54 research outputs found

    Feeding during the first three months of life

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    Universidade Federal de São Paulo (UNIFESP) Departamento de PediatriaUniversidade Federal de São Paulo (UNIFESP)UNIFESP, Depto. de PediatriaUNIFESPSciEL

    Caloric compensation in preschool children: relationships with body mass and differences by food category

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    Maintaining a healthy weight may involve compensating for previously consumed calories at subsequent meals. To test whether heavier children demonstrated poorer caloric compensation across a range of conditions, and to explore whether compensation failure was the result of inadequate adjustment of overall intake or specific over-consumption of highly palatable, high energy-density 'junk' foods, we administered two compensation tests to a sample of 4-5 y olds. For Test A, preloads varied only in carbohydrate content and were organoleptically indistinguishable (200 ml orange-flavored beverage [0 kcal vs. 200 kcal]). For Test B, the preloads varied substantially in both macronutrient composition and learned gustatory cues to caloric content (200 ml water [0 kcal] vs. 200 ml strawberry milkshake [200 kcal]). Each preload was followed 30 min later by a multi-item ad-libitum meal containing junk foods (chocolate cookies, cheese-flavored crackers) and core foods (fruits and vegetables, bread rolls, protein foods). Testing took place at the children's own school under normal lunch-time conditions. Children were weighed and measured. Caloric compensation occurred in both tests, in terms of total, junk and core food intake (RMANOVA, all p < 0.01). Higher BMI z scores were associated with greater average caloric compensation (r = -0.26p < 0.05), such that overweight/obese children showed least compensation (41%), children over the 50th centile the next least (59%), and children under the 50th centile (80%) the most. For Test A only, obese/overweight children compensated less well than normal weight children in terms of junk food intake (RMANOVA preload-by-weight group interaction p < 0.05), with no significant effect for core foods. Our results suggest that caloric compensation is consistently poorer in heavier children, and that overweight/obese children's preferences for junk foods may overwhelm intake regulation mechanisms within meals containing those foods. (C) 2017 Elsevier Ltd. All rights reserved.National Institute of Diabetes and Ingestive and Kidney Diseases (NIDDK)Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)Office of the Director, National Institutes of Health (OD)Coordenação de Aperfeiçoamento de Pessoal de Níel Superior (CAPES)Medical Research Council (MRC)Johns Hopkins Univ, Sch Med, Dept Psychiat & Behav Sci, Div Child & Adolescent Psychiat, 600 N Wolfe St Phipps 300, Baltimore, MD 21287 USAUniv Roehampton, Dept Psychol, London, EnglandFed Univ São Paulo UNIFESP, Dept Pediat, Discipline Nutrol, São Paulo, SP, BrazilFed Univ São Paulo UNIFESP, Dept Pediat, Discipline Nutrol, São Paulo, SP, BrazilNIDDK: R00DK088360OD: U54HD070725Web of Scienc

    Peso al nacer de niños brasileños menores de dos años

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    Low birth weight is associated with increased risk of dying in the first year of life. This study was motivated by recent changes in the determination of birth weight patterns with the advent of the perinatal epidemiological transition. We analyzed data from the Brazilian National Survey of Demographic and Health of Children and Women including only children < 24 months. Prevalence of low birth weight in Brazil was 6.1%. Risk factors included female gender, residence in the South and Southeast geographic regions, low maternal education, and maternal smoking. The low birth weight profile changed, with higher prevalence in more economically developed regions, reflecting the neonatal epidemiological transition determined by changes in patterns of childbirth care and incorporation of perinatal life support technologies, in addition to the previously known biological risks associated with poverty and misinformation.El bajo peso al nacer tiene una gran relación con el riesgo de morir en el primer año de vida. Estudios muestran su asociación con problemas de desarrollo en la infancia y enfermedades en la vida adulta. Dada la importancia de este indicador, el objetivo de este estudio fue investigar los factores sociales, demográficos, biológicos y ambientales involucrados en su determinación. Se analizaron los datos de la Investigación Nacional de Demografía y Salud del Niño y de la Mujer (PNDS-2006), incluyendo solamente niños menores de 24 meses de vida. La prevalencia de bajo peso al nacer en Brasil fue de un 6,1%. Los factores de riesgo identificados fueron sexo femenino, residir en las macrorregiones Sur y Sudeste y ser hijo de madres con baja escolaridad o tabaquistas. Hubo cambios en el perfil de bajo peso al nacer, con mayor prevalencia en regiones más desarrolladas económicamente, reflejando la transición epidemiológica perinatal, caracterizada por cambios en los padrones de asistencia al parto e incorporación de los avances tecnológicos en la asistencia perinatal, además de factores de riesgo biológicos conocidos, asociados a la pobreza y a la desinformación.O baixo peso ao nascer tem grande relação com risco de morrer no primeiro ano de vida. Estudos mostram sua associação com problemas de desenvolvimento na infância e doenças na vida adulta. Dada a importância desse indicador, o objetivo deste estudo foi investigar os fatores sociais, demográficos, biológicos e ambientais envolvidos na sua determinação. Analisaram-se dados da Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher (PNDS-2006), incluindo apenas crianças menores de 24 meses de vida. A prevalência de baixo peso ao nascer no Brasil foi de 6,1%. Os fatores de risco identificados foram sexo feminino, residir nas macrorregiões Sul e Sudeste e ser filho de mães com baixa escolaridade ou tabagistas. Houve mudanças no perfil do baixo peso ao nascer, com maior prevalência em regiões mais desenvolvidas economicamente, refletindo a transição epidemiológica perinatal, caracterizada por mudanças nos padrões de assistência ao parto e incorporação dos avanços tecnológicos na assistência perinatal, além de fatores de risco biológicos conhecidos associados à pobreza e à desinformação.Universidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

    Fatores associados à subestimação do status do peso da criança pelos pais

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    Objective: The aim of this study was to examine the prevalence of parental misperception of child weight status, and identify socioeconomic, anthropometric, behavioral and dietary factors associated with underestimation. Method: Cross-sectional study. Data was collected in 14 Brazilian private schools. Parents of children aged 2-8 years (n= 976) completed a self-reported questionnaire assessing their perception of their child's weight status, and sociodemographic, anthropometric, behavioral and dietary information. To measure the agreement between parental perception about child weight status and actual child weight status, the Kappa coefficient was estimated, and to investigate associations between parental underestimation and independent variables, chi-squared tests were performed, followed by multiple logistic regression, considering p <= 0.05 for statistical significance. Results: Overall, 48.05% of the parents incorrectly classified their child's weight. Specifically, 45.08% underestimated their child's weight status, with just 3% of parents overestimating. Children with higher body mass index (OR = 2.03p< 0.001) and boys (OR = 1.70p < 0.001) were more likely to have their weight status underestimated by parents. Conclusion: Since awareness of weight problems is essential for prevention and treatment, clinical practitioners should help parents at high risk of misperception to correctly evaluate their child's weight status. (C) 2017 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda.Objetivo: Analisar a prevalência de percepção errônea dos pais sobre o status do peso infantil e identificar fatores socioeconômicos, antropométricos, comportamentais e dietéticos associados à subestimação. Método: Trata-se de um estudo transversal. Os dados foram coletados em 14 escolas particulares brasileiras. Pais de crianças de dois a oito anos de idade (n = 976) preencheram um questionário autoaplicável sobre sua percepção do estado nutricional do seu filho e informações sociodemográficas, antropométricas, comportamentais e dietéticas. Para medir o grau de concordância entre a percepção dos pais do peso do filho e o peso real do filho, estimamos o coeficiente Kappa e investigamos as associações entre subestimação do pai e variáveis independentes, calculamos o qui-quadrado seguido do modelo de regressão logística múltipla considerando p≤0,05 para significância estatística. Resultados: Em geral, 48,05% dos pais classificaram incorretamente o peso de seus filhos; particularmente, 45,08% subestimaram o peso do seu filho e apenas 3% subestimaram o peso infantil. A regressão logística demonstrou que as crianças com maior índice de massa corporal (OR = 2,03; p < 0,001) e os meninos (OR = 1,70; p < 0,001) tinham maior probabilidade de ter seu peso subestimado pelos pais. Conclusão: Médicos clínicos devem concentrar suas intervenções nessas crianças para ajudar os pais a avaliar corretamente o seu peso. A consciência dos pais sobre um problema de peso em crianças é essencial para a prevenção e tratamento da obesidade infantil e estilos de vida saudáveis.CAPESNational Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (OD)Office of the Director, National Institutes of Health (OD)Conselho Nacional de Pesquisa (CNPq)Univ Fed Sao Paulo UNIFESP, Dept Pediat, Disciplina Nutrol, Sao Paulo, SP, BrazilUniv Sao Paulo, Fac Saude Publ, Dept Epidemiol, Sao Paulo, SP, BrazilJohns Hopkins Univ, Sch Med, Dept Psychiat & Behav Sci, Div Child & Adolescent Psychiat, Baltimore, MD 21205 USAUniv Fed Sao Paulo UNIFESP, Dept Pediat, Disciplina Nutrol, Sao Paulo, SP, BrazilNIDDK: R00DK088360NICHD/OH: U54HD070725NIH/OH: U54HD070725Web of Scienc

    Validation of the comprehensive feeding practices questionnaire in parents of preschool children in Brazil

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    Background: Recent national surveys in Brazil have demonstrated a decrease in the consumption of traditional food and a parallel increase in the consumption of ultra-processed food, which has contributed to a rise in obesity prevalence in all age groups. Environmental factors, especially familial factors, have a strong influence on the food intake of preschool children, and this has led to the development of psychometric scales to measure parents' feeding practices. The aim of this study was to test the validity of a translated and adapted Comprehensive Feeding Practices Questionnaire in a sample of Brazilian preschool-aged children enrolled in private schools. Methods: A transcultural adaptation process was performed in order to develop a modified questionnaire (43 items). After piloting, the questionnaire was sent to parents, along with additional questions about family characteristics. Test-retest reliability was assessed in one of the schools. Factor analysis with oblique rotation was performed. Internal reliability was tested using Cronbach's alpha and correlations between factors, discriminant validity using marker variables of child's food intake, and convergent validity via correlations with parental perceptions of perceived responsibility for feeding and concern about the child's weight were also performed. Results: The final sample consisted of 402 preschool children. Factor analysis resulted in a final questionnaire of 43 items distributed over 6 factors. Cronbach alpha values were adequate (0.74 to 0.88), between-factor correlations were low, and discriminant validity and convergent validity were acceptable. Conclusions: The modified CFPQ demonstrated significant internal reliability in this urban Brazilian sample. Scale validation within different cultures is essential for a more comprehensive understanding of parental feeding practices for preschoolers.Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior (CAPES), Brasilia (DF), BrazilNational Institute of Health (NIH)Conselho Nacional de Pesquisa (CNPq)Fed Univ Sao Paulo UNIFESP, Discipline Nutrol, Dept Pediat, Rua Loefgreen 1647, BR-04040032 Sao Paulo, SP, BrazilUniv Sao Paulo, Sch Publ Hlth, Dept Epidemiol, Sao Paulo, SP, BrazilJohns Hopkins Univ, Sch Med, Dept Psychiat & Behav Sci, Div Child & Adolescent Psychiat, Baltimore, MD 21205 USAFed Univ Sao Paulo UNIFESP, Discipline Nutrol, Dept Pediat, Rua Loefgreen 1647, BR-04040032 Sao Paulo, SP, BrazilWeb of Scienc

    Changes in air pollution exposure after residential relocation and body mass index in children and adolescents:A natural experiment study

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    Air pollution exposure may affect child weight gain, but observational studies provide inconsistent evidence. Residential relocation can be leveraged as a natural experiment by studying changes in health outcomes after a sudden change in exposure within an individual. We aimed to evaluate whether changes in air pollution exposure due to residential relocation are associated with changes in body mass index (BMI) in children and adolescents in a natural experiment study. This population-based study included children and adolescents, between 2 and 17 years, who moved during 2011–2018 and were registered in the primary healthcare in Catalonia, Spain (N = 46,644). Outdoor air pollutants (nitrogen dioxides (NO2), particulate matter &lt;10 μm (PM10) and &lt;2.5 μm (PM2.5)) were estimated at residential census tract level before and after relocation; tertile cut-offs were used to define changes in exposure. Routinely measured weight and height were used to calculate age-sex-specific BMI z-scores. A minimum of 180 days after moving was considered to observe zBMI changes according to changes in exposure using linear fixed effects regression. The majority of participants (60–67% depending on the pollutant) moved to areas with similar levels of air pollution, 15–49% to less polluted, and 14–31% to more polluted areas. Moving to areas with more air pollution was associated with zBMI increases for all air pollutants (β NO2 = 0.10(95%CI 0.09; 0.12), β PM2.5 0.06(0.04; 0.07), β PM10 0.08(0.06; 0.10)). Moving to similar air pollution areas was associated with decreases in zBMI for all pollutants. No associations were found for those moving to less polluted areas. Associations with moving to more polluted areas were stronger in preschool- and primary school-ages. Associations did not differ by area deprivation strata. This large, natural experiment study suggests that increases in outdoor air pollution may be associated with child weight gain, supporting ongoing efforts to lower air pollution levels.</p

    Parents Matter: Associations of Parental BMI and Feeding Behaviors With Child BMI in Brazilian Preschool and School-Aged Children

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    Background: Brazil is undergoing nutritional transition and rates of obesity in preschool and school-aged children are increasing. Excess weight in the first years of life could predict excess weight in adulthood, making it essential to study risk factors in this population.Objective: Our goal was to investigate associations of parent feeding behaviors, as well as more distal familial influences including family SES and maternal and paternal weight, with BMI z-score in preschool and school-aged children in a Brazilian sample.Methods: Cross-sectional study. Data were collected in 14 Brazilian private schools. Parents of children aged 2–8 years (n = 1,071) completed a questionnaire assessing parent feeding behaviors, as well as sociodemographic and anthropometric information. Hierarchical linear regression models were fitted to investigate relationships between parent and child characteristics and child BMI z-score in preschool (2–5 years, n = 397) and school-aged (6–8 years, n = 618) children.Results: Final models indicated that higher maternal BMI and “restriction for weight control” were associated with higher child BMI z-score in both age groups (excessive weight, i.e., BMI ≥ +1 z-score, in preschoolers and school-aged children: 24.4 and 35.9%, respectively). In preschoolers only, “healthy eating guidance” and “pressure” were associated with lower child BMI z-score. For school-aged children, male sex, higher father BMI, and “restriction for health” were associated with higher child BMI z-score.Conclusions: Parent feeding behaviors and parent weight, as well as child sex, are associated with child BMI z-score, with evidence for differential relationships in preschool and school-aged children. Optimal obesity prevention and treatment strategies may differ by child age
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