Introdução de alimentos industrializados e de alimentos de uso tradicional na dieta de crianças de creches públicas no município de São Paulo

Navigating the Global Pandemic in Pediatric Overweight and Obesity: Emerging Challenges and Proposed Solutions

BACKGROUND

Since 1990, childhood overweight and obesity have been rising on every continent and have almost doubled worldwide. The deleterious consequences include hypertension, type 2 diabetes mellitus, and dyslipidemia leading to metabolic syndrome in childhood and myocardial infarction, stroke, cancer and other disabling conditions in adulthood.

PURPOSE

In Southern Europe, including Greece, Italy, and Spain, 10 to 15% of children are obese. Obesity in Eastern European countries is somewhat lower, but the rates of rise are very steep and will approach those in Southern Europe during the next few years. Worldwide, Asia accounts for nearly half of all overweight children under the age of 5, while Africa is home to one quarter of overweight children under 5. In Latin America, about 20% of children under 20 are overweight. Further, children living in poverty can suffer simultaneous overweight and obesity as well as malnutrition. In the US, the risk of being overweight in adolescence is several times higher when a younger child has a body mass index (BMI) in the 50th or greater percentile.

FINDINGS

If the clinical, non-clinical and public health communities ignore these challenges, such inaction will surely portend an unprecedented future pandemic of overweight and obesity in children and adolescents leading to future premature morbidity and mortality. All clinical, non-clinical and public health professionals should exert concerted efforts concerning their individual patients, their families, communities, and policymakers.

CONCLUSIONS

Such coordinated interdisciplinary efforts may curb these alarming trends and secure healthier futures for children and their families throughout the world.

Intersectoral Actions for the Promotion and Prevention of Obesity, Diabetes and Hypertension in Brazilian Cities: A Systematic Review and Meta-Analysis

This study showed the effectiveness of biomedical interventions in obesity, diabetes and hypertension (NCDs), but innovative and intersectoral elements in the fight against obesity, type 2 diabetes and hypertension were rare.

BACKGROUND

Is it possible to find effective and innovative actions to promote health and prevent NCDs in Brazilian municipalities? Can they be replicated?

OBJECTIVE

Our objectives were to identify innovative and effective intersectoral actions for promoting and preventing NCDs in Brazilian municipalities.

METHODS

This is a systematic review in an exploratory theoretical essay with a qualitative and quantitative approach. It is descriptive and analytical in terms of reporting findings and results. Inclusion and exclusion criteria favored health promotion work. Bias risk assessments was performed using the Cochrane GRADE and bias risk, with meta-analyses using RevMan and Iramuteq.

RESULTS

Meta-analysis of biometric markers resulted in -4.46 [95% IC; -5.42, -3.49], p = 0.00001, indicating a reduction in NCD risk rates. The textual meta-analysis revealed P(r) ≈ 83% (Reinert), meaning low connectivity between the 'halos'.

CONCLUSIONS

There is evidence of the effectiveness in interventions, but innovative and intersectoral elements to combat and prevent NCDs were barely seen. While evidence of intervention effectiveness was observed, innovative and intersectoral elements to combat and prevent NCDs were barely noticed.

Food consumption of children from zero to 23 months in a Brazilian municipality

Objective: to identify the frequency of food consumption in children aged zero to 23 months. Methods: this analytical research with a quantitative approach was conducted with 911 mothers/guardians of children aged under 23 months. In data collection, sociodemographic information and information on the frequency of food consumption of the child in the last 24 hours were obtained through a questionnaire of food consumption markers from SISVAN. Results: more than two-thirds of the participants reported having offered inappropriate foods for the child's age the day before. Among children under six months of age, inadequate food consumption had a prevalence of 38.3%. In the age group from 6 to 23 months, this frequency of consumption was 88.4%. The most inappropriate foods consumed by children under six months of age were water/tea, fruit, and salty foods. Between the ages of six and 23 months, the consumption of non-breast milk, sugary drinks, stuffed biscuits, sweets, and candies predominated. Conclusion: the consumption of inappropriate foods for age was highly prevalent, especially in children above six months old.

Dietary patterns of children aged 6-24 months assisted by the Bolsa Família Program

OBJECTIVE

This study aimed to verify the association between socio-economic and demographic characteristics and dietary patterns (DP) of children assisted by the Conditional Cash Transfer Program, Bolsa Família Program (BFP).

DESIGN

This is a cross-sectional study. DP were defined using a principal component analysis. The association of the predictive variables and DP was modelled using multilevel linear regression analysis.

SETTING

This study was conducted in six municipalities from the State of Alagoas, Brazil.

PARTICIPANTS

The participants were children aged 6-24 months who were assisted by the BFP.

RESULTS

A total of 1604 children were evaluated. Four DP were identified (DP1, DP2, DP3 and DP4). DP1 is composed of traditional Brazilian food. DP2 is formed mostly from ultra-processed foods (UPF). DP3 consists of milk (non-breast) with added sugar, while DP4 consists of fresh and minimally processed foods. Caregivers with higher age and education (β = -0·008; (95 % CI -0·017, -0·000); β = -0·037; (95 % CI -0·056, -0·018), respectively) were negatively associated with DP2. We observed a negative association between households with food insecurity (β = -0·204; (95 % CI -0·331, -0·078)) and DP4 and a positive association between caregivers with higher age and education (β = 0·011; (95 % CI (0·003; 0·019); β = 0·043; (95 % CI 0·025, 0·061), respectively) and DP4.

CONCLUSION

This study identified the association between socio-economic inequities and DP early in life, with an early introduction of UPF, in children assisted by BFP in the State of Alagoas.

Marketing of commercial foods for infant and young children in Uruguay: sugary products, health cues on packages and fun social products on Facebook

OBJECTIVE

To analyse the content of the marketing of commercial foods for infants and young children on packages and social media.

DESIGN

Commercial foods targeted at children, regarded as potential breast-milk substitutes according to the Uruguayan breast-feeding standard, were considered: dairy products; teas, juices and bottled waters; glucose solutions; cereals and mixtures of fruits and vegetables. All the products sold at forty-four retail outlets were purchased. A Facebook search was performed to identify accounts of these products. For each account, all the content posted by the brands between July 2017 and July 2019 was recorded. The visual and textual information included in the packages and Facebook posts was analysed using content analysis. Products were classified using the nutrient profile model of the Pan American Health Organization.

SETTING

Montevideo, Uruguay.

RESULTS

Seventy-six unique commercial foods targeted at infants and young children were identified, 96 % of which were excessive in sugar. Packages frequently included textual and visual elements to convey health-related associations, including images of fruits and vegetables, nutrient content claims and endorsement logos. Ten Facebook accounts were identified, which generated 302 posts. Parents and caregivers were the main target audience of the posts, which mainly included content related to fun and social aspects of food consumption. Additionally, the posts frequently conveyed the idea that products would contribute to children's growth and development.

CONCLUSIONS

Results suggest the need to implement comprehensive regulations on the marketing of commercial foods targeted at children, regarded as potential breast-milk substitutes according to the Uruguayan breast-feeding standard.

Food environment surrounding public and private schools: an opportunity or challenge for healthy eating?

The study analyzed and compared the types of food sold in the surroundings of 30 private and 26 public elementary schools in the city of Niterói, Rio de Janeiro. Data were collected by audit using a checklist instrument to characterize establishments (formal or informal) and identify the types of food and beverages sold, which were classified by processing level (fresh, processed, and ultraprocessed). Mann-Whitney statistical tests were used to verify the difference in the type of trade outlets d the categories of food sold between schools. The Kruskal-Wallis test was used to verify the difference in the amount of food traded between the categories. The amount of ultraprocessed food in the surroundings of public and private schools was statistically higher (p=0.0001) than the other categories. Some culinary preparations had a high rate of energy contribution from ultraprocessed foods (above 15%). There was no statistically significant difference (p = 0.478) in the categories of food sold between public and private schools. The sale of ultraprocessed products predominates around public and private schools, favoring the exposure of children to an environment that encourages the consumption of these products.

Food consumption of children enrolled in five municipal schools according to socio-demographics characteristics

ABSTRACT Objective To describe children food consumption in the five municipal schools in Pelotas, Rio Grande do Sul, and their main characteristics. Methods Cross-sectional study of children enrolled in five municipal schools. The mothers were interviewed at the school. The questionnaire about habitual food consumption was based on the guidelines of the Food and Nutrition Surveillance System. The data were entered in EpiData 3.1 and reviewed in Stata 14.0. The consumption frequency was reported according to each exposure category. Statistical tests based on Chi-Square test with 5% significance level and adjusted analyses through Poisson regression were used. Results A total of 548 children were included. Females represented 51.1% of the total sample; the average age was 48.3 months. Children up to two years of age were those who consumed the most fruits and vegetables while sweets were mostly consumed by older children, aged between three and four years. Unhealthy foods had a high frequency of consumption, with sweet being the most consumed (58.8%), followed by packet snacks (53.3%). In the adjusted analysis, eating meals in front of the screens remained associated with lower consumption of vegetables. Conclusion Eating meals in front of the screens reduces children’s vegetables consumption. At the same time, the child’s age and maternal education seem to have some influence on the consumption of unhealthy foods, indicating the need for nutritional education interventions.

Healthy Eating Index: adaptation for children aged 1 to 2 years

The goal was to adapt the Healthy Eating Index (HEI) to the US Dietary Guidelines for Brazilian children. Cross-sectional study conducted in a population-based sample of 1185 children 13-35 months old of São Luís municipality (MA). A 24-hour dietary recall Survey measured the food consumption and set the intrapersonal variance diet. We evaluated the construct validity by Principal Component Analysis and the Pearson correlation coefficient to see whether the index measures the quality of independent dietary energy consumed. We evaluated the reliability for the analysis of internal consistency, by calculating the alpha coefficient Conbrach and the correlations between each component and the total score. The correlations between the scores of components and energy were low (r ≤ 0.29). Four factors with eigenvalues > 1 were retained with cumulative variance of 58%. Cronbach's alpha was 0.48. The variety of the diet (r = 0.77) and vegetables and legumes (r = 0.60) had higher positive correlations with the total score (p < 0.05). The average of the HEI was 74.8 (± 13.2) points to 58.7% of children with diets that needed improvement. The adapted HEI proved to be valid to assess the overall quality of the diet of children.

Frequência do consumo de alimentos in natura ou minimamente processados em lactentes

Objetivou-se avaliar o consumo de alimentos in natura ou minimamente processados na dieta de crianças de 0 a 24 meses, que estejam em alimentação complementar. Tratando-se de um estudo transversal realizado durante o período de maio a julho de 2016, com os responsáveis por lactentes de 0 a 24 meses, frequentadores de 5 UAPS das regiões central e oeste do município de Juiz de Fora- MG. Foram coletados dados socioeconômicos e dados referente ao consumo alimentar, através de um questionário semiestruturado de frequência alimentar que contemplava questões sobre o consumo de alimentos in natura ou minimamente processados usualmente ingeridos pelo público alvo.  Utilizou-se o programa SPSS 19.0 para proceder as análises estatísticas. O nível de significância adotado foi de 5%. A amostra foi constituída por 112 indivíduos, cuja mediana de idade era de 13 (1-24) meses, desses, 50% eram do sexo feminino. As famílias apresentaram renda mediana de 2 (1-5) salários mínimos. Foi constatado que 42% e 20% dos lactentes não consomem carnes e verduras diariamente. As crianças que não consomem verduras diariamente, apresentaram mediana de idade maior do que aquelas que consomem diariamente. Também foi encontrado uma variação do consumo de acordo com a renda familiar, e as crianças que consomem frutas, legumes e verduras diariamente, apresentam mediana de renda maior do que aquelas que não consomem tais alimentos diariamente.  Os resultados encontrados reforçam a necessidade de ações efetivas para estimular o consumo de alimentos in natura ou minimamente processados, entre os lactentes.

Introduction of inappropriate complementary feeding in the first year of life and associated factors in children with low socioeconomic status

The study aimed to identify factors associated with the introduction of inappropriate complementary feeding in the first year of life in children living in municipalities (counties) with low socioeconomic statusl. This was a cross-sectional multicenter study in 1,567 children 12 to 59 months of age in 48 municipalities participating in the Brazil Without Poverty plan in the South of Brazil. A structured questionnaire was applied to the children's parents to obtain socio-demographic information and the age at which inappropriate complementary foods were introduced for the first time in complementary feeding. Prevalence of introduction of sugar before four months of age was 35.5% (n = 497; 95%CI: 33.1-38.0). The prevalence rates for the introduction of cookies/crackers, creamy yogurt, and jelly before six months of age were 20.4% (n = 287; 95%CI: 18.3-22.3), 24.8% (n = 349; 95%CI: 22.4-27.1), and 13.8% (n = 192; 95%CI: 12.0-15.7), respectively. Associations were identified between low maternal schooling (PR = 1.25; 95%CI: 1.03-1.51) and low monthly family income (PR = 1.22; CI95%: 1.01-1.48) and the introduction of inappropriate complementary feeding. The study identified the introduction of inappropriate complementary feeding in the first year of life among children in municipalities with high socioeconomic vulnerability in the South of Brazil, associated with low maternal schooling and low monthly family income.

Processed and ultra-processed food consumption among children aged 13 to 35 months and associated factors

Abstract: The aim of this study was to evaluate the consumption of processed and ultra-processed foods among children aged 13-35 months and its associated factors. We studied 1,185 children within the BRISA cohort in São Luís, Maranhão State, Brazil. The food consumption was investigated using a 24-hour recall, and the percentages of daily caloric intake and nutrients were estimated by food groups according to “NOVA” classification. We chose to categorize children belonging to the upper tertile of the distribution as having a high consumption of processed and ultra-processed food products. The Poisson regression model with robust variance estimation using a hierarchical modeling approach was used to calculate the prevalence ratios (PRs) of variables associated with high consumption of processed and ultra-processed food products. The mean energy intake was 1,226Kcal/day. After adjustments, there was a higher proportion of high consumption of processed and ultra-processed food products among children whose mothers had < 12 years of education and among children who were older than 16 months. Mothers with low schooling and children older than 16 months should be the targets of interventions aimed at reducing consumption of these food products and preventing adverse health outcomes in later life.

Excess weight in preschool children: The role of food intake

ABSTRACT Objective: The study aimed to compare the food intake of overweight/obese and normal weight preschoolers and to verify whether excess weight is associated with low birth weight, catch-up growth, early weaning, and physical activity/inactivity Methods: This case-control study was conducted in family healthcare units of the city of Olinda, Pernambuco, from May to August 2014 Results: A total of 253 children were studied, 84 with 'excess weight' and 164 with 'normal weight'. In the 'overweight/obese' and 'normal weight' groups, 77% and 43% of the children, respectively, had high calorie intake. The 'overweight/obese' group had lower fruit intake, higher maternal education level, higher family income, higher maternal excess weight, and presence of catch-up growth and inactivity Conclusion: The results suggest that food intake has an important role, but that other variables contribute to excess weight in children. Recognition of the problem's many causes should guide the public policies directed at this age group to prevent this nutritional disorder.

Food consumption of children younger than 6 years according to the degree of food processing

OBJECTIVE

To evaluate food intake according to the degree of processing, stratified by family income and age, in a representative sample of children younger than 6 years in the city of Pelotas, RS, Brazil.

METHODS

Cross-sectional population-based study carried out with 770 children aged 0-72 months of age living in the urban area of Pelotas. The dietary intake of children was assessed by 24-h recall administered to mothers or guardians. The energy intake was estimated and each food item was classified according to the food processing degree. Food consumption was stratified by age (younger than 24 months; 24 months or older) and associations between quintiles of family income and relative contribution of each food to total energy were performed by linear regression. The Wald test was applied to test linear trend across groups.

RESULTS

The mean energy intake was 1725.7kcal/day. The mean contribution of processed and ultraprocessed foods was 19.7% among children younger than 24 months and 37% in those aged 24 months or older, while the mean consumption of natural and minimally processed food was 61% and 44%, respectively. Among children aged 24 months or older, a greater consumption of canned foods, cheese and sweets was observed as family income quintiles increased, while breads were more consumed by those children belonging to the lower income quintiles.

CONCLUSION

A high caloric contribution of ultraprocessed foods in detriment to a lower consumption of natural and minimally processed foods was observed in the diet of children younger than 6 years.

Parental dietary patterns and social determinants of children's dietary patterns

ABSTRACT Objective To identify dietary patterns in children up to thirty months of age and verify whether they are associated with parental dietary patterns, and socioeconomic and demographic characteristics. Methods This is a cross-sectional study with baseline data from a population-based study composed of 1,085 households from a representative sample of a metropolitan region in Rio de Janeiro, Brazil. The children's food intake was evaluated by two 24-hour recalls, and the dietary patterns were identified by principal component analysis stratified into two groups according to the children's age: 6 to 17 months; and 18 to 30 months. The explanatory variables collected by a structured questionnaire were socioeconomic and demographic characteristics, age at introduction of complementary foods, and parental dietary pattern. A Food Frequency Questionnaire was administered to assess parental dietary pattern, which was determined by principal component analysis. Multivariate linear regression estimated the effect of each explanatory variable on the children's dietary patterns. Results Three dietary patterns were identified in children aged 6-17 months (basic-mixed; mixed-plus; and milk-flours) and two dietary patterns were identified in children aged 18-30 months: basic-mixed and mixed-plus. Multivariate linear regression showed that complementary feeding (b=0.108; p=0.004) was positively associated with the basic-mixed dietary pattern, and family income (b=0.002; p£0.01), with the mixed-plus dietary pattern. A negative association was found between the traditional parental dietary pattern and children's mixed-plus pattern in children aged 6-17 months (b=0.152; p=0.006) and in children aged 18-30 months (b=0.152; p=0.016). In children aged up to 18 months, parental education level (b=0.368; p£0.01) was positively associated with the mixed-plus dietary pattern. Conclusion Family income, parental education level, and parental dietary patterns are associated with children's dietary patterns.

Assessing the nutritional information for children younger than two years old available on popular websites

OBJECTIVE

To analyze whether the information found on popular Internet sites are in accordance with the steps recommended by the Food Guide for Children Younger than Two Years of the Ministry of Health (2010).

METHODS

Descriptive/comparative study, carried out between August and October 2014, which carried out a search for popular sites (for lay people) in Portuguese, containing information on nutrition of children younger than two years. The Google search engine was used. These findings were compared with the Food Guide for Children Younger than Two Years of the Ministry of Health (2010). It was verified whether the information shown on the websites was in accordance with the Guide.

RESULTS

A total of 50 sites were analyzed, including blogs, food company websites and websites specialized in child nutrition. Only 10% of those pages correctly showed every step of the Food Guide. The recommendations were: exclusive breastfeeding up to six months of life (80%); complementary feeding from six months of life (36%); baby food consistency according to the guide (48%); encouraging the consumption of fruits and vegetables daily (60%). Regarding the complementary feeding safety and hygiene, 26% contained correct information. Only 36% correctly warned about which foods should be avoided in the first years of life.

CONCLUSIONS

The information found on the sites is largely in disagreement with the Ministry of Health recommendations, which can lead to misconceptions in the nutritional care of the children younger than two years.

Ultra-processed foods: Consumption among children at day-care centers and their classification according to Traffic Light Labelling system

Objective: To identify the age at which ultra-processed foods are introduced in the diet of infants enrolled in public daycare centers and analyze these foods' nutritional composition according to the Traffic Light Labelling system adapted to the Brazilian norms and recommendations.Methods: Cross-sectional study including 636 nursery age children attending day care centers. Their mothers were interviewed about the age of introduction of instant noodles, snack chips, encased meat, chocolate, ice cream, and stuffed cookies. The proximate composition of these foods was evaluated according to the Traffic Light Labelling adapted to the Brazilian norms and recommendations, which classifies total fat, saturated fat, trans fat, fiber, and sodium amounts as green, yellow, or red indicators.Results: It was found that before 12 months of age 70.6% of children had consumed instant noodles, 65.9% snack chips, 54.7% encased meat, 67.1% chocolate, 36.9% ice cream, and 68.7% stuffed cookies. In addition, all foods were classified as red for saturated fat and sodium and 50.0% were classified as red for total fat.Conclusion: The introduction of ultra-processed foods in the children's diets occurred early, but it is worth mentioning that such foods have an inadequate nutritional composition, contributing to the excess consumption of total fat, saturated fat, and sodium, as well as low fiber.

[Socioeconomic, cultural and demographic maternal factors associated with dietary patterns of infants]

Objective:

To analyze dietary patterns of infants and its association with maternal socioeconomic, cultural, and demographic variables.

Methods:

A cross-sectional study was conducted with two groups of mothers of children up to 24 months (n=202) living in the city of Maceió, Alagoas, Northeast Brazil. The case group consisted of mothers enrolled in a Family Health Unit. The comparison group consisted of mothers who took their children to two private pediatric offices of the city. Dietary intake was assessed using a qualitative and validated food frequency questionnaire (FFQ). The evaluation of the FFQ was performed by a method in which the overall rate of consumption frequency is converted into a score.

Results:

Children of higher income families and mothers with better education level (control group) showed the highest median of consumption scores for fruits and vegetables (p<0.01) and meat, offal, and eggs (p<0.01), when compared with children of the case group. On the other hand, the median of consumption scores of manufactured goods was higher among children in the case group (p<0.01).

Conclusions:

Maternal socioeconomic status influenced the quality of food offered to the infant. In the case group, children up to 24 months already consumed industrial products instead of healthy foods on their menu.

Fatores associados ao consumo de bebidas açucaradas entre pré-escolares brasileiros: inquérito nacional de 2006

ResumoO crescente consumo de bebidas açucaradas como os refrigerantes ou sucos artificiais está associado à prevalência de obesidade no Brasil e no mundo. Este estudo se propõe a conhecer a frequência de consumo destas bebidas entre crianças brasileiras de 24 a 59 meses e investigar associações com variáveis demográficas, socioeconômicas e nutricionais. Utilizando dados da Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher − 2006, o padrão alimentar foi obtido com o questionário de frequência de alimentos e bebidas nos sete dias anteriores à data da entrevista e a antropometria usou medidas de peso e de estatura das crianças. Entre os pré-escolares, 37,3% consumiram refrigerantes e sucos artificiais 4 dias ou mais por semana. Os fatores que apresentaram associação estatisticamente significante com consumo frequente de BA foram residir em regiões de maior desenvolvimento econômico do país, em áreas urbanas, pertencer ao estrato de maior poder aquisitivo, mães que assistiam TV regularmente e excesso de peso da criança, estavam associados ao consumo de refrigerantes e sucos artificiais em 4 ou mais dias por semana. Novos estudos são necessários para a compreensão da real contribuição das bebidas açucaradas na epidemia de obesidade infantil.

[Healthy eating and the difficulties faced in making it a reality: perceptions of parents/guardians of pre-school children in Belo Horizonte/MG, Brazil]

A cross-sectional qualitative study was conducted to establish the perceptions of 77 guardians of preschool children enrolled in a Child Day Care Center in Belo Horizonte/Minas Gerais State, regarding what is a healthy diet and the difficulties faced in having a healthy diet. The instrument used was a pretested semi-structured questionnaire containing leading questions obtained in face-to-face interviews. For data analysis, the Collective Subject Discourse technique was used, which elicited data organization of a verbal nature. It was revealed that the guardians have a notion of what healthy diet is, however their answers implied inadequate eating habits. They attributed insufficient financial resources, lack of time and ingrained eating habits as being the main difficulties in having a healthy diet. These three difficulties are the reasons given by some guardians who do not believe they have a healthy diet. The conclusion drawn is that the guardians need to have a better diet, because their eating habits influence their children's eating habits. These findings revealed the need for food and nutrition education strategies to enable the guardians to recognize and have a healthy diet.

[The impact of health workers' training on breastfeeding and complementary feeding practices]

This study aimed to evaluate the impact on feeding practices for infants (<1 year of age) resulting from update training for health workers in the Ten Steps to Healthy Feeding of Children Under Two. Health Care Centers (HCC) in Porto Alegre, Rio Grande do Sul State, Brazil, were randomized into a control group (n=11) and an intervention group (n=9). Health centers organized according to Brazil's Family Health Program (FHP) were included as an intervention cluster (n=12). Infant feeding practices were evaluated at the health centers at 6 months (n=918) and again at 12 months of age (n=799). The results showed that mean duration of exclusive breastfeeding was significantly longer in the two groups that received the intervention (2.56±1.91 months in the FHP intervention and 2.32±1.63 months in the HCC intervention) compared to the HCC control group (1.91±1.60 months). There was a positive impact on the quality of complementary feeding of infants treated at the health centers that participated in the intervention, especially those with the FHP.

Características sociodemográficas e nutricionais de crianças brasileiras menores de 2 anos beneficiárias de programas de transferência condicionada de renda em 2006

Programas de transferência condicionada de renda (PTCR) visam o combate à pobreza e à fome e a garantia da segurança alimentar. Crianças menores de 2 anos de famílias beneficiárias são mais vulneráveis às condições ambientais. Este estudo objetiva caracterizar esta população segundo variáveis socioeconômicas, demográficas e nutricionais. Utilizaram-se dados secundários da Pesquisa Nacional de Demografia e Saúde da Crian ça e da Mulher (PNDS-2006). Descreveram-se os dados em média e desvios-padrão. Para as associações utilizou-se o teste qui-quadrado e intervalos de confiança de 95%. Das 1735 crianças 29,4% eram beneficiárias de PTCR com renda média familiar de R$430,20 e valor médio dos benefícios de R$75. Dentre as que residiam no Nordeste ou na região rural do país, uma em cada três recebiam PTCR. Entre as que viviam em insegurança alimentar grave, 52,3% pertenciam a PTCR. Classes econômicas D e E e baixa escolaridade materna associaram-se a PTCR. Entre os desvios nutricionais das crianças beneficiárias, prevaleceu o peso elevado para idade. Das que interromperam o aleitamento materno exclusivo antes dos dois meses, 31,2% eram de PTCR. Identifica-se a necessidade de educação nutricional preventiva a fim de otimizar a utilização do benefício.

Diagnóstico das práticas de alimentação complementar para o matriciamento das ações na Atenção Básica

A alimentação complementar adequada e oportuna é essencial para o crescimento e o desenvolvimento saudáveis da criança, sendo a Atenção Primária à Saúde, em especial os Núcleos de Apoio à Saúde da Família, o lócus ideal para o desenvolvimento de ações pertinentes a esta prática. Estudo transversal com aplicação de questionário para mães e avaliação antropométrica de 324 crianças visou desenvolver um escore de inadequações na alimentação complementar e estudar suas relações com variáveis socioeconômicas, clínico-epidemiológicas e nutricionais. Para quantificação das inadequações alimentares foi criado um escore por meio do Método Delphi. Foram observadas altas frequências para todas as inadequações, especialmente na introdução tardia de sólidos (80,2%), precoce de açúcares/engrossantes (78,1%) e precoce de líquidos (73,5%). Entre as variáveis mais significantemente associadas com o escore estão desmame precoce do aleitamento materno exclusivo (p = 0,000) e total (p = 0,005), ausência de companheiro (p = 0,001) e a mãe ser chefe da família (p = 0,025). A utilização do escore identifica situações de maior risco para subsidiar as ações prioritárias da assistência nutricional, especialmente para promover o trabalho matricial.

Relationship of socio-economic factors and parental eating habits with children's food intake in a population-based study in a metropolitan area of Brazil

OBJECTIVE

To evaluate the association of sociodemographic factors and parental food consumption with children's food intake.

DESIGN

A cross-sectional survey.

SETTING

A population-based study with a representative sample in a metropolitan region of Rio de Janeiro, Brazil. Parents' socio-economic variables, age and education level and children's age were obtained by face-to-face interviews. The parental food intake was assessed using an FFQ and the children's food intake was assessed using two 24 h recalls.

SUBJECTS

Children (n 366) aged 6-30 months and their parents.

RESULTS

The hierarchical regression analysis indicated that parents' age was positively associated with the intake of vegetables among children (β = 0·73, 95% CI 0·11, 1·34), while parents' educational level was positively associated with the intake of fats (β = 3·52, 95% CI 0·04, 7·01) and negatively associated with the intake of beans (β = -13·98, 95% CI -27·94, -0·03). The age of the children was positively associated with the intakes of meats and eggs (β = 2·88, 95% CI 1·55, 4·22), sugars (β = 5·08, 95% CI 1·85, 8·30) and coffee (β = 1·77, 95% CI 0·71, 2·84), and negatively associated with the intake of vegetables (β = -2·12, 95% CI -3·20, -1·05). The influence of parental food intake was observed for the food groups of breads, cereals and tubers (β = 0·06, 95% CI 0·003, 0·12), beans (β = 0·11, 95% CI -0·003, 0·22) and fruits (β = 0·10, 95% CI 0·03, 0·16). Unfavourable socio-economic variables were associated with intakes of breads, cereals and tubers, vegetables, fruits, meats, sugars and coffee by children.

CONCLUSIONS

Parental food intake is associated with children's intake of cereals, beans and fruits independent of socio-economic status.

Processed foods aimed at children and adolescents: sodium content, adequacy according to the dietary reference intakes and label compliance

OBJECTIVE: This study determined the sodium content of processed foods aimed at children and adolescents and the adequacy of its content in relation to the dietary reference intakes, and verified label compliance. METHODS: The sodium content of 17 food samples (instant noodles, breaded items, hamburger patties, hot dogs and bologna sausages) was determined by flame photometry and chloride titration, and the results were compared with nutritional data. The labels were checked for compliance with the pertinent laws. RESULTS: According to flame photometry and chloride titration, 13 and 5 products, respectively, had sodium contents that exceeded those reported on the nutrition facts label by more than 20%. All samples had more than 480mg of sodium per serving. The tolerable upper intake level for sodium for children aged 4-8 years was exceeded in 8 instant noodles and 3 breaded items according to flame photometry, and in 9 items according to chloride titration. Regarding the legislation, 5 products used a daily reference intake other than that provided by the legislation to report their percent sodium content per serving. Moreover, the serving sizes of 3 instant noodles, the terminology used in 1 instant noodles and the protein content of 1 breaded item were also not compliant with the legislation. CONCLUSION: The sodium contents in the study samples were high and there was no regard for the legislation.

Qualitative evaluation of the menu and plate waste in public day care centers in São Paulo city, Brazil

OBJECTIVE: This study assessed menu quality and plate waste in public day care centers of São Paulo (SP), Brazil. METHODS: This cross-sectional study collected data from the nurseries of seven day care centers, totaling 366 children aged 12 to 36 months. Each day care center was assessed for three days, totaling 42 days and 210 meals. Menu quality was assessed by the Qualitative Analysis of Menu Preparations method (Análise Qualitativa das Preparações do Cardápio), adapted for day care centers, which provides nutritional and sensory criteria. Food waste was determined by the Plate Waste-Ingestion Index. RESULTS: The supply of vegetables was inadequate in more than 90% of the days, and the amount of leafy vegetables and high-sulfur foods met the recommended amounts on 50% of the days. The supply of sweets and foods containing trans fatty acids was considerable. The Plate Waste-Ingestion Index for daycare centers varied from 25% to 43%, and the Plate Waste-Ingestion Index for food items varied from 11% to 47%. CONCLUSION: The preparations served and serving sizes clearly need to be reviewed, and new menu creation strategies are needed to control food waste.

Cárie dentária e práticas alimentares entre crianças de creches do município de São Paulo

OBJETIVO: Este estudo tem como objetivo avaliar associações entre a cárie dentária e a introdução de alimentos complementares em crianças de 11 a 34 meses matriculadas em creches. MÉTODOS: Trata-se de estudo transversal com 288 crianças de oito creches do município de São Paulo, realizado em 2007. Para o diagnóstico da cárie dentária foi utilizado o Índice de Cárie Modificado, que foi investigado por uma equipe de três cirurgiãs-dentistas treinadas quanto à precisão e acurácia. A introdução de alimentos foi avaliada por meio de questionário pré-codificado e pré-testado. Para quantificar as associações foi utilizado o teste Quiquadrado. Para análise multivariada foram ajustados modelos de regressão logística (p<0,05). RESULTADOS: Foram examinadas 228 crianças com idade entre 11 e 34 meses (M=24 meses; Dp=6,02), das quais 53,9% eram do sexo masculino e 57,45% frequentavam creches filantrópicas. A maioria da amostra (77,0%) apresentou Índice de Cárie Modificado igual ou superior a 1, enquanto o índice médio encontrado foi de 3,8 cáries por criança. Como fatores de risco significantes, foram identificados o sexo masculino (OR=1,815; p=0,03) e a escolaridade paterna inferior a oito anos (OR=1,94; p=0,02). O modelo de regressão logística identificou a exposição a carboidratos simples como fator de risco independente após o controle dos efeitos de sexo e escolaridade paterna, responsável por aumento de 2,5 vezes nas chances de apresentar o Índice de Cárie Modificado igual ou superior a 1. CONCLUSÃO: Atenção especial deve ser dada a esse grupo de indivíduos, adotando-se políticas preventivas em saúde bucal e formação de hábitos alimentares saudáveis nas creches.

[Perceptions of day care center teachers about daily practices of infant feeding: the impact of training]

This article stresses the importance of the qualification of professionals involved in the feeding of children in daycare centers, such that they offer adequate food and programs are developed in order to foster healthy food habits in infants from birth. Thus, the scope of this paper was to evaluate the impact of a training program for these daycare teachers in their perceptions and practices in infant feeding. A qualitative approach was used to evaluate the impact of training, with the application of the focus group technique. Sixteen groups were created, eight of which were daycare centers with training and eight without training, the average number of participants being 6 to 11 per institution aged between 19 and 66. The discourse of the teachers who took part in the training program is replete with signs of small changes, or at least with the recognition that it is indeed necessary and possible to promote change. The importance of organizing and conducting training programs for the nutritional education of teachers in day care centers is emphasized, with the continuous supervision of the effects of the qualification as a strategy for infant health.