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Sanghvi TG, Godha D, Frongillo EA. Inequalities in large-scale breastfeeding programmes in Bangladesh, Burkina Faso and Vietnam. MATERNAL & CHILD NUTRITION 2024:e13687. [PMID: 39020511 DOI: 10.1111/mcn.13687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 05/21/2024] [Accepted: 05/29/2024] [Indexed: 07/19/2024]
Abstract
Inequalities in breastfeeding programmes and practices have slowed global progress in providing the life-saving protection of breastfeeding for millions of infants despite well-known life-long impacts. As breastfeeding interventions are scaled up, inequalities in coverage and breastfeeding practices should be tracked, particularly in disadvantaged groups, who are likely to suffer the most serious health and developmental impacts of poor childhood nutrition. The literature provides evidence of inequalities in breastfeeding practices, but research is limited on socioeconomic disparities in the coverage of breastfeeding interventions. This paper (1) compares inequalities in breastfeeding practices in intervention and nonintervention areas and (2) documents inequalities in programme coverage by type of intervention. We disaggregated endline evaluation surveys in Bangladesh, Burkina Faso and Vietnam, where rigorous evaluations had documented significant overall improvements, and analysed whether inequalities in breastfeeding practices and programme coverage differed by treatment areas. We used Erreygers index to quantify inequalities and found that breastfeeding practices were largely pro-poor; intervention coverage was not consistently pro-poor. While counselling coverage often favoured women from the poorest quintile, public education/media coverage consistently favoured better-off women. Inequalities favoured more educated mothers in the coverage of combined interventions. None of the programmes had explicit equality objectives. The results indicate the need for introducing specific actions to reduce inequalities in breastfeeding policies and programmes. This is a priority unfinished agenda for nutrition programming.
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Affiliation(s)
- Tina G Sanghvi
- Alive & Thrive initiative, FHI 360, Family Health International, Washington DC and Durham, North Carolina, USA
| | - Deepali Godha
- Consultant FHI 360, 406 Ghanshyam Castle, Khajrana Square, Indore, Madhya Pradesh, India
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behaviour, University of South Carolina, Columbia, South Carolina, USA
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Mathias FB, Cademartori MG, Buffarini R, Barros F, Bertoldi AD, Demarco FF, Goettems ML. Breastfeeding, consumption of ultraprocessed foods, and dental caries at 4 years of age: A birth cohort study. Int J Paediatr Dent 2024; 34:103-113. [PMID: 37171456 DOI: 10.1111/ipd.13087] [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: 02/04/2022] [Revised: 03/14/2023] [Accepted: 04/25/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Cohort studies have demonstrated an association between prolonged and/or frequent breastfeeding and early childhood caries (ECC). AIM To investigate the association between prolonged breastfeeding and ECC at 48 months, while considering the interaction between prolonged breastfeeding and ultraprocessed foods (UPF). DESIGN Data from a birth cohort study conducted in southern Brazil were used (n = 3645). Poisson regression was used to evaluate the influence of breastfeeding and UPF consumption on the prevalence and experience of caries. To measure the interaction on the additive scale between breastfeeding and UPF consumption on the prevalence and experience of ECC, the relative excess risk due to interaction (RERI) was calculated. RESULTS Prolonged breastfeeding was associated with higher prevalence (PR = 1.82; CI:1.59-2.08) and experience (RR = 2.47; CI:1.97-3.10) of ECC. Greater prevalence (PR = 1.16; CI: 1.04-1.30) and experience of ECC (RR = 1.22; CI: 1.00-1.48) were found in children who had high consumption of UPFs. Negative RERIs were observed for the prevalence and experience of ECC (-0.25 and -0.001). CONCLUSION High UPF consumption and prolonged breastfeeding were associated with ECC. No interaction, however, was observed, showing that the two exposures have independent effects. To prevent ECC, policies and programs are needed to support breastfeeding until the age of 2 years and to limit the consumption of UPF.
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Mosquera PS, Lourenço BH, Matijasevich A, Castro MC, Cardoso MA. Prevalence and predictors of breastfeeding in the MINA-Brazil cohort. Rev Saude Publica 2024; 57Suppl 2:2s. [PMID: 38422331 PMCID: PMC10897961 DOI: 10.11606/s1518-8787.2023057005563] [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: 05/19/2023] [Accepted: 08/29/2023] [Indexed: 03/02/2024] Open
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.
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Affiliation(s)
- Paola S. Mosquera
- Universidade de São PauloFaculdade de Saúde PúblicaDepartamento de NutriçãoSão PauloBrasilUniversidade de São Paulo. Faculdade de Saúde Pública. Departamento de Nutrição. São Paulo, Brasil
| | - Bárbara H. Lourenço
- Universidade de São PauloFaculdade de Saúde PúblicaDepartamento de NutriçãoSão PauloBrasilUniversidade de São Paulo. Faculdade de Saúde Pública. Departamento de Nutrição. São Paulo, Brasil
| | - Alicia Matijasevich
- Universidade de São PauloFaculdade de MedicinaDepartamento de Medicina PreventivaSão PauloBrasilUniversidade de São Paulo. Faculdade de Medicina. Departamento de Medicina Preventiva. São Paulo, Brasil
| | - Marcia C. Castro
- Harvard T.H. Chan School of Public HealthDepartment of Global Health and PopulationBostonMAEstados UnidosHarvard T.H. Chan School of Public Health. Department of Global Health and Population. Boston, MA, Estados Unidos.
| | - Marly A. Cardoso
- Universidade de São PauloFaculdade de Saúde PúblicaDepartamento de NutriçãoSão PauloBrasilUniversidade de São Paulo. Faculdade de Saúde Pública. Departamento de Nutrição. São Paulo, Brasil
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Chen Z, Sharma S, Chen S, Kim R, Subramanian SV, Li Z. Prevalence, trend, and inequality of prolonged exclusive breastfeeding among children aged 6-23 months old in India from 1992-2021: A cross-sectional study of nationally representative, individual-level data. J Glob Health 2024; 14:04026. [PMID: 38334279 PMCID: PMC10854209 DOI: 10.7189/jogh.14.04026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024] Open
Abstract
Background Prolonged exclusive breastfeeding (PEB) for children older than six months old is a threat to appropriate complementary feeding practices. This study aims to examine the trend of PEB among children aged 6-23 months in India. Methods We adopted five waves of National Family Health Survey (NFHS) data between 1992-93 and 2019-21. PEB was defined as children aged six months and above currently consuming breastmilk as the only source of energy, protein and micronutrients. We generated descriptive statistics and a series of multivariable logistic regressions to estimate the prevalence and trend in the PEB rate. Moreover, we assessed how child age and socioeconomic factors (i.e. child gender and age, place of residence, household wealth, and maternal education) were related with PEB using mutually and single-adjusted model. Results There were 184 891 Indian children aged 6-23 months old included in this study with 48.0% being female. We found that the proportion of PEB increased from 4.3% in 1992 to 7.7% in 2021, of which the rate for children aged six-eight months rose from 14.0 to 20.1%. Our results showed that children who were from poorer households or with lower-educated mothers were more likely to experience prolonged exclusive breastfed. Take the year of 2019-21 as an example, compared to the households of the richest quintile, children from households of the poorer quintile were significantly more likely to experience PEB, with odds ratio (OR) of 1.33 (95% confidence interval (CI) = 1.09-1.61). Moreover, children with illiterate mothers had 21% higher odds of having prolonged exclusively breastfeeding (OR = 1.21; 95% CI = 1.01-1.44) compared with children with mothers who have college and above education. Conclusions PEB among children over six months old is prevalent in India, particularly among children from disadvantaged households. Poverty reduction and maternal education are of great potential importance for policymakers to promote appropriate complementary feeding practice.
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Affiliation(s)
- Zekun Chen
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Smriti Sharma
- Mother Infant and Young Child Nutrition, Tata Trusts, Delhi, India
| | - Shaoru Chen
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Rockli Kim
- Division of Health Policy and Management, College of Health Science, Korea University, Seoul, South Korea
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea
| | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Harvard Center for Population and Development Studies, Cambridge, Massachusetts, USA
| | - Zhihui Li
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
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Degli Esposti M, Matijasevich A, Collishaw S, Martins-Silva T, Santos IS, Baptista Menezes AM, Domingues MR, Wehrmeister FC, Barros F, Murray J. Secular trends and social inequalities in child behavioural problems across three Brazilian cohort studies (1993, 2004 and 2015). Epidemiol Psychiatr Sci 2023; 32:e23. [PMID: 37066785 PMCID: PMC10130841 DOI: 10.1017/s2045796023000185] [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: 06/28/2022] [Revised: 01/31/2023] [Accepted: 03/24/2023] [Indexed: 04/18/2023] Open
Abstract
AIMS Previous epidemiological evidence identified a concerning increase in behavioural problems among young children from 1997 to 2008 in Brazil. However, it is unclear whether behavioural problems have continued to increase, if secular changes vary between sociodemographic groups and what might explain changes over time. We aimed to monitor changes in child behavioural problems over a 22-year period from 1997 to 2019, examine changing social inequalities and explore potential explanations for recent changes in behavioural problems between 2008 and 2019. METHODS The Child Behaviour Checklist was used to compare parent-reported behavioural problems in 4-year-old children across three Brazilian birth cohorts assessed in 1997 (1993 cohort, n = 633), 2008 (2004 cohort, n = 3750) and 2019 (2015 cohort, n = 577). Response rates across all three population-based cohorts were over 90%. Moderation analyses tested if cross-cohort changes differed by social inequalities (demographic and socioeconomic position), while explanatory models explored whether changes in hypothesized risk and protective factors in prenatal development (e.g., smoking during pregnancy) and family life (e.g., maternal depression and harsh parenting) accounted for changes in child behavioural problems from 2008 to 2019. RESULTS Initial increases in child behavioural problems from 1997 to 2008 were followed by declines in conduct problems (mean change = -2.75; 95% confidence interval [CI]: -3.56, -1.94; P < 0.001), aggression (mean change = -1.84; 95% CI: -2.51, -1.17; P < 0.001) and rule-breaking behaviour (mean change = -0.91; 95% CI: -1.13, -0.69 P < 0.001) from 2008 to 2019. Sex differences in rule-breaking behaviour diminished during this 22-year period, whereas socioeconomic inequalities in behavioural problems emerged in 2008 and then remained relatively stable. Consequently, children from poorer and less educated families had higher behavioural problems, compared to more socially advantaged children, in the two more recent cohorts. Changes in measured risk and protective factors partly explained the reduction in behavioural problems from 2008 to 2019. CONCLUSIONS Following a rise in child behavioural problems, there was a subsequent reduction in behavioural problems from 2008 to 2019. However, social inequalities increased and remained high. Continued monitoring of behavioural problems by subgroups is critical for closing the gap between socially advantaged and disadvantaged children and achieving health equity for the next generation.
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Affiliation(s)
- Michelle Degli Esposti
- Human Development and Violence Research Centre (DOVE), Federal University of Pelotas, Pelotas, Brazil
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Alicia Matijasevich
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, University of São Paulo, São Paulo, Brazil
| | - Stephan Collishaw
- Wolfson Centre for Young People’s Mental Health and MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, Wales
| | - Thaís Martins-Silva
- Human Development and Violence Research Centre (DOVE), Federal University of Pelotas, Pelotas, Brazil
| | - Iná S. Santos
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | | | | | | | - Fernando Barros
- Post Graduate Course in Health in the Life Cycle, Universidade Católica de Pelotas, Pelotas, Brazil
| | - Joseph Murray
- Human Development and Violence Research Centre (DOVE), Federal University of Pelotas, Pelotas, Brazil
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
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Huang YY, Liu Q, Li JY, Yue SW, Xue B, Redding SR, Zhou WB, Ouyang YQ. Breastfeeding Practices of Women Returning to Full-Time Employment in China: Prevalence and Determinants. Workplace Health Saf 2023; 71:68-77. [PMID: 36514253 DOI: 10.1177/21650799221126371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Returning to work after childbirth is a common reason for women to stop breastfeeding. This study aimed to assess breastfeeding practices and breastfeeding support available to employed women in China, and factors affecting breastfeeding duration. METHODS A cross-sectional survey of 1,243 breastfeeding women employed full-time was conducted. Participants completed a sociodemographic questionnaire and the Workplace Breastfeeding Support Scale (WBSS). Multiple linear regression analysis was used to explore the factors that are associated with breastfeeding. RESULTS The mean exclusive breastfeeding duration and any breastfeeding duration of full-time employed women were 5.7 ± 0.5 months and 9.8 ± 1.5 months, respectively. The total WBSS score was 46.6 ± 5.3 (M ± SD). Generally, women perceived coworkers (M [SD] = 4.8 [1.0]) and supervisors (M [SD] = 5.7 [1.2]) to be supportive of breastfeeding. Lower scores on the WBSS were related to lack of technical and facility support, indicating no access to a refrigerator to store breast milk (M [SD] = 2.0 [1.5]) or to a breast pump (M [SD] = 1.7 [1.7]). Similarly, a private area for expressing breast milk (M [SD] = 1.4 [1.0]) was unavailable. Maternity leave, residential province, ethnicity, education level, average monthly household income, main reason for stopping exclusive breastfeeding, commute time greater than 1 hour, and the total WBSS score were also factors influencing breastfeeding duration of the full-time employed women. CONCLUSIONS There were gaps in breastfeeding practices and workplace breastfeeding support of Chinese full-time employed women when compared with the World Health Organization recommendations. Occupational health providers should consider these findings when developing programs to support breastfeeding in the workplace.
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Affiliation(s)
| | - Qian Liu
- Zhongnan Hospital of Wuhan University
| | | | | | - Bing Xue
- School of Nursing, Wuhan University
| | | | - Wen-Bin Zhou
- Department of Psychology, Hubei Provincial Corps Hospital, Chinese People Armed Police Forces
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Socio-economic inequalities in the effect of public policies and the COVID-19 pandemic on exclusive breastfeeding in Chile. Public Health 2023; 214:61-68. [PMID: 36521273 PMCID: PMC9640405 DOI: 10.1016/j.puhe.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 10/27/2022] [Accepted: 11/01/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess the impact of the addition of 12 maternity leave (ML) weeks (2011), a pay for performance (P4P) exclusive breastfeeding (EBF) promotion strategy (2015), and the COVID-19 pandemic in EBF inequalities in Chile. STUDY DESIGN Interrupted time-series analyses (ITSAs). METHODS Aggregated national EBF data by municipality and month were collected from 2009 to 2020. We assess the impact of the three events in EBF inequalities using two procedures: 1. ITSA stratified by municipal SES quintiles (Q1-Q5); 2. Calculating the EBF slope index of inequality (SII). RESULTS The EBF prevalence was higher in lower SES municipalities before and after the three time-events. No impact in EBF inequalities was observed after the extended ML. The P4P strategy increased EBF at six months in all SES quintiles (effect size between 4% and 5%), but in a higher level in poorer municipalities (SII: -0.36% and -1.05%). During COVID-19, wealthier municipalities showed a slightly higher EBF at six months prevalence (SII: 1.44%). CONCLUSION The null impact of the extended ML in EBF inequalities could be explained by a low access to ML among affiliated to the public health system (20%). The P4P strategy includes multiple interventions that seemed effective in increasing EBF across all SES quintiles, but further in lower quintiles. The restrictions in healthcare access in poorer municipalities could explain EBF inequalities during COVID-19.
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How do the determinants of exclusive breast-feeding change over time? A multi-survey quasi-longitudinal study in Lao People's Democratic Republic. Public Health Nutr 2022; 25:2380-2394. [PMID: 35657684 PMCID: PMC9991563 DOI: 10.1017/s1368980022001380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The current study aimed to assess trends, associated factors and the changes in these factors for exclusive breast-feeding (EBF) over the past two decades in Lao People's Democratic Republic (Lao PDR). DESIGN The current study used a quasi-longitudinal design. Descriptive analyses were done with correction for complex survey design. Inferential analyses were done for survey years separately using multiple logistic regression. Finally, pooled logistic regression analysis was done using interaction terms to quantify the difference in association per year. SETTING The current study used data from all provinces of Lao PDR collected in the years 2000, 2006, 2011/2012 and 2017. PARTICIPANTS Children aged six months or younger from Lao PDR. RESULTS EBF practice was estimated at 19·03 %, 26·87 %, 40·67 % and 44·89 % in the four survey years, respectively. Factors significantly associated with EBF included: region of residence, ethnicity, wealth index and age of child. Region and ethnicity saw significant changes in association, and the South developing positively over time as well as in the Lao-Thai ethnic group. Having had any antenatal visits was not associated with EBF practice, nor did this change over time. CONCLUSIONS Our study shows how EBF trends, and factors associated with EBF, changed over time. We applied an easily replicable methodology to assess similar public health phenomena. We argue that such analysis is particularly relevant for transitioning countries. In such rapidly evolving settings, it is crucial to take into account changing underlying factors when assessing and developing public health policy.
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Dourado BLLFS, De Melo JMM, Longo-Silva G, de Menezes RCE, da Silveira JAC. Early-life determinants of excessive weight gain among low-income children: Examining the adherence of theoretical frameworks to empirical data using structural equation modelling. Pediatr Obes 2022; 17:e12912. [PMID: 35293703 DOI: 10.1111/ijpo.12912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 02/15/2022] [Accepted: 02/28/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although childhood obesity is increasing in low-income regions, theoretical models cannot be adequately applied due to the lack of prospective studies with under 2-year-old children from impoverished populations. OBJECTIVE To analyse direct and indirect effects of environmental, maternal, and individual factors on excess weight gain among low-income children during the first year of life. METHODS We analysed data from a prospective birth cohort conducted in Brazil, which followed infants at birth, 3rd, 6th, and 12th month of life (n = 205). The weight-for-age z-score was used to calculate the conditional weight gain (CWG). Direct and indirect effects on CWG were estimated using structural equation modelling. RESULTS Children's consumption of ultra-processed food (UPF) ≥1 time/day, breastfeeding duration >90 days, and maternal obesity showed a statistically significant direct effect on children's CWG. We observed a positive indirect pathway linking the maternal intake of UPF ≥4 times/day to the CWG, given its direct effect on the infant's UPF consumption. CONCLUSIONS In this low-income population, women who were frequent users of UPF tended to introduce these products more frequently into their children's diets. The early trade-off trend in children's diet between breastfeeding and UPF was the leading cause of excessive weight gain.
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Affiliation(s)
- Bruna Larine Lemos Fontes Silva Dourado
- Graduate Program in Nutrition, School of Nutrition (FANUT), Federal University of Alagoas (UFAL), Maceió, Brazil.,Food Environment Studies and Research Center (NEPAAL), School of Nutrition (FANUT), Federal University of Alagoas (UFAL), Maceió, Brazil
| | - Jayanne Mayara Magalhães De Melo
- Graduate Program in Nutrition, School of Nutrition (FANUT), Federal University of Alagoas (UFAL), Maceió, Brazil.,Food Environment Studies and Research Center (NEPAAL), School of Nutrition (FANUT), Federal University of Alagoas (UFAL), Maceió, Brazil
| | - Giovana Longo-Silva
- Graduate Program in Nutrition, School of Nutrition (FANUT), Federal University of Alagoas (UFAL), Maceió, Brazil.,Food Environment Studies and Research Center (NEPAAL), School of Nutrition (FANUT), Federal University of Alagoas (UFAL), Maceió, Brazil
| | - Risia Cristina Egito de Menezes
- Graduate Program in Nutrition, School of Nutrition (FANUT), Federal University of Alagoas (UFAL), Maceió, Brazil.,Food Environment Studies and Research Center (NEPAAL), School of Nutrition (FANUT), Federal University of Alagoas (UFAL), Maceió, Brazil
| | - Jonas Augusto Cardoso da Silveira
- Graduate Program in Nutrition, School of Nutrition (FANUT), Federal University of Alagoas (UFAL), Maceió, Brazil.,Food Environment Studies and Research Center (NEPAAL), School of Nutrition (FANUT), Federal University of Alagoas (UFAL), Maceió, Brazil.,Department of Nutrition (DNUT), Sector of Health Sciences (SCS), Federal University of Paraná (UFPR), Maceió, Brazil
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Influence of maternal excess weight before pregnancy on breast-feeding and weaning: pooled analyses of four population-based cohorts born between 1982 and 2015. Br J Nutr 2022; 128:124-130. [PMID: 34378497 DOI: 10.1017/s0007114521003019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
To investigate the associations of maternal excess weight before pregnancy with (1) weaning at 3 months of age, (2) duration of exclusive breast-feeding at 6 months of age, (3) duration of any breast-feeding at 12 months of age and (4) to compare the magnitude of these associations over four decades. Data were from participants in the Pelotas (Brazil) Birth Cohorts born in 1982 (n 5334), 1993 (n 1442), 2004 (n 4092) and 2015 (n 4102). Maternal pre-pregnancy weight was collected after the delivery and breast-feeding status was assessed when children were 3 and 12 months old. Only in the most recent cohort (2015), women with excess weight (BMI ≥ 25 kg/m2) before pregnancy had higher risk of discontinuing exclusive breast-feeding within the first 6 months postpartum than women with normal weight (hazard ratio = 1·22 (95 % CI 1·15, 1·30)). Duration of any type of breast-feeding until 12 months of age was not affected by pre-pregnancy weight. Excess weight before pregnancy is associated with exclusive breast-feeding only in the most recent birth cohort coinciding with increases in excess weight and breast-feeding over time.
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LINHARES AO, SILVA LSD, GIGANTE DP. Breastfeeding duration comparison of children enrolled in municipal preschools in 2004 and 2018. REV NUTR 2022. [DOI: 10.1590/1678-9865202235e210122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective To describe and compare the duration of breastfeeding of children enrolled in municipal preschools in Pelotas (RS), Brazil, in 2004 and 2018, taking into account sociodemographic and health factors. Methods Cross-sectional study, with children aged zero to six years. Data collection included interview with parents and children anthropometric assessment. Data was entered on EpiData 3.1 and analyzed on Stata 14.0. Median duration of breastfeeding was assessed according to the independent variables. Two children life tables were elaborated for the years 2004 and 2018. The statistical significance of the median analysis was based on the Wilcoxon Rank Sum test for dichotomic exposure and Kruskal Wallis test for polytomous exposure. Results A total of 1902 children were studied. In 2004, the median duration of breastfeeding was five months (IQR: 2.0;12.0) which increased one month for each weight category increase at birth. In 2018, the median was six months (IQR: 2.0;17.0) and increased two months for each weight category increase at birth. The life table showed that around 20.0% of the children in 2004 and 33% of the children in 2018 continued to be breastfed after 11 months of age. Conclusion The breastfeeding median increased in the period under review. The greater the birth weight, the longer the breastfeeding median duration.
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Cherubini KA, Schmidt MI, Vigo Á, Drehmer M. Breastfeeding rates and related factors at one year postpartum in women with gestational diabetes initially recruited for a diabetes prevention program. Can J Diabetes 2022; 46:441-448. [DOI: 10.1016/j.jcjd.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 12/02/2021] [Accepted: 01/12/2022] [Indexed: 10/19/2022]
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Mattiello R, Kotoski A, Ayala CO, Recha CL, Quiroga CV, Machado CR, Roxo CDO, Varela FH, Couto GT, Cassão G, Lopes JB, Gonçalves JIB, Silva JFD, Barh MBD, Rocha ND, Albuquerque NSD, Corte RAD, Bernardes R, Richter SA, Rossi T, Santos IS. Prevalence and factors associated with no intention to exclusively breastfeed for the first 6 months of life. J Pediatr (Rio J) 2022; 98:39-45. [PMID: 33775629 PMCID: PMC9432053 DOI: 10.1016/j.jped.2021.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/19/2021] [Accepted: 02/19/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To investigate the prevalence and factors associated with no intention to exclusively breastfeed for the first 6 months of life in a sample of women in the first 24 h postpartum during the hospital stay. METHODS Cross-sectional study with data from screening phase of a birth cohort. The proportion of mothers who did not intend to breastfeed exclusively for 6 months (primary outcome) derived from a negative response to the question "Would you be willing to try to breastfeed exclusively for the first 6 months?", in an interview conducted by previously trained interviewers. Crude and adjusted prevalence ratios (PR) with 95% confidence intervals were obtained by Poisson regression with robust variance. RESULTS A total of 2964 postpartum women were interviewed. The overall prevalence of mothers who did not intend to breastfeed exclusively for 6 months was 17.8% (16.4-19.1%). After adjusting for maternal age and type of pregnancy (singleton or multiple), no intention to exclusively breastfeed was higher in mothers with a monthly household income < 3 minimum wages (PR, 1.64; 1.35-1.98) and in those who intended to smoke 4-7 days/week after delivery (PR, 1.42; 1.11-1.83). The presence of significant newborn morbidity (PR, 0.32; 0.19-0.54) and intention to breastfeed up to 12 months (PR, 0.46; 0.38-0.55) had a protective effect against not intending to breastfeed exclusively for 6 months. CONCLUSIONS Approximately 1 in every 5 mothers did not intend to breastfeed exclusively for 6 months. Strategies aimed at promoting exclusive breastfeeding should focus attention on mothers from lower economic strata and smokers.
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Affiliation(s)
- Rita Mattiello
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Escola de Medicina, Programa Pós-graduação Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil
| | - Aline Kotoski
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Escola de Medicina, Programa Pós-graduação Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil
| | - Camila Ospina Ayala
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Escola de Medicina, Programa Pós-graduação Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil
| | - Carine Lucena Recha
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Escola de Medicina, Programa Pós-graduação Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil
| | - Carolina Villanova Quiroga
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Escola de Medicina, Programa Pós-graduação Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil
| | - Cátia Regina Machado
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Escola de Medicina, Programa Pós-graduação Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil
| | - Cristiano de Oliveira Roxo
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Escola de Medicina, Programa Pós-graduação Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil
| | - Fernanda Hammes Varela
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Escola de Medicina, Programa Pós-graduação Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil
| | - Giovanna Trevisan Couto
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Escola de Medicina, Programa Pós-graduação Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil
| | - Gisele Cassão
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Escola de Medicina, Programa Pós-graduação Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil
| | - Jéssica Blatt Lopes
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Escola de Medicina, Programa Pós-graduação Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil
| | - João Ismael Budelon Gonçalves
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Escola de Medicina, Programa Pós-graduação Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil
| | - Juliana Fernandes da Silva
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Escola de Medicina, Programa Pós-graduação Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil
| | - Mariana Barth de Barh
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Escola de Medicina, Programa Pós-graduação Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil
| | - Natalie Duran Rocha
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Escola de Medicina, Programa Pós-graduação Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil
| | - Nathalia Saraiva de Albuquerque
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Escola de Medicina, Programa Pós-graduação Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil
| | - Ricardo Arlindo Dalla Corte
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Escola de Medicina, Programa Pós-graduação Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil
| | - Rossana Bernardes
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Escola de Medicina, Programa Pós-graduação Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil
| | - Samanta Andresa Richter
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Escola de Medicina, Programa Pós-graduação Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil
| | - Tainá Rossi
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Escola de Medicina, Programa Pós-graduação Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil
| | - Ina S Santos
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Escola de Medicina, Programa Pós-graduação Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil.
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Li JY, Huang YY, Huang Y, Du MC, Xu J, Li L, Redding SR, Ouyang YQ. Development of a breastfeeding duration risk nomogram for use in postpartum Chinese women. Res Nurs Health 2021; 45:94-107. [PMID: 34907548 DOI: 10.1002/nur.22203] [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: 05/05/2021] [Revised: 11/08/2021] [Accepted: 11/27/2021] [Indexed: 11/11/2022]
Abstract
Previous studies have investigated influencing factors of early discontinuation of breastfeeding, but few studies have developed an easy-to-use tool to identify risk of breastfeeding cessation at 6 months after birth. This research team aimed to develop and validate an exclusive breastfeeding duration risk nomogram in Chinese mothers. A longitudinal cohort survey was conducted. Data were collected from 394 postpartum women in three hospitals in Hubei Province, China from December 2017 to December 2018. The LASSO regression model was used to screen for optimized factors in an exclusive breastfeeding duration model. Multivariable logistic regression was applied to construct a prediction model. Discrimination and calibration were assessed using a C-index and calibration curve, and internal validity was established using bootstrapping validation. Factors integrated in the prediction risk nomogram were monthly household income (odds ratio [OR] = 1.31, 95% confidence interval [CI]: [0.95, 1.80]), experiences of breastfeeding (OR = 1.23, 95% CI: [0.92, 1.63]), attitude (OR = 1.72, 95% CI: [0.94, 3.16]), self-efficacy (OR = 2.45, 95% CI: [1.40, 4.29]), perceived insufficient milk supply (OR = 0.12, 95% CI: [0.06, 0.25]) and postpartum depression (OR = 0.06, 95% CI: [0.02, 0.17]). The model displayed good discrimination with a C-index of 0.87 (95% CI: [0.84, 0.91]) and good calibration. The C-index interval validation was confirmed to be 0.86. This study resulted in the development of a novel nomogram with good accuracy to aid healthcare professionals in assessing the probability of a mother discontinuing exclusive breastfeeding at the breast before 6 months.
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Affiliation(s)
- Jun-Yan Li
- School of Nursing, Wuhan University, Wuhan, Hubei, China
| | - Yi-Yan Huang
- School of Nursing, Wuhan University, Wuhan, Hubei, China
| | - Yi Huang
- School of Nursing, Wuhan University, Wuhan, Hubei, China
| | - Mei-Chen Du
- School of Nursing, Wuhan University, Wuhan, Hubei, China
| | - Jing Xu
- School of Nursing, Wuhan University, Wuhan, Hubei, China
| | - Lu Li
- School of Nursing, Wuhan University, Wuhan, Hubei, China
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de Melo JMM, Dourado BLLFS, de Menezes RCE, Longo-Silva G, da Silveira JAC. Early onset of overweight among children from low-income families: The role of exclusive breastfeeding and maternal intake of ultra-processed food. Pediatr Obes 2021; 16:e12825. [PMID: 34169658 DOI: 10.1111/ijpo.12825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 05/21/2021] [Accepted: 06/09/2021] [Indexed: 11/28/2022]
Abstract
CONTEXT There is an increasing prevalence of overweight during early childhood in the most impoverished areas in Brazil, although there is a lack of evidence regarding its onset. OBJECTIVES To investigate the incidence and risk factors associated with overweight among low-income children during their first year of life. METHODS We analysed data from a prospective birth cohort study conducted in Brazil, which followed-up children at birth, 3rd, 6th and 12th months (n = 196). The overweight incidence (zBMI/A > 2SD) was analysed using the Kaplan-Meier survival estimator and its associated factors by the Coxs regression model. Missing data were addressed with multiple imputations and results on the final adjusted model were calculated by pooling the estimates generated for each imputed dataset. RESULTS The overweight incidence was 17 events/100 children-year, and most cases occurred before the 6th month. The final model showed that children exclusively breastfed up to 30 days (vs. >30 days; HR 2.68; 95%CI 1.11-6.49) and whose mothers consumed ultra-processed foods more than 4 times/day (vs. ≤4 times/day; HR 3.02; 95%CI 1.28-7.13) presented a higher risk of developing overweight. CONCLUSION The overweight incidence was high in this impoverished population. Shorter exclusive breastfeeding duration and an unhealthy household food environment provided a short-term risk increase.
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Affiliation(s)
- Jayanne Mayara Magalhães de Melo
- Center for Studies and Research on Food Environment, Nutrition Graduate Program, Faculty of Nutrition, Universidade Federal de Alagoas, Maceió, Alagoas, Brazil
| | - Bruna Larine Lemos Fontes Silva Dourado
- Center for Studies and Research on Food Environment, Nutrition Graduate Program, Faculty of Nutrition, Universidade Federal de Alagoas, Maceió, Alagoas, Brazil
| | - Risia Cristina Egito de Menezes
- Center for Studies and Research on Food Environment, Nutrition Graduate Program, Faculty of Nutrition, Universidade Federal de Alagoas, Maceió, Alagoas, Brazil
| | - Giovana Longo-Silva
- Center for Studies and Research on Food Environment, Nutrition Graduate Program, Faculty of Nutrition, Universidade Federal de Alagoas, Maceió, Alagoas, Brazil
| | - Jonas Augusto Cardoso da Silveira
- Center for Studies and Research on Food Environment, Nutrition Graduate Program, Faculty of Nutrition, Universidade Federal de Alagoas, Maceió, Alagoas, Brazil.,Department of Nutrition, Center for Health Sciences, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
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16
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Silva MDB, de Oliveira RDVC, da Silveira Barroso Alves D, Melo ECP. Predicting risk of early discontinuation of exclusive breastfeeding at a Brazilian referral hospital for high-risk neonates and infants: a decision-tree analysis. Int Breastfeed J 2021; 16:2. [PMID: 33397423 PMCID: PMC7783998 DOI: 10.1186/s13006-020-00349-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 12/09/2020] [Indexed: 12/01/2022] Open
Abstract
Background Determinants at several levels may affect breastfeeding practices. Besides the known historical, socio-economic, cultural, and individual factors, other components also pose major challenges to breastfeeding. Predicting existing patterns and identifying modifiable components are important for achieving optimal results as early as possible, especially in the most vulnerable population. The goal of this study was building a tree-based analysis to determine the variables that can predict the pattern of breastfeeding at hospital discharge and at 3 and 6 months of age in a referral center for high-risk infants. Methods This prospective, longitudinal study included 1003 infants and was conducted at a high-risk public hospital in the following three phases: hospital admission, first visit after discharge, and monthly telephone interview until the sixth month of the infant’s life. Independent variables were sorted into four groups: factors related to the newborn infant, mother, health service, and breastfeeding. The outcome was breastfeeding as per the categories established by the World Health Organization (WHO). For this study, we performed an exploratory analysis at hospital discharge and at 3 and at 6 months of age in two stages, as follows: (i) determining the frequencies of baseline characteristics stratified by breastfeeding indicators in the three mentioned periods and (ii) decision-tree analysis. Results The prevalence of exclusive breastfeeding (EBF) was 65.2% at hospital discharge, 51% at 3 months, and 20.6% at 6 months. At hospital discharge and the sixth month, the length of hospital stay was the most important predictor of feeding practices, also relevant at the third month. Besides the mother’s and child’s characteristics (multiple births, maternal age, and parity), the social context, work, feeding practice during hospitalization, and hospital practices and policies on breastfeeding influenced the breastfeeding rates. Conclusions The combination algorithm of decision trees (a machine learning technique) provides a better understanding of the risk predictors of breastfeeding cessation in a setting with a large variability in expositions. Decision trees may provide a basis for recommendations aimed at this high-risk population, within the Brazilian context, in light of the hospital stay at a neonatal unit and period of continuous feeding practice. Supplementary Information The online version contains supplementary material available at 10.1186/s13006-020-00349-x.
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Affiliation(s)
- Maíra Domingues Bernardes Silva
- Human Milk Bank at the National Institute of Women, Children and Adolescents Health Fernandes Figueira (IFF) of the Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, Brazil.
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17
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Introduction to complementary feeding in the first year of life and risk of overweight at 24 months of age: changes from 2004 to 2015 Pelotas (Brazil) Birth Cohorts. Br J Nutr 2020; 124:620-630. [PMID: 32381141 DOI: 10.1017/s0007114520001634] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Complementary feeding (CF) and overweight relationships during early childhood are inconsistent in the literature. We described the association of CF during the first year of life with risk of overweight at 24 months of age in the population-based 2004 and 2015 Pelotas (Brazil) Birth Cohorts (2004c and 2015c). CF introduction was evaluated at the 3 and 12 months' follow-ups by asking mothers using a list of foods. Risk of overweight at 24 months of age was BMI-for-age z-score above +1sd from the median of the WHO 2006 growth standards. Our analyses included 3823 (2004c) and 3689 (2015c) children. Early introduction CF (before 6 months of age) prevalence in 2004c was 93·3 (95 % CI 92·5, 94·1) % and in 2015c was 87·2 (95 % CI 86·1, 88·2) %. Tea was the item introduced earlier in both 2004c (68·8 %) and 2015c (55·7 %). At 6 months of age, vegetable mash was the most introduced food in 2004c (33·5 %) and 2015c (47·9 %). Between 2004c and 2015c, the introduction of fresh milk decreased 82·1 to 60·5 % and yogurt from 94·4 to 78·1 % during the first year. Risk of overweight prevalence at 24 months was 33·0 (95 % CI 31·6, 34·5) % in 2004c and 32·0 (95 % CI 30·5, 33·5) % in 2015c. In 2015c, the adjusted odds of risk of overweight at 24 months were increased 1·66 and 1·50 times with the early introduction of fresh/powdered milk: plus water, tea or juice, and plus semi-solid/solid food groups, respectively. It is essential to reinforce the adherence to global recommendations on timely feeding introduction and encourage exclusive breast-feeding until 6 months of age to prevent child overweight.
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Abstract
OBJECTIVE To (i) describe the infant feeding practices of South African women living in Soweto and (ii) understand from the mothers' perspective what influences feeding practices. DESIGN Semi-structured focus group discussions (FGD) and in-depth interviews (IDI) were conducted, and data were analysed using thematic analysis. SETTING Soweto, South Africa. PARTICIPANTS Nineteen mothers were stratified into three FGD according to their baby's age as follows: 0-6-month-olds, 7-14-month-olds and 15-24-month-olds. Four mothers from each FGD then attended an IDI. RESULTS Although mothers understood that breast-feeding was beneficial, they reported short durations of exclusive breast-feeding. The diversity and quality of weaning foods were low, and 'junk' food items were commonly given. Infants were fed using bottles or spoons and feeding commonly occurred separately to family meal times. Feeding practices were influenced by mothers' beliefs that what babies eat is important for their health and that an unwillingness to eat is a sign of ill health. As such, mothers often force-fed their babies. In addition, mothers believed that feeding solid food to babies before 6 months of age was necessary. Family matriarchs were highly influential to mothers' feeding practices; however, their advice often contradicted that of health professionals. CONCLUSIONS In South Africa, interventions aimed at establishing healthier appetites and eating behaviours in early life should focus on: (i) fostering maternal self-efficacy around exclusive breast-feeding; (ii) challenging mixed feeding practices and encouraging more responsive feeding approaches and (iii) engaging family members to promote supportive household and community structures around infant feeding.
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Vaz JDS, Dos Santos LP, Gatica-Dominguez G, Bierhals IO, Gomes AP, Gonçalves H, Kac G, Menezes AB, Assunção MCF. Intergenerational breastfeeding practices among parents and children: 1993 Pelotas (Brazil) birth cohort. MATERNAL AND CHILD NUTRITION 2020; 17:e13058. [PMID: 32633038 PMCID: PMC7729557 DOI: 10.1111/mcn.13058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 06/11/2020] [Accepted: 06/17/2020] [Indexed: 11/28/2022]
Abstract
The objective of this study was to investigate intergenerational breastfeeding practices according to parental sex and age at delivery in the 1993 Pelotas (Brazil) birth cohort study. This is a prospective birth cohort study, and at the 22‐year follow‐up, a substudy with all children of the cohort members who had become parents was conducted (93Cohort‐II). First generation breastfeeding data were collected at 3 months and 4‐year‐old follow‐ups. In the 93Cohort‐II, parents answered a questionnaire about their children's breastfeeding practices. Adjusted Tobit and Poisson regression models with robust variance were applied to estimate the association between predominant parental breastfeeding duration and exclusive breastfeeding duration of the children at 3 and 6 months. Out of 3,810 cohort participants, 955 (25%) had delivered at least one live‐born infant, and 1,222 children were assessed. Fifty‐four percent of parents were ≤19 years old. Direct effects of predominant parental breastfeeding duration on exclusive breastfeeding duration of their children were only observed when data were stratified by parental age: children born to parents aged ≥20 years old and who were predominantly breastfed for at least 3 months presented higher exclusive breastfeeding duration and higher prevalence of being exclusively breastfed for at least 3 months. When analyses were stratified by mothers and fathers, the result remained significant only among mothers. Longer predominant breastfeeding duration in the first generation was associated with longer exclusive breastfeeding duration in the second generation, but only among older mothers. Education and social support surrounding breastfeeding should be intensified among fathers and younger parents to create a positive environment supportive of breastfeeding.
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Affiliation(s)
- Juliana Dos Santos Vaz
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.,Faculty of Nutrition, Federal University of Pelotas, Pelotas, Brazil
| | | | | | | | | | - Helen Gonçalves
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Gilberto Kac
- Institute of Nutrition, Federal University of Rio de Janeiro, Brazil
| | - Ana Baptista Menezes
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Maria Cecilia Formoso Assunção
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.,Rio Grande University Foundation, Rio Grande, Brazil
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Validation of maternal recall on exclusive breastfeeding 12 months after childbirth. Public Health Nutr 2020; 23:2494-2500. [PMID: 32456727 DOI: 10.1017/s136898002000018x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE We aimed to assess the validity of maternal recall of exclusive breastfeeding (EBF) at 3 months obtained 12 months after childbirth. DESIGN A population-based birth cohort study. The gold standard is maternal report of EBF at the age of 3 months (yes or no) and age of introduction of other foods in the infant's diet. EBF was considered when the mother reported that no liquid, semi-solid or solid food was introduced up to that moment. The variable to be validated was obtained at 12 months after childbirth when the mother was asked about the age of food introduction. The prevalence of EBF at 3 months, and sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and accuracy of 12-month recall with 95 % CI were calculated. SETTING Pelotas, Brazil. PARTICIPANTS 3700 mothers of participants of the Pelotas 2004 Birth Cohort. RESULTS The prevalence of EBF at 3 months was 27·8 % (95 % CI 26·4, 29·3) and 49·0 % (95 % CI 47·4, 50·6) according to gold standard and maternal recall, respectively. The sensitivity of maternal recall at 12 months was 98·3 % (95 % CI 97·4, 99·0), specificity 70·0 % (95 % CI 68·2, 71·7), PPV 55·8 % (95 % CI 53·4, 58·1), NPV 99·1 % (95 % CI 98·6, 99·5) and accuracy 77·9 % (95 % CI 76·6, 79·2). When the analyses were stratified by maternal and infant characteristics, the sensitivity remained around 98 %, and the specificity ranged from 64·4 to 81·8 %. CONCLUSIONS EBF recalled at the end of the first year of infant's life is a valid measure to be used in epidemiological investigations.
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Farías-Antúnez S, Santos IS, Matijasevich A, de Barros AJD. Maternal mood symptoms in pregnancy and postpartum depression: association with exclusive breastfeeding in a population-based birth cohort. Soc Psychiatry Psychiatr Epidemiol 2020; 55:635-643. [PMID: 31897581 DOI: 10.1007/s00127-019-01827-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 12/24/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE This study aimed to evaluate the association between mood symptoms during pregnancy and exclusive breastfeeding at 3 months, as well as the association between exclusive breastfeeding at 3 months and maternal depression at 12 months postpartum. METHODS Data from the Pelotas 2004 Birth Cohort with 4231 live births were used. Maternal mood symptoms during pregnancy were assessed through the question "During pregnancy, did you have depression or nervous problems?" and depression symptomatology at 12 months postpartum was assessed with the Edinburg Postnatal Depression Scale (EPDS). Information on exclusive breastfeeding at 3 months was collected through a dietary recall questionnaire. Crude and adjusted relative risks (RR) with 95% confidence intervals (95% CI) were estimated by Poisson regression. RESULTS Prevalence of mood symptoms during pregnancy was 25.1% (95% CI 23.8; 26.4%) and prevalence of EPDS ≥ 10 at 12 months after birth was 27.6% (95% CI 26.2; 29.0%). Prevalence of exclusive breastfeeding at 3 months was 26.5% (95% CI 25.2; 27.9%). In crude analyses, maternal mood symptoms during pregnancy were associated with non-exclusive breastfeeding at 3 months and non-exclusive breastfeeding at 3 months was associated with postpartum maternal depression at 12 months. In the adjusted analyses, both associations were lost after the inclusion of maternal education (RR 0.92; 95% CI 0.81-1.04 and RR 0.92; 95% CI 0.81-1.03, respectively). CONCLUSION In our study, the crude association between mood symptoms in pregnancy, exclusive breastfeeding at 3 months, and postpartum depression was due more to the low maternal education than to a true relationship between them.
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Affiliation(s)
- Simone Farías-Antúnez
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Marechal Deodoro St., 1160, 3º floor, Centro, Pelotas, RS, 96020-220, Brazil.
| | - Iná Silva Santos
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Marechal Deodoro St., 1160, 3º floor, Centro, Pelotas, RS, 96020-220, Brazil
| | - Alicia Matijasevich
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Marechal Deodoro St., 1160, 3º floor, Centro, Pelotas, RS, 96020-220, Brazil
- Department of Preventive Medicine, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Aluisio Jardim Dornellas de Barros
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Marechal Deodoro St., 1160, 3º floor, Centro, Pelotas, RS, 96020-220, Brazil
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Wehrmeister FC, Victora CG, Horta BL, Menezes AMB, Santos IS, Bertoldi AD, da Silva BGC, Barros FC. Hospital admissions in the first year of life: inequalities over three decades in a southern Brazilian city. Int J Epidemiol 2019; 48:i63-i71. [PMID: 30883660 PMCID: PMC6422058 DOI: 10.1093/ije/dyy228] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Hospital admissions in infancy are declining in several countries. We describe admissions to neonatal intensive care units (NICU) and other hospitalizations over a 33-year period in the Brazilian city of Pelotas. METHODS We analysed data from four population-based birth cohorts launched in 1982, 1993, 2004 and 2015, each including all hospital births in the calendar year. NICU and other hospital admissions during infancy were reported by the mothers in the perinatal interview and at the 12-month visit, respectively. We describe these outcomes by sex of the child, family income and maternal skin colour. RESULTS In 1982, NICUs did not exist in the city; admissions into NICUs increased from 2.7% of all newborns in 1993 to 6.7% in 2015, and admission rates were similar in all income groups. Hospitalizations during the first year of life fell by 29%, from 23.7% in 1982 to 16.8% in 2015, and diarrhoea admissions fell by 95.2%. Pneumonia admissions fell by 46.3% from 1993 to 2015 (no data available for 1982). Admissions due to perinatal causes increased during the period. In the poorest income quintile, total admissions fell by 33% (from 35.7% to 23.9%), but in the richest quintile these remained stable at around 10%, leading to a reduction in inequalities. Over the whole period, children born to women with black or brown skin were 30% more likely to be admitted than those of white-skinned mothers. CONCLUSIONS Whereas NICU admissions increased, total admissions in the first year of life declined by nearly one-third. Socioeconomic disparities were reduced, but important gaps remain.
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Affiliation(s)
| | - Cesar G Victora
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Bernardo L Horta
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Ana M B Menezes
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Iná S Santos
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | | | - Bruna G C da Silva
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Fernando C Barros
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil
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Matijasevich A, Victora CG, Silveira MF, Wehrmeister FC, Horta BL, Barros FC. Maternal reproductive history: trends and inequalities in four population-based birth cohorts in Pelotas, Brazil, 1982-2015. Int J Epidemiol 2019; 48:i16-i25. [PMID: 30883655 PMCID: PMC6422066 DOI: 10.1093/ije/dyy169] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2018] [Indexed: 12/29/2022] Open
Abstract
Background Brazil experienced important progress in maternal and child health in recent decades. We aimed at describing secular trends as well as socioeconomic and ethnic inequalities in reproductive history indicators (birth spacing, previous adverse perinatal outcome, parity and multiple births) over a 33-year span. Methods Four population-based birth cohort studies included all hospital births in 1982, 1993, 2004 and 2015 in Pelotas, Southern Brazil. Information on reproductive history was collected through interviews. Indicators were stratified by family income quintiles and skin colour. Absolute and relative measures of inequality were calculated. Results From 1982 to 2015, the proportion of primiparae increased from 39.2% to 49.6%, and median birth interval increased by 23.2 months. Poor women were more likely to report short intervals and higher parity, although reductions were observed in all income and ethnic groups. History of previous low birthweight was inversely related to income and increased by 7.7% points (pp) over time—more rapidly in the richest (12.1 pp) than in the poorest quintile (0.4 pp). Multiple births increased from 1.7% to 2.7%, with the highest increase observed among the richest quintile and for white women (220% and 70% increase, respectively). Absolute and relative income and ethnic-related inequalities for short birth intervals increased, whereas inequalities for previous low birthweight decreased over time. Conclusions In this 33-year period there were increases in birth intervals, multiple births and reports of previous low-birthweight infants. These trends may be explained by increased family planning coverage, assisted reproduction and a rise in preterm births, respectively. Our results show that socioeconomic and ethnic inequalities in health are dynamic and vary over time, within the same location.
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Affiliation(s)
- Alicia Matijasevich
- Department of Preventive Medicine, Faculty of Medicine FMUSP, University of São Paulo, São Paulo, Brazil.,Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Cesar G Victora
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Mariangela F Silveira
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | | | - Bernardo L Horta
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Fernando C Barros
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.,Postgraduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil
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Silva AAMD. Monitoring trends in socioeconomic, maternal and child health inequalities. Int J Epidemiol 2019; 48:i1-i3. [PMID: 30883652 DOI: 10.1093/ije/dyz024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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25
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Gonçalves H, Barros FC, Buffarini R, Horta BL, Menezes AMB, Barros AJD, Domingues MR, Victora CG. Infant nutrition and growth: trends and inequalities in four population-based birth cohorts in Pelotas, Brazil, 1982-2015. Int J Epidemiol 2019; 48:i80-i88. [PMID: 30883656 PMCID: PMC6422060 DOI: 10.1093/ije/dyy233] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Levels of child undernutrition have declined in many middle-income countries, whereas overweight and obesity have increased. We describe time trends in nutritional indicators at age 1 year in the 1982, 1993, 2004 and 2015 Pelotas (Brazil) Birth Cohorts. METHODS Each study included all children born in the urban area of the city, with over 4 200 births in each cohort. Children were measured at approximately 12 months of age. Anthropometric indicators were calculated according to World Health Organization Growth Standards. Stunting and wasting were defined as <-2 Z scores for length for age and weight for length, and overweight as >2 Z scores for weight for length. Prevalence was stratified by sex, maternal skin colour and family income. RESULTS The prevalence of stunting declined by 53% (from 8.3% to 3.9%) from 1982 to 2015. Wasting prevalence remained stable at low levels (1.8% in 1982 and 1.7% in 2015), whereas overweight increased by 88% (6.5% to 12.2%). Undernutrition was more common among boys, those born to mothers with brown or black skin colour and in the poorest quintile of families. Socioeconomic inequalities in undernutrition decreased markedly over time. Overweight was markedly more common among the rich in 1982, but fast increase among the poor eliminated socioeconomic differences by 2015, when all groups showed similar prevalence. CONCLUSIONS Our results confirm the rapid nutrition transition in Brazil, with marked reduction in levels and inequalities in undernutrition in parallel with a rapid increase in overweight, which became the main nutritional problem for children.
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Affiliation(s)
- Helen Gonçalves
- Post Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Fernando C Barros
- Post Graduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil
| | - Romina Buffarini
- Post Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Bernardo L Horta
- Post Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Ana M B Menezes
- Post Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Aluísio J D Barros
- Post Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Marlos R Domingues
- Post Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Cesar G Victora
- Post Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
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Barros FC, Victora CG. Commentary: A tale of many cities in one: the Pelotas (Brazil) Birth Cohorts, 1982-2015. Int J Epidemiol 2019; 48:i89-i93. [PMID: 30883658 PMCID: PMC6422057 DOI: 10.1093/ije/dyy214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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