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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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          Ultra-Processed Food Products and Obesity in Brazilian Households (2008–2009)

          Background Production and consumption of industrially processed food and drink products have risen in parallel with the global increase in overweight and obesity and related chronic non-communicable diseases. The objective of this study was to analyze the relationship between household availability of processed and ultra-processed products and the prevalence of excess weight (overweight plus obesity) and obesity in Brazil. Methods The study was based on data from the 2008–2009 Household Budget Survey involving a probabilistic sample of 55,970 Brazilian households. The units of study were household aggregates (strata), geographically and socioeconomically homogeneous. Multiple linear regression models were used to assess the relationship between the availability of processed and ultra-processed products and the average of Body Mass Index (BMI) and the percentage of individuals with excess weight and obesity in the strata, controlling for potential confounders (socio-demographic characteristics, percentage of expenditure on eating out of home, and dietary energy other than that provided by processed and ultra-processed products). Predictive values for prevalence of excess weight and obesity were estimated according to quartiles of the household availability of dietary energy from processed and ultra-processed products. Results The mean contribution of processed and ultra-processed products to total dietary energy availability ranged from 15.4% (lower quartile) to 39.4% (upper quartile). Adjusted linear regression coefficients indicated that household availability of ultra-processed products was positively associated with both the average BMI and the prevalence of excess weight and obesity, whereas processed products were not associated with these outcomes. In addition, people in the upper quartile of household consumption of ultra-processed products, compared with those in the lower quartile, were 37% more likely to be obese. Conclusion Greater household availability of ultra-processed food products in Brazil is positively and independently associated with higher prevalence of excess weight and obesity in all age groups in this cross-sectional study.

            Author and article information

            [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@
            Nutrition (Burbank, Los Angeles County, Calif.)
            Elsevier Science
            1 March 2018
            March 2018
            : 47
            : 27-32
            29429531 5825382 S0899-9007(17)30213-7 10.1016/j.nut.2017.09.012
            © 2017 The Author(s)

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



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