazilian women. Methods: This was a cross-sectional, multicenter study conducted with pregnant women over 18 years of age, users of the Unified Health System (SUS). A semi-structured questionnaire was used to obtain sociodemographic information. Iodine status was assessed by urinary iodine concentration (UIC). The iodine content of salt and homemade and industrial seasonings was determined by the titrimetric method. Dietary intake was estimated through a 24-hour dietary recall. The chi-square test and hierarchical multinomial logistic regression were used for statistical analysis. The significance level was set at p ≤ 0.05. Results: Among Brazilian pregnant women, the median UIC was 186.7 µg/L (P25: 118.05 µg/L-P75: 280.93 µg/L). Regarding iodine nutritional status, the prevalence of deficiency was 36.7% (n = 694), above the requirement was 28.7% (n = 543), and excess iodine intake was 3.6% (n = 68). We observed that non-white pregnant women were more likely (OR = 1.83; 95% CI: 1.27–2.64) to have iodine deficiency, and those who did not work were less likely (OR = 0.71; 95% CI: 0.52–0.98). Pregnant women in the last trimester of pregnancy were less likely to have iodine intake above the requirements (OR = 0.52; 95% CI: 0.31–0.88). Conclusions: A substantial proportion of pregnant women had iodine deficiency or intake above the required level. Iodine deficiency is more chance among non-white pregnant women and less chance among those not employed during pregnancy. On the other hand, pregnant women who were in their third trimester of pregnancy were less likely to have iodine intake above the required level.

Introduction: The Collaborating Center for School Feeding and Nutrition (CECANE) began its activities in Espírito Santo in 2022 through a work plan agreed upon between the Federal University of Espírito Santo and the National Fund for Educational Development. Among the planned actions, workshops were proposed to identify the challenges faced by executing entities in implementing purchases from Family Farming (AF) within the scope of the National School Feeding Program (PNAE) and, consequently, to assist in directing solutions to the identified problems. Objective: Thus, this study aims to present an assessment of the main difficulties encountered in the proper execution of the PNAE in the state's municipalities. Methods: A total of 20 municipalities were selected. The assessment of challenges was conducted through online meetings and in-person workshops across different regions of the state. The main obstacles highlighted include the COVID-19 pandemic, operational issues related to purchasing and selling, factors inherent to public call notices, as well as others such as a reduced technical staff and the absence of organic product certification. Results: CECANE plays a crucial role in strengthening Family Farming by promoting the exchange between local agricultural production and school feeding, benefiting not only farmers but also students and, consequently, the community as a whole. By identifying the challenges in the execution of the PNAE in the state, CECANE can develop actions that facilitate training, experience-sharing among executing entities, rural farmers, and the School Feeding Council, improving the relationship between the various actors involved in the PNAE.

Objectives: to investigate the relation between insulin use, pregestational nutritional status, and maternal weight gain during pregnancy among women with gestational diabetes mellitus. Methods: a retrospective cross-sectional study (2017-2022) was conducted with data from women followed at a University hospital in the Southeast of Brazil. Maternal weight gain adequacy was assessed according to new curves proposed for Brazilian pregnant women. Pregestational nutritional status, age, height, race, schooling, marital status, residence, parity, number of pregnancies and abortions, fasting glucose, and hypertensive disorders were analyzed. The use of insulin was considered the outcome in a multiple logistic regression model, using as reference, the categories least associated with gestational diabetes mellitus. Results: among the 353 participants, 48.7% were obese and 47.4% required insulin. Obese women were more likely to use insulin (OR= 2.26; 95%CI= 1.16-4.41; p=0.003). Regarding to weight gain, eutrophic women with above-adequate gain had greater odds of insulin use (OR= 3.22; 95%CI= 1.15-9.05; p=0.024). Conversely, among those with adequate or below-adequate gain, obese women showed higher chances of needing insulin (OR= 4.33; 95%CI= 1.76-10.6; p=0.001). Conclusion: the findings reinforce the necessity for specific guidelines on gestational weight gain for women with gestational diabetes mellitus, considering differences in both nutritional status and weight gain patterns throughout pregnancy.

Resumo Objetivos: investigar a relação entre uso de insulina, estado nutricional pré-gestacional e ganho de peso materno durante a gestação de mulheres com diabetes mellitus gestacional. Métodos: estudo transversal retrospectivo (2017-2022) com dados de mulheres atendidas em um hospital universitário do sudeste do Brasil. A adequação do ganho de peso foi avaliada segundo curvas específicas para gestantes brasileiras. Foram analisados estado nutricional pré-gestacional, idade, estatura, raça, escolaridade, situação conjugal, localidade, paridade, número de gestações e abortos, glicemia de jejum e distúrbios hipertensivos. O uso de insulina foi considerado desfecho em modelo de regressão logística múltipla, adotando-se como referência as categorias menos associadas ao diabetes mellitus gestacional. Resultados: entre 353 participantes, 48,7% eram obesas e 47,4% utilizaram insulina. Obesas apresentaram maiores chances de uso de insulina (OR= 2,26; IC95%= 1,16-4,41; p=0,003). Quanto ao ganho de peso, eutróficas com ganho acima do adequado tiveram maior chance de utilizar insulina (OR= 3,22; IC95%= 1,15-9,05; p=0,024). Entre as que tiveram ganho adequado ou abaixo do adequado, obesas mostraram maiores chances de necessitar insulina (OR= 4,33; IC95%= 1,76-10,6; p=0,001). Conclusão: os achados reforçam a necessidade de diretrizes específicas de ganho de peso para mulheres com diabetes mellitus gestacional, considerando diferenças de estado nutricional e padrão de ganho durante a gestação.

Resumo Objetivo Analisar a tendência temporal das taxas de mortalidade neonatal e de óbitos neonatais evitáveis na Bahia. Métodos estudo de série temporal de óbitos neonatais na Bahia, no período 2010-2020. Foram calculadas as taxas de mortalidade neonatal e seus componentes e distribuição segundo características sociodemográficas, obstétricas do recém-nascido e causas de óbitos. Análises de regressão jointpoint foram adotadas para os cálculos de tendência, variação percentual anual (APC) e intervalos de confiança 95% (IC95%). Resultados Foram identificados 26.661 óbitos neonatais. Observa-se tendência decrescente das taxas de mortalidade neonatal (APC-1,9; IC95% -2,4; -1,5) e neonatal precoce (APC-2,2; IC95%-2,6; -1,8) e tendência estacionária para mortalidade neonatal tardia (APC-0,7; IC95% -2,1; 0,7). Maiores frequências de óbitos neonatais ocorreram entre: mães de 20 a 34 anos; escolaridade de 8 a 11 anos de estudos; gravidez única; nascimento prematuro; parto vaginal; sexo masculino; baixo peso ao nascer e entre aqueles com algumas afecções originadas no período perinatal e malformações congênitas. Foi observada tendência decrescente de mortalidade neonatal para as causas evitáveis por adequada atenção à mulher na gestação e no parto. Identificou-se padrão ascendente para algumas causas evitáveis de óbitos neonatais, como sífilis congênita. Conclusão A queda na taxa de mortalidade neonatal indica avanços na assistência pré-natal e na atenção ao parto. As diferenças nas tendências dos óbitos evitáveis enfatizam a necessidade de ampliar e qualificar os serviços de saúde, por meio de políticas públicas que abordem as desigualdades regionais e fortaleçam a atenção integral à saúde materno-infantil.

Objective To analyze the temporal trend of neonatal mortality rates and preventable neonatal deaths in Bahia. Methods This was a time series study of neonatal deaths in Bahia from 2010 to 2020. Neonatal mortality rates and their components were calculated and analyzed according to sociodemographic, obstetric, and newborn characteristics, as well as causes of death. Joinpoint regression analyses were used to estimate trends, annual percentage change (APC), and 95% confidence intervals (95%CI). Results A total of 26,661 neonatal deaths were identified. A decreasing trend was observed for neonatal mortality (APC -1.9; 95%CI -2.4; -1.5) and early neonatal mortality (APC -2.2; 95%CI -2.6; -1.8), while late neonatal mortality showed a stationary trend (APC -0.7; 95%CI -2.1; 0.7). Higher frequencies of neonatal deaths were observed among children born to mothers aged 20 to 34 years, with 8 to 11 years of schooling, single pregnancies, preterm births, vaginal deliveries, male newborns, low birth weight, and those with certain conditions originating in the perinatal period and congenital malformations. A decreasing trend was found in neonatal mortality due to preventable causes through adequate care during pregnancy and childbirth. However, an upward trend was identified for some preventable causes of neonatal death, such as congenital syphilis. Conclusion The decline in neonatal mortality rates indicated progress in prenatal and childbirth care. Differences in trends of preventable deaths emphasized the need to expand and improve health services through public policies that address regional inequalities and strengthen comprehensive maternal and child health care.