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      Ultra-processed food consumption among infants in primary health care in a city of the metropolitan region of São Paulo, Brazil, Translated title: Consumo de alimentos ultraprocessados entre crianças com menos de um ano na atenção primária à saúde em uma cidade da região metropolitana de São Paulo, Brasil,

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          Abstract

          Abstract Objective: To analyze the prevalence of ultra-processed food intake among children under one year of age and to identify associated factors. Methods: A cross-sectional design was employed. We interviewed 198 mothers of children aged between 6 and 12 months in primary healthcare units located in a city of the metropolitan region of São Paulo, Brazil. Specific foods consumed in the previous 24 h of the interview were considered to evaluate the consumption of ultra-processed foods. Variables related to mothers' and children's characteristics as well as primary healthcare units were grouped into three blocks of increasingly proximal influence on the outcome. A Poisson regression analysis was performed following a statistical hierarchical modeling to determine factors associated with ultra-processed food intake. Results: The prevalence of ultra-processed food intake was 43.1%. Infants that were not being breastfed had a higher prevalence of ultra-processed food intake but no statistical significance was found. Lower maternal education (prevalence ratio 1.55 [1.08-2.24]) and the child's first appointment at the primary healthcare unit having happened after the first week of life (prevalence ratio 1.51 [1.01-2.27]) were factors associated with the consumption of ultra-processed foods. Conclusions: High consumption of ultra-processed foods among children under 1 year of age was found. Both maternal socioeconomic status and time until the child's first appointment at the primary healthcare unit were associated with the prevalence of ultra-processed food intake.

          Translated abstract

          Resumo: Objetivo: Analisar a prevalência do consumo de alimentos ultraprocessados entre crianças com menos de um ano e identificar os fatores associados. Métodos: Foi realizado um estudo transversal. Entrevistamos 198 mães de crianças com idades entre 6 e 12 meses em unidades de atenção primária à saúde localizadas em Embu das Artes, uma cidade da região metropolitana de São Paulo, Brasil. Alimentos específicos consumidos nas 24 horas anteriores à entrevista foram considerados para avaliar o consumo de alimentos ultraprocessados. As variáveis relacionadas às características das mães e crianças e as unidades de atenção primária à saúde foram agrupadas em três blocos de influência cada vez mais proximal com o resultado. Foi realizada uma análise de regressão de Poisson de acordo com um modelo estatístico hierárquico para determinar os fatores associados ao consumo de alimentos ultraprocessados. Resultados: A prevalência de consumo de alimentos ultraprocessados foi 43,1%. As crianças que não eram amamentadas apresentaram maior prevalência de consumo de alimentos ultraprocessados, porém não foi encontrada diferença estatística. Menor nível de escolaridade materna (RP 1,55 [1,08-2,24]) e o fato de a primeira consulta da criança na unidade de atenção primária à saúde acontecer na primeira semana de vida (RP 1,51 [1,01-2,27]) foram fatores associados ao consumo de alimentos ultraprocessados. Conclusões: Foi encontrado consumo elevado de alimentos ultraprocessados entre crianças com menos de um ano. A situação socioeconômica materna e o tempo da primeira consulta da criança na unidade de atenção primária à saúde foram associados à prevalência de consumo de alimentos ultraprocessados.

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          Consumption of ultra-processed food products and its effects on children's lipid profiles: a longitudinal study.

          Cardiovascular disease development is related to known risk factors (such as diet and blood lipids) that begin in childhood. Among dietary factors, the consumption of ultra-processing products has received attention. This study investigated whether children's consumption of processed and ultra-processing products at preschool age predicted an increase in lipid concentrations from preschool to school age.
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            Impact of maternal education about complementary feeding and provision of complementary foods on child growth in developing countries

            Background Childhood undernutrition is prevalent in low and middle income countries. It is an important indirect cause of child mortality in these countries. According to an estimate, stunting (height for age Z score < -2) and wasting (weight for height Z score < -2) along with intrauterine growth restriction are responsible for about 2.1 million deaths worldwide in children < 5 years of age. This comprises 21 % of all deaths in this age group worldwide. The incidence of stunting is the highest in the first two years of life especially after six months of life when exclusive breastfeeding alone cannot fulfill the energy needs of a rapidly growing child. Complementary feeding for an infant refers to timely introduction of safe and nutritional foods in addition to breast-feeding (BF) i.e. clean and nutritionally rich additional foods introduced at about six months of infant age. Complementary feeding strategies encompass a wide variety of interventions designed to improve not only the quality and quantity of these foods but also improve the feeding behaviors. In this review, we evaluated the effectiveness of two most commonly applied strategies of complementary feeding i.e. timely provision of appropriate complementary foods (± nutritional counseling) and education to mothers about practices of complementary feeding on growth. Recommendations have been made for input to the Lives Saved Tool (LiST) model by following standardized guidelines developed by Child Health Epidemiology Reference Group (CHERG). Methods We conducted a systematic review of published randomized and quasi-randomized trials on PubMed, Cochrane Library and WHO regional databases. The included studies were abstracted and graded according to study design, limitations, intervention details and outcome effects. The primary outcomes were change in weight and height during the study period among children 6-24 months of age. We hypothesized that provision of complementary food and education of mother about complementary food would significantly improve the nutritional status of the children in the intervention group compared to control. Meta-analyses were generated for change in weight and height by two methods. In the first instance, we pooled the results to get weighted mean difference (WMD) which helps to pool studies with different units of measurement and that of different duration. A second meta-analysis was conducted to get a pooled estimate in terms of actual increase in weight (kg) and length (cm) in relation to the intervention, for input into the LiST model. Results After screening 3795 titles, we selected 17 studies for inclusion in the review. The included studies evaluated the impact of provision of complementary foods (±nutritional counseling) and of nutritional counseling alone. Both these interventions were found to result in a significant increase in weight [WMD 0.34 SD, 95% CI 0.11 – 0.56 and 0.30 SD, 95 % CI 0.05-0.54 respectively) and linear growth [WMD 0.26 SD, 95 % CI 0.08-0.43 and 0.21 SD, 95 % CI 0.01-0.41 respectively]. Pooled results for actual increase in weight in kilograms and length in centimeters showed that provision of appropriate complementary foods (±nutritional counseling) resulted in an extra gain of 0.25kg (±0.18) in weight and 0.54 cm (±0.38) in height in children aged 6-24 months. The overall quality grades for these estimates were that of ‘moderate’ level. These estimates have been recommended for inclusion in the Lives Saved Tool (LiST) model. Education of mother about complementary feeding led to an extra weight gain of 0.30 kg (±0.26) and a gain of 0.49 cm (±0.50) in height in the intervention group compared to control. These estimates had been recommended for inclusion in the LiST model with an overall quality grade assessment of ‘moderate’ level. Conclusion Provision of appropriate complementary food, with or without nutritional education, and maternal nutritional counseling alone lead to significant increase in weight and height in children 6-24 months of age. These interventions can significantly reduce the risk of stunting in developing countries and are recommended for inclusion in the LiST tool.
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              Development of food acceptance patterns in the first years of life.

              As young omnivores, children make the transition from the exclusive milk diet of infancy to consuming a variety of foods. They must learn to accept a set of the foods available in their environmental niche, and they 'come equipped' with a set of predispositions that facilitate the development of food acceptance patterns, constrained by predisposition and limited by what is offered to them. While children are predisposed to like sweet or salty foods and to avoid sour or bitter foods, their preferences for the majority of foods are shaped by repeated experience. The predispositions that shape food acceptance patterns also include neophobia and the predisposition to learn to prefer and accept new foods when they are offered repeatedly. In addition, the predisposition for associative conditioning affects children's developing food acceptance patterns, resulting in preferences for foods offered in positive contexts, while foods presented in negative contexts will become more disliked via the learning of associations with the social and environmental contexts. Children also learn to prefer energy-dense foods when consumption of those foods is followed by positive post-ingestive consequences, such as those produced when high-energy-density foods are eaten when hungry. Although children are predisposed to be responsive to the energy content of foods in controlling their intake, they are also responsive to parents' control attempts. We have seen that these parental control attempts can refocus the child away from responsiveness to internal cues of hunger and satiety and towards external factors such as the presence of palatable foods. This analysis suggests that taking a closer look at what children are learning about food and eating may provide clues regarding the formation of children's food acceptance patterns, and that this approach also suggests potential causative factors implicated in the aetiology of obesity and the emergence of weight concerns. Current data, although limited, suggest that child-feeding practices play a causal role in the development of individual difference in the controls of food intake, and perhaps in the aetiology of problems of energy balance, especially childhood obesity. These relationships should be pursued in future research.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                jped
                Jornal de Pediatria
                J. Pediatr. (Rio J.)
                Sociedade Brasileira de Pediatria (Porto Alegre, RS, Brazil )
                0021-7557
                1678-4782
                September 2019
                : 95
                : 5
                : 584-592
                Affiliations
                [2] Cuiabá MT orgnameSecretaria de Estado de Saúde de Mato Grosso Brazil
                [3] New Haven orgnameYale Univeristy orgdiv1Yale School of Public Health United States
                [4] São Paulo SP orgnameSecretaria de Estado de Saúde de São Paulo orgdiv1Instituto de Saúde Brazil
                [1] São Paulo São Paulo orgnameUniversidade de São Paulo orgdiv1Faculdade de Saúde Pública orgdiv2Programa de Pós-Graduação Nutrição em Saúde Pública Brazil
                Article
                S0021-75572019000600584
                10.1016/j.jped.2018.05.004
                29890116
                6f5478e3-753e-4ec3-a7bd-e88e66f86db4

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 29 December 2017
                : 07 May 2018
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 30, Pages: 9
                Product

                SciELO Brazil

                Categories
                Original Articles

                Complementary feeding,Infant feeding practices,Primary health care,Ultra-processed food,Alimentação complementar,Práticas de alimentação infantil,Atenção primária à saúde,Alimento ultraprocessado

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