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Yisahak SF, Racke CA, Edlund KM, Keim SA. Human Milk Feeding and Ultraprocessed Food Intake in Toddlerhood. Breastfeed Med 2024; 19:629-637. [PMID: 38808467 DOI: 10.1089/bfm.2024.0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
Objective: The objective of the study was to estimate associations between early-life human milk feeding and ultraprocessed food (UPF) intake at two timepoints during toddlerhood among children born at <35 weeks' gestation. Study Design: Children were enrolled in the Omega Tots trial (2012-2017, Ohio) at 10-17 months' corrected age after having discontinued human milk and formula feeding. Caregivers reported children's human milk feeding history at baseline and past month diet through a food frequency questionnaire at baseline and follow-up (180 days later). We used the NOVA classification system to estimate UPF intake. We estimated covariate-adjusted associations between human milk feeding (ever and duration) and UPF intake at baseline and follow-up using linear and logistic regression. Results: Nearly 89% (n = 295) of 333 toddlers had received human milk but only 4.2% (n = 14) were fed exclusively human milk to 6 months of age. UPFs represented 37.7 (standard deviation [SD] = 13.2)% and 43.4 (SD = 11.3)% of total calories at the two timepoints. Human milk feeding (exclusive or otherwise) was unassociated with UPF intake in toddlerhood (e.g., months of exclusive human milk feeding with the number of daily servings of UPFs at follow-up: β = -0.09, 95% confidence interval [CI]: -0.26, 0.08). Conclusion: In this sample of toddlers born preterm, any exposure to as well as the duration of human milk feeding was unassociated with UPF intake during the second year of life. These results require replication in larger samples given the small number of children in some human milk feeding categories.
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Affiliation(s)
- Samrawit F Yisahak
- Center for Biobehavioral Health, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Caroline A Racke
- Center for Biobehavioral Health, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Karolina M Edlund
- Center for Biobehavioral Health, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Sarah A Keim
- Center for Biobehavioral Health, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, USA
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Becker de Oliveira L, Fonseca-Souza G, Rolim TZC, Scariot R, Feltrin-Souza J. Breastfeeding and Cleft Lip and Palate: A Systematic Review and Meta-Analysis. Cleft Palate Craniofac J 2024; 61:1344-1355. [PMID: 37078146 DOI: 10.1177/10556656231170137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
OBJECTIVE To evaluate the association between cleft lip and/or cleft palate (CL/P) and breastfeeding (BF). DESIGN A systematic review and meta-analysis were performed based on studies published in PubMed, Scopus, Web of Science, Cochrane Library, LILACS, BBO, and Embase databases, and in the gray literature. The search occurred in September 2021 and was updated in March 2022. Observational studies evaluating the association between BF and CL/P were included. Risk of bias was analyzed using the Newcastle-Ottawa Scale. A random-effects meta-analysis was conducted. Certainty of evidence was evaluated using the GRADE approach. MAIN OUTCOME MEASURE(S) Frequency of BF in relation to the presence or absence of CL/P, as well as to the type of CL/P. The association between cleft type and BF challenges was also evaluated. RESULTS From a total of 6863 studies identified, 29 were included in the qualitative review. Risk of bias was moderate and high in most studies (n = 26). There was a significant association between the presence of CL/P and absence of BF (OR = 18.08; 95% CI 7.09-46.09). Individuals with cleft palate with or without cleft lip (CP ± L) had a significantly lower frequency of BF (OR = 5.93; 95% CI 4.30-8.16) and a significantly higher frequency of BF challenges (OR = 13.55; 95% CI 4.91-37.43) compared to individuals with CL. Certainty of the evidence was low or very low in all analyses. CONCLUSION The presence of clefts, especially those with palate involvement, is associated with higher chances of absence of BF.
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Affiliation(s)
- Luiza Becker de Oliveira
- Department of Stomatology, Universidade Federal do Paraná, Setor de Ciências da Saúde, Av. Prefeito Lothário Meissner 632, Curitiba, State of Paraná 80210-170, Brazil
| | - Gabriela Fonseca-Souza
- Department of Stomatology, Universidade Federal do Paraná, Setor de Ciências da Saúde, Av. Prefeito Lothário Meissner 632, Curitiba, State of Paraná 80210-170, Brazil
| | - Tatiane Zahn Cardoso Rolim
- Department of Stomatology, Universidade Federal do Paraná, Setor de Ciências da Saúde, Av. Prefeito Lothário Meissner 632, Curitiba, State of Paraná 80210-170, Brazil
| | - Rafaela Scariot
- Department of Stomatology, Universidade Federal do Paraná, Setor de Ciências da Saúde, Av. Prefeito Lothário Meissner 632, Curitiba, State of Paraná 80210-170, Brazil
| | - Juliana Feltrin-Souza
- Department of Stomatology, Universidade Federal do Paraná, Setor de Ciências da Saúde, Av. Prefeito Lothário Meissner 632, Curitiba, State of Paraná 80210-170, Brazil
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Brito FDSB, da Costa ES, Romeiro ACT, dos Santos DM, Brito ADS, de Oliveira ASD, Adegboye ARA. Exploring Maternal Socio-Demographic Factors Shaping Children's Dietary Patterns in Brazil: Results from the 2019 National Health Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:992. [PMID: 39200603 PMCID: PMC11353673 DOI: 10.3390/ijerph21080992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Revised: 07/17/2024] [Accepted: 07/24/2024] [Indexed: 09/02/2024]
Abstract
This study aimed to identify the dietary patterns of Brazilian children aged 6-23 months and to investigate their association with maternal socio-demographic factors. Data from the 2019 Brazilian National Health Survey were used in this cross-sectional study. Mothers of 1616 children aged 6-23 months reported on their children's dietary intake. Dietary patterns were identified using principal component analysis, and their associations with maternal socio-demographic characteristics were assessed using linear regression models. The first consisted of healthy patterns and the second, unhealthy ones. Linear regression showed that adherence to a healthy dietary pattern was higher among children of mothers who were older (β = 0.02, p = 0.01), had more years of education (β = 0.49, p = 0.04), reported living with a partner (β = 0.29, p = 0.01), and resided in an urban area (β = 0.35, p = 0.01). Conversely, adherence to the unhealthy pattern was positively associated with mothers who declared themselves as black or brown (β = 0.25, p = 0.03). Our results show that older mothers with higher levels of education and paid work and who live with a partner are more likely to contribute to their children's healthy eating patterns. We conclude that socio-demographic factors may influence the quality of the food offered to children. Nevertheless, advocating for public policies promoting nutritious complementary diets emphasising fresh and minimally processed foods remains crucial for children whose mothers do not possess these favourable socio-demographic characteristics.
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Affiliation(s)
- Flávia dos Santos Barbosa Brito
- Nutrition Institute, Rio de Janeiro State University, São Francisco Xavier Street, 524, Rio de Janeiro 20550-900, Brazil; (E.S.d.C.); (D.M.d.S.); (A.S.D.d.O.)
| | - Emanuela Santos da Costa
- Nutrition Institute, Rio de Janeiro State University, São Francisco Xavier Street, 524, Rio de Janeiro 20550-900, Brazil; (E.S.d.C.); (D.M.d.S.); (A.S.D.d.O.)
| | | | - Debora Martins dos Santos
- Nutrition Institute, Rio de Janeiro State University, São Francisco Xavier Street, 524, Rio de Janeiro 20550-900, Brazil; (E.S.d.C.); (D.M.d.S.); (A.S.D.d.O.)
| | - Alexandre dos Santos Brito
- Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-598, Brazil;
| | - Alessandra Silva Dias de Oliveira
- Nutrition Institute, Rio de Janeiro State University, São Francisco Xavier Street, 524, Rio de Janeiro 20550-900, Brazil; (E.S.d.C.); (D.M.d.S.); (A.S.D.d.O.)
| | - Amanda Rodrigues Amorim Adegboye
- Centre for Agroecology, Water and Resilience (CAWR), Coventry University, Coventry CV8 3LG, UK
- Centre for Healthcare Research, Coventry University, Coventry CV1 5FB, UK
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Andrade-Silva A, Farias DR, Carrilho TRB, de Castro IRR, Kac G, de Castro MBT. Trends in Complementary Feeding Indicators in Children Aged 6-23 Months According to Participation in a Conditional Cash Transfer Program: Data from the Brazilian Food and Nutrition Surveillance System, 2015-2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:923. [PMID: 39063499 PMCID: PMC11276628 DOI: 10.3390/ijerph21070923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 07/05/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024]
Abstract
Inadequate practices during complementary feeding are associated with malnutrition, especially in children experiencing vulnerable conditions and social inequality. The aim of this study was to evaluate the trends in complementary feeding indicators (CFIs) according to participation in a Brazilian cash transferu program-the Bolsa Família Program (BFP). This was a time-series study with secondary data from 600,138 children assisted from 2015 to 2019 and registered within the Brazilian Food and Nutrition Surveillance System. The CFIs assessed were food introduction, minimum meal frequency and appropriate consistency, minimum dietary diversity, iron-rich food, vitamin A-rich food, ultra-processed food consumption, and zero vegetable or fruit consumption. Prevalence and 95% confidence intervals were calculated for the CFIs according to BFP, the region of residence, and the child's age. The Prais-Winsten regression method was used to analyze the temporal trend. There was a steady trend for all CFIs of a healthy diet. A decrease in ultra-processed food consumption for both BFP (-10.02%) and non-BFP children (-9.34%) was observed over the years. Children residing in the North and Northeast regions and those enrolled in the BFP were more distant from the recommended feeding practices when compared to the other regions and non-BFP children. The results highlight the relevance of nutritional surveillance and the need to improve food and nutrition public policies for children aged 6-23 months, particularly for those experiencing greater social vulnerability.
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Affiliation(s)
- Andreia Andrade-Silva
- Department of Social and Applied Nutrition, Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro 21941-902, Brazil
| | - Dayana Rodrigues Farias
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro 21941-902, Brazil
| | - Thais Rangel Bousquet Carrilho
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, BC V6H3N1, Canada
| | - Inês Rugani Ribeiro de Castro
- Department of Social Nutrition, Institute of Nutrition, State University of Rio de Janeiro, Rio de Janeiro 20550-013, Brazil
| | - Gilberto Kac
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro 21941-902, Brazil
| | - Maria Beatriz Trindade de Castro
- Department of Social and Applied Nutrition, Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro 21941-902, Brazil
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Abreu de Carvalho C, Viola PCDAF, Magalhães EIDS, Machado SP, Matijasevich A, Menezes AMB, Tovo-Rodrigues L, Santos IS, Goncalves H, Wehrmeister FC, Horta BL, Moura da Silva AA. Association between breast feeding and food consumption according to the degree of processing in Brazil: a cohort study. BMJ Open 2024; 14:e083871. [PMID: 38569686 PMCID: PMC10989181 DOI: 10.1136/bmjopen-2024-083871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 03/05/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND The benefits of breast feeding may be associated with better formation of eating habits beyond childhood. This study was designed to verify the association between breast feeding and food consumption according to the degree of processing in four Brazilian birth cohorts. METHODS The duration of exclusive, predominant and total breast feeding was evaluated. The analysis of the energy contribution of fresh or minimally processed foods (FMPF) and ultra-processed foods (UPF) in the diet was evaluated during childhood (13-36 months), adolescence (11-18 years) and adulthood (22, 23 and 30 years). RESULTS Those who were predominantly breastfed for less than 4 months had a higher UPF consumption (β 3.14, 95% CI 0.82 to 5.47) and a lower FMPF consumption (β -3.47, 95% CI -5.91 to -1.02) at age 22 years in the 1993 cohort. Exclusive breast feeding (EBF) for less than 6 months was associated with increased UPF consumption (β 1.75, 95% CI 0.25 to 3.24) and reduced FMPF consumption (β -1.49, 95% CI -2.93 to -0.04) at age 11 years in the 2004 cohort. In this same cohort, total breast feeding for less than 12 months was associated with increased UPF consumption (β 1.12, 95% CI 0.24 to 2.19) and decreased FMPF consumption (β -1.13, 95% CI -2 .07 to -0.19). Children who did not receive EBF for 6 months showed an increase in the energy contribution of UPF (β 2.36, 95% CI 0.53 to 4.18) and a decrease in FMPF (β -2.33, 95% CI -4 .19 to -0.48) in the diet at 13-36 months in the 2010 cohort. In this cohort, children who were breastfed for less than 12 months in total had higher UPF consumption (β 2.16, 95% CI 0.81 to 3.51) and lower FMPF consumption (β -1.79, 95% CI -3.09 to -0.48). CONCLUSION Exposure to breast feeding is associated with lower UPF consumption and higher FMPF consumption in childhood, adolescence and adulthood.
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Affiliation(s)
| | | | | | | | - Alicia Matijasevich
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, Sao Paulo, Brazil
| | | | | | - Ina S Santos
- Universidade Federal de Pelotas, Pelotas, Brazil
| | - Helen Goncalves
- Social Medicine, Universidade Federal de Pelotas, Pelotas, Brazil
- Post-graduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
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Bernate Angulo SV, Nezami BT, Martin SL, Kay MC, Richardson TN, Wasser HM. Concordance in dietary intake among caregivers and infants during the period of complementary feeding: A scoping review. Appetite 2024; 194:107178. [PMID: 38141877 PMCID: PMC11027945 DOI: 10.1016/j.appet.2023.107178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/07/2023] [Accepted: 12/17/2023] [Indexed: 12/25/2023]
Abstract
Dietary intake during infancy shapes later food preferences and is important for short- and long-term health and wellbeing. Although caregivers are thought to influence the developing food preferences of infants, children less than two years have been notably absent in existing meta-analyses on the topic. This scoping review seeks to fill this gap by using a systematic process to identify and summarize the published literature on the resemblance of caregiver and infant diet during the period of complementary feeding (6-23 months). Articles were included if they assessed intake of foods or beverages other than human milk or commercial milk formula and reported a test of association between the intake of caregivers and infants. Four electronic databases (PubMed, EMBASE, Scopus, and Global Health) were systematically searched for articles published since 2000. Thirty-three articles, representing 32 studies, were identified. The majority of studies examined infant intake of food groups/items (n = 20), seven studies examined infant dietary patterns, and six studies examined dietary diversity. Studies predominantly reported associations between diets of mothers and infants (n = 31); three studies reported associations for fathers. Most studies assessed infant diet at one timepoint (n = 26), with 12 studies combining the intakes of younger (0-11 months) and older infants (12-23 months). Food groups examined, in order of frequency, included 'non-core' foods and beverages (n = 14), vegetables (n = 13), fruits (n = 12), protein foods (n = 6), grains (n = 5), and dairy foods (n = 4). Definitions of variables for food groups and dietary patterns were highly heterogeneous, but consistent for dietary diversity. Nearly all studies (n = 31) reported significant associations between dietary intakes of caregivers and infants. Findings suggest caregiver diet may be a promising focus for interventions aiming to shape the food preferences and dietary intakes of infants.
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Affiliation(s)
- Sara V Bernate Angulo
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Brooke T Nezami
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Stephanie L Martin
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Melissa C Kay
- Department of Pediatrics, Duke University, Durham, NC, 27708, USA
| | - Taylor N Richardson
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Heather M Wasser
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA; Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
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Cardoso MA, Lourenço BH, Matijasevich A, Castro MC, Ferreira MU. Prevalence and correlates of childhood anemia in the MINA-Brazil birth cohort study. Rev Saude Publica 2024; 57Suppl 2:6s. [PMID: 38422335 PMCID: PMC10897962 DOI: 10.11606/s1518-8787.2023057005637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/08/2023] [Indexed: 03/02/2024] Open
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.
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Affiliation(s)
- Marly A Cardoso
- Universidade de São PauloFaculdade de Saúde PúblicaDepartamento de NutriçãoSão PauloSPBrasilUniversidade de São Paulo. Faculdade de Saúde Pública. Departamento de Nutrição. São Paulo, SP, Brasil
| | - Bárbara H. Lourenço
- Universidade de São PauloFaculdade de Saúde PúblicaDepartamento de NutriçãoSão PauloSPBrasilUniversidade de São Paulo. Faculdade de Saúde Pública. Departamento de Nutrição. São Paulo, SP, Brasil
| | - Alicia Matijasevich
- Universidade de São PauloFaculdade de MedicinaDepartamento de Medicina PreventivaSão PauloSPBrasilUniversidade de São Paulo. Faculdade de Medicina. Departamento de Medicina Preventiva. São Paulo, SP, Brasil
| | - Marcia C Castro
- Harvard T.H. Chan School of Public HealthDepartment of Global Health and PopulationBostonMAUnited States of AmericaHarvard T.H. Chan School of Public Health. Department of Global Health and Population. Boston, MA, United States of America
| | - Marcelo U Ferreira
- Universidade de São PauloInstituto de Ciências BiomédicasDepartamento de ParasitologiaSão PauloSPBrasilUniversidade de São Paulo, Instituto de Ciências Biomédicas. Departamento de Parasitologia. São Paulo, SP, Brasil
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Lacerda EMDA, Bertoni N, Alves-Santos NH, Carneiro LBV, Schincaglia RM, Boccolini CS, Castro IRRD, Anjos LAD, Berti TL, Kac G, Rodrigues Farias D, de Freitas MB, Normando P, Andrade PG. Minimum dietary diversity and consumption of ultra-processed foods among Brazilian children 6-23 months of age. CAD SAUDE PUBLICA 2023; 39:e00081422. [PMID: 37878864 PMCID: PMC10599228 DOI: 10.1590/0102-311xen081422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 04/03/2023] [Accepted: 05/04/2023] [Indexed: 10/27/2023] Open
Abstract
The study aimed to estimate the prevalence of minimum dietary diversity (MDD) and consumption of ultra-processed foods in children 6-23 months of age according to sociodemographic variables. Three indicators of complementary feeding of 4,354 children from the Brazilian National Survey on Child Nutrition (ENANI-2019) were built based on a questionnaire about food consumption on the day before the interview: MDD, consumption of ultra-processed foods, and MDD without the consumption of ultra-processed foods. The prevalence and 95%CI were calculated, stratified by macroregion; race/skin color, education and work status of the mother or caregiver; enrollment in the Brazilian Income Transfer Program; household food security; sanitation; and child enrollment in daycare/school. The overall prevalence of MDD was 63.4%, with lower prevalences among children who lived in the North Region (54.8%), whose mothers or caregivers had 0-7 years of education (50.6%), and lived under moderate or severe food insecurity (52.6%). Ultra-processed foods were consumed by 80.5% of the children, with the highest prevalence in the North Region (84.5%). The prevalence of MDD without ultra-processed foods was 8.4% and less prevalent among children with black mothers or caregivers (3.6%) and among those whose mother or caregiver had 8-10 years of education (3.6%). The most frequently consumed food groups from the MDD indicator were grains, roots and tubers (90.2%), dairy products (81%) and those from ultra-processed food were sweet or salty cookies/crackers (51.3%) and instant flours (41.4%). The ubiquitous presence of ultra-processed foods in the diets of Brazilian children and the low frequency of diversified foods, especially among the most vulnerable populations, indicate the need to strengthen policies and programs to ensure adequate and healthy infant nutrition.
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Affiliation(s)
| | - Neilane Bertoni
- Divisão de Pesquisa Populacional, Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro, Brasil
| | - Nadya Helena Alves-Santos
- Instituto de Estudos em Saúde e Biológicas, Universidade Federal do Sul e Sudeste do Pará, Belém, Brasil
| | | | | | - Cristiano Siqueira Boccolini
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | | | - Talita Lelis Berti
- Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Gilberto Kac
- Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
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Nantel A, Gingras V. Are Complementary Feeding Practices Aligned with Current Recommendations? A Narrative Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050794. [PMID: 37238342 DOI: 10.3390/children10050794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 05/28/2023]
Abstract
The complementary feeding introduction period (introduction of solid foods alongside breastmilk or formula) is defining in children's health; however, it appears that many parents do not follow complementary feeding guidelines. Our aim was to describe current parental feeding practices during complementary feeding in relation to current recommendations and explore determinants of adherence to guidelines. We included any relevant studies published within the last decade in French or English and summarized findings by recommendation category. The timing of complementary food introduction varied widely across and within continents (earlier in North America and often delayed in Asia). The introduction of allergenic foods tended to be delayed globally. Although some parents now begin complementary feeding with solid foods (i.e., baby-led weaning), delayed introduction of lumpy textures was still prevalent in the United States and in Europe. The consumption of iron-rich foods was predominantly low in Africa. Added sugars were globally introduced early, especially in America. Evidence for the prevalence of responsive feeding practices among parents is unclear due to the small number of studies. Determinants of complementary feeding practices included parental characteristics, such as age, education, socio-economic status, and race/ethnicity. Interventions aiming to increase adherence to complementary feeding guidelines must account for parental characteristics.
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Affiliation(s)
- Audrey Nantel
- Department of Nutrition, Université de Montréal, Montreal, QC H3T 1A8, Canada
- Research Center of the Sainte-Justine University Hospital, Montreal, QC H3T 1C5, Canada
| | - Véronique Gingras
- Department of Nutrition, Université de Montréal, Montreal, QC H3T 1A8, Canada
- Research Center of the Sainte-Justine University Hospital, Montreal, QC H3T 1C5, Canada
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Maternal sociodemographic factors and their association with ultra-processed foods consumption among children. J Public Health (Oxf) 2023. [DOI: 10.1007/s10389-022-01809-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
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Soares MM, Juvanhol LL, Ribeiro SAV, Franceschini SDCC, Shivappa N, Hebert JR, Araújo RMA. Proinflammatory maternal diet and early weaning are associated with the inflammatory diet index of Brazilian children (6-12 mo): A pathway analysis. Nutrition 2023; 105:111845. [PMID: 36323148 DOI: 10.1016/j.nut.2022.111845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 08/28/2022] [Accepted: 08/29/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE The aim of this study was to assess the dietary inflammatory index (DII) and its association with maternal factors and excess body weight in Brazilian children aged <2 y during complementary feeding. METHODS This was a cross-sectional study (2016-2019), conducted with 231 mothers and children ages 6 to 24 mo. The food consumption of the mother-child dyad was obtained through the mean of three 24-h recalls, as well as information on the consumption of breast milk. The DII was used to verify the quality of the diet. Children's weight and length were measured, and the weight/height index was calculated. Path analysis was used to assess the interrelationships between variables. Multiple linear regression was conducted to identify the components of the child's DII (C-DII) that contributed the most to explaining its variation. RESULTS The children had an anti-inflammatory diet (C-DII -0.37 ± 0.91) whereas the mothers had a proinflammatory diet (M-DII +0.24 ± 0.86). Fiber was the nutrient that contributed most to the variations in the C-DII. Approximately 28% of children were overweight. In the pathway analysis, we verified a direct negative effect of education on excess body weight (standardized coefficients [SC], -0.180; P = 0.034) and C-DII (SC, -0.167; P = 0.002); negative direct effect of breastfeeding on the C-DII (SC, -0.294; P < 0.001); and positive direct effect of M-DII on C-DII (SC, 0.119; P = 0.021). CONCLUSION Children's proinflammatory diet during the period of complementary feeding was associated with maternal proinflammatory diets, lower education, and absence of breastfeeding practice.
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Affiliation(s)
- Marcela Martins Soares
- Department of Nutrition and Health of the Federal University of Viçosa, Minas Gerais, Brazil.
| | | | | | | | - Nitin Shivappa
- University of South Carolina, Arnold School of Public Health, Department of Epidemiology and Biostatistics, Columbia, South Carolina, USA
| | - James R Hebert
- University of South Carolina, Arnold School of Public Health, Department of Epidemiology and Biostatistics, Columbia, South Carolina, USA
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12
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Moreira PR, Nunes LM, Giugliani ERJ, Gomes E, Führ J, Neves RO, Belin CHS, Bernardi JR. Complementary feeding methods and introduction of ultra-processed foods: A randomized clinical trial. Front Nutr 2022; 9:1043400. [PMID: 36570172 PMCID: PMC9767977 DOI: 10.3389/fnut.2022.1043400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Complementary feeding (CF) is defined as a period when foods, other than milk, are introduced to the infant's diet. Unfortunately, frequent consumption of ultra-processed foods (UPF) has become highly prevalent early in an infant's life. The aim was to verify the association of CF methods with the introduction of UPF in early childhood. Methods This randomized clinical trial involved pairs of mother-infants, allocated in groups receiving different CF interventions: strict Parent-Led Weaning (PLW); strict Baby-Led Introduction to SolidS (BLISS), or mixed-method. The intervention consisted of a counseling session on healthy eating at the child's 5.5 months of age. A structured questionnaire was created based on the NOVA classification for the definition of UPF and applied at 9 and 12 months. The effect of the CF method intervention was measured by a survival curve for UPF offered for the first time in early childhood between groups. Cox regression was used to estimate its magnitude. The primary analysis was done in three groups (PLW, BLISS, and Mixed) and the secondary analysis was done in two groups (PLW, and BLISS + Mixed). Results A total of 139 mother-infant pairs were eligible and 129 followed the study. The prevalence of infants who were exposed to UPF in early childhood was 58.9% (n = 76), being 71.4% in the PLW group, 53.3% in the BLISS group, and 52.4% in the Mixed group, without differences between them (p = 0.133). The PLW group intervention had a greater chance of exposure to ice cream or popsicles (p = 0.032) and sweet crackers (p = 0.009), compared with the other two CF groups. The Cox regression did not find significant differences between the three groups. However, the regression with two groups estimated a 38% reduction in the offer of UPF in the BLISS + Mixed group intervention (p = 0.049). Discussion The CF intervention promoting greater infant autonomy (BLISS and Mixed) was associated with a reduction in the offer of UPF in early childhood. This knowledge may contribute to supporting strategies aimed at reducing UPF consumption by the young infant. Brazilian registry of clinical trials ReBEC [https://ensaiosclinicos.gov.br/rg/RBR-229scm], identifier [RBR-229scm U1111-1226-9516].
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Affiliation(s)
- Paula Ruffoni Moreira
- Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil,Graduate Program in Food, Nutrition, and Health, Department of Nutrition, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil,Graduate Program in Child and Adolescent Health, Department of Pediatrics, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Leandro Meirelles Nunes
- Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil,Graduate Program in Child and Adolescent Health, Department of Pediatrics, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Elsa Regina Justo Giugliani
- Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil,Graduate Program in Child and Adolescent Health, Department of Pediatrics, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Erissandra Gomes
- School of Dentistry, Department of Surgery and Orthopedics, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Jordana Führ
- Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil,Graduate Program in Child and Adolescent Health, Department of Pediatrics, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Renata Oliveira Neves
- Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil,Graduate Program in Child and Adolescent Health, Department of Pediatrics, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Christy Hannah Sanini Belin
- Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil,Graduate Program in Child and Adolescent Health, Department of Pediatrics, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Juliana Rombaldi Bernardi
- Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil,Graduate Program in Food, Nutrition, and Health, Department of Nutrition, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil,Graduate Program in Child and Adolescent Health, Department of Pediatrics, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil,*Correspondence: Juliana Rombaldi Bernardi,
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13
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Abstract
Dramatically increasing trends in consumption of ultra-processed foods have been reported across the globe. Public concern about the health consequences of ultra-processed foods is high. This manuscript provides a comprehensive review of trends in global consumption of ultra-processed foods, dietary nutrient profile of ultra-processed foods, demographic, socioeconomic, psychological, and behavioral characteristics of ultra-processed food consumers, current evidence from longitudinal studies at the population level on the association between ultra-processed foods consumption and major health outcomes (including all-cause and cause-specific mortality, cardiovascular disease, overweight and obesity, body composition and fat deposition, diabetes, cancer, and gastrointestinal and other diseases), potential mechanisms linking ultra-processed foods with these outcomes (nutrient displacement, factors that influence adiposity, and processing), and challenges and future research directions. The global trends in consumption of ultra-processed foods, the generally unfavorable nutrient profile of ultra-processed foods, the characteristics of ultra-processed food consumers, the accumulating longitudinal studies associating ultra-processed foods with major health outcomes, and the uncertainties and complexities in putative mechanisms all highlight the need for future high-quality epidemiologic and mechanistic investigations on this topic. It is critical to interpret findings in the light of the totality of evidence.
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Affiliation(s)
- Yin Zhang
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Edward L Giovannucci
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
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14
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de Oliveira PG, de Sousa JM, Assunção DGF, de Araujo EKS, Bezerra DS, Dametto JFDS, Ribeiro KDDS. Impacts of Consumption of Ultra-Processed Foods on the Maternal-Child Health: A Systematic Review. Front Nutr 2022; 9:821657. [PMID: 35634416 PMCID: PMC9136982 DOI: 10.3389/fnut.2022.821657] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 04/20/2022] [Indexed: 12/17/2022] Open
Abstract
Background and Aims Changes in eating patterns have been leading to an increase in the consumption of ultra-processed foods (UPF), negatively impacting the quality of the diet and generating risk of harm to the health of the adult population, however, there is no systematized evidence of the impact of UPF in maternal-child health. Thus, in this study we aimed to evaluated the association between UPF consumption and health outcomes in the maternal-child population. Methods Systematic review registered on the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42021236633), conducted according to the PRISMA diagram in the following databases: PubMed, Medline, Scopus, Web of Science, Scielo, and CAPES thesis and dissertation directory. We included original cross-sectional, case-control and cohort studies in any language. Eligibility criteria were (a) food consumption assessment by the NOVA classification, (b) health outcome (nutritional or diseases), and (c) maternal-child population (pregnant, lactating women and infants/children). All data were analyzed and extracted to a spreadsheet structured by two independent reviewers. We evaluated the methodological quality of the studies included using the Newcastle-Otawa Scale and RoB 2. Results Searches retrieved 7,801 studies and 15 contemplated the eligibility criteria. Most studies included were cohort studies (n = 8, 53%), had children as their population (n = 9, 60%) and only one study evaluated UPF consumption in infants and lactating women. Panoramically, we observed that a higher participation of UPF in children’s diet has been associated with different maternal-child outcomes, such as increase of weight gain, adiposity measures, overweight, early weaning, lower diet quality, metabolic alterations, diseases, and consumption of plastic originated from packaging. Only one of the studies included did not present high methodological quality. Conclusion Despite the limited literature on UPF consumption and health outcomes in the maternal-child population, the highest UPF consumption negatively impacted nutrition and disease development indicators in pregnant, lactating women and children. Considering the expressive participation of these foods in the diet, other studies should be conducted to further investigate the impact of UPF consumption on different health indicators, especially in the lactation phase for this was the one to present the most important knowledge gap. Systematic Review Registration [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021236633], identifier [CRD42021236633].
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Affiliation(s)
| | - Juliana Morais de Sousa
- Post Graduate Program in Nutrition, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | | | - Danielle Soares Bezerra
- Health Sciences College of Trairi, Federal University of Rio Grande do Norte, Santa Cruz, Brazil
| | | | - Karla Danielly da Silva Ribeiro
- Post Graduate Program in Nutrition, Federal University of Rio Grande do Norte, Natal, Brazil
- Department of Nutrition, Federal University of Rio Grande do Norte, Natal, Brazil
- *Correspondence: Karla Danielly da Silva Ribeiro,
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15
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Sarmiento-Santos J, Souza MBN, Araujo LS, Pion JMV, Carvalho RA, Vanin FM. Consumers' Understanding of Ultra-Processed Foods. Foods 2022; 11:1359. [PMID: 35564081 PMCID: PMC9099562 DOI: 10.3390/foods11091359] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/28/2022] [Accepted: 05/04/2022] [Indexed: 11/17/2022] Open
Abstract
Food classification systems have been proposed to improve food quality criteria. Among these systems, "processing level" has been used as a criterion. NOVA classification, as the denotation "ultra-processed" food (UPF), has been widely used in different countries. However, even though some studies have pointed out some controversial aspects, no study has evaluated its comprehension by the population where it is used as reference. Therefore, this study explored the understanding of the term UPF for Brazilian consumers, where this denotation has been used in the last 8 years. A questionnaire was used, with questions referring to different aspects of self-assessment of knowledge about UPF. Altogether, 939 valid participants completed the questionnaire, and 81.9% of them declared to know the term UPF. For 78.2%, a better definition for UPF should be "foods that have gone through many processes in industry". Finally, it was concluded that the term UPF is still confusing for most Brazilians, indicating the risk of use and the urgent necessity to improve the classifications systems and consequently consumer understanding. Only when all parties interested in healthy food work together could this problem be solved.
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Affiliation(s)
- Juliana Sarmiento-Santos
- Laboratory of Bread and Dough Process (LAPROPAMA), Food Engineering Department, Faculty of Animal Science and Food Engineering (USP/FZEA), University of São Paulo, Av. Duque de Caxias Norte 225, Pirassununga 13635-900, SP, Brazil; (J.S.-S.); (M.B.N.S.); (L.S.A.)
| | - Melissa B. N. Souza
- Laboratory of Bread and Dough Process (LAPROPAMA), Food Engineering Department, Faculty of Animal Science and Food Engineering (USP/FZEA), University of São Paulo, Av. Duque de Caxias Norte 225, Pirassununga 13635-900, SP, Brazil; (J.S.-S.); (M.B.N.S.); (L.S.A.)
| | - Lydia S. Araujo
- Laboratory of Bread and Dough Process (LAPROPAMA), Food Engineering Department, Faculty of Animal Science and Food Engineering (USP/FZEA), University of São Paulo, Av. Duque de Caxias Norte 225, Pirassununga 13635-900, SP, Brazil; (J.S.-S.); (M.B.N.S.); (L.S.A.)
| | - Juliana M. V. Pion
- NOZ Pesquisa e Inteligência, Rua Cauowaá, 1575-92, São Paulo 01258-011, SP, Brazil;
| | - Rosemary A. Carvalho
- Food Engineering Department, Macromolecules Functionality Multi-User Center (CEMFUM), Faculty of Animal Science and Food Engineering (USP/FZEA), University of São Paulo, Av. Duque de Caxias Norte 225, Pirassununga 13635-900, SP, Brazil;
| | - Fernanda M. Vanin
- Laboratory of Bread and Dough Process (LAPROPAMA), Food Engineering Department, Faculty of Animal Science and Food Engineering (USP/FZEA), University of São Paulo, Av. Duque de Caxias Norte 225, Pirassununga 13635-900, SP, Brazil; (J.S.-S.); (M.B.N.S.); (L.S.A.)
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