Despite the growing burden of obesity in middle-income settings, evidence integrating socioeconomic and racial dimensions remains insufficient. This study examined educational inequalities in obesity prevalence among Brazilian adults in 2013 and 2019, assessing intersections with race/skin color and sex. Cross-sectional study with a representative sample of Brazilian adults aged ≥ 23 years, using data from the National Health Survey (PNS), 2013 and 2019 editions. Obesity was assessed using BMI, calculated from self-identified weight and height. Descriptive data and complex measures of inequality (Slope Index of Inequality – SII and Relative Index of Inequality – RII) were used. Analyses were stratified by sex, race/skin color, and educational level, with an intersectional approach when analytically possible. A difference in the magnitude of relative educational inequality was observed only for Brown women (RII = 0.5 in 2013 and 0.7 in 2019), largely reflecting greater increases in obesity prevalence among women with secondary and tertiary education. Among Black men, both absolute and relative inequality were higher in 2019 survey than in 2013, with a shift in higher obesity prevalence from the less educated to the more educated. In 2019, White and Brown women showed negative SII values (-15.0 and − 9.7, respectively) and RII values less than one (0.5 and 0.7, respectively), indicating a lower obesity prevalence among those with higher educational attainment, which was not significant for Black women. Among men, educational inequality was greater for Black and Brown individuals, with higher obesity prevalence among the more educated (SII = 9.9 and 8.5, respectively); among White men, there was no significant inequality. Educational inequality in obesity prevalence in Brazil shows patterns consistent with the nutritional transition observed in high-income countries with higher obesity prevalences among less educated subgroups. However, racial intersections revealed significant differences, placing Black and Brown individuals at a disadvantage in both sexes. Among women, education appears to have a less protective effect against obesity among Black women, whereas among men—where a positive educational gradient in obesity is commonly observed—this pattern is more pronounced among Black and Brown men.

Objectives:This study examined associations between sociodemographic characteristics and periodontal conditions in the Brazilian population across adolescents, adults, and older adults, and assessed temporal changes over a 13-year period. Methods:This descriptive cross-sectional study used data from the SB Brasil 2010 and 2023 national oral health surveys. Adolescents (15-19 years), adults (35-44 years), and older adults (65-74 years) with ≥20 natural teeth were included. Gingival signs, periodontal involvement, and its severe form were defined using standardized epidemiological thresholds. Weighted regression models accounting for the complex multistage sampling design and survey weights of the SB Brasil surveys were used to estimate associations and temporal differences. Results:Higher levels of educational attainment were inversely associated with severe periodontal involvement among older adults (odds ratio [OR] = 0.14; 95% confidence interval [CI]: 0.05-0.39). Women showed 35% lower odds of periodontal involvement and 58% lower odds of its severe form. Adolescents had approximately threefold higher odds of gingival signs, but 88% lower odds of periodontal involvement and 95% lower odds of severe periodontal conditions compared with older adults. Among adolescents, Black individuals had more than fourfold higher odds of periodontal involvement than their White counterparts. Between 2010 and 2023, this condition decreased in the overall population, particularly among adults, women, mixed-race individuals, and those with intermediate levels of education, whereas the prevalence of gingival signs increased among adults. Conclusions:Patterns of periodontal conditions varied according to age and disease severity. While the prevalence of more advanced periodontal conditions was lower in 2023 than in 2010, early inflammatory conditions remained common. These findings highlight the importance of preventive strategies that address behavioral factors and broader social determinants of oral health.

Regulatory measures on the sale of food at schools can influence consumption by students. The aims of the present cross-sectional study were to determine whether attending schools with norms that regulate the sale of food is associated with the consumption of ultra-processed foods by students in Brazilian state capitals and investigate the association between the availability and consumption of ultra-processed foods in school cafeterias. A systematic survey was performed of Brazilian norms in force up to 2019 that regulate the sale of food and beverages in school cafeterias. In terms of regulatory coverage, schools were categorized as covered/not covered. The availability and consumption of ultra-processed foods were assessed using data from the 2019 Brazilian National Survey of School Health. Multilevel linear regression analyses were adjusted by sociodemographic variables and school characteristics to test the association between regulatory coverage and the consumption of ultra-processed foods by students (n = 81,362). A second analysis restricted to students at schools with cafeterias (n = 53,137) investigated the association between the availability and consumption of these foods. Attending schools with regulatory coverage on the sale of food and beverages was associated with a reduction of -0.10 points (95%CI: -0.16; -0.03) in the consumption score of ultra-processed foods by students in Brazilian capital cities, whereas the availability of ultra-processed foods in school cafeterias was associated with an increase of 0.02 points (95%CI: 0.00; 0.03) in the consumption score in the adjusted analyses. These findings can assist in the establishment of a national Law on the offer of ultra-processed foods at schools.

Medidas regulatórias sobre a venda de alimentos nas escolas podem influenciar o consumo alimentar dos estudantes. Este estudo transversal teve como objetivos: investigar se frequentar escolas cobertas por normas que regulamentam a venda de alimentos está associado ao consumo de ultraprocessados por estudantes de capitais brasileiras; e verificar se há associação entre a disponibilidade de ultraprocessados em cantinas escolares e seu consumo. Foi realizado um levantamento sistemático de normas brasileiras vigentes até 2019 que regulamentam a venda de alimentos e bebidas em cantinas escolares. A cobertura normativa das escolas foi avaliada por uma variável dicotômica (cobertas/não cobertas). A disponibilidade e o consumo de ultraprocessados foram avaliados por meio de escores com dados da Pesquisa Nacional de Saúde do Escolar de 2019. Foram realizadas análises de regressão linear multinível, ajustadas por variáveis sociodemográficas e características das escolas, para avaliar associação entre a cobertura normativa das escolas e o consumo de ultraprocessados pelos estudantes (n = 81.362). Uma segunda análise, restrita a alunos de escolas com cantinas (n = 53.137), avaliou a associação entre a disponibilidade desses alimentos e seu consumo. Frequentar escolas com cobertura normativa sobre a venda de alimentos e bebidas esteve associado a uma redução de -0,10 (IC95%: -0,16; -0,03) pontos no escore de consumo de ultraprocessados por estudantes de capitais brasileiras, enquanto a disponibilidade de ultraprocessados nas cantinas escolares foi associada ao aumento de 0,02 (IC95%: 0,00; 0,03) pontos no escore de consumo, nas análises ajustadas. Os achados podem fundamentar uma lei nacional sobre a oferta de ultraprocessados nas escolas.

Global dietary patterns are increasingly driven by ultra-processed foods–cheap, highly palatable, and ready-to-eat options. Exploring time-related eating patterns and its association with ultra-processed foods could help in intervention efforts, but knowledge on this topic is still limited. This study assessed the association of time-related eating patterns with unprocessed/minimally processed and ultra-processed food consumption across different life stages. Two 24-hour food recalls from a nationally representative sample in Brazil (Brazilian Household Budget Survey, POF, 2017–2018; n = 46,164) were used to estimate tertiles of first and last intake times, eating midpoint, caloric midpoint time, and night fasting (independent variables). All consumed foods were classified according to the Nova classification system, and the outcomes of interest were consumption of unprocessed/minimally processed and ultra-processed foods. Multiple linear regression models were performed for all individuals and stratified for each age group: adolescents (10–19 years, n = 8,469), adults (20–59 years, n = 29,332), and older individuals (≥ 60 years, n = 8,322). The later tertile of first food intake time, last food intake time, caloric midpoint, and eating midpoint were positively associated with consumption of ultra-processed foods (β = 3.69, 95

Chrononutrition studies suggest that eating later and extending the eating window are linked to higher energy intake and obesity. However, the relationship between chrononutrition variables and dietary intake, as well as with BMI, is still little explored at a population level. This study explored how chrononutrition variables relate to dietary intake and BMI at a population level. We analyzed data from the NHANES 2017–2018, including 2937 participants aged 18 years or older. Dietary intake was assessed by two 24-h dietary recalls. Caloric midpoint, eating window duration, sleep end-first meal and last meal-sleep onset intervals were determined by mealtime. The findings indicate a trend of increased total consumption of energy (kcal) (p < 0.001; p < 0.001; p < 0.001; p < 0.001), carbohydrates (g) (p = 0.001; p < 0.001; p < 0.001; p < 0.001); protein (g) (p < 0.001; p = 0.008; p < 0.001; p < 0.001), fat (g) (p < 0.001; p = 0.007; p < 0.001; p < 0.001), and sugar (g) (p < 0.001; p < 0.001; p < 0.001; p < 0.001) as the sleep end-first meal interval decreases and the last meal-sleep onset interval, eating window, and energy intake after 8 pm increases, respectively. In addition, our findings suggest a trend of increased BMI in the group with BMI ≥ 30 kg/m² (p = 0.018) as sleep end-first meal interval increases and in the group with BMI < 25 kg/m² (p = 0.006) as the eating window increases. Our findings suggest that eating later and having longer eating window are associated with higher dietary intake and higher BMI.

The study aimed to analyze the association between school climate and victimization or perpetration by bullying in adolescents from public and private schools in the city of São Paulo. A cross-sectional study was performed using data from the São Paulo Project for the Social Development of Children and Adolescents, with a representative sample of Brazilian adolescents in the 9th grade of elementary school II (n = 1,939 students, 119 schools), in 2017. The school climate was assessed using 37 questions from which, using exploratory factor analysis, three factors were identified representing different dimensions that make up the school climate, subsequently divided into tertiles. We evaluated the prevalence of bullying. The association between the tertiles of each construct of school climate and types of bullying was analyzed by multiple logistic regression adjusted by covariates, with a 95% confidence interval and the linear p-trend value. The three climate constructs identified were named "positive climate," "disorder climate" and "low legitimacy climate." We found that the more positive the school climate in the perception of students, the lower the likelihood of perpetration (OR2nd tertile = 0.46, 95% CI: [0.31, 0.70]; OR3rd tercile = 0.30; [0.25, 0.59], p-trend < .01) and victimization by at least one type of bullying (OR2nd tertile = 0.58, [0.41, 0.81]; OR3rd tertile = 0.52, [0.38, 0.70], p-trend < .01). On the other hand, a school climate of disorder and low legitimacy were associated with a higher probability of bullying. Our results can support intervention strategies to improve the school climate to reduce school bullying and its negative consequences for adolescent health.

The study aims to assess the association between family physical violence and different domains of physical activity in students. Cross-sectional study with data from the National School Health Survey 2015. Physical activity was measured with a validated questionnaire and comprised the previous seven days. Physical activity domains investigated were commuting, leisure, physical education class, and total physical activity. Family physical violence was obtained with a question about exposure to physical aggression in the last month. Quantile regression analysis was performed to assess the association between exposure and outcomes, stratified by sex. Girls and boys exposed to family physical violence spent more time in commuting physical activity compared to those not exposed. Boys exposed to family physical violence spent less time in leisure physical activity compared to those not exposed, whereas girls exposed to violence spent more time in this activity than not exposed. For physical education class, exposed boys at the 80th percentile had more time for physical activity. For total physical activity, exposed girls had more time in this activity than unexposed girls. Associations were distinct for each physical activity domain by sex.

Resumo: Buscou-se, com este estudo, verificar a associação entre valores do produto interno bruto em paridade do poder de compra (PIB PPC) e escores da ferramenta World Breastfeeding Trends Initiative (WBTi). Estudo ecológico realizado com 98 países de renda baixa (n = 43), média (n = 27) e alta (n = 28). A avaliação das ações pró-aleitamento materno foram obtidas da WBTi e o PIB PPC do Banco Mundial. Foram estimados média e desvio padrão (DP) das pontuações total e de cada item da WBTi. Foram usados o teste ANOVA e o teste de Tukey para comparar as médias da ferramenta WBTi segundo o PIB PPC dos países. A associação entre PIB PPC e as pontuações total e de cada item da WBTi foi analisada por regressão linear. Maiores pontuações da WBTi foram identificadas para os itens de sistemas de cuidado de saúde e nutrição (item 5: média = 6,4; DP: ±2,0) e suporte de informações válidas (item 7: média = 6,4; DP: ±2,5). As médias da pontuação total e dos itens 3 (implementação do código), 7 (suporte de informações válidas), 9 (aleitamento materno em emergências) e 10 (monitoramento e avaliação) foram superiores nos países de baixa e média renda e do item 4 (licença maternidade) nos países de alta renda (p < 0,05). Observamos associação negativa entre PIB PPC e pontuação total da ferramenta (β = -2,67; IC95%: -5,06; -0,29), item 3 (β = -0,50; IC95%: -0,91; -0,08), item 7 (β = -0,67; IC95%: -1,07; -0,27), item 8 (aleitamento materno e HIV; β = -0,59; IC95%: -1,07; -0,11) e item 9 (β = -0,91; IC95%: -1,34; -0,48). Observamos associação positiva entre PIB PPC e o item 4 (proteção à maternidade; β = 0,63; IC95%: 0,24; 1,02). Países com menor PIB PPC apresentaram maiores pontuações da ferramenta, com exceção da proteção à maternidade que apresentou maior pontuação em países com maior PIB PPC.

This study aimed to verify the association between gross domestic product values - purchasing power parity (GDP PPP) and scores of the World Breastfeeding Trends Initiative (WBTi) tool. This is an ecological study carried out with 98 low-income (n = 43), middle-income (n = 27), and high-income (n = 28) countries. The evaluation of pro-breastfeeding actions was obtained from the WBTi and the GDP PPP from the World Bank. The mean and standard deviation (SD) of the total and each item WBTi scores were estimated. ANOVA and Tukey's test were used to compare the means of the WBTi tool according to the countries' GDP PPP. The association between GDP PPP and total and individual WBTi scores was analyzed by linear regression. Higher WBTi scores were identified for the items health and nutrition care system (item 5: mean = 6.4; SD: +/- 2.0) and Information Support (item 7: mean = 6.4; SD: +/- 2.5). The means of the total score and of items 3 (implementation of the code of marketing of breast-milk substitutes), 7 (information support), 9 (infant feeding during emergencies) and 10 (mechanisms of monitoring and evaluating systems) were higher in low- and middle-income countries, while item 4 (maternity protection in the workplace) presented a high mean in high-income countries (p < 0.05). We observed a negative association between GDP PPP and the total tool score (beta = -2.67; 95%CI: -5.06; -0.29), item 3 (beta = -0.50; 95%CI: -0.91; -0.08), item 7 (beta = -0.67; 95%CI: -1.07; -0.27), item 8 (infant feeding and HIV; beta = -0.59; 95%CI: -1.07; -0.11), and item 9 (beta = -0.91; 95%CI: -1.34; -0.48). We observed a positive association between GDP PPP and item 4 (maternity protection in the workplace; beta = 0.63; 95%CI: 0.24; 1.02). Countries with lower GDP PPP presented higher scores of the tool, with the exception of item 4, which had higher scores in countries with higher GDP PPP.

BackgroundUltra-processed foods have been associated with several negative outcomes, but it is not clear whether they are related to bullying perpetration. Moreover, no previous study has investigated the potential role of deviant behaviors as a mediator of this association. Our objective was to evaluate the association between ultra-processed dietary pattern and bullying, and the mediating effect of deviant behaviors in this association, among school adolescents.MethodsWe used data from a representative sample of 9th grade Brazilian adolescents (N = 2,212) from the São Paulo Project for the social development of children and adolescents (SP-PROSO). Exploratory factor analysis was used to obtain the dietary patterns, through questions of frequency of consumption in the last week of several foods. The ultra-processed dietary pattern was considered as exposure. The outcomes were the types of bullying (any type, social exclusion, psychological/verbal aggression, physical aggression, property destruction, and sexual harassment). Deviant behaviors (mediator) were assessed through a score. Mediation analyses were carried out using logistic regression based on the KHB method.ResultsAfter adjusting for covariates, the mediating effect of deviant behaviors was found in the association between ultra-processed dietary pattern and all the types of bullying perpetration, especially for psychological/verbal aggression (39.4%). A small mediating effect of deviant behaviors in the association of ultra-processed dietary pattern with physical aggression (17.7%) and property destruction (18.5%) was observed, but this effect explained only a small portion of the total effect of such association (significant direct effect).ConclusionThe ultra-processed dietary pattern was associated with bullying, and the association was mediated through deviant behaviors. Policies and actions for improving the adolescent’s diet and managing the adoption of deviant and bullying behaviors by this public are required.

Background:Cardiovascular disease (CVD) and cancer are the first and second leading causes of death in Brazil and worldwide. However, an ongoing epidemiological transition in which cancer surpasses CVD has been observed in many high and middle-income countries. In this study, we provided a nationwide analysis of the transition towards cancer mortality predominance over CVD mortality in Brazil. Methods:We leveraged data from 5570 municipalities using the Mortality Information System and classified the causes of death using ICD-10 codes. Age-standardized CVD and cancer mortality rates were calculated annually between 2000 and 2019. Mortality rate ratios (MRRs = CVD rates divided by cancer rates) described the predominance of cancer or CVD mortality across municipalities and states. Choropleth maps displayed state-specific MRRs and the transition in the predominant cause of death over time. Findings:From 2000 to 2019, CVD mortality rates declined in 25 out of 27 states, whereas cancer mortality increased in 15 states, indicating a shift towards cancer predominance. While in 2000 cancer mortality was lower than CVD in all states and only exceeded the latter in 7% of the municipalities, by 2019 the gap narrowed considerably, with 13% of municipalities displaying higher cancer mortality rates vs CVD mortality rates. Additionally, higher household income correlated with higher mortality from cancer vs CVD. Interpretation:An ongoing epidemiological transition in which cancer mortality surpasses CVD mortality is occurring in Brazil, particularly in municipalities with higher household incomes. Our findings may provide important information for policymakers and public health practitioners in Brazil. Funding:National Council for Scientific and Technological Development (CNPq).

The study aims to evaluate the association between substance use and social isolation with food consumption in adolescents. A cross-sectional study was conducted with 2,040 adolescents from a medium-sized city in Brazil. The exposures assessed were the use of alcohol, tobacco, and other substances, and social isolation. The outcomes were the regular consumption (≥5 times/week) of beans, fruit/fruit salad, candies, and soft drinks, and an unhealthy eating score. The association between health risk behaviors and food consumption was assessed through logistic and linear regressions. Regular users of alcohol were more likely to have regular consumption of candies and soft drinks, and those who used tobacco regularly were less likely to have regular bean consumption and more likely to have regular candies consumption. The use of at least one substance was negatively associated with regular bean consumption and positively associated with regular consumption of sweets and soft drinks. Socially isolated adolescents were less likely to have regular bean consumption. Substance use was positively associated with the unhealthy eating score. In conclusion, substance use and social isolation were associated with less regular consumption of healthy food markers and greater regular consumption of unhealthy food markers.

ObjectiveThe aim of this study was to identify patterns related to health and their association with chronic kidney disease (CKD) in the Brazilian population.MethodsWe used data from the National Health Survey (PNS), 2019. Participants were interviewed and answered questions related to socioeconomic and demographic information (gender, age, education, race/color), health conditions (presence of hypertension, diabetes mellitus, hyperlipidemia, cardiovascular disease, overweight and CKD) and lifestyle (smoking, alcohol consumption, physical activity and food consumption). To identify patterns, we used exploratory factor analysis. We performed logistic regression models to describe the association of CKD with each pattern in crude models and adjusted for gender, age group, education level and race/color.ResultsA total of 90,846 individuals were evaluated. The prevalence of CKD was 1.49% (95% CI: 1.3–1.6). Three health-related patterns – metabolic factors, behavioral risk factors and behavioral protective factors – were identified by factor analysis. Metabolic factors were determined by the presence of hypertension, diabetes mellitus, hyperlipidemia and cardiovascular diseases. Behavioral risk factors were determined by smoking, alcohol consumption, regular consumption of soft drinks, sweets and artificial juices, and high salt consumption. The protective behavioral factors were established by the practice of physical activity and regular consumption of vegetables and fruits. Participants of the highest tertile for metabolic factors were more likely to have CKD in the adjusted model (OR = 3.61, 95% CI: 2.69–4.85), when compared to those of the lower tertile.ConclusionThe pattern referring to metabolic factors was associated with a higher chance of presenting CKD.

BACKGROUND & AIMS:Chrononutrition is an emerging area that suggests that late eating time is associated with poor nutritional and metabolic outcomes. However, epidemiological studies are scarce on this topic. The aim of this study was to characterize the chrononutrition patterns in a large and representative US population (NHANES 2015-2016 and 2017-2018) of adults and elderly and investigate their association with obesity and metabolic disorders that make up the metabolic syndrome. METHODS:A total of 7379 adults and elderly individuals were included in the analysis. Meal timing data were collected through two 24-h dietary recalls in both cycles. Poisson regression adjusted for confounders was used to evaluate the association between chrononutrition variables (eating duration and tertiles of first and last meal timing, eating midpoint and eating occasions) and obesity, abdominal obesity and metabolic parameters from metabolic syndrome. RESULTS:Adults with a longer eating duration (>12 h) had a higher prevalence of abdominal obesity (IRR, 1.15; 95% CI, 1.03-1.28) when compared with those who ate their meals in a shorter eating duration (≤12 h). In addition, adults in the third tertile of the time of the last meal (mean 22:03) had a higher prevalence of abdominal obesity (IRR, 1.12; 95% CI, 1.01-1.25) compared to first tertile. Adults with later eating midpoints (second and third tertile) had a higher prevalence of elevated fasting glucose (IRR, 1.30; 95% CI, 1.07-1.59 and IRR, 1.65; 95% CI, 1.22-2.22, respectively). Among the elderly, participants with a longer eating duration (>12 h) had a higher prevalence of elevated triglycerides (IRR, 2.74; 95% CI, 1.25-5.96) when compared with those elderly who ate their meals in a shorter eating duration (≤12 h). CONCLUSION:These findings suggest that a long eating duration and late first and last meal timing are chrononutrition patterns associated with cardiometabolic risks in free-living Americans.

Evidence suggests that differences in meal timing between weekends and weekdays can disrupt the body's circadian rhythm, leading to a higher BMI. We aimed to investigate the associations between mealtime variation from weekdays to weekends (eating midpoint jetlag), dietary intake and anthropometric parameters, based on individuals' chronotype. The study utilised data from National Health and Nutrition Examination Survey 2017-2018. Food consumption was estimated by weighted average of participants' food intake on weekdays and weekends. Eating midpoint jetlag, defined as the difference between the midpoint of the first and last mealtimes on weekends and weekdays, was calculated. Chronotype was assessed by participants' mid-sleep time on weekends, adjusted for sleep debt. Linear regression analysis was conducted to investigate the associations between variables. The sample was categorised into chronotype tertiles. Among individuals in the third chronotype tertile, there was a positive association between eating midpoint jetlag and BMI (β = 1·2; 95 % CI (1·13, 1·27)). Individuals in the first tertile showed a positive association between eating midpoint jetlag and energy (β = 96·9; 95 % CI (92·9, 101·7)), carbohydrate (β = 11·96; 95 % CI (11·2, 12·6)), fat (β = 3·69; 95 % CI (3·4, 3·8)), cholesterol (β = 32·75; 95 % CI (30·9, 34·6)) and sugar (β = 8·84; 95 % CI (8·3, 9·3)) intake on weekends. Among individuals with an evening tendency, delaying meals on weekends appears to be linked to a higher BMI. Conversely, among individuals with a morning tendency, eating meals later on weekends is associated with higher energetic intake on weekends.

IntroductionStudies in Latin America have focused either on analyzing factors associated with exclusive breastfeeding (EBF) or infant formula (IF).PurposeAnalyze the association between economic, sociodemographic, and health factors with EBF, mixed milk feeding (MixMF), and exclusive use of IF in three Latin American and Caribbean countries in the 1990s, 2000s, and 2010s.MethodsCross-sectional time-series study using data from Demographic and Health Surveys between the 1990s and 2010s in Colombia (1995–2010), Haiti (1994–2017), and Peru (1996–2012) accounting for a sample of 12,775 infants under 6 months. Hierarchical logistic multilevel regression models were used to estimate the adjusted association between infant feeding outcomes (EBF, MixMF, exclusive use of IF) and contextual level DHS survey decade (1990s, 2000s and 2010s) and economic factors (Gross Domestic Product by purchasing power parity, female wage and salaried workers, labor force participation rate female) as well as individual level sociodemographic (maternal age, maternal education, number of children in the household, wealth index, mother living with a partner, area of residence, mother working outside of home), and health factors (breastfed in the first hour, C-section).ResultsFactors associated with EBF cessation were c-section (OR: 0.76; 95%CI: 0.64, 0.92), mothers working outside of the home (OR: 0.79; 95%CI: 0.69, 0.90), families in the highest income quintile (OR: 0.64; 95%CI: 0.49, 0.84), and female wage and salaried workers (OR: 0.92; 95%CI: 0.91, 0.94). MixMF was associated with women with higher education (OR: 1.54; 95%CI: 1.21, 1.97), mother working outside of the home (OR: 1.26; 95%CI: 1.10, 1.43), c-section (OR: 1.37; 95%CI: 1.15, 1.62), families in the highest income quintiles (OR: 2.77; 2.10, 3.65). and female wage and salaried workers (OR: 1.08;95% CI: 1.05, 1.09). Exclusive use of IF was associated with a mother working outside of the home (OR: 2.09; 95%CI: 1.41, 3.08), c-section (OR: 1.65; 95%CI: 1.09, 2.51), families in the highest income quintiles (OR: 12.08; 95% CI: 4.26, 34.28), the 2010s (OR: 3.81; 95%CI: 1.86, 7.79), and female wage and salaried workers (OR: 1.12; 95%CI: 1.07, 1.16).Discussion/ConclusionFactors related to women empowerment and gender equality jeopardized EBF and favored the exclusive use of IF in Latin America. Therefore, workplace interventions to promote, protect, and support breastfeeding practices are key to reducing exclusive use of IF.

Abstract Objective: to analyze the profile of violence against the elderly and the degree of completeness of event notification forms in Niterói, Rio de Janeiro, Brazil. Methods: this was a descriptive study having as its data source violence notification forms held on the Notifiable Health Conditions Information System for the period 2011-2020; analysis of form completeness was performed according to criteria proposed by the Ministry of Health. Results: of the 486 registered cases, physical violence was the most reported type of violence (48.1%), followed by psychological violence (22.2%) and self-harm (21.4%); the fields with the highest degree of incompleteness were victim’s level of schooling (32.8%) and repeat violence (41.5%). Conclusion: despite the increase in notifications in the period, predominantly of physical violence, completeness of some of the form fields continues to be poor, which reinforces the importance of training professionals to improve the reporting process and data quality.

Time-related eating patterns have been associated with metabolic and nutritional diseases such as obesity. However, there is a lack of representative studies on this subject. This study's aim was to assess the association between the timing of eating and obesity in a large and representative sample of the Brazilian adult population (POF 2008–2009 survey). Two days of adults’ food diary (n = 21,020) were used to estimate tertiles of first and last meal intake times, eating midpoint, caloric midpoint time, and calories consumed from 18:00 h onwards. BMI was estimated and its values, as well as excess weight (BMI ≥ 25 kg/m2) and obesity (BMI ≥ 30 kg/m2) were used as outcomes. Multiple linear and logistic regressions were performed. The first (β = 0.65, 95

Background:Racial/ethnic disparities in prostate cancer are reported in the United States (US). However, long-term trends and contributors of racial/ethnic disparities in all-cause and cause-specific death among patients with prostate cancer remain unclear. We analysed the trends and contributors of racial/ethnic disparities in prostate cancer survivors according to the cause of death in the US over 25 years. Methods:In this retrospective, population-based longitudinal cohort study, we identified patients diagnosed with first primary prostate cancer between 1995 and 2019, with follow-up until Dec 31, 2019, using population-based cancer registries' data from the Surveillance, Epidemiology, and End Results (SEER) Program. We calculated the cumulative incidence of death for each racial/ethnic group (Black, white, Hispanic, Asian or Pacific Islander [API], and American Indian or Alaska Native [AI/AN] people), by diagnostic period and cause of death. We quantified absolute disparities using rate changes for the 5-year cumulative incidence of death between racial/ethnic groups and diagnostic periods. We estimated relative (Hazard ratios [HR]) racial/ethnic disparities and the percentage of potential factors contributed to racial/ethnic disparities using Cox regression models. Findings:Despite a decreasing trend in the cumulative risk of death across five racial/ethnic groups, AI/AN and Black patients consistently had the highest rate of death between 1995 and 2019 with an adjusted HR of 1.48 (1.40-1.58) and 1.40 (1.38-1.42) respectively. The disparities in all-cause mortality between AI/AN and white patients increased over time, with adjusted HR 1.32 (1.17-1.49) in 1995-1999 and 1.95 (1.53-2.49) in 2015-2019. Adjustment of stage at diagnosis, initial treatment, tumor grade, and household income explained 33% and 24% of the AI/AN-white and Black-white disparities in all-cause death among patients with prostate cancer. Interpretation:The enduring racial/ethnic disparities in patients with prostate cancer, call for new interventions to eliminate health disparities. Our study provides important evidence and ways to address racial/ethnic inequality. Funding:National Key R&D Program of China, National Natural Science Foundation of China, Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support, the Open Research Fund from Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Key Projects of Philosophy and Social Sciences Research, Ministry of Education of China.