Estilo parental na alimentação e o comportamento alimentar aos 12 meses

Introdução: A formação do comportamento alimentar é um processo complexo que inicia na infância e é determinada por inúmeros fatores, dentre eles a interação entre criança e cuidador no momento das refeições. Objetivo: Analisar a associação entre estilo parental na alimentação e o comportamento alimentar em lactentes aos 12 meses de vida. Metodologia: Estudo transversal aninhado a um ensaio clínico randomizado, com lactentes nascidos a termo e com peso de nascimento ≥2500g em Porto Alegre – RS e região metropolitana cujas mães participaram da intervenção aos 5,5 meses de vida da criança. O comportamento alimentar da criança foi avaliado pelo Questionário do Comportamento Alimentar da Criança (CEBQ) e o estilo parental na alimentação pelo Questionário de Estilos Parentais na Alimentação (QEPA), ambos aos 12 meses por questionário on-line. As variáveis sociodemográficas da família foram coletadas no início da pesquisa por questionário on-line. As variáveis quantitativas foram descritas como média e desvio-padrão (DP) ou mediana e intervalo interquartílico [P25 – P75] e as variáveis categóricas, utilizando frequências absolutas (n) e relativas (%). Um modelo de regressão linear múltipla foi construído para avaliar a associação entre os domínios ―Interesse por comida‖ e ―Desinteresse por comida‖ do CEBQ (variável dependente) e QEPA (variável independente), ajustado para as variáveis que demonstraram associação com p<0,10 na regressão linear univariada. Foram considerados fatores de exposição as dimensões do estilo parental ―Exigência‖ e ―Responsividade‖, idade materna, amamentação aos 12 meses, renda familiar total e escolaridade materna. O desfecho analisado foi o escore infantil nos domínios do comportamento alimentar ―Interesse por comida‖ e ―Desinteresse por comida‖. Para as análises estatísticas foi considerado o nível de significância de 5% (p<0,05). Resultados: Foram avaliados 118 pares mãe-lactentes aos 12 meses. A mediana de idade materna foi de 33 anos [28 – 36 anos], renda familiar total R$6.000 [R$ 3.850 – 10.000] e escolaridade materna de 18 anos [15 – 20 anos]. O aleitamento materno aos 12 meses reduziu em 0,388 unidades o ―Interesse por comida‖ no modelo ajustado (p=0,003). O aumento de um escore da ―Exigência‖ parental aumentou em 0,364 unidades o ―Desinteresse por comida‖ (p=0,002) e estar em aleitamento materno aos 12 meses aumentou em 0,262 unidades o ―Desinteresse por comida‖ (p=0,024) no modelo ajustado. Conclusão: A ―Exigência‖ parental e o aleitamento materno aos 12 meses estão associados ao comportamento de controle da ingestão alimentar em lactentes.Introduction: The formation of eating behavior is a complex process that begins in childhood and is specified by numerous factors, including an interaction between child and caregiver at mealtime. Objective: To analyze an association between parenting style in eating and eating behavior in infants at 12 months of age. Methods: Cross-sectional study nested in a clinical trial, with full-term infants with birth weight ≥2500g in Porto Alegre - RS and metropolitan region, mothers participated in the intervention at the age of 5.5 months of the child. The child's eating behavior was verified by the Child Eating Behavior Questionnaire (CEBQ) and the parenting style in eating by the Caregiver's Feeding Styles Questionnaire (CFSQ), both at 12 months of age through an on-line questionnaire. The sociodemographic variables of the family were collected at the beginning of the survey through an on-line questionnaire. Quantitative variables were found as mean and standard deviation (SD) or median and interquartile range [P25 - P75] and categorical variables, using absolute (n) and relative (%) frequencies. A multiple linear regression model was constructed to assess the association between the CEBQ ―Food Approach‖ and ―Food Avoidance domains‖ (dependent variable) and CFSQ (independent variable), adjusted for variables that showed association with p<0.10 in linear regression univariate. Exposure factors were considered as parenting style dimensions ―Demandingness‖ and ―Responsiveness‖, maternal age, breastfeeding at 12 months, total family income and maternal education. The outcome analyzed was the child score in the eating behavior domains ―Food Approach‖ and ―Food Avoidance‖. For statistical analysis, a significance level of 5% (p <0.05) was considered. Results: We studied 118 mother-infant pairs at 12 months. The median maternal age was 33 years [28 - 36 years], total family income R$6,000 [R$3,850 - 10,000] and maternal education of 18 years [15 - 20 years]. Breastfeeding at 12 months reduced 0.388 units of ―Food Approach‖ (p = 0.003) in model adjusted. Increasing the parental demandingness score increased the ―Food Avoidance‖ 0.364 units (p = 0.002) and being breastfeeding at 12 months increased the ―Food Avoidance‖ 0.262 units (p = 0.024) in model adjusted. Conclusion: Parental demandingness and breastfeeding at 12 months are associated with behavior to control food intake in infants

Can the complementary feeding method be a strategy to reduce the offer of ultra-processed foods?

Objective: To verify the prevalence of the offer of ultra-processed foods (UPFs), and to analyze their associated factors in the child's first year of life. Methods: Cross-sectional study with 119 mother-infant pairs. At 5.5 months of the child, the mothers received guidance on complementary feeding (CF) according to three methods: Parent-Led Weaning (PLW), Baby-Led Introduction to SolidS (BLISS), or mixed (a combination of PLW and BLISS). At nine and 12 months, the mothers answered a questionnaire about the offer of UPFs. The NOVA classification, which classifies foods according to the nature, extent, and purposes of the industrial processes to which they are subjected, was used to list the UPFs. Descriptive statistics and multivariate Poisson regression, following a multilevel hierarchical model according to the proximity to the outcome, were used to estimate the association between dependent and independent variables. Results: The prevalence of UPF consumption was 63% (n = 75) in the first year of life. Receiving guidance on healthy CF in the BLISS method showed to be a protective factor for offering UPFs (RR 0.72; CI95 0.52-0.99). Attending less than six prenatal consultations was a risk factor for the UPFs provision (RR 1.39; CI95 1.07-1.80). Conclusion: The prevalence of UPFs offered in the first year of life in this study can be considered high, and future interventions aimed at avoiding UPFs offered in this population should consider the CF method

Duração da amamentação e comportamentos alimentares na primeira infância : uma revisão sistemática

Objectives: to analyze the influence of breastfeeding duration on eating behavior in children aged two to six years. Methods: this review was conducted by PRISMA guidelines. SciELO, Lilacs, Embase, and PubMed databases were researched by using a specific syntax, for studies published from 2000 to 2020. The Joanna Briggs Institute Critical Appraisal checklist was used to assess the risk of study bias. Results: a total of 26,211 articles were identified, of which seven were included in the study. The results showed a significant association in four studies. All authors used their own questionnaires to assess breastfeeding exposure; there was no standard classification of exclusive and total breastfeeding duration. The breastfeeding duration was associated with reduced food neophobia, lower scores on the food responsiveness subscale, and lower ‘picky eating’ behavior. Validated instruments were predominantly used to assess the outcome of eating behavior; however, this assessment was not similar between studies. Conclusion: a significant association was observed between breastfeeding duration and eating behavior in children aged two to six years. Further research should be conducted to describe the mechanisms involved in this association.Objetivos: analisar a influência da duração do aleitamento materno no comportamento alimentar em crianças de dois a seis anos. Métodos: esta revisão foi conduzida de acordo com as diretrizes PRISMA. As bases de dados SciELO, Lilacs, Embase e PubMed foram pesquisadas usando uma sintaxe específica, para estudos publicados de 2000 a 2020. O Joanna Briggs Institute Critical Appraisal checklist foi utilizado para avaliar o risco de viés do estudo. Resultados: foram identificados 26.211 artigos, dos quais sete foram incluídos no estudo. Os resultados mostraram associação significativa em quatro estudos. Todos os autores usaram seus próprios questionários para avaliar a exposição à amamentação; não havia uma classificação padrão de duração do aleitamento materno exclusivo e total. A duração do aleitamento materno foi associada à redução da neofobia alimentar, menores escores na subescala de responsividade alimentar e menor comportamento alimentar exigente. Instrumentos validados foram usados predominantemente para avaliar o resultado do comportamento alimentar, no entanto, essa avaliação não foi semelhante entre os estudos. Conclusão: observou-se associação significativa entre a duração da amamentação e o comportamento alimentar em crianças de dois a seis anos. Mais pesquisas devem ser realizadas para descrever os mecanismos envolvidos nesta associação

Síntomas de estreñimiento funcional y métodos de alimentación complementaria : ensayo clínico aleatorizado

Introduction The aim of the study was to investigate the impact of different complementary feeding methods on the prevalence of functional constipation symptoms in infants at 12 months of age. Material and methods Randomized clinical trial in mother–infant dyads that underwent the intervention at 5.5 months post birth, randomly allocated to one of three complementary food introduction methods: PLW (parent-led weaning), Baby-led Introduction to SolidS (BLISS) and a mixed approach. The symptoms of constipation were assessed at 12 months with an online questionnaire based on the Rome IV diagnostic criteria and adapted to our sample. The data were summarised as absolute frequencies and percentages and compared by means of the χ2 test. The project was approved by the ethics committee of the Hospital de Clínicas de Porto Alegre under number 2019-0230. Results We analysed data corresponding to 135 infants, 45 allocated to PLW, 48 to BLISS and 42 to the mixed approach. The prevalence of constipation symptoms was 49.6% in the overall sample (n = 67), 60% (n = 27) in the PLW group, 47.9% (n = 23) in the BLISS group and 40.5% (n = 17) in the mixed approach group. We found no association between functional constipation symptoms and the method used to introduce complementary foods (P = .183). Conclusions The prevalence of functional constipation symptoms was high in the study population. The presence of constipation symptoms was not associated with the complementary feeding approach.Introducción El objetivo del estudio fue investigar el impacto de diferentes métodos de alimentación complementaria en la prevalencia de síntomas de estreñimiento funcional en lactantes a los 12 meses de edad. Materiales y métodos Ensayo clínico aleatorizado realizado en díadas madre-lactante sometidas a intervención a los 5,5 meses del nacimiento, con asignación aleatoria a uno de los tres métodos de introducción de sólidos: destete dirigido por la madre, o parent-led weaning (PLW), método Baby-Led Introduction to SolidS (BLISS) dirigido por el lactante, y mixto. Los síntomas de estreñimiento se evaluaron a los 12 meses mediante un cuestionario en línea basado en los criterios diagnósticos de Roma IV y adaptado a la muestra. Los análisis se realizaron mediante la prueba χ2 y los datos se expresaron como frecuencias absolutas y porcentajes. El proyecto fue aprobado por el comité de ética del Hospital de Clínicas de Porto Alegre con el número 2019-0230. Resultados Se analizaron los datos de 135 lactantes, 45 asignados al método PLW, 48 al BLISS y 42 al método mixto. La prevalencia de síntomas de estreñimiento fue del 49,6% en la muestra global (n = 67), siendo del 60% (n = 27) en el método PLW, 47,9% (n = 23) en el BLISS y 40,5% (n = 17) en el mixto. No hubo asociación entre los síntomas de estreñimiento funcional y el método de introducción de la alimentación complementaria (p = 0,183). Conclusiones La prevalencia de estreñimiento y sus síntomas fue alta en la población estudiada. La prevalencia de los síntomas de estreñimiento funcional no se asoció con el método de alimentación complementaria

Choking, gagging and complementary feeding methods in the first year of life : a randomized clinical trial

Objective: Compare the occurrence of choking and gagging in infants subjected to three complementary feeding (CF) methods. Methods: Randomized clinical trial with mother-infant pairs, allocated according to the following methods of CF: a) Parent-Led Weaning (PLW) — group control, b) Baby-Led Introduction to SolidS (BLISS), and c) mixed (initially BLISS and if the infant presents a lack of interest or dissatisfaction, PLW), with the last two methods guided by the infant. Mothers received nutritional intervention on CF and prevention of choking and gagging according to the method at 5.5 months of age and remained in follow-up until 12 months. Frequencies of choking and gagging were collected by questionnaire at nine and 12 months. The comparison between groups was performed using the analysis of variance test (p 0.05). The choking was caused mainly by the semi-solid/solid consistency. Moreover, 100 (80%) infants aged from six to 12 months presented gagging and their characteristics were not statistically different among groups (p > 0.05). Conclusion: Infants following a baby-led feeding method that includes advice on minimizing choking risk do not seem more likely to choke than infants following traditional feeding practice that includes advice on minimizing choking risk

Food consumption markers and minimum dietary diversity in different complementary feeding methods: a randomized clinical trial

Objective: To evaluate food consumption markers and minimum dietary diversity in 12-month-old infants exposed to different methods of food introduction. Methods: A randomized clinical trial with mother-infant pairs undergoing intervention on food introduction in three methods: Parent-Led Weaning (PLW), Baby-Led Introduction to SolidS (BLISS), and mixed (combination of the two techniques). Food consumption markers were evaluated by an online questionnaire at 12 months based on food consumed the previous day, using food consumption markers for children under 2 years of the Food and Nutrition Surveillance System. The study was approved by the ethics committee. Results: At 12 months, 136 children were evaluated: 45 allocated to PLW, 48 to BLISS, and 43 to mixed. The foods with the highest prevalence of consumption were breast milk 103 (75.7%), vegetables 122 (89.7%), meat 135 (99.3%), beans 115 (84.6%), rice, potatoes, or yam 135 (99.3%). Ultra-processed foods were present in the diet of infants, including hamburgers or sausages 3 (2.2%), sweetened beverages 2 (1.5%), instant noodles 4 (2.9%), and sandwich cookies 2 (1.5 %). No differences were found between the methods of introducing complementary feeding. The minimum dietary diversity was present in the diet of 22 infants (16.2%), being: 6 (13.3%) in the PLW, 8 (16.7%) in the BLISS, and 8 (18.6%) in the mixed (p=0.793). Conclusion: Breast milk, vegetables, meat, beans, and rice were present in the diet of most infants; however, the prevalence of minimal dietary diversity was low. The consumption of ultra-processed foods was also present in the diet of infants.   Brazilian Registry of Clinical Trials (ReBEC) identification RBR-229scm

Risk factors for the development of cardiovascular disease in patients with depression in a hospital in Southern Brazil

Introdução: A associação entre depressão e fatores de risco cardiovascular é recorrente. O aumento de risco em deprimidos está relacionado à fatores como obesidade, sedentarismo, dislipidemia, alcoolismo e tabagismo. O objetivo deste trabalho foi identificar a presença de fatores de risco para o desenvolvimento de doenças cardiovasculares em pacientes com quadro de depressão internados em um hospital do sul do Brasil. Métodos: Estudo transversal que envolveu adultos de ambos os sexos internados por episódio depressivo. O estado nutricional foi avaliado pelas medidas antropométricas de peso, altura e circunferência da cintura. Um questionário foi aplicado englobando perfil sociodemográfico, histórico familiar de doenças, consumo de produtos de tabaco e de álcool, atividade física, além do questionário autoaplicável para medida da severidade da depressão. Para avaliação do risco cardiovascular global, foi calculado o escore de Framingham. Os testes qui-quadrado de Pearson (χ2 ) ou exato de Fisher foram utilizados para testar a associação entre as variáveis categóricas, considerando o nível de significância quando p ≤ 0,05 e IC95%. Resultados: Foram avaliados 54 indivíduos, predominantemente mulheres (n = 32), com idade média de 40,2 ± 10,8 anos. A depressão foi classificada como grave na maioria dos pacientes (n = 29). Fatores de risco relacionados ao nível de atividade física (sedentarismo), dislipidemia e estado nutricional (sobrepeso e obesidade) estiveram presentes em 81,5%, 73,1% e 66,7% da amostra, respectivamente. Percentual de risco obtido por meio do escore de Framingham foi encontrado acima do normal em 42,9% dos indivíduos. Depressão leve associou-se positivamente aos pacientes com magreza/eutrofia e, ao serem estratificados como severos e não-severos, o primeiro grupo teve associação positiva com histórico familiar de excesso de peso e hipertensão. Conclusões: Diversos fatores de risco cardiovascular foram encontrados, alertando para a importância do cuidado integral da saúde do paciente e avaliação destes indicadores.Introduction: The association between depression and cardiovascular risk factors is recurrent. Increased risk of depression is related to factors such as obesity, sedentary lifestyle, dyslipidemia, alcoholism, and smoking. The aim of this study was to identify the presence of risk factors for the development of cardiovascular disease in patients with depression admitted to a hospital in southern Brazil. Methods: A cross-sectional study involving adults of both sexes hospitalized for a depressive episode. Nutritional status was assessed by the anthropometric measurements of weight, height and waist circumference. A questionnaire was applied covering sociodemographic data, family history of diseases, consumption of tobacco and alcohol products, and physical activity, in addition to a self-administered questionnaire to measure the severity of depression. The Framingham risk score was calculated for global cardiovascular risk evaluation. Pearson’s chi-square test (χ2 ) or Fisher’s exact Test were used to test the association between categorical variables, considering the level of significance at p ≤ 0.05 and 95% CI. Results: Fifty-four individuals were evaluated, most were women (n = 32), with a mean age of 40.2 ± 10.8 years were evaluated. Depression was classified as severe in most patients (n = 29). Risk factors related to the physical activity level (sedentary lifestyle), dyslipidemia and nutritional status (overweight and obesity) were present in 81.5%, 73.1% and 66.7% of the sample, respectively. Percentage of risk obtained by the Framingham risk score was found above normal in 42.9% of the individuals. Mild depression was positively associated with thin/eutrophic patients and, when stratified as severe and non-severe, the first group had a positive association with family history of overweight and hypertension. Conclusions: Several cardiovascular risk factors were found, alerting to the importance of integral health care for patients and evaluation of these indicators