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BACKGROUND: Studies investigating the quality of the diet and dietary intake of children with Down syndrome (DS) are required because the features attributed to the syndrome can affect growth, development and quality of life. METHODS: This cross-sectional study was conducted with 77 Brazilian children with DS between 5 and 36 months of age receiving care at the multidisciplinary outpatient clinic of the University Hospital. Participants' sociodemographic, dietary and anthropometric data were collected from the care protocols. Dietary data were collected from 24-h recalls and dietary practices were assessed according to the WHO dietary guidelines. Associations between inadequate feeding practices and demographic variables were assessed using logistic regression models. RESULTS: Fruits, milk or infant formula, vegetables, beans and meat were among the five most consumed foods by the children investigated. Overall, we observed a high number of cases of early weaning (50.6%), low minimum dietary diversity (MDD; 40.3%), inadequate consistency for age (64.9%), early presence of ultra-processed foods (76.6%), sugars and sweets (33.8%) in the diet of the children with DS. In the associations of inadequate feeding practices by age group, low MDD [odds ratio (OR): 18.6; 95% confidence interval (CI): 3.4; 57.1] and inadequate consistency (OR: 6.65; 95% CI: 1.8; 24.7) were more frequent among children aged below 12 months while this relationship was inverse for early introduction of sugar and sweets (OR: 0.04; 95% CI: 0.01; 0.29). CONCLUSION: Our findings showed a high number of cases of inadequate dietary practices in children with DS investigated, which could adversely affect the long-term health of this population.

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BACKGROUND: The first 2 years of life represent a critical phase for growth and development, with the quality of the diet at this stage having repercussions throughout adulthood. The present study aimed to develop an Index for Measuring the Quality of Complementary Feeding (IMQCF) for infants, as well as to evaluate diet quality and its effects on the nutritional status of preterm infants. METHODS: This cross-sectional study was conducted at a Brazilian University Hospital. The data were extracted by care protocol of outpatient preterm infants at 2 years of corrected age (CA). Dietary data were collected from 24-h recalls. The diet quality was assessed by the IMQCF composed of nine items based on a Brazilian Food Guide for children aged <2 years. Response options were scored 0-100, with scores closer to 100 representing a better quality diet. Association with growth indicators (Z-scores for weight- and length-for-age (WAZ and LAZ) were evaluated via tests of mean difference and multiple linear regression. RESULTS: The median complementary feeding (CF) score was 72.2 (61.1-77.8) A shorter breastfeeding duration or infant formula use and the early introduction of wheat-based foods, ultra-processed foods and cow's milk in the preterm's diet were the main factors interfering in the adequacy of diet. There was an association between the quality of the diet score and WAZ (0.44; 95% confidence interval = 0.03-0.85; P = 0.03). CONCLUSIONS: The introduction of poor quality food in the first 2 years of life interfered with the CF quality of preterm infants and can affect nutritional status at 2 years of CA, possibly in the long term.

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The objectives of this study were to evaluate the cross-cultural measurement equivalence of the Healthy Eating Index (HEI) for children aged 1-2 years and to analyse the quality of nutrition of preterm infants. This was a cross-sectional study with 106 premature infants attended in two specialised outpatient clinics of university hospitals. The quality of the diet was analysed through an adapted HEI to meet the dietary recommendations of Brazilian children aged 1-2 years. Food consumption was measured by 24-h recalls. The reliability of the instrument was evaluated by internal consistency analysis and inter-observer reliability using Cronbach's α coefficient and κ with quadratic ponderation. The construct validity was evaluated by principal component analysis and by Spearman's correlation coefficient with total energy and consumption of some groups' food. The diet quality was considered adequate when the total HEI score was over 80 points. Cronbach's α was 0·54. Regarding inter-observer reliability, ten items showed strong agreement (κ > 0·8). The item scores had low correlations with energy consumed (r ≤ 0·30), and positive and moderate correlation of fruit (r 0·67), meat (r 0·60) and variety of diet (r 0·57) with total scores. When analysing the overall quality of the diet, most patients need improvement (median 78·7 points), which can be attributed to low total vegetable intake and the presence of ultraprocessed foods in the diet. The instrument showed auspicious psychometric properties, being promising to evaluate the quality of the diet in children aged 1-2 years.

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BACKGROUND AND AIMS: Despite evidence of the lipid-lowering effect of plant sterols among adults with hypercholesterolemia, data regarding phytosterol use in children are limited. In this paper, we examined the effects of daily consumption of a phytosterol-enriched milk compound on the lipid profiles of Brazilian children and adolescents with dyslipidemia. METHODS AND RESULTS: This was a randomized, double blind, crossover clinical trial. Twenty eight dyslipidemics outpatients (aged 6-9 years) from an University Hospital were randomly allocated to control or intervention group. The intervention group received milk enriched with 1.2 g/day of plant sterol and the control group received the equivalent amount of skim milk during the period of 8 weeks. Changes from baseline in the mean lipid profile, including total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), and triglyceride (TG) concentrations. Serum lipid profiles, glucose levels, dietary and anthropometric data were determined at weeks 0, 4, 8, 16, and 20. Details regarding the safety and tolerance of phytosterol were obtained, using an open-ended questionnaire. Intention-to-treat analysis were performed, using the proc mixed procedure in SAS. After 8 weeks, the mean concentrations of TC and LDL-C were significantly reduced in the intervention group as compared to the control group with reductions of 5.9% (p = 0.09) and 10.2% (p = 0.002), respectively. In addition, TG concentrations were reduced by 19.7% (p = 0.09). No serious side effects were reported during the study. CONCLUSION: Our results confirm that plant sterols are an effective and safe treatment of infantile dyslipidemia. TRIAL REGISTRATION: RBR-3h7f9k.

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INTRODUCTION: Atherosclerosis represents a disease that begins in childhood, and alterations in lipid concentration play a fundamental role in the development of this condition. OBJECTIVE: To evaluate which of the currently applied obesity parameters (the body index mass, the percentage of body fat, the waist circumference and the upper arm fat area) can predict the risk for dyslipidemia in Brazilian children and adolescents. METHODS: Cross-sectional study, standardized anthropometric data and lipid profile were collected from 874 subjects between the ages of 6 and 19 years. Logistic regression models were used to evaluate the degree of association between the anthropometric measurements and the lipid profile, controlling for potentially confounding variables, such as age and gender. RESULTS: Individuals with excess body weight, elevated percentage of body fat, waist circumference and upper arm fat above the 90th percentile showed a positive correlation with alterations in the lipid profile. After adjusting for age and income, a body mass index above the 85th percentile and an elevated percentage of body fat were the variables most strongly associated with dyslipidemia in the youngest subjects (odds ratio (OR) = 2.00, p < 0.001 and OR = 1.47, p = 0.014, respectively). Children (64.5%) and adolescents aged 10-12 years (51.0%) had the highest rates of dyslipidemia. CONCLUSION: Compared with other variables, such as the percentage of body fat, the body mass index was the best predictor of dyslipidemia in children and adolescents.

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OBJETIVO: Analisar a pressão plantar e o equilíbrio postural nos três trimestres de gravidez, bem como a correlação com as características antropométricas. METODOLOGIA: 60 voluntárias com idade média de 23,3 ± 5,5 anos, sendo 15 mulheres em cada grupo: não-gestantes (C), primeiro (1T), segundo (2T) e terceiro trimestre (3T). A avaliação foi efetuada por meio de plataforma de pressão na posição bipodal com os olhos abertos. As variáveis analisadas nos pés direito e esquerdo foram: pico de pressão em todo o pé (PT), no antepé (PA) e no retropé (PR); distância entre a borda medial dos pés (largura da base de suporte); distância do centro de força ao limite anterior (CFF) e posterior (CFC) dos pés; deslocamento ântero-posterior (AP) e médio--lateral (ML) do centro de força; e área de contato (AC). RESULTADOS: Não houve diferença no pico de pressão de contato e na distância CFF e CFC entre os grupos. O deslocamento AP foi maior (p< 0,05) no grupo 3T em relação ao 1T. Não se observou diferença (p> 0,05) entre os grupos para o deslocamento ML. Houve correlação positiva entre peso ganho durante a gestação com AC para o grupo 2T e com PT no pé direito do grupo 1T. CONCLUSÃO: Os resultados demonstram a influência das mudanças anatômicas e fisiológicas inerentes à gestação na pressão plantar, além de sugerir uma redução do equilíbrio postural no 3T, relacionada ao maior deslocamento AP nessa fase.

OBJECTIVE: To analyze plantar pressure and postural balance during the three trimesters of pregnancy, and also to correlate these with anthropometric characteristics. METHOD: Sixty volunteers participated in this study, with a mean age of 23.3 ± 5.5 years. There were 15 subjects in each group: non-pregnant (C), first trimester (1T), second trimester (2T) and third trimester (3T). Evaluations were performed in bipedal stance with open eyes, using a pressure platform. The following variables were analyzed in the right and left feet: peak pressures in the whole foot (WFP), forefoot (FFP) and hindfoot (HFP); distance between the medial borders of the foot (width of support base); the distance from the center of force to the anterior (COF-A) and posterior (COF-P) limits of the foot; anteroposterior (AP) and mediolateral (ML) COF displacements; and the contact area (CA). RESULTS: There were no differences in peak contact pressures and COF-A and COF-P distances between the groups. The AP displacement was greater (p< 0.05) in 3T than in 1T. There was no difference (p> 0.05) between the groups regarding ML displacement. There was a positive correlation between weight gained during pregnancy and CA for the 2T group, and between weight gain and WFP in the right feet in the 1T group. CONCLUSION: The results demonstrate the influence of the anatomical and physiological changes inherent to pregnancy on plantar pressure. They also suggest that postural equilibrium decreases in the third trimester, associated with greater AP displacement during this phase.

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OBJETIVO: Analisar a impedância elétrica dos tecidos biológicos durante estimulação elétrica em diferentes segmentos, faces e freqüências da corrente, aumentando-se a distância intereletrodos. MÉTODO: 20 voluntárias, idade média 23 ± 2,25anos e índice de massa corporal 20,65 ± 1,44kg/m², permaneceram em decúbito, sendo um eletrodo posicionado proximalmente às interlinhas articulares do punho e tornozelo, anterior e posteriormente, ou à espinha ilíaca póstero-superior, e outro eletrodo distanciado seqüencialmente em 10, 20, 30 e 40cm. Foram aplicadas duas correntes (100us e 10mA), uma de 100Hz (BF) e outra de 2000Hz modulada em 100 por cento da amplitude para 100Hz (MF), com intervalo mínimo de 7 dias. A impedância foi calculada, indiretamente, pela Lei de Ohm, a partir da intensidade aplicada e da tensão elétrica captada em sistema composto por osciloscópio digital (TDS 210, Tektronix®) e gerador de corrente constante (Dualpex 961, Quark®). Para análise estatística, aplicou-se Anova-F e Kruskal-Wallis com post hoc (SNK), teste de Friedman e coeficiente de correlação de Spearman, considerando p< 0,05. RESULTADOS: Apesar de o comportamento da impedância elétrica com o aumento da distância intereletrodos ser similar para ambas as correntes, houve uma redução da impedância sob estimulação com MF. Nos membros, aproximadamente 50 por cento da variabilidade da impedância é explicada pelo afastamento dos eletrodos, relação essa não observada na face posterior do tronco. Independente do tipo de corrente, o tronco apresentou os menores valores de impedância elétrica, seguido pelo membro inferior. CONCLUSÕES: A impedância elétrica dos tecidos sofre influência da freqüência da corrente e da localização e distância intereletrodos, apresentando padrão não uniforme nos diferentes segmentos.

OBJECTIVE: To analyze the electrical impedance of biological tissues during electrical stimulation in relation to different segments, surfaces and current frequencies, with increasing distance between electrodes. METHOD: 20 female volunteers of mean age 23 ± 2.25 years and mean body mass index 20.65 ± 1.44 kg/m² were positioned in decubitus with one electrode placed proximally to the wrist and ankle joint lines, anteriorly and posteriorly, or on the posterosuperior iliac spine, and the other electrode was placed at distance of 10, 20, 30 and 40 cm, sequentially. Two currents (100 us and 10 mA) were applied: one at 100 Hz (LF) and the other at 2000 Hz modulated at 100 percent of the amplitude for 100 Hz (MF), with a minimum interval of seven days. The impedance was calculated indirectly using Ohm's Law, from the applied intensity and the electrical voltage picked up by a system consisting of a digital oscilloscope (TDS 210, Tektronix®) and a direct current generator (Dualpex 961, Quark®). For statistical analysis, Anova-F and Kruskal-Wallis were applied, with post hoc (SNK), Friedman test and Spearman correlation coefficient, taking p< 0.05. RESULTS: Despite similar electrical impedance behavior with increasing distance between electrodes for the two currents, there was a reduction in impedance under MF stimulation. In the limbs, approximately 50 percent of the impedance variance was explained by the increase in electrode separation, although this relationship was not observed on the posterior surface of the trunk. Independent of the current type, the trunk presented the lowest electrical impedance, followed by the lower limbs. CONCLUSION: The electrical impedance of the tissues was influenced by current frequency and the positioning and distance between electrodes, thus presenting a non-uniform pattern in the different segments.

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We investigated the feeding habits of the teiid lizard Cnemidophorus littoralis in the markedly seasonal habitat of Restinga da Barra de Maricá (22 degrees 57'S, 43 degrees 50'W), Rio de Janeiro State, Brazil, to evaluate to what extent its diet is ontogenetically, sexually, and/or seasonally conservative. Lizard stomach contents were analyzed, identified, counted, estimated for volume (in mm3), and grouped in four classes (active, sedentary, and clumped preys, and plant material). The relative contribution of each food class to the total prey volume consumed by adult males and females and juveniles was compared in three ways: between juveniles and adults, sexes, and seasons (wet and dry). Sexual dimorphism in head size was tested by comparing head width and jaw length using analysis of covariance (ANCOVA). Isopterans were the most important prey item, occurring in 93% of the lizard stomachs examined and corresponding to 96.4% of total prey content and 69.7% of total prey volume. They occurred in high frequencies in the stomachs of C. littoralis throughout all study months. We found no sexual, ontogenetic, or seasonal differences in C. littoralis diet although the sexes differed significantly in head width. We concluded that isopterans are the main item in the diet of C. littoralis in Restinga da Barra de Maricá, both for juveniles and adults. The lack of seasonal, sexual, or ontogenetic variation in its diet results from the massive consumption of these insects. Isopterans are small, occur in clumps, and are available year-round, and thus are an advantageous food item for the active forager C. littoralis. We also found sexual dimorphism in the head size of C. littoralis: males have wider heads than females. This dimorphism, however, does not seem to be related with the diet of the species, and is probably a result of sexual selection.

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We investigated the feeding habits of the teiid lizard Cnemidophorus littoralis in the markedly seasonal habitat of Restinga da Barra de Maricá (22º57'S, 43º50'W), Rio de Janeiro State, Brazil, to evaluate to what extent its diet is ontogenetically, sexually, and/or seasonally conservative. Lizard stomach contents were analyzed, identified, counted, estimated for volume (in mm ), and grouped in four classes (active, sedentary, and clumped preys, and plant material). The relative contribution of each food class to the total prey volume consumed by adult males and females and juveniles was compared in three ways: between juveniles and adults, sexes, and seasons (wet and dry). Sexual dimorphism in head size was tested by comparing head width and jaw length using analysis of covariance (ANCOVA). Isopterans were the most important prey item, occurring in 93 percent of the lizard stomachs examined and corresponding to 96.4 percent of total prey content and 69.7 percent of total prey volume. They occurred in high frequencies in the stomachs of C. littoralis throughout all study months. We found no sexual, ontogenetic, or seasonal differences in C. littoralis diet although the sexes differed significantly in head width. We concluded that isopterans are the main item in the diet of C. littoralis in Restinga da Barra de Maricá, both for juveniles and adults. The lack of seasonal, sexual, or ontogenetic variation in its diet results from the massive consumption of these insects. Isopterans are small, occur in clumps, and are available year-round, and thus are an advantageous food item for the active forager C. littoralis. We also found sexual dimorphism in the head size of C. littoralis: males have wider heads than females. This dimorphism, however, does not seem to be related with the diet of the species, and is probably a result of sexual selection

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We investigated the feeding habits of the teiid lizard Cnemidophorus littoralis in the markedly seasonal habitat of Restinga da Barra de Maricá (22º57'S, 43º50'W), Rio de Janeiro State, Brazil, to evaluate to what extent its diet is ontogenetically, sexually, and/or seasonally conservative. Lizard stomach contents were analyzed, identified, counted, estimated for volume (in mm³), and grouped in four classes (active, sedentary, and clumped preys, and plant material). The relative contribution of each food class to the total prey volume consumed by adult males and females and juveniles was compared in three ways: between juveniles and adults, sexes, and seasons (wet and dry). Sexual dimorphism in head size was tested by comparing head width and jaw length using analysis of covariance (ANCOVA). Isopterans were the most important prey item, occurring in 93% of the lizard stomachs examined and corresponding to 96.4% of total prey content and 69.7% of total prey volume. They occurred in high frequencies in the stomachs of C. littoralis throughout all study months. We found no sexual, ontogenetic, or seasonal differences in C. littoralis diet although the sexes differed significantly in head width. We concluded that isopterans are the main item in the diet of C. littoralis in Restinga da Barra de Maricá, both for juveniles and adults. The lack of seasonal, sexual, or ontogenetic variation in its diet results from the massive consumption of these insects. Isopterans are small, occur in clumps, and are available year-round, and thus are an advantageous food item for the active forager C. littoralis. We also found sexual dimorphism in the head size of C. littoralis: males have wider heads than females. This dimorphism, however, does not seem to be related with the diet of the species, and is probably a result of sexual selection.

Estudamos a dieta do lagarto teídeo Cnemidophorus littoralis no ambiente sazonal da Restinga da Barra de Maricá (22º57'S, 43º50'W), Estado do Rio de Janeiro, Brasil, analisando em que extensão a dieta do lagarto é sexual, ontogenética e/ou sazonalmente conservativa. O conteúdo do estômago dos lagartos foi analisado, identificado, contado, estimado seu volume e agrupado em quatro classes (presas ativas, sedentárias, distribuídas de forma agregada e material vegetal). A contribuição relativa de cada tipo de presa para o número e volume total consumido por adultos machos e fêmeas e para jovens foi comparada entre jovens e adultos, entre os sexos e entre as estações (seca e úmida). O dimorfismo sexual no tamanho da cabeça foi testado comparando a largura da cabeça e o comprimento da mandíbula por análise de covariância (ANCOVA). Os isópteros foram as presas mais importantes, ocorrendo nos estômagos de 93% dos lagartos e correspondendo a 96,4% do número total de presas e a 69,7% do volume total das presas, apresentando altas freqüências nos estômagos em todos os meses do ano. Não houve diferenças sexuais, ontogenéticas ou sazonais na dieta de C. littoralis, embora os sexos tenham diferido significativamente na largura da cabeça. Portanto, concluímos que isópteros constituem o principal item da dieta de C. littoralis na Restinga da Barra de Maricá, tanto para jovens quanto para adultos, e que a ausência de variação sazonal, ontogenética ou sexual na dieta da espécie resulta do elevado consumo desses insetos. Os isópteros são pequenos, ocorrem agrupados e estão disponíveis ao longo de todo o ano, constituindo item alimentar vantajoso para o forrageador ativo C. littoralis. O dimorfismo sexual no tamanho da cabeça (machos com cabeças mais largas) parece não estar relacionado à dieta da espécie, sendo provavelmente resultado da seleção sexual.