Práticas alimentares na infância, crescimento infantil e obesidade na vida adulta

A saúde infantil é amplamente afetada pelo estado nutricional. Há um interesse crescente acerca da possibilidade do estado nutricional apresentado pela criança e das práticas alimentares na primeira infância estarem relacionados à obesidade em indivíduos adultos, aumentando os riscos para complicações metabólicas. Sabe-se que estudos prospectivos possibilitam a investigação e a avaliação apropriadas de determinantes do desenvolvimento infantil. Consequentemente, o presente artigo objetivou revisar as principais evidências disponíveis a partir de estudos longitudinais sobre associações entre práticas alimentares na primeira infância, padrões de crescimento infantil e estado nutricional verificados durante a vida adultaChild health is widely affected by nutritional status, and there is growing interest surrounding the possibility that child nutritional status and infant feeding practices may be linked to obesity in adulthood, increasing risks of metabolic complications. Prospective studies enable appropriate investigation and evaluation of the determinants of childhood development. The present paper therefore aimed to provide a review of the main evidence to date from longitudinal studies concerning the associations of infant feeding practices, patterns of childhood growth and nutritional status exhibited in adult lifeFAPESP n. 08/57796-3, e CNPq n. 300167/97-

Protocol for a Randomized Controlled Trial

Funding Information: This work was supported by the Brazilian National Council of Technological and Scientific Development (CNPq; grants 407255/2013-3 and 404500/2021-8) and the São Paulo Research Foundation (FAPESP; grant 2016/00270-6). ACDAH is the recipient of the FAPESP PhD scholarship (grant 2022/03401-5). MAC is the recipient of the CNPq senior research scholarship (grant 303794/2021-6). The funders had no role in the design and analysis of the study or the writing of this study. Publisher Copyright: © Ana Carolina de Andrade Hovadick, Marly Augusto Cardoso.Background: Stunting and micronutrient deficiencies have persistently affected children in the Brazilian Amazon for decades. However, in recent years, a notable increase in childhood overweight prevalence has been observed, particularly in the context of heightened food insecurity exacerbated by the COVID-19 pandemic. Despite the limited number of effective solutions proposed to tackle this problem, digital interventions have shown great promise worldwide in preventing obesity and promoting healthy diets. Objective: This study aims to describe the protocol of a family-based WhatsApp intervention, specifically designed to investigate the efficacy of multimedia messaging in preventing excessive weight gain and improving healthy eating practices among school-aged children in the Amazon region. Methods: This study protocol outlines a theory-driven randomized controlled trial based on the cognitive theory of multimedia learning and the social cognitive theory. A total of 240 parents or caregivers of children enrolled in the Maternal and Child Health and Nutrition Cohort Study in Acre (MINA-Brazil) will be recruited by phone and social media. The intervention group will receive persuasive multimedia messages through WhatsApp over 19 weeks, while the waitlist control group will remain in the usual care. The primary outcome is a change in children’s BMI in z score. Secondary outcomes are changes in dietary intake and biochemical indicators of the children. Outcome measures will be assessed at baseline and 5 months after randomization in comparison to usual care. The analysis will use an intent-to-treat approach and will be conducted using the statistical package Stata (version 18.0), with a significance level set at P<.05. Paired and unpaired 2-tailed t tests will be applied to compare mean changes in the outcomes. Results: Data collection started in June 2023, and final measurements are scheduled to be completed in December 2023. The results of the main analysis are expected to be available in 2024. Conclusions: This innovative multimedia message intervention holds significant potential for fostering behavioral changes among Amazonian children.publishersversionpublishe

Avaliação de validade de um questionário de freqüência alimentar em mulheres de baixa renda residentes em São Paulo, Brasil

This study describes the validity of a food frequency questionnaire (FFQ) in 93 low-income women (20-65 years), participating in a case-control study in São Paulo, Brazil. Two FFQ (FFQ1 and FFQ2, 12 months apart) and three 24-hour dietary recalls (24hR) were conducted between 2003 and 2004 to estimate dietary intake during the past year. The Pearson correlation coefficients (crude, energy-adjusted and de-attenuated) were used for comparisons between FFQ and 24hR. The agreement between the methods was further examined by the Bland-Altman analysis. For the assessment of long-term reliability, the energy-adjusted intra-class correlation coefficients were mostly around 0.40, but higher for vitamin A and folate (0.50-0.56). Energy-adjusted, attenuation-corrected Pearson validity correlations between FFQ and DR ranged from 0.30-0.54 for macronutrients to 0.20-0.48 for micronutrients, with higher value for calcium (0.75). There were small proportions of grossly misclassified nutrient intakes, while Bland-Altman plots indicated that the FFQ is accurate in assessing nutrient intake at a group level.Este estudo compara a validade de questionário de freqüência alimentar (QFA) em 93 mulheres participantes de estudo caso-controle em São Paulo, Brasil. Dois QFA (12 meses de intervalo entre QFA1 e QFA2) e 3 recordatórios de 24 horas (R24h) foram obtidos entre 2003 e 2004. Coeficientes de correlação de Pearson (brutos, ajustados pelas calorias totais e com correção intra-indivíduos) foram utilizados na comparação entre os métodos. A concordância entre QFA e R24h foi avaliada pela análise de Bland-Altman. Na avaliação de reprodutibilidade em longo prazo, coeficientes de correlação intraclasse ajustados pelas calorias totais foram próximos de 0,40, com valores maiores para vitamina A e folato (0,50-0,56). Coeficientes de correlação de Pearson ajustados pelas calorias totais e de-atenuados variaram de 0,30-0,54 para macronutrientes a 0,20-0,48 para micronutrientes, com valores maiores para cálcio (0,75). Houve uma pequena proporção de erro de classificação, e a análise de Bland-Altman sugere que o QFA é adequado para a classificação do consumo de nutrientes para o grupo de indivíduos estudado.(FAPESP) São Paulo Research FoundationNational Research Council (CNPq

Complementary feeding and nutritional status of 6-24-month-old children in Acrelândia, Acre State, Western Brazilian Amazon

Com objetivo de investigar o estado nutricional e alimentação complementar em crianças de 6 a 24 meses, residentes na Amazônia Ocidental Brasileira, um estudo transversal foi realizado na área urbana do Município de Acrelândia, Estado do Acre, com 164 crianças. As prevalências de déficit de estatura/idade e anemia foram de 12% e 40%, respectivamente, e de deficiência de ferro isolada, de 85%. Os níveis séricos das vitaminas A e B12 estavam baixos em 15% e 12% das crianças, respectivamente. Houve baixo consumo alimentar dos seguintes nutrientes (% de crianças abaixo das recomendações): ácido fólico (33%), vitamina C (40%), vitamina A (42%), zinco (46%) e ferro (71%). A biodisponibilidade de ferro da dieta foi de 8%. Observou-se baixo consumo de frutas, hortaliças e carnes, com consumo excessivo de leite de vaca e mingau.Our objective was to investigate nutritional status and complementary feeding practices in children from 6 to 24 months of age living in the Western Brazilian Amazon. A cross-sectional study was conducted within an urban area of Acrelândia, Acre State. A total of 164 children were studied. Prevalence rates for stunting and anemia were 12% and 40%, respectively, and overall prevalence of iron deficiency was 85%. Vitamin A and B12 serum levels were below normal thresholds in 15% and 12% of children, respectively. Low intake was observed for the following nutrients (% of children): folic acid (33%), vitamin C (40%), vitamin A (42%), zinc (46%), and iron (71%). Iron bioavailability in the diet was approximately 8%. Very low dietary intakes of fruits, vegetables, and meats were observed, in contrast with excessive consumption of cow's milk and porridge.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e tecnológico (CNPq

Exclusive breastfeeding frequency at 30 days of life: review of longitudinal studies

A nutrição adequada no início da vida pode afetar o desenvolvimento e a sobrevivência infantil, por isso a adesão às práticas de aleitamento materno e o seu monitoramento regular tornam-se essenciais. Este artigo objetiva realizar uma revisão integrativa da literatura sobre a frequência do aleitamento materno exclusivo (AME) aos 30 dias de vida, divulgada em estudos longitudinais. Para isso, foram identificados artigos nas bases de dados PubMed e LILACS. A combinação dos termos de pesquisa foi “estudo prospectivo” e “aleitamento materno”. A busca limitou-se aos artigos em inglês, espanhol e português, e compreendeu as publicações entre os anos 2015 e 2020. Foram selecionados 17 estudos originais. Apesar das diferenças metodológicas entre eles, em relação ao tipo e tamanho de amostra, a definição do AME e método de mensuração, os resultados indicam alta taxa de início da amamentação (≥86%) e ampla variação da ocorrência de AME aos 30 dias (4,5%-86%), com declínio substancial (&lt;60%) em 63% dos locais investigados. Esses resultados distam do cumprimento da recomendação da Organização Mundial da Saúde de AME até o sexto mês, e indicam a necessidade de investigações, com metodologia padronizada, para comparação dentro dos e entre os países, visando ao planejamento de ações para incentivo da amamentação.Early life feeding can affect children’s development and survival. Adherence to breastfeeding practices and regular monitoring is essential. This study aims an integrative review of longitudinal studies on the frequency of exclusive breastfeeding (EBF) at 30 days of life. Articles were retrieved from the PubMed and LILACS databases. The combination of descriptors used was: “prospective study” and “breast feeding.” The search was limited to articles published between 2015 and 2020 in English, Spanish, and Portuguese. We selected 17 original studies. Despite their methodological differences regarding sample size and type, follow-up period, and EBF definition and measurement method, results indicated a high rate of breastfeeding initiation (≥86%) and a wide variation in the occurrence of EBF at 30 days (4.5% - 86%) with substantial decline (&lt;60%) in 63% of the investigated areas. These results are far from complying with the recommendation from the World Health Organization of maintaining EBF up to the sixth month of children’s life and point to the need for further investigations with a standardized methodology for comparisons within and between countries, aiming at planning actions which support breastfeeding

Internal consistency of the Strengths and Difficulties Questionnaire in Amazonian children

OBJECTIVE: To describe the frequency of behavioral problems and the internal consistency of the parent version of the Strengths and Difficulties Questionnaire (SDQ-P) in Amazonian preschool children during the covid-19 pandemic. METHODS: Data from the Maternal and Child Health and Nutrition in Acre (MINA-Brazil) study, a population-based birth cohort in the Western Brazilian Amazon, were used. The SDQ-P was applied in 2021 at the five-year follow-up visit to parents or caregivers of 695 children (49.4% of which were girls). This instrument is a short behavioral screening questionnaire composed of 25 items reorganized into five subscales: emotional symptoms, conduct problems, hyperactivity/inattention, peer relationship problems, and prosocial behavior. Cases of behavioral problems were defined according to the original SDQ cut-offs based on United Kingdom norms. Moreover, cut off points were estimated based on the SDQ-P percentile results of our study sample. Internal consistency was assessed by calculating Cronbach's alpha coefficient and McDonald's omega for each scale. RESULTS: According to the cut-offs based on our studied population distribution, 10% of all children had high or very high total difficulty scores, whereas it was almost twice when the original SDQ cut-offs based on United Kingdom norms, were applied (18%). Differences were also observed in the other scales. Compared to girls, boys showed higher means of externalizing problem and lower means of prosocial behavior. The five-factor model showed a moderate internal consistency of the items for all scales (0.60 ≤ α ≤ 0.40), except for total difficulty scores, which it considered substantial (α > 0.61). CONCLUSIONS: Our results support the usefulness of SDQ in our study population and reinforce the need for strategies and policy development for mental health care in early life in the Amazon.publishersversionpublishe

Breastfeeding practices and head circumference in young children: a systematic review

OBJECTIVE: To review observational studies on the association between breastfeeding (BF) practices and head circumference (HC) of children &lt; 2 years old. METHODS: A systematic review was conducted using the following electronic databases of ​​health sciences: PubMed, Latin American and Caribbean Literature in Health Sciences (Lilacs), Web of Science and Scopus. We selected observational studies published in any language from January 01, 2010 to November 19, 2021, from different populations that investigated the association between BF practice and HC among healthy children &lt;2 years old. Titles and abstracts were screened independently by two evaluators. RESULTS: From the 4229 articles identified, 24 were included in this review: 6 cross-sectional, 17 longitudinal, and 1 case-control. The studies varied in their definition of the variables for BF and in reporting its practice, frequency, duration, and feeding method. Regarding HC, the authors analyzed the mean differences, abnormal values ​​(z-score above + 2SD or below -2SD according to the World Health Organization (WHO) growth standards, 2007), and longitudinal growth parameters. The findings of this review suggest that BF may have a positive relationship with HC at the beginning of life. CONCLUSIONS: Our findings suggest that BF, especially exclusive BF, may play a protective role against abnormal HC values in young children. However, more robust evidence with standardized BF indicators and WHO growth standards (2007) are required

Influence of early life factors on body mass index trajectory during childhood: a population‐based longitudinal analysis in the Western Brazilian Amazon

Low‐ to middle‐income countries may experience the occurrence of a dual burden of under and overnutrition. To better understand the overall progression of body mass index (BMI) during childhood, we estimated average BMI‐for‐age z‐score (BAZ) growth curves in a population‐based longitudinal study of 255 children living in the Brazilian Amazon. Children were aged 0.1–5.5 years at recruitment (2003). We collected data on socio‐economic and maternal characteristics, children's birthweight and infant feeding practices. Child anthropometric measurements were taken in 2003, 2007 and 2009. BAZ differences among categories of exposure variables were calculated at 6 and 12 months, and 2, 7 and 10 years. At baseline, the mean (standard deviation) age was 2.6 (1.4) years; 12.9% were overweight and 3.9% thin. After adjustment, mean BAZ estimates were mostly negative. Boys were close to the median value for BAZ until 12 months, whereas girls were below the median (P = 0.05). Children from households above the wealth median were 0.36 z‐ and 0.49 z‐less underweight than poorer children at 7 and 10 years, respectively (P < 0.01). Maternal BMI was positively associated with children's BAZ since 12 months old; BAZ in children from overweight mothers was higher by 0.69 compared with their counterparts at 10 years (P < 0.01). Birthweight was positively related to BAZ up until 2 years (P = 0.01). Socio‐economic background and maternal nutritional status are important predictors of BAZ throughout childhood. Although excessive weight gain is a public health concern, it is critical to restrict inequities, while promoting healthier growth in developing countries.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/110869/1/mcn12005.pd

Health outcomes of the Bolsa Família program among Brazilian Amazonian children

OBJECTIVE: One of the primary objectives of Brazil’s conditional cash transfer program, Bolsa Família, is to break the intergenerational transmission of poverty by improving human capital via conditionalities. In this study, we hypothesized that health indicators of Bolsa Família participants would be comparable to those of other local children who were nonparticipants after two years of follow-up in the city of Acrelândia, Acre state, Western Brazilian Amazon. METHODS: Data from a population-based longitudinal study were analyzed to examine school enrollment, vaccination coverage, height and body mass index for age z-scores, and biomarkers of micronutrient deficiencies (iron and vitamin A) between Bolsa Família participants (n = 325) and nonparticipants (n = 738). RESULTS: Out of 1063 children 10 years and younger included in the 2007 baseline survey, 805 had anthropometric measurements and 402 had biochemical indicators in the 2009 follow-up survey. Prevalence rate ratio (PRR) for non-enrollment in school at 4 years of age was 0.58 (95%CI: 0.34–1.02) when comparing Bolsa Família participants with nonparticipants. No difference was found for vaccination coverage, which was insufficient for most vaccine-preventable diseases. Bolsa Família participants were less likely to show a positive change in body mass index for age z-scores compared with nonparticipants (PRR = 0.81, 95%CI: 0.70–0.95), while a positive change in height for age z-scores was similar in the groups. No differences in micronutrient deficiencies were found between groups after 2 years. CONCLUSIONS: Early school enrollment and consistent nutritional indicators between Bolsa Família participants and nonparticipants suggest Bolsa Família was facilitating similarities between groups over time