Objective: To verify, through a systematic review, the accuracy of nutritional assessment in children and adolescents using the length/height-for-age and BMI-for-age growth charts of the Centers for Disease Control and Prevention (CDC) (2000), the World Health Organization (WHO) (2006/2007) and the International Obesity Task Force (IOTF) (2012). Data source: We selected articles from the databases Medical Literature Analysis and Retrieval System Online (MEDLINE), through PubMed, National Library of Medicine and The National Institutes of Health (NIH), Scientific Electronic Library Online (SciELO) and Virtual Health Library (VHL). The following descriptors were used for the search: “Child”, “Adolescent”, “Nutritional Assessment”, “Growth Chart”, “Ethnic Groups”, “Stature by age”, “Body Mass Index”, “Comparison”, “CDC”, “WHO”, and “IOTF”. The selected articles were assessed for quality through the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies of the NIH. Data synthesis: Thirty-three studies published between 2007 and 2020 were selected and, of these, 20 presented good quality, 12 presented fair quality and one presented poor quality. For children under five years old, the WHO length/height-for-age growth charts were shown appropriate for children from Argentina, South Africa, Brazil, Gabon, Qatar, Pakistan and the United States. For those five years old and older, the WHO BMI-for-age growth charts were accurate for the Brazilian and Canadian populations, while the IOTF growth charts were accurate for the European populations. Conclusions: There are difficulties in obtaining international growth charts for children from 5 years old and older that go along with a long period of growth, and which include genetic, cultural and socioeconomic differences of multiethnic populations who have already overcome the secular trend in height.

Objective: To identify and to discuss the progress of actions for the protection, promotion and support of breastfeeding in Brazil from the perspective of the indicators proposed by the Global Breastfeeding Collective. Data source: A narrative review was conducted according to the methodological orientation of the implementation research and through a qualitative approach. Publications from the World Health Organization and the United Nations Children’s Fund were selected, as well as publications from the Brazilian Ministry of Health were collected from the Virtual Health Library and from the libraries of the Department of Primary Care’s portal and the Brazilian’s Institute of Geography and Research. Data synthesis: Brazil has shown promising results regarding the implementation of breastfeeding protection legislation, the participation of municipalities in community breastfeeding support programs, and the continued evaluation of these programs. However, reports of breastfeeding rates have not been produced every five years and the progress of these indicators is very far from the agreed targets for 2030. There is also a need to improve the number of births in child-friendly hospitals and financial donations for breastfeeding programs. Conclusions: It is necessary to strengthen systematic monitoring of breastfeeding and following up current strategies to more effectively impact the breastfeeding rates in the country. Furthermore, it is suggested that the practice of donations is a pathway to be explored to support breastfeeding programs.

No abstract

Objective: Our study aimed to describe body phenotypes (BP) estimated by multivariate analysis and their association with body mass. Design: Body phenotypes were defined based on demographic variables, anthropometric data (body mass, height, skinfolds and circumferences), body composition (phase angle measured by bioelectrical impedance analysis), biochemical parameters (triglycerides, glucose, total cholesterol ratio/Low Density Lipoproteins (LDL), haemoglobin and sexual maturation (pubic hair and breasts or gonads). Analysis of variance (ANOVA) was performed to verify the differences between skin colour and the stages of pubertal development, body phenotypes, body composition, anthropometric, and biochemical variables. Setting: Cities of São Paulo-SP, Piracicaba-SP and Florianópolis-SC from Brazil and the United States. Participants: 9269 adolescents aged between 10 to 15 years old. Results: The composition of BP was similar in all surveys, which are: BP1 was composed by skinfolds, body mass and circumferences variables; BP2 by pubic hair, breast in girls or gonad in boys, height and age; BP3 by cholesterol, triglycerides and glucose; and BP4 by phase angle, haemoglobin and glucose (negative loading). There was a strong correlation (r = 0.9, p <0.001) between BP1 and body mass index. Conclusion: We highlighted independence observed between biochemical parameters, anthropometry, body composition and sexual maturation. BP may support the calculation of scores for diagnosis of obesity based on anthropometric variables and overcome ambiguity in the isolated use of body mass index.

Objectives: To develop new height references (MULT) based on longitudinal data of multi-ethnic populations and to compare them to the height references from the Dutch Growth Study, from the Centers for Disease Control and Prevention (CDC) and from the World Health Organization (WHO). Methods: The MUL height references were developed through the LMS method and the Generalized Additive Models for Location Scale and Shape. They were constructed based on 2611 subjects (15 292 measurements) from the advantaged quintile of the Young Lives (Younger Cohort), Millennium Cohort Study, Adolescent Nutritional Assessment Longitudinal Study, and Epidemiological Health Investigation of Teenagers in Porto studies. The M, S curves were described to compare the growth trajectory of the MULT, DUTCH, CDC and WHO height references. For the population comparative analysis, we used the total sample of the studies (91 063 observations, 17 641 subjects). The Lin's concordance correlation coefficient (CCC) and Cohen's kappa coefficient (K) were used to verify the agreement between MULT, WHO and CDC height references. Results: The MULT height references showed taller boys for the periods of 61-174 months and 196-240 months and taller girls for 61-147 and 181-240 months, when compared to CDC and WHO height references. There was an almost perfect agreement between WHO and MULT height references (CCC >0.99) for the subjects aged 2 to 5 years. Conclusions: MULT height references presented a taller population and a high agreement with WHO growth charts, especially for children under 5 years, indicating that it could be useful to assess nutritional status of multiethnic populations.

A demanda em integrar ensino acadêmico e as Tecnologias em Informação e Comunicação (TICs) é crescente nos dias atuais, visto que os avanços na tecnologia impactam diretamente a produção científica e estão fortemente presentes no cotidiano dos universitários. O objetivo deste trabalho foi avaliar a percepção de graduandos da área da saúde da Universidade de São Paulo, campus capital, com relação à integração entre ensino acadêmico e tecnologia, por meio de um questionário eletrônico. O questionário apresentava questões sobre o perfil do graduando, o acesso a plataformas digitais durante a formação acadêmica e na prática clínica e os conhecimentos em tecnologias adquiridos durante o curso. As frequências absoluta e relativa referentes a sexo, curso, acesso a dispositivos móveis e percepção dos universitários foram calculadas. O questionário obteve um total de 57 participantes, sendo 46 (80,7%) do sexo feminino e 11 (19,3%) do sexo masculino. Dentre os participantes, 93% referiram o uso de plataformas digitais na formação acadêmica, 94,7% demonstraram interesse em aprender mais sobre tecnologia durante a graduação, e mais de 90% apontaram que as ferramentas tecnológicas podem auxiliar na compreensão dos conteúdos ministrados em sala de aula e na aproximação da prática profissional. Evidências apontam a necessidade de implementação das TICs no sistema universitário, assim como o estímulo para a incorporação de ferramentas tecnológicas pelos docentes. Além disso, é preciso construir estratégias de ensino aprendizagem com recursos tecnológicos que acolham o conteúdo necessário para a formação do profissional da saúde.

A metodologia do apoio matricial tem apresentado evidências de sua contribuição positiva na resolutividade da Atenção Básica e os programas de Residência Multiprofissional em Saúde (RMS) vão de encontro a essa proposta ao capacitar profissionais para atuarem de maneira interdisciplinar na gestão na saúde. Objetivo: Buscou-se analisar a incorporação das ferramentas para o apoio matricial em um programa de RMS. Método: Pesquisa de abordagem qualitativa, de natureza descritiva, com delineamento de estudo caso único. Incluiu revisão bibliográfica integrativa no tema ferramentas para o apoio matricial e utilizou técnica de observação participante para coleta de dados do caso, os quais foram analisados buscando sentido entre a teoria e os fenômenos concretos, barreiras e facilitadores. Resultados: Foram identificadas oito ferramentas para o apoio matricial reconhecidas na literatura, as quais foram todas incorporadas nas atividades interdisciplinares do programa de RMS observado. As principais barreiras e facilitadores para a efetiva incorporação das ferramentas na rotina de trabalho estavam relacionadas à carga horária disponível, infraestrutura, perfil da equipe e presença de preceptoria ativa. Foram observados maiores desafios para consecução do apoio matricial na Unidade Básica de Saúde quando comparado as atividades realizadas dentro da instituição coordenadora do programa. Conclusão: Considera-se que aplicar o apoio matricial de acordo com sua proposta tem sido um desafio, contudo, a qualificação profissional por meio dos programas de RMS com ênfase na Estratégia Saúde da Família é uma iniciativa intersetorial que tem potencial para promover a implementação do apoio matricial como metodologia de trabalho na Atenção Básica.

ObjectivesTo develop a new Body Mass Index (BMI) reference (MULT) based on longitudinal data of multi‐ethnic populations and to compare it to international BMI references.MethodsThe MULT BMI reference was constructed through the LMS method and the Generalized Additive Models for Location Scale and Shape (GAMLSS), with 81 310 observations of 17 505 subjects aged 0–22 years old, from the United Kingdom, Ethiopia, Peru, India, Vietnam, Brazil, and Portugal. Outlier values were removed based on weight z‐scores (population level) and based on BMI z‐scores using the linear mixed effects model (individual level). The MULT M, S and L curves were compared to the ones of the World Health Organization (WHO), Centers for Disease Control and Prevention (CDC), International Obesity Task Force (IOTF), and Dutch Growth Study (DUTCH). The MULT BMI percentile cutoffs for overweight and obesity were calculated using the adult BMI values of 25 and 30 kg/m2 at 17, 18, 19, and 20 years old.ResultsMULT presented the lowest mean BMI values for the ages 102–240 months for boys and 114–220 months for girls. MULT S values were similar to the WHO and IOTF for children under 60 months of age and the highest during puberty, while the L curve showed to be more symmetric than the other BMI references.ConclusionThe MULT BMI reference was constructed based on recent data of populations from 10 countries, being a good option to assess the nutritional status of multi‐ethnic populations.