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      Early feeding practices and consumption of ultraprocessed foods at 6 y of age: Findings from the 2004 Pelotas (Brazil) Birth Cohort Study

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          The aim of this study was to examine the association between early feeding practices and consumption of ultraprocessed foods in children at age 6 y.


          This was a prospective cohort study using data from 3427 children who participated in the 2004 Pelotas Cohort Study and who had available food frequency questionnaire information at 6 y. Information about exclusive and total breastfeeding duration as well as age at introduction of semisolid and solid foods was used to define early feeding practices. Consumption of ultraprocessed foods was defined as proportion of total daily energy intake that came from ultraprocessed foods at age 6 y. Crude and adjusted linear regression models were employed to analyze the effect of early feeding practices on ultraprocessed foods consumption.


          It was determined that 40.3% of total daily energy intake at 6 y came from ultraprocessed foods. In crude linear regression models, early feeding practices (exclusive and total breastfeeding duration, and age at introduction of semisolid and solid foods) were negatively associated with ultraprocessed foods consumption. After adjustment, only exclusive breastfeeding duration and age at introduction of solid foods remained associated with consumption of ultraprocessed foods, although the observed effects size was small. Children exclusively breastfed for ≥3 mo and those who had solid foods introduced at ≥4 mo consumed a lower proportion of daily energy intake from ultraprocessed foods.


          This study supports the need to promote healthy early feeding practices including the support of breastfeeding to promote healthier eating habits later in childhood.


          • Newborn infants from southern Brazil were followed up in infancy and childhood.
          • Breastfeeding duration and timing of introduction of foods were recorded.
          • Ultraprocessed food intake was evaluated by a food frequency questionnaire.
          • Introduction of solid foods was related with consumption of ultraprocessed foods.
          • Longer exclusively breastfed infants had lower ultraprocessed food consumption later.

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          Most cited references 37

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          Profits and pandemics: prevention of harmful effects of tobacco, alcohol, and ultra-processed food and drink industries.

          The 2011 UN high-level meeting on non-communicable diseases (NCDs) called for multisectoral action including with the private sector and industry. However, through the sale and promotion of tobacco, alcohol, and ultra-processed food and drink (unhealthy commodities), transnational corporations are major drivers of global epidemics of NCDs. What role then should these industries have in NCD prevention and control? We emphasise the rise in sales of these unhealthy commodities in low-income and middle-income countries, and consider the common strategies that the transnational corporations use to undermine NCD prevention and control. We assess the effectiveness of self-regulation, public-private partnerships, and public regulation models of interaction with these industries and conclude that unhealthy commodity industries should have no role in the formation of national or international NCD policy. Despite the common reliance on industry self-regulation and public-private partnerships, there is no evidence of their effectiveness or safety. Public regulation and market intervention are the only evidence-based mechanisms to prevent harm caused by the unhealthy commodity industries. Copyright © 2013 Elsevier Ltd. All rights reserved.
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            Parental influence on eating behavior: conception to adolescence.

            The first years of life mark a time of rapid development and dietary change, as children transition from an exclusive milk diet to a modified adult diet. During these early years, children's learning about food and eating plays a central role in shaping subsequent food choices, diet quality, and weight status. Parents play a powerful role in children's eating behavior, providing both genes and environment for children. For example, they influence children's developing preferences and eating behaviors by making some foods available rather than others, and by acting as models of eating behavior. In addition, parents use feeding practices, which have evolved over thousands of years, to promote patterns of food intake necessary for children's growth and health. However in current eating environments, characterized by too much inexpensive palatable, energy dense food, these traditional feeding practices can promote overeating and weight gain. To meet the challenge of promoting healthy weight in children in the current eating environment, parents need guidance regarding alternatives to traditional feeding practices.
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              The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing.

              Given evident multiple threats to food systems and supplies, food security, human health and welfare, the living and physical world and the biosphere, the years 2016-2025 are now designated by the UN as the Decade of Nutrition, in support of the UN Sustainable Development Goals. For these initiatives to succeed, it is necessary to know which foods contribute to health and well-being, and which are unhealthy. The present commentary outlines the NOVA system of food classification based on the nature, extent and purpose of food processing. Evidence that NOVA effectively addresses the quality of diets and their impact on all forms of malnutrition, and also the sustainability of food systems, has now accumulated in a number of countries, as shown here. A singular feature of NOVA is its identification of ultra-processed food and drink products. These are not modified foods, but formulations mostly of cheap industrial sources of dietary energy and nutrients plus additives, using a series of processes (hence 'ultra-processed'). All together, they are energy-dense, high in unhealthy types of fat, refined starches, free sugars and salt, and poor sources of protein, dietary fibre and micronutrients. Ultra-processed products are made to be hyper-palatable and attractive, with long shelf-life, and able to be consumed anywhere, any time. Their formulation, presentation and marketing often promote overconsumption. Studies based on NOVA show that ultra-processed products now dominate the food supplies of various high-income countries and are increasingly pervasive in lower-middle- and upper-middle-income countries. The evidence so far shows that displacement of minimally processed foods and freshly prepared dishes and meals by ultra-processed products is associated with unhealthy dietary nutrient profiles and several diet-related non-communicable diseases. Ultra-processed products are also troublesome from social, cultural, economic, political and environmental points of view. We conclude that the ever-increasing production and consumption of these products is a world crisis, to be confronted, checked and reversed as part of the work of the UN Sustainable Development Goals and its Decade of Nutrition.

                Author and article information

                Nutrition (Burbank, Los Angeles County, Calif.)
                Elsevier Science
                1 March 2018
                March 2018
                : 47
                : 27-32
                [a ]Post-Graduate Program in Epidemiology, Federal University of Pelotas, Brazil
                [b ]Nutrition Department, Federal University of Pelotas, Brazil
                [c ]Nutrition School, Federal University of Pampa, Brazil
                [d ]Department of Preventive Medicine, School of Medicine, University of São Paulo, Brazil
                Author notes
                [* ]Corresponding author. Tel./fax: +55 (53) 32841300. renatabielemann@
                © 2017 The Author(s)

                This is an open access article under the CC BY license (


                Nutrition & Dietetics

                cohort studies, ultraprocessed foods, complementary feeding, breastfeeding


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