Does family mealtime have a protective effect on obesity and good eating habits in young people? A 2000-2016 review

Abstract Objectives: to review the prevalence of family meals and its impact on BMI and eating habits during childhood and adolescence. Methods: reviews are from Bireme / Lilacs / Scielo / Cochrane and Pubmed, between 2000-2016 with descriptors "family meal or mealtime", "behavior", "nutrition or diet or consumption or eating", and "child or children or adolescence"; performed by two independent examiners, according to the systematic steps in English and Portuguese. The articles were selected based on prevalence and/ or discussion between nutritional variables. 2,319 articles were found, which 15 were selected all in English: systematic reviews (n=2), cross-sectional studies (n=8), longitudinal studies (n=8); all related to children (n=5), adolescents (n=6) and both (n=5). Results: the mean of shared meals was 1x/day, with a prevalence of 27 to 81%. Most studies (n=13) reported the beneficial impact on BMI, higher consumption of fruit and vegetables, protein, calcium and a lower consumption of sweets and sugar sweetened beverages, family union and self-regulation of appetite. Conclusions: having daily family mealtime has beneficial effect on the nutritional status and children and adolescents' eating behavior.

Position statement on nutrition therapy for overweight and obesity: nutrition department of the Brazilian association for the study of obesity and metabolic syndrome (ABESO-2022)

Obesity is a chronic disease resulting from multifactorial causes mainly related to lifestyle (sedentary lifestyle, inadequate eating habits) and to other conditions such as genetic, hereditary, psychological, cultural, and ethnic factors. The weight loss process is slow and complex, and involves lifestyle changes with an emphasis on nutritional therapy, physical activity practice, psychological interventions, and pharmacological or surgical treatment. Because the management of obesity is a long-term process, it is essential that the nutritional treatment contributes to the maintenance of the individual's global health. The main diet-related causes associated with excess weight are the high consumption of ultraprocessed foods, which are high in fats, sugars, and have high energy density; increased portion sizes; and low intake of fruits, vegetables, and grains. In addition, some situations negatively interfere with the weight loss process, such as fad diets that involve the belief in superfoods, the use of teas and phytotherapics, or even the avoidance of certain food groups, as has currently been the case for foods that are sources of carbohydrates. Individuals with obesity are often exposed to fad diets and, on a recurring basis, adhere to proposals with promises of quick solutions, which are not supported by the scientific literature. The adoption of a dietary pattern combining foods such as grains, lean meats, low-fat dairy, fruits, and vegetables, associated with an energy deficit, is the nutritional treatment recommended by the main international guidelines. Moreover, an emphasis on behavioral aspects including motivational interviewing and the encouragement for the individual to develop skills will contribute to achieve and maintain a healthy weight. Therefore, this Position Statement was prepared based on the analysis of the main randomized controlled studies and meta-analyses that tested different nutrition interventions for weight loss. Topics in the frontier of knowledge such as gut microbiota, inflammation, and nutritional genomics, as well as the processes involved in weight regain, were included in this document. This Position Statement was prepared by the Nutrition Department of the Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO), with the collaboration of dietitians from research and clinical fields with an emphasis on strategies for weight loss.

Delayed Development of Feeding Skills in Children with Feeding Difficulties-Cross-sectional Study in a Brazilian Reference Center

BACKGROUND

Delays in gross motor development, sensory processing issues, and organic and behavioral problems are known to interfere in the development of feeding skills (FS); and-therefore-in the success of the process of feeding a child. Children with feeding difficulties (FD) commonly present inadequacy of FS.

OBJECTIVES

Assessment of five FS in Brazilian children with FD, and search of associations with types of FD.

METHODS

Cross-sectional study with 70 children below 10 years old. Data were obtained from medical records: age, gender, age at texture transitions, feeding phase (breastfeeding, weaning to solids or full solids) at first complaint; characteristics of the meal (duration, environment, and shared meals with adults), self-feeding practices, use of feeding equipment and bottle, mouthing, feeding position and FD diagnosis. Skills were categorized according to standards for age. Chi-Square, Anova Test (or non-parametric equivalent) and Multinomial logistic regression tests were used, with a significance level of 5%.

RESULTS

There was no difference in FS (p > 0.05) or in the number of FS inadequateness (p = 0.84) according to FD diagnosis. The majority (94%) of children presented at least one delayed development of FS; 1/3 presented delays in more than half of the FS. The most prevalent inadequacies in FS were inadequate feeding position (73.5%), prolonged bottle feeding (56.9%), and inadequate self-feeding practices (37.9%). Feeding complaints first appeared at 10.9 ± 11.4 months, and picky eating was the most prevalent type of FD (37.1%). Most children were fed in inadequate environments (55.2%), without the company of adults (78%). Transition to solid foods occurred at 16 ± 5.6 months. Multinomial logistic regression showed no difference in likelihood of presenting any type of FD compared to picky eating, according to FS. Age at texture transition both from breastfeeding to complementary feeding (p = 0.95), and from complementary feeding to solid foods (p = 0.43) did not vary according to FD diagnosis.

CONCLUSION

FS development or number of FS inadequateness did not vary according to FD diagnosis. Identification of these inadequacies could help the discussion for multi-professional treatment of patients with FD.

Fatty acid intake and metabolic syndrome among overweight and obese women

ABSTRACT: Objective: To examine relations between fatty acids intake and metabolic syndrome (MetS) status among overweight and obese women (n = 223). Methods: This was a cross-sectional study. The physical and laboratory tests included anthropometry, body composition evaluation and measurements of blood pressure, fasting blood glucose, insulinemia and lipid profiles. A three-day food diary was used to evaluate fatty acids consumption. Statistical analysis included χ2 test and odds ratio measurements. Results: The women had 35.2 (6.9) years old and 15.2% presented MetS. Women with MetS presented higher serum levels of very low-density lipoprotein cholesterol, triglycerides, glucose and insulin in addition to higher diastolic blood pressure in comparison to women without MetS. Overweight women with MetS consumed higher amounts of monounsaturated fatty acids - 24.3 g (24.7 - 36.4) versus overweight women without MetS - 23.9 g (23.8 - 26.8), polyunsaturated fatty acids - 16.7 g (14.6 - 21.1) versus overweight women without MetS - 13.6 g (13.8 - 15.8) and linoleic fatty acids - 15.9 g (6.5) versus overweight women without MetS - 13.1 g (5.1). Among obese women with MetS, higher intake of linoleic fatty acids was also noted - 17.6 g (6.1) versus obese women without MetS - 14.3 g (6.6) in addition to higher consumption of trans fatty acids - 4.7 g (4.8 - 6.3) versus obese women without MetS - 3.9 g (2.9 - 4.6). Increased quartiles of monounsaturated, polyunsaturated, linoleic and trans fatty acid intake were significantly associated with a greater occurrence of MetS. Conclusion: Lipid intake may be related to MetS, although other factors also need to be considered, such as lifestyle, genetics and metabolism.

How parents' feeding styles, attitudes, and multifactorial aspects are associated with feeding difficulties in children

BACKGROUND

Parental complaints about feeding difficulties (FD) during childhood are frequent in pediatrics. Behavioral factors about children's feeding and parental aspects are fundamental in solving these problems, but research in this area lacks information considering the joint presence of fathers and mothers. Thus, this study aimed to investigate the features of children, parents and mealtime practices related to FD reported by fathers and mothers and to identify parenting styles, mealtime actions, practices and factors associated with FD in children.

METHODS

323 parents (226 mothers and 97 fathers) of children aged 1 to 7 years were recruited in the emergency waiting room at Sabará Hospital Infantil, in São Paulo, Brazil, and self-completed electronic questionnaires on parenting style (Caregiver's Feeding Styles Questionnaire), parents' mealtime actions (Parent Mealtime Action Scale), socioeconomic information, personal and children's health data and routine meal practices.

RESULTS

The prevalence of FD in children was 26.6%. Indulgent parenting style was the most frequent (44.2%), followed by authoritarian (25.1%), authoritative (23.8%), and uninvolved (6.9%) styles. Most parents (75.8%) reported presence during meals, and 83.6% used distractions. Regression analyses after adjustments showed, as factors associated with FD, female children (OR: 2.06; 95%CI: 1.19-3.58), parents' FD history (OR: 3.16; 95%CI: 1.77-5.64), and greater frequency of parents' behavior of offering many food options (OR: 2.69; 95%CI: 1.18-6.14). Parents with indulgent styles had decreased chances of reporting FD in their children (OR: 0.13; 95%CI: 0.06-0.27). Furthermore, the practice of children sharing the family menu (OR: 0.43; 95%CI: 0.18-0.99) and higher frequency of parents' behavior of setting snack limits (OR: 0.44; 95%CI: 0.23-0.85) were inversely associated with FD.

CONCLUSIONS

This study reinforces the multifactorial aspects involved in the feeding difficulties context. It points out the importance of expanding knowledge of the individual role of fathers and mothers to compose a scenario that can guide future studies and interventions.

TRIAL REGISTRATION

CAAE #99221318.1.0000.5567 with registration number 2,961,598.

O papel do fonoaudiólogo no diagnóstico e tratamento multiprofissional da criança com dificuldade alimentar: uma nova visão

O presente artigo relata o caso clínico de paciente de dois anos e seis meses atendida por equipe multidisciplinar. A paciente apresentou dificuldades alimentares caracterizadas por recusa alimentar, tempo prolongado das refeições, defesa sensório-oral, reflexo de vômito anteriorizado e dificuldade mastigatória. Não se alimentava sozinha, nem participava das refeições em família. Apresentava refluxo gastroesofágico, alergia a proteína do leite de vaca e tosse seguida por vômito. Não apresentou comprometimento pondero-estatural. Foi utilizado o Programa de Refeição Compartilhada. Após acompanhamento médico, a conduta de trabalho foi definida e iniciada pelo trabalho sensório-oral, seguido do trabalho com a mastigação, associados ao trabalho de orientação familiar. A paciente passou a realizar as refeições com a família e participar das rotinas sociais de alimentação. O tempo de refeição foi reduzido e a recusa alimentar eliminada. Os aspectos sensório-motores-orais melhoraram significantemente. Após a alta e reavaliação em três meses, apresentou melhora no refluxo gastro-esofágico e a medicação foi suprimida. A nutricionista iniciou a introdução de derivados do leite, com boa aceitação por parte da paciente. O programa utilizado mostrou-se eficaz para o diagnóstico e tratamento da dificuldade alimentar apresentada pela paciente. A equipe multidisciplinar foi capaz de ter uma visão ampliada da dificuldade alimentar apresentada pela paciente, compreendendo as questões motoras, orais, orgânicas e nutricionais da alimentação da criança inseridas no seu contexto familiar.

O PEDIATRA DEVE INVESTIGAR SINTOMAS DE TRANSTORNOS OBSESSIVOS COMPULSIVOS EM CRIANÇAS COM DIFICULDADES ALIMENTARES?

RESUMO Objetivo: Revisar evidências atuais da relação entre transtorno obsessivo compulsivo e dificuldades alimentares. Métodos: Revisão das bases Science Direct e PubMed no período entre 2007 e 2017 em inglês, português e espanhol, com os termos em associação “transtorno obsessivo compulsivo” e “picky eating/dificuldade alimentar”. Foram selecionados apenas estudos de coorte, caso controle ou transversal, realizados em qualquer país, com crianças, adolescentes e/ou adultos e de qualquer tamanho amostral. Foram excluídos os artigos de opinião. Resultados: Cerca de 245 artigos foram selecionados e apenas 4 foram incluídos no estudo, segundo critérios de seleção. Os trabalhos descrevem essencialmente que há diferença no comportamento seletivo entre os sujeitos com e sem transtorno obsessivo compulsivo, com tendência para exacerbação de sintomas como nojo, ansiedade e escore de inflexibilidade de comportamento alimentar nos pacientes com esse transtorno. Conclusões: Existem sintomas compartilhados entre transtorno obsessivo compulsivo e dificuldade alimentar. O estudo alerta aos profissionais que acompanham pacientes com dificuldades alimentares para a importância da investigação de possíveis comorbidades psiquiátricas.

Common gastrointestinal symptoms in healthy infants receiving goat milk-based formula or cow's milk-based formula: a double-blind, randomized, controlled trial

OBJECTIVE

To assess common gastrointestinal symptoms in healthy Brazilian infants receiving goat milk-based formula (GMF) compared to cow's milk-based formula (CMF).

METHODS

We performed a 24-weeks double-blind, randomized, controlled study in Brazil, enrolling healthy infants from 3 to 12 months of age. Primary outcome were the gastrointestinal (GI) symptoms stool consistency, regurgitation frequency and crying duration. Secondary outcomes were growth trajectories and hemoglobin levels. Repeated mixed models were used to compare outcomes variables between GMF and CMF groups, while adjusting for age at baseline.

RESULTS

Fifty-six infants were recruited and randomly allocated in the GMF (n = 26) and the CMF (n = 30) group. Scores on all measured GI symptoms were low and similar among the groups throughout intervention period and improved over time. Average age- and sex-adjusted WHO z-scores of weight, length, head circumference, and weight-for-length were all within +/-1 SD and similar between groups, indicating adequate growth. Serum hemoglobin was 11.1 (SD 0.7) g/dL in infants fed GMF and 11.0 (SD 0.8) g/dL in infants fed CMF after the intervention and was similar between groups.

CONCLUSION

GMF was well tolerated, safe and supported adequate growth in infants. This was shown by the low occurrence of GI symptoms, adequate blood hemoglobin levels and adequate growth within WHO standards.

TRIAL REGISTRATION

The clinical trial was approved by the ethics committee of the Federal University of Bahia under number CAAE06923319.5.0000.5577. The study was retrospectively registered in clinicaltrials.gov on 02/05/2024 under identifier NCT06395571.

Association between parental feeding styles, body mass index, and consumption of fruits, vegetables and processed foods with mothers´ perceptions of feeding difficulties in children

BACKGROUND

Feeding difficulties (FDs) are complex phenomena influenced by parental factors, feeding behaviour, and cultural factors. However, studies of the influences of these factors on FDs incidence are scarce. Thus, this study aimed to identify the associations between mothers' perceptions of FDs in children and parental feeding styles, body mass index, and the consumption of fruits, vegetables and processed foods.

METHOD

Two hundred and fifty-seven mothers of children aged 1 to 6 years and 11 months participated in this cross-sectional study and self-completed electronic questionnaires on sociographic variables, parental feeding styles, the consumption of fruits, vegetables and processed foods and FDs. Nutritional status was classified by body mass index (kg/m2).

RESULTS

The prevalence of FDs in children was 48.2%, and the mean age was 43.8 (± 17.6) months. The indulgent parental feeding style was the most common (40.1%), followed by the authoritative (31.1%), authoritarian (23.7%), and uninvolved (5.1%) styles. An indulgent parental feeding style (OR: 4.66; 95% CI: 2.20-9.85), a high body mass index (OR: 1.35; 95% CI: 1.09-1.68), and the consumption of processed foods (OR: 5.21; 95% CI: 2.85-9.53) were positively associated with increased odds of the absence of FDs in children. The associations of authoritarian and uninvolved parental feeding styles and the consumption of fruits and vegetables with FDs in children were not significant.

CONCLUSION

This study identified multiple factors that are possibly associated with feeding behaviours in young children. However, further studies need to be undertaken to evaluate how such behaviours affect FDs.

Impact of the hypocaloric diet using food substitutes on the body weight and biochemical profile

Recent studies using balanced hypocaloric diets with food substitutes in some meals, have presented positive results. There are no studies with the Brazilian population on the efficacy of using food substitute, together with a hypocaloric diet. Main objective of this study was to verify the effects of a hypocaloric diet using food substitutes as meal replacement on the body weight, lipid profile, and glucose and insulin plasma levels. Seventy eight subjects of both genders were selected, 20-50 years old, and a body weight index between 25 kg/m2 and 35 kg/m2. The study lasted for six months and it was divided in 2 phases of three months each- mass reduction for 3 months and 3 months for maintenance. The sample was randomly divided in two groups: Group A (control- 3 months of general nutritional and physical orientation followed by 3 months with 1 meal replacement) and Group B (intervention- 2 meals replacement a day plus nutritional and physical orientation for 3 months followed by 3 months with 1 meal replacement). Anthropometric measurements, percent body fat (%BF), biochemical profile and intake survey were performed at moments 0, 3 and 6 months. Both groups showed a significant decrease in %BF, weight, and consequently in their BMI, in the third and sixth month of follow up. However, weight loss in group B was higher than in group A. At the end of the treatment, 0 and 25.0% of the patients of the group A and B, respectively, presented a weight loss higher than 10% of the initial weight. Comparing the triglycerides, LDL-cholesterol and glucose levels, between the beginning and after the three and six months of treatment, there was a significant reduction in the individuals only in group B. In conclusion, the use of food substitutes as meal replacement, together with a balanced, hypocaloric diet, proved to be efficient in weight loss for Brazilian overweighed individuals.

Transgenerational transmission of eating habits

OBJECTIVE

To investigate the relationship between the biopsychosocial environment and eating habits and behaviors that lead to the selection and consumption of certain food from the earliest stages of life. To clarify whether there is an interaction between genetic and epigenetic factors, and how they shape eating habits.

DATA SOURCE

A narrative review based on research in PubMed and Web of Science electronic databases was carried out over the last 10 years, searching the title and summary fields using the keywords Children OR adolescents Feeding Behavior eating OR Dietary Habits OR Eating Behavior OR Eating Habits OR Children obesity.

DATA SYNTHESIS

The generational transmission of eating habits is related to the home, community, and school environments, mainly during the first years of life, and can exert the modulation of habits during all stages of life. During childhood, the family's role in consolidating eating habits is very broad and ranges from choosing foods to prioritizing family meals, including the lifestyle.

CONCLUSIONS

Eating habits are transmitted from parents to children in different ways: environmental, emotional, social, and educational. In cases of obesity, a greater association of genetic influence can be observed.

Crianças com dificuldades alimentares apresentam um consumo excessivo de bebidas açucaradas

Introdução: O consumo excessivo de bebidas açucaradas na infância é uma preocupação no acompanhamento das dificuldades alimentares, visto que pode gerar inadequações do estado nutricional. Objetivo: Estimar o perfil do consumo de alimentos de consistência líquida em crianças com dificuldades alimentares atendidas em um centro especializado e, verificar a associação entre a quantidade ingerida e a contribuição energética de bebidas açucaradas e idade e índice de massa corporal por idade. Métodos: Estudo transversal com 119 crianças de 0 a 18 anos, realizado em ambulatório especializado no atendimento de dificuldades alimentares. Os dados foram coletados de prontuários e diário alimentar. Resultados: A maioria da amostra era do gênero masculino (66,1%), considerada eutrófica quanto ao IMC/idade (77,3%), com média de idade de 4,1 anos (± 3,25). Houve diferença estatisticamente significativa para ingestão total de sucos, sendo que os meninos tiveram maior média de ingestão. A média de contribuição energética tanto para o sexo masculino quanto para o feminino é maior em relação ao consumo de leite. No entanto, não houve diferenças estatisticamente significativas entre os resultados (p > 0,05). Foram encontradas correlações muito fracas ou fracas entre volume ingerido e contribuição energética de bebidas açucaradas e idade e índice de massa corporal por idade. Conclusão: Crianças com dificuldades alimentares apresentam consumo elevado de bebidas açucaradas, havendo maior ingestão de sucos por crianças do sexo masculino e o leite foi o líquido que apresentou maior contribuição energética na dieta total deles. As associações encontradas entre volume consumido e contribuição energética de bebidas, idade e índice de massa corporal são fracas ou muito fracas não correspondendo à correlação entre as mesmas. Palavras-chave: Alimentação infantil; bebidas; crianças.