Brazilian National Survey Research Articles

Hypertensive disorders during pregnancy as a major cause of preterm birth and adverse perinatal outcomes: findings from a Brazilian National Survey.

This study aimed to evaluate the prevalence of hypertensive disorders during pregnancy among Brazilian women with preterm births and to compare the epidemiological characteristics and perinatal outcomes among preterm births of women with and without hypertension. This was a secondary cross-sectional analysis of the Brazilian Multicenter Study on Preterm Birth. During the study period, all women with preterm births were included and further split into two groups according to the occurrence of any hypertensive disorder during pregnancy. Prevalence ratios were calculated for each variable. Maternal characteristics, prenatal care, and gestational and perinatal outcomes were compared between the two groups using χ2 and t-tests. A total of 4,150 women with preterm births were included, and 1,169 (28.2%) were identified as having hypertensive disorders. Advanced maternal age (prevalence ratio (PR) 2.49) and obesity (PR= 2.64) were more common in the hypertensive group. The gestational outcomes were worse in women with hypertension. Early preterm births were also more frequent in women with hypertension. Hypertensive disorders of pregnancy were frequent among women with preterm births, and provider-initiated preterm births were the leading causes of premature births in this group. The factors significantly associated with hypertensive disorders among women with preterm births were obesity, excessive weight gain, and higher maternal age.

Association of Evening Eating with Sleep Quality and Insomnia among Adults in a Brazilian National Survey

Abstract Objective To examine the association of evening eating clock time, its elapsed time to the midpoint of sleep (TEM), consumption of caffeine and sugary foods, and dinner meal size with sleep quality indicators and insomnia. Methods The present study's participants (n = 2,050; 18–65 y) were part of a population-based research, with virtual data collection. Logistic regression models were fitted to assess differences in the odd ratios (ORs) (95% confidence interval [CI]) of sleep duration < 7 hours, sleep latency > 30 min, poor sleep quality, and insomnia (outcomes) with the evening diet-related variables. Linear regression analyses evaluated differences in sleep duration and latency associated with the same variables. Restricted cubic splines were used to investigate the shape of the association of mealtime and TEM with sleep duration and latency. Results For each hour delay in evening eating and increase in the duration of TEM, the odds of sleep duration < 7 h [OR(95%CI):1.30(1.20,1.40); OR(95%CI):0.51(0.47,0.56)], sleep latency > 30 [OR(95%CI):1.14(1.07,1.22); 0.88(0.83,0.94)], poor sleep quality [OR(95%CI):1.21(1.13,1.30); 0.80(0.76,0.85)] and insomnia [OR(95%CI):1.12(1.04,1.20); 0.89(0.84,0.95)], respectively, increased and decreased. We found a dose-response association of evening eating (clock time and TEM) with sleep duration. The shortest latency was seen when evening eating was at ∼ 8 PM and ∼ 7 to 8 hours before the midpoint of sleep. Participants who reported dinner as their largest meal and consumed caffeine and/or sugary foods/beverages after 6 PM presented higher odds of sleep duration < 7 hours, poor sleep quality, and insomnia. Conclusions Our findings indicate that an early-eating schedule has beneficial sleep effects and that it will be necessary to consider evening eating patterns and timing, along with sleep and circadian hygiene, to improve sleep quality and circadian health.

Multiple behavioral risk factors for non-communicable diseases among the adolescent population in Brazil: the analysis derived from the Brazilian national survey of school health 2019

BackgroundHealth risk behaviors often emerge or intensify during adolescence and tend to co-occur, exposing individuals to an even greater risk for the development of non-communicable diseases (NCDs). The likelihood of exhibiting multiple health risk factors also increases throughout life and is associated with sociodemographic characteristics contributing to their escalation and severity. In this context, the objective of this study was to analyze the association between sociodemographic characteristics and multiple behavioral risk factors for non-communicable diseases among the adolescent population in Brazil.MethodsThis cross-sectional study utilized data from the Brazilian National Survey of School Health 2019. The sample comprised 121,580 adolescents aged 13 to 17. The analyzed variables included irregular intake of fruits and vegetables, regular consumption of soft drinks and treats, insufficient physical activity, sedentary lifestyle, cigarette smoking, and alcohol consumption. To analyze MBRFs, a classification ranging from zero to five was created, and associations were estimated using Odds Ratio (OR) with the respective 95% confidence interval (CI). The Backward method was employed for the multivariate regression model, utilizing ordinal logistic regression.ResultsAdolescents without behavioral risk factors for NCDs constituted only 3.9% (95% CI 3.7–4.1). The most prevalent categories were two and three MBRFs, accounting for 28.3% (95% CI: 27.7–28.8) and 27.0% (95% CI: 26.5–27.5), respectively. Adolescents aged 16 and 17 (ORadj: 1.39; 95% CI: 1.32–1.48), residing in the Brazilian Southeast (ORadj: 1.66; 95% CI: 1.52–1.81), and those reporting poor or very poor self-rated health (ORadj: 2.05; 95% CI: 1.87–2.25) were more likely to exhibit multiple behavioral risk factors. Conversely, male adolescents (adjusted OR: 0.65; 95% CI: 0.62–0.69), those of mixed race (adjusted OR: 0.92; 95% CI: 0.87–0.97), and residents of rural areas (adjusted OR: 0.76; 95% CI: 0.70–0.84) were less likely to manifest MBRFs for NCDs.ConclusionThe majority of adolescents displayed MBRFs for NCDs, positively associated with age, region, and perceived health status. This underscores the necessity for healthcare promotional interventions throughout the life cycle, as these behaviors may persist into adulthood.

Sleep duration and bedtime are associated with BMI among adults in a Brazilian National Survey

Sleep duration and bedtime are associated with BMI among adults in a Brazilian National Survey

Food poverty among children aged 6-59 months in Brazil: results from the Brazilian National Survey on Child Nutrition (ENANI-2019).

To describe the prevalence of food poverty according to dimensions of socio-economic inequality and the food groups consumed by Brazilian children. Dietary data from a structured qualitative questionnaire collected by the Brazilian National Survey on Child Nutrition (ENANI-2019) were used. The new UNICEF indicator classified children who consumed 3-4 and <3 out of the eight food groups as living in moderate and severe food poverty, respectively. The prevalence of consumption of each food group and ultra-processed foods (UPF) was estimated by level of food poverty according to age categories (6-23; 24-59 months). The most frequent combinations of food groups consumed by children living in severe food poverty were calculated. Prevalence of levels of food poverty were explored according to socio-economic variables. 123 municipalities of the five Brazilian macro-regions. 12 582 children aged 6-59 months. The prevalence of moderate and severe food poverty was 32·5 % (95 % CI 30·1, 34·9) and 6·0 % (95 % CI 5·0, 6·9), respectively. Children whose mother/caregiver had lower education (<8 years) and income levels (per capita minimum wage <¼) had the highest severe food poverty prevalence of 8·3 % (95 % CI 6·2, 10·4) and 7·5 % (95 % CI 5·6, 9·4), respectively. The most consumed food groups among children living in food poverty in all age categories were 'dairy products', 'grains, roots, tubers, and plantains' and 'ultra-processed foods'. Food poverty prevalence was high among Brazilian children. A significant occurrence of milk consumption associated with grains and a considerable prevalence of UPF consumption were found among those living in severe food poverty.

Serum Zinc Concentrations by Inflammation Status, Time of Day, and Fasting Status for Estimating Zinc Deficiency in 6–59-Mo-Old Children: Results from the Brazilian National Survey on Child Nutrition (ENANI-2019)

BackgroundSerum zinc concentration (SZC) is considered the best biomarker of zinc status in population-level evaluations. However, zinc deficiency (ZD) estimations can be biased if they do not consider blood collection timing, inflammation, and fasting status. ObjectivesThe objectives of this study were to determine SZC without and with adjustment for inflammation, according to blood collection timing and fasting status, estimate ZD prevalence, and evaluate the associated factors with ZD in a representative sample of Brazilian children aged <5 y. MethodsPopulation-based study with 7597 children aged 6–59 mo surveyed by the Brazilian National Survey on Child Nutrition. SZC was adjusted for inflammation using the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia regression correction approach, with high-sensitive C-reactive protein, assessed according to blood collection timing (morning/afternoon) and fasting status (<8 and ≥8 h). SZC <65 μg/dL (morning collection) or SZC <57 μg/dL (afternoon collection) were classified as ZD. The analysis between associated factors and ZD used the adjusted prevalence ratio (PR). ResultsAfter adjusting for inflammation, SZC was higher in all percentiles and varied according to collection timing and fasting status. Children who had blood collected in the morning without fasting or in the afternoon had lower SZC than those assessed in the morning with fasting. The differences in adjusted SZC according to the timing of collection and fasting status were greater in the higher percentiles of the distribution, with the greatest absolute difference observed when comparing the 95th percentile of morning fasting compared with nonfasting (20.3 μg/dL). The prevalence of ZD estimated without and with adjusting SZC for inflammation was 17.8% and 13.8%, respectively. The occurrence of diarrhea, fever, or respiratory symptoms in the 15 d before blood collection was associated with a higher prevalence of ZD (PR: 1.42; 95% confidence interval: 1.04, 1.94). ConclusionsAdjusting SZC for inflammation and considering fasting status is important to avoid overestimating the prevalence of ZD.

Self-perception of body image of Brazilian adolescents from 2009 to 2019 according to Brazilian National Survey of School Health (PeNSE)

This study analyzes the self-perception of body image reported by adolescents from 2009 to 2019 according to sex and region, based on the Brazilian National Survey of School Health (PeNSE). An epidemiological, descriptive time-series analysis was carried out with prevalence and trend measures of how adolescents perceive themselves in relation to their bodies according to the data provided by the PeNSE surveys from 2009 to 2019. The prevalence of adolescents who considered themselves normal reached 47.6% (95%CI: 46.1-49.1) in 2019, representing a negative difference of 12.5 percentage points (p.p.) and a variation of 20.7% compared to 2009. In 2019, 31.4% (95%CI: 30.0-32.9) of boys reported feeling thin or very thin, a difference of 8.4p.p. compared to 2009. On the other hand, 28.6% (95%CI: 26.1-31.1) of girls perceived themselves as fat or very fat in 2019, representing a variation of 7.3p.p. compared to 2009. In recent years, there has been a change in the body self-perception of adolescents, with a reduction in the prevalence of those who consider themselves normal and an increase among those who consider themselves thin or very thin for males and fat or very fat for females. These results indicates the importance of investigating the consequences of perceiving oneself as thin or very thin and fat or very fat in the lives of adolescents.

Access to medicines for the treatment of systemic arterial hypertension and type 2 diabetes mellitus in the Brazilian population: data from the 2019 Brazilian National Health Survey

This study aimed to measure access to medicines for the treatment of systemic arterial hypertension and type 2 diabetes mellitus in Brazil according to the mode of acquisition, as well as to analyze the factors associated with this access, based on data from the 2019 Brazilian National Survey of Health (PNS, acronym in Portuguese). Socioeconomic data and data related to the use of medicines by people aged 15 and over were analyzed in relation to access via the Brazilian Popular Pharmacy Program (PFPB, acronym in Portuguese) and via public services. The majority of Brazilians who took part in the PNS reported using medication to control hypertension in the previous 15 days (91.5%) and using oral medication for diabetes (95.2%) and/or insulin (70%). Most participants obtained oral medication for hypertension and type 2 diabetes mellitus via PFPB (45.2% and 53.6%, respectively), and the factors that most negatively influenced this access were older age, lower income, lower schooling, very poor self-rated health and not having private health insurance. Access to insulin, on the other hand, was most often via the public health service (69.7%), and the factors that most negatively influenced this access were black/mixed-race skin color, lower income, very poor self-rated health and not having private health insurance. Generally, the importance of the PFPB as a policy to increase access to essential medicines in Brazil was highlighted, considering the free supply of antihypertensive and antidiabetic drugs.

Intersectoral actions and the recognition of a source of primary care for Brazilian adolescents

This study aimed to analyze the association between the development of intersectoral actions between school/primary health care (PHC) services and the recognition of a usual source of care of PHC among Brazilian adolescents. This is a cross-sectional study, from the Brazilian National Survey of School Health (2015) conducted with a complex sampling of 97,903 adolescents. The association between intersectoral actions between PHC services and schools and the recognition of a usual source of care of PHC were estimated by the prevalence ratio (PR), using the logistic regression model and considering the sample weight factor with Stata 14.0 Of the analyzed adolescents, 72.8% of them studied in schools that developed intersectoral actions with PHC services. Among adolescent students from schools that developed intersectoral actions, an association was observed between the recognition of usual source of care of PHC and intersectoral actions (PR = 1.11; 95%CI: 1.08-1.14). When analyzed for actions of the School Health Program (PR = 1.40; 95%CI: 1.37-1.43), and the development of actions between the school and PHC services (PR = 1.08; 95%CI: 1.05-1.12). The results show that there is a positive association between the recognition of PHC services as a usual source of care and intersectoral actions. However, from the perspective of an intersectoral practice, there are challenges in the articulation between health and education sectors for implementing prevention and promoting adolescent health in school. They involve greater knowledge about the adolescents' perception of the quality of the service offered by health units.

Circadian dinner timing and BMI among adults in a Brazilian national survey

AimsTo examine if the Time elapsed between Dinner and the Midpoint of sleep (TDM) is associated with BMI and obesity. MethodsParticipants (n = 1303) were part of a virtual exploratory, population-based survey. To evaluate differences in BMI associated with TDM we performed linear and quantile regression analyses. Logistic regression models were fitted to assess ORs (95%CI) of obesity associated with TDM. Restricted cubic splines were also used to study the shape of the association. ResultsWe found a dose-response association between TDM and BMI, which decreased by 0.22 kg/m2 for each additional hour of TDM, with stronger and higher effects in the highest percentile of BMI. By increasing TDM, the odds of obesity decreased [OR (95%CI):0.87 (0.78,0.97); P = 0.01]. These associations were independent of age, gender, marital status, weekly duration of physical activity, and the largest meal of the day. ConclusionsBecause we found that having dinner farther from the midpoint of sleep was significantly associated with BMI, our data reflect the pertinence of assessing the circadian meal timing, along with the energy intake and the quality of meals, in nutritional recommendations and obesity prevention and treatment.

PO1_06. Hypertensive disorders in pregnancy as a major cause of preterm birth and adverse perinatal outcomes: findings from a Brazilian national survey

PO1_06. Hypertensive disorders in pregnancy as a major cause of preterm birth and adverse perinatal outcomes: findings from a Brazilian national survey

Trends of breastfeeding indicators in Brazil from 1996 to 2019 and the gaps to achieve the WHO/UNICEF 2030 targets

BackgroundThe comprehension of breastfeeding patterns and trends through comparable indicators is essential to plan and implement public health policies.ObjectiveTo evaluate the trends of breastfeeding indicators in Brazil from 1996 to...

Prevalence and predictors of vitamin D insufficiency in Brazilian children under 5 years of age: Brazilian National Survey on Child Nutrition (ENANI-2019).

To analyse the association of socio-demographic and health factors with vitamin D insufficiency and 25-hydroxyvitamin D (25(OH)D) concentration in Brazilian children aged 6-59 months. Data from 8145 children from the Brazilian National Survey on Child Nutrition (ENANI-2019) were analysed. The serum concentration of 25(OHD)D was measured using a chemiluminescent immunoassay. The prevalence of vitamin D insufficiency (25(OH)D < 50 nmol/l) and 95 % CI was calculated. Logistic and linear regression models were used to identify the variables associated with vitamin D insufficiency and serum 25(OH)D concentrations, respectively. The mean 25(OH)D concentration was 98·6 ± 36·0 nmol/l, and 4·3 % of the children presented vitamin D insufficiency. Children aged 6-23 months (OR = 2·23; 95 % CI 1·52, 3·26); belonging to Southeast (OR = 5·55; 95 % CI 2·34, 13·17) and South (OR = 4·57; 95 % CI 1·77, 11·84) regions; the second tertile of the National Wealth Score (OR = 2·14; 95 % CI 1·16, 3·91) and winter (OR = 5·82; 95 % CI 2·67, 12·71) and spring (OR = 4·84; 95 % CI 2·17, 10·80) seasons of blood collection were associated with a higher chance of vitamin D insufficiency. Female sex (β = -5·66, 95 % CI - 7·81, -3·51), urban location (β = -14·19, 95 % CI -21·0, -7·22) and no vitamin D supplement use (β = -6·01, 95 % CI -9·64, -2·39) were inversely associated with serum 25(OH)D concentration. The age of children and the Brazilian geographical region of household location were the main predictors of vitamin D insufficiency. In Brazil, vitamin D insufficiency among children aged 6-59 months is low and is not a relevant public health problem.

Poor access to health services for depression treatment in Brazil.

To analyze the factors associated with poor access to health services for the depression treatment in Brazil. This study used data from the Brazilian National Survey of Health, conducted in the years 2019 and 2020. The sample consisted of 8,332 individuals with a self-reported diagnosis of depression, and poor access to healthcare was identified from the question "what is the main reason for you to not visit the physician/health service regularly for your depression?" From which poor access was identified by the affirmative answer reporting distance of health services or difficulties with transportation; waiting time at the health service; financial difficulties; opening hours of the health service; Not being able to schedule a consultation via health insurance; does not know who to look for or where to go, among others. Sociodemographic aspects and health conditions were analyzed. Bivariate and multivariate analysis was performed using Poisson Regression. The prevalence of poor access to health services for depression treatment was 14.9% (95%CI: 13.6-16.2), relating to individuals aged 15-29 years (PR = 1.52) and 30-59 years old (PR = 1.22), without education (PR = 1.43), who rate their health as regular/poor/very poor (PR = 1.26), who have some limitation in their usual activities (PR = 2.71), who had the last consultation within 6 months of less than 2 years (PR = 2.63) and for more than 2 years (PR = 2.25) and who do not undergo psychotherapy (PR = 4.28). Poor access to health services for depression treatment was associated with individual factors and health conditions.

Technological Upgrade in Emerging Markets: The Importance of Interorganizational Cooperation for Product and Process Upgrades

Considering the relevance of different market partners and research partners with which companies can cooperate for innovation, we wonder whether cooperation with such partners is essential for the technological upgrade of products and processes. Therefore, as our main aim, we propose to analyze the importance of cooperating with market and research partners to technologically upgrade products and processes in an emerging market. To do this, we used data from the Brazilian national innovation survey stratified by sectors of the economy. The data analysis technique adopted for this study was panel data. Our results add to the existing studies on the importance of considering the effects of different partners on types of upgrades (product and process) that are relevant to a technological upgrade in emerging countries. Furthermore, this research demonstrated which kind of partnership is the most suitable for each type of upgrade.

P18-014-23 Association Between Breastfeeding, Diet Quality Markers and Early Childhood Development: Brazilian National Survey on Child Nutrition (ENANI-2019)

P18-014-23 Association Between Breastfeeding, Diet Quality Markers and Early Childhood Development: Brazilian National Survey on Child Nutrition (ENANI-2019)

High Serum Folate Concentration, Vitamin B12 Deficiency, and Anthropometric Nutritional Status in Brazilian Children Aged 6–59 Months: Data from the Brazilian National Survey of Child Nutrition

BackgroundVitamin B12 and folate are key nutrients that help children reach their full potential in growth and development; however, little is known about the status of these vitamins in Brazilian children. ObjectivesTo describe the serum concentrations of vitamin B12 and folate, to investigate the association between high folate concentration (HFC) and vitamin B12 deficiency, and to evaluate the association between vitamin B12 and stunting/underweight in Brazilian children aged 6–59 mo. MethodsData from 7417 children aged 6–59 mo collected during the Brazilian National Survey on Child Nutrition were used. Serum concentrations of vitamin B12 of <150 pmol/L and folate of <10 nmol/L were classified as deficient, and folate concentrations of >45.3 nmol/L were classified as HFC. Children with length/height-for-age z-score of less than −2 were considered stunted, and those with weight-for-age z-score of less than −2 were underweight. Logistic regression models were performed. ResultsIn Brazil, 14.2% (95% CI: 12.2, 16.1) of children aged 6–59 mo had vitamin B12 deficiency, 1.1% (95% CI: 0.5, 1.6) had folate deficiency, and 36.9% (95% CI: 33.4, 40.3) had HFC. Vitamin B12 deficiency was higher in children from the northern region of Brazil (28.5%), between 6 and 24 mo (25.3%), whose mothers had lower formal education (0–7 y; 18.7%). Children with HFC had 62% lower odds (OR: 0.38; 95% CI: 0.27, 0.54) of vitamin B12 deficiency than those with normal/deficient folate. Children with vitamin B12 deficiency and normal/deficient folate had higher odds of stunting (OR: 1.58; 95% CI: 1.02, 2.43) than children without vitamin B12 deficiency and normal/deficient folate. ConclusionsVitamin B12 deficiency is a public health problem among Brazilian children aged <2 y with vulnerable socioeconomic status. HFC was inversely associated with vitamin B12 deficiency, and lower odds of stunting were observed in children with HFC and vitamin B12 deficiency than in those with vitamin B12 deficiency and normal/deficient folate.

Biodiversity is overlooked in the diets of different social groups in Brazil

Food biodiversity is essential for improving nutrition and reducing hunger in populations worldwide. However, in middle and low-income countries, the biodiversity of food production does not necessarily represent food consumption patterns by population. We used Brazil, one of the world's megabiodiverse countries, as a case study to investigate the following questions: what is the prevalence of consumption of biodiverse foods in Brazil, and what are the socioeconomic factors that influence their consumption throughout the country? We used data from a Brazilian representative national dietary survey to estimate the frequency of food consumption of unconventional food plants, edible mushrooms, and wild meat, in according to socioeconomic variables. Thus, we investigated the socioeconomic predictors of Unconventional Food Plants consumption using methods of Machine Learning (ML) and multiple zero-inflated Poisson (ZIP) regression. We showed that biodiverse food consumption in Brazil is low, just related by 1.3% of the population, varying in according to area, ethnicity, age, food insecurity, sex, and educational level. Our findings of low utilization of biodiversity suggest an important mismatch between the rich biodiversity of the country and its representation in the human diet.

Association of development quotient with nutritional status of vitamins B6, B12, and folate in 6–59-month-old children: Results from the Brazilian National Survey on Child Nutrition (ENANI-2019)

BackgroundVitamins B6, B12, and folate are essential for the formation and maintenance of the human brain, but studies evaluating these vitamins with early childhood development (ECD) in children under 5 y are limited and controversial. ObjectivesTo evaluate the association between vitamins B6, B12, and folate concentrations/status and ECD. MethodsData regarding 6520 children aged 6–59 mo from the ENANI-2019 (the Brazilian National Survey on Child Nutrition) were analyzed. ECD was assessed using the Survey of Well-being of Young Children’s milestones questionnaire. Vitamin B6 concentration (nmol/L) was classified according to the tertile of the distribution and with the cutoff <20 nmol/L. Folate concentrations >45.3 nmol/L were classified as high, and vitamin B12 <150 pmol/L was deficient. The graded response model was used to estimate developmental age, and the developmental quotient (DQ) was calculated as the developmental age divided by chronological age. Multiple linear regression models were adjusted for confounders. ResultsThe DQ mean (95% confidence interval) for Brazilian children was 0.99 (0.97–1.01). Children aged 6–23 mo [1.13 (1.10–1.16)] had a higher DQ mean than those aged 24–35 [0.99 (0.95–1.03)] and 36–59 mo [0.89 (0.86–0.92)]. Child age was inversely associated with DQ (β = –0.007; P < 0.001). An interaction between child age and vitamin B12 deficiency in the DQ (β = –0.005; P < 0.001) indicated that, in children aged 36–59 mo, the DQ was markedly lower in children with vitamin B12 deficiency than in those without vitamin B12 deficiency. Vitamin B6 concentrations were directly associated with the DQ (β = 0.0004; P = 0.031) among children aged 24–59 mo in the adjusted model. No association was observed between folate status and DQ. ConclusionsIn Brazil, the DQ is lower among older children and those with vitamin B12 deficiency. Vitamin B6 status was directly associated with the DQ in children aged 24–59 mo.

Tobacco use by sexual and gender minorities: findings from a Brazilian national survey

ObjectiveThe study aims to identify the prevalence of use of tobacco products by sexual and gender minorities (SGM) in Brazil, the users’ profile and associations between tobacco use and social...