ABSTRACT OBJECTIVE: This study aimed to describe the prevalence and predictors of childhood anemia in an Amazonian population-based birth cohort study. METHODS: Prevalence of maternal anemia was estimated at delivery (hemoglobin [Hb] concentration < 110 g/L) in women participating in the MINA-Brazil birth cohort study and in their children, examined at ages one, two (Hb < 110 g/L), and five (Hb < 115 g/L). Moreover, ferritin, soluble transferrin receptor, and C-reactive protein concentrations were measured in mothers at delivery and in their 1- and 2-year-old children to estimate the prevalence of iron deficiency and its contribution to anemia, while adjusting for potential confounders by multiple Poisson regression analysis (adjusted relative risk [RRa]). RESULTS: The prevalence 95% confidence interval (CI) of maternal anemia, iron deficiency, and iron-deficiency anemia at delivery were 17.3% (14.0–21.0%), 42.6% (38.0–47.2%), and 8.7% (6.3–11.6)%, respectively (n = 462). At one year of age (n = 646), 42.2% (38.7–45.8%) of the study children were anemic, 38.4% (34.6–42.3%) were iron-deficient, and 26.3 (23.0–29.9) had iron-deficiency anemia. At two years of age (n = 761), these values decreased to 12.8% (10.6–15.2%), 18.1% (15.5–21.1%), and 4.1% (2.8–5.7%), respectively; at five years of age (n = 655), 5.2% (3.6–7.2%) were anemic. Iron deficiency (RRa = 2.19; 95%CI: 1.84–2.60) and consumption of ultra-processed foods (UPF) (RRa = 1.56; 95%CI: 1.14–2.13) were significant contributors to anemia at 1 year, after adjusting for maternal schooling. At 2 years, anemia was significantly associated with maternal anemia at delivery (RRa: 1.67; 95%CI: 1.17–2.39), malaria since birth (2.25; 1.30–3.87), and iron deficiency (2.15; 1.47–3.15), after adjusting for children's age and household wealth index. CONCLUSIONS: Anemia continues to be highly prevalent during pregnancy and early childhood in the Amazon. Public health policies should address iron deficiency, UPF intake, maternal anemia, and malaria to prevent and treat anemia in Amazonian children. OBJECTIVE populationbased population based METHODS hemoglobin Hb [Hb 11 g/L gL g L MINABrazil MINA Brazil g/L, , g/L. . Moreover ferritin receptor Creactive C reactive 2yearold yearold old adjusted RRa. RRa [RRa]) RESULTS 95 CI (CI irondeficiency 173 17 3 17.3 14.0–21.0%, 140210 14.0–21.0% 14 0 21 (14.0–21.0%) 426 42 6 42.6 38.0–47.2%, 380472 38.0–47.2% 38 47 (38.0–47.2%) 87 8 7 8.7 6.3–11.6%, 63116 6.3–11.6 %, (6.3–11.6)% n 462. 462 462) 646, 646 646) 422 42.2 38.7–45.8% 387458 45 (38.7–45.8% anemic 384 4 38.4 34.6–42.3% 346423 34 (34.6–42.3% irondeficient, irondeficient deficient, deficient iron-deficient 263 26 26. 23.0–29.9 230299 23 29 9 (23.0–29.9 761, 761 761) 128 12 12.8 10.6–15.2%, 106152 10.6–15.2% 10 15 (10.6–15.2%) 181 18 18.1 15.5–21.1%, 155211 15.5–21.1% 5 (15.5–21.1%) 41 4.1 2.8–5.7%, 2857 2.8–5.7% (2.8–5.7%) 655, 655 655) 52 5.2 3.6–7.2% 3672 (3.6–7.2% 2.19 219 19 95%CI 95CI 1.84–2.60 184260 84 60 ultraprocessed ultra processed (UPF 1.56 156 56 1.14–2.13 114213 13 schooling 1.67 167 67 1.17–2.39, 117239 1.17–2.39 39 1.17–2.39) 2.25 225 25 (2.25 1.30–3.87, 130387 1.30–3.87 30 1.30–3.87) 2.15 215 (2.15 1.47–3.15, 147315 1.47–3.15 1.47–3.15) childrens s index CONCLUSIONS Amazon intake [RRa] 17. 14021 14.0–21.0 (14.0–21.0% 42. 38047 38.0–47.2 (38.0–47.2% 8. 6.3–11.6% 6311 6.3–11. % (6.3–11.6) 46 64 38.7–45.8 38745 (38.7–45.8 38. 34.6–42.3 34642 (34.6–42.3 23.0–29. 23029 (23.0–29. 76 12. 10615 10.6–15.2 (10.6–15.2% 18. 15521 15.5–21.1 (15.5–21.1% 4. 285 2.8–5.7 (2.8–5.7% 65 5. 3.6–7.2 367 (3.6–7.2 2.1 1.84–2.6 18426 1.5 1.14–2.1 11421 1.6 16 11723 1.17–2.3 2.2 22 (2.2 13038 1.30–3.8 (2.1 14731 1.47–3.1 [RRa 1402 14.0–21. (14.0–21.0 3804 38.0–47. (38.0–47.2 631 6.3–11 (6.3–11.6 38.7–45. 3874 (38.7–45. 34.6–42. 3464 (34.6–42. 23.0–29 2302 (23.0–29 1061 10.6–15. (10.6–15.2 1552 15.5–21. (15.5–21.1 28 2.8–5. (2.8–5.7 3.6–7. 36 (3.6–7. 2. 1.84–2. 1842 1. 1.14–2. 1142 1172 1.17–2. (2. 1303 1.30–3. 1473 1.47–3. 140 14.0–21 (14.0–21. 380 38.0–47 (38.0–47. 63 6.3–1 (6.3–11. 38.7–45 387 (38.7–45 34.6–42 346 (34.6–42 23.0–2 230 (23.0–2 106 10.6–15 (10.6–15. 155 15.5–21 (15.5–21. 2.8–5 (2.8–5. 3.6–7 (3.6–7 1.84–2 184 1.14–2 114 117 1.17–2 (2 130 1.30–3 147 1.47–3 14.0–2 (14.0–21 38.0–4 (38.0–47 6.3– (6.3–11 38.7–4 (38.7–4 34.6–4 (34.6–4 23.0– (23.0– 10.6–1 (10.6–15 15.5–2 (15.5–21 2.8– (2.8–5 3.6– (3.6– 1.84– 1.14– 1.17– ( 1.30– 1.47– 14.0– (14.0–2 38.0– (38.0–4 6.3 (6.3–1 38.7– (38.7– 34.6– (34.6– 23.0 (23.0 10.6– (10.6–1 15.5– (15.5–2 2.8 (2.8– 3.6 (3.6 1.84 1.14 1.17 1.30 1.47 14.0 (14.0– 38.0 (38.0– 6. (6.3– 38.7 (38.7 34.6 (34.6 23. (23. 10.6 (10.6– 15.5 (15.5– (2.8 3. (3. 1.8 1.1 1.3 1.4 14. (14.0 (38.0 (6.3 (38. 34. (34. (23 10. (10.6 15. (15.5 (3 (14. (6. (38 (34 (10. (15. (14 (6 (10 (15 (1

RESUMO OBJETIVO: O objetivo deste estudo foi descrever a prevalência e os preditores de anemia na infância em um estudo de coorte de nascimentos de base populacional amazônica. MÉTODOS: Estimou-se a prevalência de anemia materna no parto (concentração de hemoglobina [Hb] < 110 g/L) em mulheres participantes do estudo de coorte de nascimentos MINA-Brasil e em seus filhos, examinados nas idades um, dois (Hb < 110 g/L) e cinco anos (Hb < 115 g/L). Além disso, as concentrações de ferritina, receptor solúvel de transferrina e proteína C reativa foram medidas em mães no parto e em seus filhos de 1 e 2 anos de idade para estimar a prevalência de deficiência de ferro e sua contribuição para anemia, ajustando para potenciais fatores de confusão por análise de regressão múltipla de Poisson (risco relativo ajustado [RRa]). RESULTADOS: As prevalências com intervalo de confiança (IC) de 95% de anemia materna, deficiência de ferro e anemia ferropriva no parto foram de 17,3% (14,0–21,0%), 42,6% (38,0–47,2%) e 8,7% (6,3–11,6%), respectivamente (n = 462). No primeiro ano de idade (n = 646), 42,2% (38,7–45,8%) das crianças estudadas eram anêmicas, 38,4% (34,6–42,3%) eram deficientes em ferro e 26,3 (23,0–29,9%) tinham anemia ferropriva. Aos dois anos de idade (n = 761), esses valores diminuíram para 12,8% (10,6–15,2%), 18,1% (15,5–21,1%) e 4,1% (2,8–5,7%), respectivamente; aos cinco anos de idade (n = 655), 5,2% (3,6–7,2%) eram anêmicos. A deficiência de ferro (RRa = 2,19, IC95%: 1,84–2,60) e consumo de alimentos ultraprocessados (AUP) (RRa = 1,56, IC95%: 1,14–2,13) foram contribuintes significantes para anemia no 1° ano de idade, após ajuste para escolaridade materna. Aos 2 anos, a anemia associou-se significativamente à anemia materna no parto (RRa = 1,67; IC95%: 1,17–2,39), malária desde o nascimento (2,25; 1,30–3,87) e deficiência de ferro (2,15; 1,47–3,15), após ajuste para idade das crianças e índice de riqueza familiar. CONCLUSÕES: A anemia continua sendo altamente prevalente durante a gravidez e a primeira infância na Amazônia. Políticas públicas de saúde devem abordar a deficiência de ferro, o consumo de AUP, a anemia materna e a malária para prevenir e tratar a anemia em crianças amazônicas. OBJETIVO amazônica MÉTODOS Estimouse Estimou se concentração Hb [Hb 11 g/L gL g L MINABrasil MINA Brasil g/L. . disso ferritina risco RRa. RRa [RRa]) RESULTADOS IC (IC 95 173 17 3 17,3 14,0–21,0%, 140210 14,0–21,0% , 14 0 21 (14,0–21,0%) 426 42 6 42,6 38,0–47,2% 380472 38 47 (38,0–47,2% 87 8 7 8,7 6,3–11,6%, 63116 6,3–11,6% (6,3–11,6%) n 462. 462 462) 646, 646 646) 422 42,2 38,7–45,8% 387458 45 (38,7–45,8% anêmicas 384 4 38,4 34,6–42,3% 346423 34 (34,6–42,3% 263 26 26, 23,0–29,9% 230299 23 29 9 (23,0–29,9% 761, 761 761) 128 12 12,8 10,6–15,2%, 106152 10,6–15,2% 10 15 (10,6–15,2%) 181 18 18,1 15,5–21,1% 155211 5 (15,5–21,1% 41 4,1 2,8–5,7%, 2857 2,8–5,7% (2,8–5,7%) 655, 655 655) 52 5,2 3,6–7,2% 3672 (3,6–7,2% anêmicos 219 19 2,19 IC95% IC95 1,84–2,60 184260 84 60 AUP (AUP 156 56 1,56 1,14–2,13 114213 13 associouse associou 1,67 167 67 1,17–2,39, 117239 1,17–2,39 39 1,17–2,39) 2,25 225 25 (2,25 1,30–3,87 130387 30 2,15 215 (2,15 1,47–3,15, 147315 1,47–3,15 1,47–3,15) familiar CONCLUSÕES Amazônia amazônicas [RRa] 17, 14021 14,0–21,0 (14,0–21,0% 42, 38,0–47,2 38047 (38,0–47,2 8, 6311 6,3–11,6 (6,3–11,6% 46 64 38,7–45,8 38745 (38,7–45,8 38, 34,6–42,3 34642 (34,6–42,3 23,0–29,9 23029 (23,0–29,9 76 12, 10615 10,6–15,2 (10,6–15,2% 18, 15,5–21,1 15521 (15,5–21,1 4, 285 2,8–5,7 (2,8–5,7% 65 5, 3,6–7,2 367 (3,6–7,2 2,1 IC9 1,84–2,6 18426 1,5 1,14–2,1 11421 1,6 16 11723 1,17–2,3 2,2 22 (2,2 1,30–3,8 13038 (2,1 14731 1,47–3,1 [RRa 1402 14,0–21, (14,0–21,0 38,0–47, 3804 (38,0–47, 631 6,3–11, (6,3–11,6 38,7–45, 3874 (38,7–45, 34,6–42, 3464 (34,6–42, 23,0–29, 2302 (23,0–29, 1061 10,6–15, (10,6–15,2 15,5–21, 1552 (15,5–21, 28 2,8–5, (2,8–5,7 3,6–7, 36 (3,6–7, 2, 1,84–2, 1842 1, 1,14–2, 1142 1172 1,17–2, (2, 1,30–3, 1303 1473 1,47–3, 140 14,0–21 (14,0–21, 38,0–47 380 (38,0–47 63 6,3–11 (6,3–11, 38,7–45 387 (38,7–45 34,6–42 346 (34,6–42 23,0–29 230 (23,0–29 106 10,6–15 (10,6–15, 15,5–21 155 (15,5–21 2,8–5 (2,8–5, 3,6–7 (3,6–7 1,84–2 184 1,14–2 114 117 1,17–2 (2 1,30–3 130 147 1,47–3 14,0–2 (14,0–21 38,0–4 (38,0–4 6,3–1 (6,3–11 38,7–4 (38,7–4 34,6–4 (34,6–4 23,0–2 (23,0–2 10,6–1 (10,6–15 15,5–2 (15,5–2 2,8– (2,8–5 3,6– (3,6– 1,84– 1,14– 1,17– ( 1,30– 1,47– 14,0– (14,0–2 38,0– (38,0– 6,3– (6,3–1 38,7– (38,7– 34,6– (34,6– 23,0– (23,0– 10,6– (10,6–1 15,5– (15,5– 2,8 (2,8– 3,6 (3,6 1,84 1,14 1,17 1,30 1,47 14,0 (14,0– 38,0 (38,0 6,3 (6,3– 38,7 (38,7 34,6 (34,6 23,0 (23,0 10,6 (10,6– 15,5 (15,5 (2,8 3, (3, 1,8 1,1 1,3 1,4 14, (14,0 (38, 6, (6,3 34, (34, 23, (23, 10, (10,6 15, (15, (3 (14, (38 (6, (34 (23 (10, (15 (14 (6 (10 (1

ABSTRACT OBJECTIVE: To describe the prevalence and factors associated with exclusive (EBF) and continued breastfeeding (BF) practices among Amazonian children. METHODS: Data from 1,143 mother-child pairs recorded on the Maternal and Child Health and Nutrition in Acre (MINA-Brazil) birth cohort were used. Information on EBF and BF was collected after childbirth (July 2015–June 2016) and during the follow-up visits at 1 and 6 months postpartum, 1, 2, and 5 years of age. For longitudinal analysis, the outcomes were EBF and BF duration. Probability of breastfeeding practices were estimated by Kaplan-Meier survival analysis. Associations between baseline predictors variables and outcomes among children born at term were assessed by extended Cox regression models. RESULTS: EBF frequencies (95% confidence interval [95%CI]) at 3 and 6 months of age were 33% (95%CI: 30.2–36.0) and 10.8% (95%CI: 8.9–12.9), respectively. Adjusted hazard ratio for predictors of early EBF cessation were: being a first-time mother = 1.47 (95%CI: 1.19–1.80), feeding newborns with prelacteals = 1.70 (95%CI: 1.23–2.36), pacifier use in the first week of life = 1.79 (95%CI: 1.44–2.23) or diarrhea in the first two weeks of life = 1.70 (95%CI: 1.15–2.52). Continued BF frequency was 67.9% (95%CI: 64.9–70.8), 29.3% (95%CI: 26.4–32.4), and 1.7% (95%CI: 0.9–2.8) at 1, 2 and 5 years of age, respectively. Adjusted hazard ratio for predictors of early BF cessation were: male sex = 1.23 (95%CI: 1.01–1.49), pacifier use in the first week of life = 4.66 (95%CI: 2.99–7.26), and EBF less than 3 months = 2.76 (95%CI: 1.64–4.66). CONCLUSIONS: EBF and continued BF duration among Amazonian children is considerably shorter than recommendations from the World Health Organization. Significant predictors of breastfeeding practices should be considered for evaluating local strategies to achieve optimal breastfeeding practices. OBJECTIVE (EBF (BF METHODS 1143 143 1,14 motherchild child MINABrazil MINA Brazil (MINA-Brazil used July 2015June June 2015 2016 followup follow up postpartum analysis KaplanMeier Kaplan Meier models RESULTS 95% 95 (95 95%CI 95CI CI [95%CI] 33 (95%CI 30.2–36.0 302360 30 36 0 108 10 8 10.8 8.9–12.9, 89129 8.9–12.9 , 9 12 8.9–12.9) respectively firsttime time 147 47 1.4 1.19–1.80, 119180 1.19–1.80 19 80 1.19–1.80) 170 70 1.7 1.23–2.36, 123236 1.23–2.36 23 1.23–2.36) 179 79 1.44–2.23 144223 44 1.15–2.52. 115252 1.15–2.52 . 15 52 1.15–2.52) 679 67 67.9 64.9–70.8, 649708 64.9–70.8 64 64.9–70.8) 293 29 29.3 26.4–32.4, 264324 26.4–32.4 26 4 32 26.4–32.4) 17 7 0.9–2.8 0928 123 1.2 1.01–1.49, 101149 1.01–1.49 01 49 1.01–1.49) 466 66 4.6 2.99–7.26, 299726 2.99–7.26 99 2.99–7.26) 276 76 2.7 1.64–4.66. 164466 1.64–4.66 1.64–4.66) CONCLUSIONS Organization 114 14 1,1 201 (9 [95%CI 30.2–36. 30236 10. 8912 8.9–12. 1. 11918 1.19–1.8 12323 1.23–2.3 1.44–2.2 14422 11525 1.15–2.5 67. 64970 64.9–70. 29. 26432 26.4–32. 0.9–2. 092 10114 1.01–1.4 46 4. 29972 2.99–7.2 27 2. 16446 1.64–4.6 11 20 ( 30.2–36 3023 891 8.9–12 1191 1.19–1. 1232 1.23–2. 1.44–2. 1442 1152 1.15–2. 6497 64.9–70 2643 26.4–32 0.9–2 09 1011 1.01–1. 2997 2.99–7. 1644 1.64–4. 30.2–3 302 89 8.9–1 119 1.19–1 1.23–2 1.44–2 144 115 1.15–2 649 64.9–7 264 26.4–3 0.9– 101 1.01–1 299 2.99–7 164 1.64–4 30.2– 8.9– 1.19– 1.23– 1.44– 1.15– 64.9– 26.4– 0.9 1.01– 2.99– 16 1.64– 30.2 8.9 1.19 1.44 1.15 64.9 26.4 0. 1.01 2.99 1.64 30. 8. 1.1 64. 26. 1.0 2.9 1.6

RESUMO OBJETIVO: Descrever a prevalência e os fatores associados às práticas de aleitamento materno exclusivo (AME) e continuado (AM) entre crianças amazônicas. MÉTODOS: Foram utilizados dados de 1.143 pares mãe-filho registrados na coorte de nascimento Materno-Infantil no Acre (MINA-Brasil). As informações sobre AME e AM foram coletadas após o parto (julho de 2015–junho de 2016) e durante as consultas de acompanhamento com 1 e 6 meses pós-parto e com 1, 2 e 5 anos de idade. A análise longitudinal considerou a duração do AME e AM como desfechos. A probabilidade das práticas de aleitamento materno foi estimada pela análise de sobrevida de Kaplan-Meier. As associações entre as variáveis preditoras basais e os desfechos entre crianças nascidas a termo foram avaliadas por modelos de regressão de Cox estendidos. RESULTADOS: As frequências de AME (intervalo de confiança de 95% [IC95%]) aos 3 e 6 meses de idade foram de 33% (IC95%: 30,2–36,0) e 10,8% (IC95%: 8,9–12,9), respectivamente. A razão de risco ajustada para preditores de interrupção precoce do AME foi: ser primípara = 1,47 (IC95%: 1,19–1,80), alimentar recém-nascidos com pré-lácteos = 1,70 (IC95%: 1,23–2,36), usar chupeta na primeira semana de vida = 1,79 (IC95%: 1,44–2,23) e apresentar diarreia nas duas primeiras semanas de vida = 1,70 (IC95%: 1,15–2,52). A frequência do AM continuado foi de 67,9% (IC95%: 64,9–70,8), 29,3% (IC95%: 26,4–32,4) e 1,7% (IC95%: 0,9–2,8) aos 1, 2 e 5 anos de idade, respectivamente. A razão de risco ajustada para preditores de cessação precoce do AM foi: sexo masculino = 1,23 (IC95%: 1,01–1,49), uso de chupeta na primeira semana de vida = 4,66 (IC95%: 2,99–7,26) e AME menor que 3 meses = 2,76 (IC95%: 1,64–4,66). CONCLUSÕES: A duração do AME e do AM continuado entre crianças amazônicas é consideravelmente menor do que as recomendações da Organização Mundial da Saúde. Preditores significativos das práticas de aleitamento materno devem ser considerados na avaliação das estratégias locais para alcançar práticas ideais de aleitamento materno. OBJETIVO (AME (AM MÉTODOS 1143 143 1.14 mãefilho mãe filho MaternoInfantil Materno Infantil MINABrasil. MINABrasil MINA Brasil . (MINA-Brasil) julho 2015junho junho 2015 2016 pósparto pós KaplanMeier. KaplanMeier Kaplan Meier. Meier Kaplan-Meier estendidos RESULTADOS intervalo 95 IC95% IC95 IC [IC95%] 33 (IC95% 30,2–36,0 302360 30 36 0 108 10 8 10,8 8,9–12,9, 89129 8,9–12,9 , 9 12 8,9–12,9) respectivamente 147 47 1,4 1,19–1,80, 119180 1,19–1,80 19 80 1,19–1,80) recémnascidos recém nascidos prélácteos pré lácteos 170 70 1,7 1,23–2,36, 123236 1,23–2,36 23 1,23–2,36) 179 79 1,44–2,23 144223 44 1,15–2,52. 115252 1,15–2,52 15 52 1,15–2,52) 679 67 67,9 64,9–70,8, 649708 64,9–70,8 64 64,9–70,8) 293 29 29,3 26,4–32,4 264324 26 4 32 17 7 0,9–2,8 0928 123 1,2 1,01–1,49, 101149 1,01–1,49 01 49 1,01–1,49) 466 66 4,6 2,99–7,26 299726 99 276 76 2,7 1,64–4,66. 164466 1,64–4,66 1,64–4,66) CONCLUSÕES Saúde 114 14 1.1 (MINA-Brasil 201 IC9 [IC95% (IC95 30,2–36, 30236 10, 8912 8,9–12, 11918 1,19–1,8 12323 1,23–2,3 1,44–2,2 14422 11525 1,15–2,5 67, 64970 64,9–70, 29, 26,4–32, 26432 0,9–2, 092 10114 1,01–1,4 46 4, 2,99–7,2 29972 27 2, 16446 1,64–4,6 11 1. 20 [IC95 (IC9 30,2–36 3023 891 8,9–12 1191 1,19–1, 1232 1,23–2, 1,44–2, 1442 1152 1,15–2, 6497 64,9–70 26,4–32 2643 0,9–2 09 1011 1,01–1, 2,99–7, 2997 1644 1,64–4, [IC9 (IC 30,2–3 302 89 8,9–1 119 1,19–1 1,23–2 1,44–2 144 115 1,15–2 649 64,9–7 26,4–3 264 0,9– 101 1,01–1 2,99–7 299 164 1,64–4 [IC 30,2– 8,9– 1,19– 1,23– 1,44– 1,15– 64,9– 26,4– 0,9 1,01– 2,99– 16 1,64– 30,2 8,9 1,19 1,44 1,15 64,9 26,4 0, 1,01 2,99 1,64 30, 8, 1,1 64, 26, 1,0 2,9 1,6

ABSTRACT OBJECTIVE: To describe the prevalence and factors associated with exclusive (EBF) and continued breastfeeding (BF) practices among Amazonian children. METHODS: Data from 1,143 mother-child pairs recorded on the Maternal and Child Health and Nutrition in Acre (MINA-Brazil) birth cohort were used. Information on EBF and BF was collected after childbirth (July 2015–June 2016) and during the follow-up visits at 1 and 6 months postpartum, 1, 2, and 5 years of age. For longitudinal analysis, the outcomes were EBF and BF duration. Probability of breastfeeding practices were estimated by Kaplan-Meier survival analysis. Associations between baseline predictors variables and outcomes among children born at term were assessed by extended Cox regression models. RESULTS: EBF frequencies (95% confidence interval [95%CI]) at 3 and 6 months of age were 33% (95%CI: 30.2–36.0) and 10.8% (95%CI: 8.9–12.9), respectively. Adjusted hazard ratio for predictors of early EBF cessation were: being a first-time mother = 1.47 (95%CI: 1.19–1.80), feeding newborns with prelacteals = 1.70 (95%CI: 1.23–2.36), pacifier use in the first week of life = 1.79 (95%CI: 1.44–2.23) or diarrhea in the first two weeks of life = 1.70 (95%CI: 1.15–2.52). Continued BF frequency was 67.9% (95%CI: 64.9–70.8), 29.3% (95%CI: 26.4–32.4), and 1.7% (95%CI: 0.9–2.8) at 1, 2 and 5 years of age, respectively. Adjusted hazard ratio for predictors of early BF cessation were: male sex = 1.23 (95%CI: 1.01–1.49), pacifier use in the first week of life = 4.66 (95%CI: 2.99–7.26), and EBF less than 3 months = 2.76 (95%CI: 1.64–4.66). CONCLUSIONS: EBF and continued BF duration among Amazonian children is considerably shorter than recommendations from the World Health Organization. Significant predictors of breastfeeding practices should be considered for evaluating local strategies to achieve optimal breastfeeding practices.

RESUMO OBJETIVO: Descrever a prevalência e os fatores associados às práticas de aleitamento materno exclusivo (AME) e continuado (AM) entre crianças amazônicas. MÉTODOS: Foram utilizados dados de 1.143 pares mãe-filho registrados na coorte de nascimento Materno-Infantil no Acre (MINA-Brasil). As informações sobre AME e AM foram coletadas após o parto (julho de 2015–junho de 2016) e durante as consultas de acompanhamento com 1 e 6 meses pós-parto e com 1, 2 e 5 anos de idade. A análise longitudinal considerou a duração do AME e AM como desfechos. A probabilidade das práticas de aleitamento materno foi estimada pela análise de sobrevida de Kaplan-Meier. As associações entre as variáveis preditoras basais e os desfechos entre crianças nascidas a termo foram avaliadas por modelos de regressão de Cox estendidos. RESULTADOS: As frequências de AME (intervalo de confiança de 95% [IC95%]) aos 3 e 6 meses de idade foram de 33% (IC95%: 30,2–36,0) e 10,8% (IC95%: 8,9–12,9), respectivamente. A razão de risco ajustada para preditores de interrupção precoce do AME foi: ser primípara = 1,47 (IC95%: 1,19–1,80), alimentar recém-nascidos com pré-lácteos = 1,70 (IC95%: 1,23–2,36), usar chupeta na primeira semana de vida = 1,79 (IC95%: 1,44–2,23) e apresentar diarreia nas duas primeiras semanas de vida = 1,70 (IC95%: 1,15–2,52). A frequência do AM continuado foi de 67,9% (IC95%: 64,9–70,8), 29,3% (IC95%: 26,4–32,4) e 1,7% (IC95%: 0,9–2,8) aos 1, 2 e 5 anos de idade, respectivamente. A razão de risco ajustada para preditores de cessação precoce do AM foi: sexo masculino = 1,23 (IC95%: 1,01–1,49), uso de chupeta na primeira semana de vida = 4,66 (IC95%: 2,99–7,26) e AME menor que 3 meses = 2,76 (IC95%: 1,64–4,66). CONCLUSÕES: A duração do AME e do AM continuado entre crianças amazônicas é consideravelmente menor do que as recomendações da Organização Mundial da Saúde. Preditores significativos das práticas de aleitamento materno devem ser considerados na avaliação das estratégias locais para alcançar práticas ideais de aleitamento materno.

ABSTRACT OBJECTIVE: This study aimed to describe the prevalence and predictors of childhood anemia in an Amazonian population-based birth cohort study. METHODS: Prevalence of maternal anemia was estimated at delivery (hemoglobin [Hb] concentration < 110 g/L) in women participating in the MINA-Brazil birth cohort study and in their children, examined at ages one, two (Hb < 110 g/L), and five (Hb < 115 g/L). Moreover, ferritin, soluble transferrin receptor, and C-reactive protein concentrations were measured in mothers at delivery and in their 1- and 2-year-old children to estimate the prevalence of iron deficiency and its contribution to anemia, while adjusting for potential confounders by multiple Poisson regression analysis (adjusted relative risk [RRa]). RESULTS: The prevalence 95% confidence interval (CI) of maternal anemia, iron deficiency, and iron-deficiency anemia at delivery were 17.3% (14.0–21.0%), 42.6% (38.0–47.2%), and 8.7% (6.3–11.6)%, respectively (n = 462). At one year of age (n = 646), 42.2% (38.7–45.8%) of the study children were anemic, 38.4% (34.6–42.3%) were iron-deficient, and 26.3 (23.0–29.9) had iron-deficiency anemia. At two years of age (n = 761), these values decreased to 12.8% (10.6–15.2%), 18.1% (15.5–21.1%), and 4.1% (2.8–5.7%), respectively; at five years of age (n = 655), 5.2% (3.6–7.2%) were anemic. Iron deficiency (RRa = 2.19; 95%CI: 1.84–2.60) and consumption of ultra-processed foods (UPF) (RRa = 1.56; 95%CI: 1.14–2.13) were significant contributors to anemia at 1 year, after adjusting for maternal schooling. At 2 years, anemia was significantly associated with maternal anemia at delivery (RRa: 1.67; 95%CI: 1.17–2.39), malaria since birth (2.25; 1.30–3.87), and iron deficiency (2.15; 1.47–3.15), after adjusting for children's age and household wealth index. CONCLUSIONS: Anemia continues to be highly prevalent during pregnancy and early childhood in the Amazon. Public health policies should address iron deficiency, UPF intake, maternal anemia, and malaria to prevent and treat anemia in Amazonian children.

RESUMO OBJETIVO: O objetivo deste estudo foi descrever a prevalência e os preditores de anemia na infância em um estudo de coorte de nascimentos de base populacional amazônica. MÉTODOS: Estimou-se a prevalência de anemia materna no parto (concentração de hemoglobina [Hb] < 110 g/L) em mulheres participantes do estudo de coorte de nascimentos MINA-Brasil e em seus filhos, examinados nas idades um, dois (Hb < 110 g/L) e cinco anos (Hb < 115 g/L). Além disso, as concentrações de ferritina, receptor solúvel de transferrina e proteína C reativa foram medidas em mães no parto e em seus filhos de 1 e 2 anos de idade para estimar a prevalência de deficiência de ferro e sua contribuição para anemia, ajustando para potenciais fatores de confusão por análise de regressão múltipla de Poisson (risco relativo ajustado [RRa]). RESULTADOS: As prevalências com intervalo de confiança (IC) de 95% de anemia materna, deficiência de ferro e anemia ferropriva no parto foram de 17,3% (14,0–21,0%), 42,6% (38,0–47,2%) e 8,7% (6,3–11,6%), respectivamente (n = 462). No primeiro ano de idade (n = 646), 42,2% (38,7–45,8%) das crianças estudadas eram anêmicas, 38,4% (34,6–42,3%) eram deficientes em ferro e 26,3 (23,0–29,9%) tinham anemia ferropriva. Aos dois anos de idade (n = 761), esses valores diminuíram para 12,8% (10,6–15,2%), 18,1% (15,5–21,1%) e 4,1% (2,8–5,7%), respectivamente; aos cinco anos de idade (n = 655), 5,2% (3,6–7,2%) eram anêmicos. A deficiência de ferro (RRa = 2,19, IC95%: 1,84–2,60) e consumo de alimentos ultraprocessados (AUP) (RRa = 1,56, IC95%: 1,14–2,13) foram contribuintes significantes para anemia no 1° ano de idade, após ajuste para escolaridade materna. Aos 2 anos, a anemia associou-se significativamente à anemia materna no parto (RRa = 1,67; IC95%: 1,17–2,39), malária desde o nascimento (2,25; 1,30–3,87) e deficiência de ferro (2,15; 1,47–3,15), após ajuste para idade das crianças e índice de riqueza familiar. CONCLUSÕES: A anemia continua sendo altamente prevalente durante a gravidez e a primeira infância na Amazônia. Políticas públicas de saúde devem abordar a deficiência de ferro, o consumo de AUP, a anemia materna e a malária para prevenir e tratar a anemia em crianças amazônicas.

Several sectors of the industry (pharmaceutical, food, and other) often occupy a prominent position in scientific meetings on health. The aim of this article is to discuss the participation of food and beverage industries (Big Food and Big Soda) in events organized by scientific institutions in health and nutrition, highlighting potential conflicts of interest in such partnerships. As an example, the authors report the case of a Brazilian national event organized by a nutrition scientific association in 2011. Focused on the theme "Evidence-based Nutrition," the event's scientific program was largely influenced by corporate sponsors. For example, a symposium at this congress was organized by a beverage company known worldwide for its sugar-sweetened products and classified as the "diamond sponsor" of the event. While debating the adoption of healthy lifestyles in the current scenario of rising occurrence of obesity, the rationale for health promotion was reduced to providing information that would motivate rational individual choices, thus ignoring any political, economic, cultural, marketing, and social factors involved in the global process of nutrition transition. The authors conclude that conflicts of interest are present in the participation of food and beverage industries in health scientific events. The industries' strategy attempts to grant legitimacy to the production and marketing of their products through an association with adequate health practices. Health professionals and policy-makers should reflect on such partnerships because their main purpose is to generate profit, not the promotion of public health.

Diversos sectores de la industria (farmacéutico, alimentario y otros) a menudo ocupan una posición prominente en las reuniones científicas sobre temas de salud. El objetivo de este artículo es tratar sobre la participación de las industrias de la alimentación y las bebidas (Big Food and Big Soda) en acontecimientos organizados por instituciones científicas del ámbito de la salud y la nutrición, señalando los potenciales conflictos de intereses que surgen de tales asociaciones. Como ejemplo, los autores comentan sobre el acontecimiento nacional organizado el año 2011 en el Brasil por una asociación científica del ámbito de la nutrición. El programa científico de este acontecimiento, dedicado al tema de "La nutrición basada en datos probatorios", se vio influido en gran parte por sus patrocinadores corporativos. Por ejemplo, un simposio de este congreso fue organizado por una empresa productora de bebidas, conocida a escala mundial por sus productos azucarados y clasificada como "patrocinador diamante" del acontecimiento. Mientras se debatía sobre la adopción de modos de vida saludables en el contexto actual de incremento de los casos de obesidad, el ámbito de promoción de la salud se redujo a suministrar información que incitara a elecciones individuales racionales, sin que se tuvieran en cuenta los factores políticos, económicos, culturales, mercadotécnicos y sociales que el proceso mundial de transición nutricional involucra. Los autores concluyen que los conflictos de intereses existen en la participación de las industrias de la alimentación y las bebidas en acontecimientos científicos sobre temas de salud. La estrategia de las industrias intenta dar legitimidad a la producción y comercialización de sus productos mediante una asociación con prácticas de salud adecuadas. Los profesionales de la salud y las instancias normativas deben reflexionar sobre tales asociaciones, ya que su principal finalidad no es la promoción de la salud pública sino la generación de beneficios.

A insatisfação com a imagem corporal é avaliada por meio da diferença entre a figura real e a idealizada e pode influenciar comportamentos alimentares. OBJETIVO: Avaliar a insatisfação corporal de universitárias do sexo feminino nas cinco regiões do país e possíveis associações e correlações com a idade, o estado nutricional, a renda e o grau de escolaridade do chefe da família. MÉTODOS: 2.402 universitárias responderam à Escala de Silhuetas de Stunkard. As regiões foram comparadas por meio da análise de variância; correlações entre as variáveis foram analisadas pelos coeficientes de Pearson e Spearman. RESULTADOS: 64,4% gostariam de ser menores do que sua figura atual, e mesmo as estudantes eutróficas escolheram figuras saudável e ideal menores. Na região Norte foram apontados os mais magros padrões ideais e de saúde e na região Centro-Oeste, os maiores. CONCLUSÃO: A ocorrência de insatisfação corporal foi bastante expressiva, com algumas diferenças regionais e sociodemográficas que devem ser consideradas.

Body image dissatisfaction is evaluated according to the difference between the real figure and idealized figure, and could influence eating behaviors. OBJECTIVE: To evaluate body dissatisfaction among female university students from the five regions of Brazil and possible associations and correlations with age, nutritional status, individual income and parental education. METHODS: 2,402 students answered the Stunkard's Body Image Scale and regions were compared by variance analysis, and correlations among variables with Pearson's and Spearman's coefficients. RESULTS: 64.4% desired a figure smaller than their actual one, and even the normal weight range students chose ideal and healthy smaller figures. In North region the ideal and healthy patterns were smaller and in the Central West bigger. CONCLUSION: Occurrence of body dissatisfaction was common among Brazilian university students and some regional and socio demographic differences must be considered.