Complementary feeding indicators from the World Health Organization and the Ministry of Health: agreement analysis and comparison of estimated prevalence in a cohort of children in southwestern Bahia, Brazil, 2018 / Indicadores de alimentación complementaria de la Organización Mundial de la Salud y del Ministerio de Salud: análisis de concordancia y comparación de prevalencias estimadas en una cohorte de niños del suroeste de Bahía, Brasil, 2018 / Indicadores de alimentação complementar da Organização Mundial da Saúde e do Ministério da Saúde: análise de concordância e comparação das prevalências estimadas em uma coorte de crianças no sudoeste da Bahia, 2018

ABSTRACT Objective To assess the agreement between complementary feeding indicators established by the World Health Organization (WHO) and the Ministry of Health (MOH) and to compare the prevalence of these indicators in the first year of a child's life. Methods : This was a cross-sectional study in a cohort of 286 children from Vitória da Conquista, state of Bahia, Brazil; agreement between indicators and comparison between prevalences were analyzed using the Kappa coefficient and McNemar's test; the prevalence of the indicators "introduction of complementary feeding" (ICF), "minimum dietary diversity" (MDD), "minimum meal frequency" (MMF) and "minimum acceptable diet" (MAD) were calculated. Results : Three indicators showed poor agreement, with only one demonstrating moderate agreement; prevalence of WHO indicators was higher than that of the MOH (ICF, 94.3% vs. 20.7%; MDD, 75.2% vs. 50.7%; MMF, 97.2% vs. 44.8%; MAD, 96.8% vs. 26.9%). Conclusion The majority of indicators showed poor agreement and the prevalence of WHO indicators exceeded that of the Ministry of Health.

RESUMEN Objetivo evaluar la concordancia entre indicadores de alimentación complementaria definidos por la Organización Mundial de la Salud (OMS) y el Ministerio de Salud (MS), y comparar la prevalencia entre estos indicadores en niños de un año. Métodos estudio transversal en una cohorte de 286 niños de Vitória da Conquista, Bahía, Brasil; se calculó la prevalencia de "introducción de alimentos complementarios" (IAC), "diversidad dietética mínima" (DMD), "frecuencia mínima de comidas" (FMR) y "dieta mínima aceptable" (DMA); para evaluar la concordancia y comparar prevalencias se utilizó el índice Kappa y la prueba de McNemar. Resultados cuatro indicadores mostraron un acuerdo pobre y sólo uno moderado; las prevalencias fueron mayores según la definición de la OMS (IAC, 94,3% vs 20,7%; DMD, 75,2% vs 50,7%; FMR, 97,2% vs 44,8%; DMA, 96,8% vs 26,9%). Conclusión la mayoría de las concordancias entre los indicadores fueron deficientes, con prevalencias más altas según las definiciones de la OMS.

RESUMO Objetivo Analisar a concordância entre indicadores de alimentação complementar da Organização Mundial da Saúde (OMS) e do Ministério da Saúde (MS) e comparar as prevalências entre esses indicadores em crianças no primeiro ano de vida. Métodos Estudo transversal em uma coorte de 286 crianças de Vitória da Conquista, Bahia, Brasil; a concordância entre indicadores e a comparação entre prevalências foram analisadas pelo índice Kappa e teste de McNemar; foram calculadas as prevalências dos indicadores "introdução de alimentos complementares" (IAC), "diversidade mínima da dieta" (DMD), "frequência mínima de refeição" (FMR) e "dieta minimamente aceitável" (DMA). Resultados Três indicadores apresentaram concordância ruim, e apenas um moderada; as prevalências dos indicadores da OMS foram superiores às do MS (IAC, 94,3% versus 20,7%; DMD, 75,2% versus 50,7%; FMR, 97,2% versus 44,8%; DMA, 96,8% versus 26,9%). Conclusão A maioria dos indicadores tiveram concordância ruim e as prevalências de indicadores da OMS superaram as do MS.

Aplicación móvil para el seguimiento del crecimiento y cuidado nutricional del bebé en hogares colombianos

Introducción: El predominio y asequibilidad actual de los teléfonos móviles inteligentes han permitido una amplia difusión de variedad de aplicaciones a nivel mundial para el monitoreo del crecimiento y del estado nutricional de los lactantes. No obstante, la mayoría de estos recursos no son lo suficientemente completos para proveer una interfaz amigable de seguimiento del crecimiento, combinada con una adecuada educación parental en materia de nutrición y alimentación complementaria. Objetivos: Este trabajo pretende presentar el desarrollo y evaluación de la aplicación propuesta "Baby Home", con el fin de estudiar su potencial como herramienta digital de apoyo a padres y cuidadores en el cuidado nutricional de sus niños desde el hogar. Materiales y métodos: Baby Home integra una interfaz de seguimiento interactivo del crecimiento del bebé con una serie de contenidos educativos alimentarios, posibilitando al usuario consultar las prácticas recomendadas según el estado nutricional estimado de su bebé. Un conjunto de 7 jueces expertos fue reunido para evaluar la validez de estos contenidos consignados en la aplicación. Posteriormente, se llevó a cabo un estudio de prueba piloto con 8 madres participantes, las cuales aportaron en las fortalezas y debilidades de las funcionalidades propuestas. Resultados: la aplicación desarrollada muestra una aprobación positiva por los especialistas consultados y una aceptación satisfactoria entre las madres participantes gracias a su diseño amigable y funcionalidades de fácil uso. Los recursos visuales implementados prueban ser adecuados para la apropiación de los contenidos alimentarios y el empoderamiento del usuario en torno a los cuidados nutricionales que requieren sus niños. Conclusiones: Baby Home se ubica como un soporte práctico y accesible para el cuidado nutricional del lactante, otorgando seguridad y confianza al usuario en la alimentación de su niño y disponiendo la posibilidad de detectar oportunamente problemas de crecimiento.

Introduction: The current prevalence and affordability of smartphones have enabled a broad diffusion of a variety of mobile applications worldwide for monitoring infant's growth and nutritional status. However, most of these resources are not comprehensive enough to provide a user-friendly interface for growth tracking combined with proper parental education on nutrition and complementary feeding. Objectives: This work aims to present the development and evaluation of the proposed application "Baby Home", in order to study its potential as a digital tool for supporting parents and caregivers in the nutritional care of their children from home. Materials and methods: Baby Home integrates an interactive baby growth monitoring interface with a collection of educational content on infant feeding, allowing the user to check the recommended practices based on the estimated nutritional status of their baby. A panel of seven expert judges was assembled to evaluate the validity of these contents included in the application. Subsequently, a pilot study was carried out with eight participating mothers who contributed to the strengths and weaknesses of the proposed functionalities. Results: The developed application received positive feedback by the consulted specialists and a satisfactory acceptance within the participating mothers thanks to its friendly design and easy-to-use functionalities. The implemented visual resources proved to be well suited for the user's appropriation of feeding contents and their empowerment regarding the nutritional care required by their children. Conclusions: Baby Home is positioned as a practical and accessible support for the nutritional care of infants, providing safeness and confidence to the user in their child's feeding and the possibility of timely detection of growth problems.

Relative validity and reproducibility of WHO indicators for assessment of feeding practices in children under two years of age / Validade relativa e reprodutibilidade de indicadores da OMS para avaliação da alimentação de crianças menores de dois anos

Abstract The study aimed to evaluate relative validity and reproducibility of seven WHO indicators of dietary practices in children aged 6-23.9 months. Data from probabilistic sample of children who used primary healthcare services in Rio de Janeiro, Brazil were collected using a 24h dietary recall (24HR) and a closed questionnaire (Q1) on feeding in the day before the study. The last one was reapplied (Q2) around 16 days later. Validity was assessed by comparing the prevalence rates estimated by 24HR and Q1 and calculating the positive (PPV) and negative (NPV) predictive values, sensitivity (Se), specificity (Sp), and accuracy index (AI) for the resulting indicators. For reproducibility, estimated prevalence rates based on Q1 and Q2 were compared and the kappa index and prevalence-adjusted bias-adjusted kappa were estimated. Of the seven estimated indicators, the prevalence of two was overestimated (Continued breastfeeding: 50.0% vs 40.0%; Sweet beverage consumption: 65.1% vs 52.7%) and the prevalence of one was underestimated (Zero vegetable or fruit consumption: 6.5% vs 18.1%). For most indicators, Se and PPV were higher than Sp and NPV. The prevalence rates determined with Q1 and Q2 were similar for 6 indicators. More than half showed good, very good or excellent agreement.

Resumo O estudo avaliou a validade relativa e a reprodutibilidade de sete indicadores da OMS sobre alimentação de crianças de 6-23,9 meses. Dados de amostra probabilística de usuários de serviços básicos de saúde na cidade do Rio de Janeiro, Brasil, foram coletados por meio de recordatório alimentar de 24 horas (R24h) e questionário fechado (Q1) sobre alimentação no dia anterior ao estudo. Este último foi reaplicado (Q2) em torno de 16 dias depois. A validade foi avaliada comparando-se as prevalências estimadas pelo R24h e Q1 e calculando-se os valores preditivos positivo (VPP) e negativo (VPN), sensibilidade (Se), especificidade (Esp) e índice de acurácia (IA) dos indicadores resultantes. Para reprodutibilidade, as prevalências estimadas com base em Q1 e Q2 foram comparadas e estimados o índice kappa e o kappa ajustado pela prevalência. Dos sete indicadores estimados, houve superestimação da prevalência de dois (aleitamento continuado: 50,0% versus 40,0%; consumo de bebidas adoçadas: 65,1% vs. 52,7%) e subestimação da prevalência de um (não consumo de frutas e hortaliças: 6,5% vs. 18,1%). Para a maioria deles, Se e VPP foram maiores do que Esp e VPN. As prevalências determinadas com Q1 e Q2 foram semelhantes para seis indicadores. Mais da metade dos indicadores apresentaram concordância boa, muito boa ou excelente.

Conocimientos en lactancia materna y alimentación complementaria en madres usuarias de los servicios de salud pública de Guatemala / Knowledge of breastfeeding and complementary feeding in mothers who use public health services in Guatemala

: Las prácticas adecuadas de lactancia materna (LM) y de alimentación complementaria (AC) contribuyen al crecimiento y desarrollo de los niños. Con el objetivo de determinar el nivel de conocimientos en LM y AC en madres usuarias de los Servicios de Salud Pública (SSP) de Guatemala, se realizó un estudio descriptivo y transversal, esperando que los resultados sean utilizados para diseñar intervenciones basadas en evidencia. Se diseñó un instrumento de recolección de datos, el cual se utilizó en una muestra de 1,956 madres entre 15 a 49 años. Se entrevistó a madres de niños menores de dos años usuarias de los SSP de los lugares de cobertura del Ejercicio Profesional Supervisado de la Universidad de San Carlos de Guatemala. Los datos se analizaron mediante estadística descriptiva, se calificó cada pregunta en cero (0) para respuesta incorrecta y uno (1) para respuesta correcta, estableciendo el nivel de conocimientos como alto (67 a 100% respuestas correctas), medio (34 a 66% respuestas correctas) o bajo (0 a 33% respuestas correctas), agrupando los resultados según variables sociodemográficas. El nivel de conocimiento sobre LM fue alto en 989 madres (51%), medio en 888 madres (45%) y bajo en 79 madres (4%) con un promedio de nota de 73.2(17.1)[58.2, 88.2] sobre 100 puntos. En cuanto al nivel de conocimiento sobre AC fue alto en 251 madres (13%), medio en 1,608 madres (82%) y bajo en 97 madres (5%) con un promedio de nota de 55.2(12.1)[44.5, 65.8]. Se concluyó que, a menor edad y escolaridad de la madre, mayor porcentaje de nivel bajo de conocimiento en LM y AC.

Appropriate breastfeeding (LM ,from its Spanish initials) and complementary feeding (AC, from its Spanish initials) practices contribute to the growth and development of children. The objective of this work was to determine the level of knowledge in LM and AC in mothers who use Public Health Services (SSP) in Guatemala. A descriptive and cross-sectional study was carried out, hoping that the results would be used to design an evidence-based impact. A data collection instrument was built, which was used in a sample of 1,956 mothers between 15 and 49 years of age. Mothers of children under two years of age who are users of the SSP covered by the Nutrition Supervised Professional Practice of the University of San Carlos of Guatemala were interviewed. The data was analyzed using descriptive statistics, each question was scored zero (0) for an incorrect answer and one (1) for a correct answer, establishing the level of knowledge as high (67 to 100% correct answers), medium (34 to 66% correct answers) or low (0 to 33% correct answers), grouping the results obtained according to sociodemographic variables. The level of knowledge about LM was high in 989 mothers (51%), medium in 888 mothers (45%), and low in 79 mothers (4%) with an average grade of 73.2(17.1)[58.2, 88.2] of a 100 points. Regarding the level of knowledge about AC, it was high in 251 mothers (13%), medium in 1,608 mothers (82%) and low in 97 mothers (5%) with an average grade of 55.2(12.1)[44.5, 65.8] . It was concluded that the lower the age and schooling of the mother, the higher the percentage of low level of knowledge in LM and AC.

A survey on breastfeeding and complementary feeding of infants and toddlers at 6 and 12 months of age / 上海预防医学

ObjectiveTo explore the status of breastfeeding and complementary feeding of infants and toddlers at 6 and 12 months of age， and to analyze the related influencing factors to inform interventions for breastfeeding and complementary feeding problems in infants and toddlers. MethodsA total of 910 children selected from Pudong New Area of the Shanghai maternal-child pairs cohort， who completed follow-up at 6 and 12 months of age， were included in the study. A feeding status questionnaire completed by the parents was used to understand the breastfeeding and complementary feeding status of children at 6 and 12 months of age， and correlation analysis was conducted between the breastfeeding and complementary feeding status and the influencing factors. ResultsThe breastfeeding rate of infants at 6 months was 76.2% （693/909）， with a higher rate among girls than boys， and the rate of continuous breastfeeding at 12 months was 35.5% （322/906）. The minimum dietary diversity （MDD） pass rate at 6 months was 16.1% （146/906）， higher in boys than in girls （χ2 =5.384， P<0.05）. The MDD pass rate at 12 months was 61.6% （554/899）. The likelihood of MDD failure in 6-month-old boys was 1.499 times higher than that in girls. Feeding of oils and their products， beverages （fruit juices）， and snacks （chocolates， candies， cakes， cookies， etc.） were risk factors for MDD failure in 6‒ and 12‒month-old children. Compared with no intake of oils and their products， beverage and snacks， the OR （95% CI） for MDD failure in 6-month-old infants fed with oils and their products， beverage and snacks were 5.866 （2.496‒13788）， 4.542 （2.943‒7.010）， and 2.599 （1.243‒5.261）， respectively. Compared with the non-fed group， the OR （95% CI） of MDD failure in infants aged 12 months fed with oils and their products， snacks， and sweet drinks were 2.335 （1.736‒3.140）， 1.549 （1.107‒2.168）， and 1.485 （1.116‒1.976）， respectively （P<0.05）. ConclusionsThe rate of continuous breastfeeding in children at 12 months in the Pudong New Area of Shanghai is low， and the dietary structure of children is unreasonable. Improvements are needed in the introduction of complementary foods. Unhealthy foods such as oils and their products， beverages， and snacks are all high-risk factors for MDD failure in children at 6 and 12 months.

Lactancia materna y alimentación complementaria en relación con la obesidad infantil

Introducción: La obesidad infantil es un problema de salud mundial, no resuelto, con incremento en todos los países. Para ello no existen estrategias de tratamiento estandarizadas. Objetivo: Describir la relación entre la lactancia materna, la alimentación complementaria y leche de fórmula con el riesgo de obesidad infantil. Método: Se realizó un estudio observacional, de corte transversal, en 126 niños comprendidos entre 6 meses a 2 años de edad, atendidos en el Hospital General Docente Ambato en el año 2019. Las variables estudiadas fueron edad, sexo, estado nutricional, el tiempo de lactancia exclusiva, el inicio de alimentación complementaria y el tiempo de consumo de la leche de fórmula. Se aplicó la estadística descriptiva y la prueba no paramétrica de U de Mann-Whitney. Resultados: Predominaron en este estudio los infantes entre 6 y 12 meses de edad que representaron el 50,8 %, se destacó el sexo femenino con el 55,2 %. De los 126 niños estudiados se observó que el 62,1 % estaban dentro del perfil de obesos, el 70,6 % recibió lactancia exclusiva en los primeros 6 meses de vida, siendo 2 meses menor por los clasificados en el perfil de obesos. Igual comportamiento se observó en los que recibieron alimentación complementaria y en 2,5 meses los que consumieron leche de fórmula. Conclusiones: La mayoría de los niños en el estudio estaban clasificados como obesos. Los niños obesos tuvieron un tiempo de lactancia exclusiva más corto y consumieron alimentación suplementaria y leche de fórmula por un período de tiempo más largo que los niños con un peso normal.

Introduction: Childhood obesity globally is an unresolved health problem, becoming increasingly present in all countries with not appropriate standard treatment strategies. Objective: To describe the relationship between breastfeeding, complementary feeding and formula milk in childhood obesity. Method: An observational cross-sectional study was conducted in 126 children, aged of 6 months to 2 years, treated at the Hospital General Docente Ambato, Ecuador, in 2019. The variables studied were as follow: age, sex, nutritional status, exclusive breastfeeding duration, time of initiation in complementary feeding and duration providing formula milk. Descriptive statistics and the nonparametric Mann-Whitney U test were applied. Results: Infants between the age of 6 to 12 months (50.8%) and female sex (55.2%) predominated. Of the total of children, 62.1% apply in obese profile, 70.6 % were exclusively breastfed in their early 6 months (2 months less than obese patients). The same behavior was observed in those who received complementary feeding and in those who consumed formula milk for 2.5 months. Conclusions: Most children in the study were classified as obese. Obese children had a short frequency of exclusive breastfeeding and consumed complementary feeding and formula milk for a longer period of time rather than children with normal weight.

Introdução: a obesidade infantil é um problema de saúde global não resolvido, com aumento em todos os países. Não há estratégias de tratamento padronizadas para isso. Objetivo: descrever a relação entre aleitamento materno, alimentação complementar e fórmula láctea com o risco de obesidade infantil. Método: estudo observacional, transversal, realizado em 126 crianças entre 6 meses e 2 anos de idade, atendidas no Hospital Geral de Ambato em 2019. As variáveis estudadas foram idade, sexo, estado nutricional, tempo de amamentação exclusiva, o início da alimentação complementar e o tempo de consumo da fórmula láctea. Aplicou-se estatística descritiva e o teste não paramétrico Mann-Whitney U. Resultados: lactentes entre 6 e 12 meses de idade predominaram neste estudo, representando 50,8%, o sexo feminino se destacou com 55,2%. Das 126 crianças estudadas, observou-se que 62,1% estavam dentro do perfil obeso, 70,6% receberam aleitamento materno exclusivo nos primeiros 6 meses de vida, sendo 2 meses mais jovem para aquelas classificadas no perfil obeso. O mesmo comportamento foi observado naqueles que receberam alimentação complementar e em 2,5 meses os que consumiram leite de fórmula. Conclusões: a maioria das crianças do estudo foi classificada como obesa. As crianças obesas apresentaram menor tempo de aleitamento materno exclusivo e consumiram alimentação complementar e fórmula láctea por mais tempo do que as crianças com peso normal.

Implementation of strategies and programs for breastfeeding, complementary feeding, and malnutrition of young children in Brazil: advances and challenges / Implementação de estratégias e programas de amamentação, alimentação complementar e desnutrição de crianças pequenas no Brasil: avanços e desafios / Implementación de estrategias y programas de lactancia materna, alimentación complementaria y desnutrición en niños pequeños en Brasil: avances y desafíos

Abstract: Malnutrition in all its forms has risen on global agendas due to the recognition of its magnitude and consequences for a wide range of human, social, and economic outcomes. Implementing strategies and programs with the needed scale and quality is a major challenge. The Brazilian National Survey on Child Nutrition (ENANI-2019) pointed out several advances but numerous challenges. In this paper, we reflect on the implementation progress of breastfeeding, complementary feeding and young children malnutrition strategies and programs in Brazil and how existing challenges can be overcome through the lens of implementation science. First, we present a brief history of such programs. Second, we selected two breastfeeding initiatives to illustrate and reflect on common implementation challenges. In these case studies, we used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework to analyze the implementation and scaling up barriers and facilitators. We found common barriers related to unclear goals about the reach of programs, challenges in assessing effectiveness and fidelity/quality during the real-world implementation, discontinuation or lack of funding, and lack of monitoring and evaluation impacting the sustainability of programs. We also discuss the use of implementation science to achieve adequate nutrition by 2030 and present critical elements for successful scale implementation of nutrition programs based on global evidence. Despite the investment to implement different actions aimed at facing infant feeding and malnutrition, high-quality implementation research must become a priority to catalyze progress in Brazil.

Resumo: A desnutrição, em todas as suas formas, cresceu nas agendas globais devido ao reconhecimento de sua magnitude e consequências para uma ampla gama de resultados humanos, sociais e econômicos. Implementar estratégias e programas com a escala e a qualidade necessárias é um grande desafio. O Estudo Nacional de Alimentação e Nutrição Infantil (ENANI-2019) apontou vários avanços, mas inúmeros desafios. Este artigo reflete sobre o progresso da implementação de estratégias e programas de amamentação, alimentação complementar e desnutrição de crianças pequenas no Brasil e como os desafios existentes podem ser superados através das lentes da ciência da implementação. Primeiramente, um breve histórico de tais programas é apresentado. Em seguida, duas iniciativas de amamentação selecionadas para ilustrar e refletir sobre os desafios comuns de implementação. Nesses estudos de caso, o modelo RE-AIM (alcance, eficácia, adoção, implementação e manutenção) foi utilizado para analisar a implementação e ampliar barreiras e facilitadores. Foram encontradas barreiras comuns relacionadas a metas pouco claras sobre o alcance dos programas, desafios na avaliação da eficácia e fidelidade/qualidade durante a implementação no mundo real, a interrupção ou falta de financiamento e a falta de monitoramento e avaliação que afetam a sustentabilidade dos programas. O uso da ciência da implementação para alcançar uma nutrição adequada até 2030 também foi discutido, apresentando elementos críticos para a implementação em escala bem-sucedida de programas de nutrição com base em evidências globais. Apesar do investimento para implementar diferentes ações voltadas para o enfrentamento da alimentação infantil e da desnutrição, a pesquisa de implementação de alta qualidade deve se tornar uma prioridade para catalisar o progresso no Brasil.

Resumen: La desnutrición, en todos sus grados, es un tema que está presente en las agendas mundiales debido a su magnitud y consecuencias para una amplia gama de resultados humanos, sociales y económicos. La implementación de estrategias y programas con la escala y calidad requeridas es un gran desafío. El Estudio Nacional de Alimentación y Nutrición Infantil (ENANI-2019) apunta varios avances y numerosos desafíos. Este artículo reflexiona sobre el progreso en la implementación de estrategias y programas para la lactancia materna, la alimentación complementaria y la desnutrición infantil en Brasil y sobre cómo se pueden superar los desafíos existentes desde la implementación. En primer lugar, se presenta una breve historia de tales programas. A continuación, se seleccionan dos iniciativas de lactancia materna para ilustrar y reflexionar sobre los desafíos comunes de implementación. En este estudio de caso se utilizó el modelo RE-AIM (alcance, eficacia, adopción, implementación y mantenimiento) para analizar la implementación y ampliar las barreras y facilitadores. Se encontraron barreras comunes relacionadas con los objetivos poco definidos sobre el alcance de los programas, con los desafíos para evaluar la efectividad y la fidelidad/calidad durante la implementación, con la interrupción o falta de financiamiento y con la falta de monitoreo y evaluación que afectan la sostenibilidad de los programas. También se discutió el uso de la implementación para lograr una nutrición adecuada para 2030, mediante la presentación de elementos críticos para implementar con éxito los programas de nutrición basados en evidencia global. Si bien se promueve la implementación de diferentes acciones destinadas al combate de la alimentación infantil y la desnutrición, la implementación de gran calidad debe ser una prioridad en Brasil.

Minimum dietary diversity and consumption of ultra-processed foods among Brazilian children 6-23 months of age / Diversidade alimentar mínima e o consumo de alimentos ultraprocessados em crianças brasileiras de 6-23 meses / Diversidad alimentaria mínima y consumo de alimentos ultraprocesados en niños brasileños de 6-23 meses de edad

Abstract: The study aimed to estimate the prevalence of minimum dietary diversity (MDD) and consumption of ultra-processed foods in children 6-23 months of age according to sociodemographic variables. Three indicators of complementary feeding of 4,354 children from the Brazilian National Survey on Child Nutrition (ENANI-2019) were built based on a questionnaire about food consumption on the day before the interview: MDD, consumption of ultra-processed foods, and MDD without the consumption of ultra-processed foods. The prevalence and 95%CI were calculated, stratified by macroregion; race/skin color, education and work status of the mother or caregiver; enrollment in the Brazilian Income Transfer Program; household food security; sanitation; and child enrollment in daycare/school. The overall prevalence of MDD was 63.4%, with lower prevalences among children who lived in the North Region (54.8%), whose mothers or caregivers had 0-7 years of education (50.6%), and lived under moderate or severe food insecurity (52.6%). Ultra-processed foods were consumed by 80.5% of the children, with the highest prevalence in the North Region (84.5%). The prevalence of MDD without ultra-processed foods was 8.4% and less prevalent among children with black mothers or caregivers (3.6%) and among those whose mother or caregiver had 8-10 years of education (3.6%). The most frequently consumed food groups from the MDD indicator were grains, roots and tubers (90.2%), dairy products (81%) and those from ultra-processed food were sweet or salty cookies/crackers (51.3%) and instant flours (41.4%). The ubiquitous presence of ultra-processed foods in the diets of Brazilian children and the low frequency of diversified foods, especially among the most vulnerable populations, indicate the need to strengthen policies and programs to ensure adequate and healthy infant nutrition.

Resumo: O objetivo do estudo foi estimar a prevalência de diversidade alimentar mínima (DAM) e consumo de alimentos ultraprocessados em crianças de 6-23 meses de acordo com variáveis sociodemográficas. Três indicadores de alimentação complementar de 4.354 crianças do Estudo Nacional de Alimentação e Nutrição Infantil (ENANI-2019) foram construídos com base em um questionário sobre o consumo alimentar do dia anterior à entrevista: DAM, consumo de alimentos ultraprocessados e DAM sem consumo de alimentos ultraprocessados. Foram calculadas as prevalências e IC95%, estratificados por macrorregião; raça/cor da pele, escolaridade e situação profissional da mãe ou cuidador; inscrição no Programa Bolsa Família; segurança alimentar do domicílio; saneamento; e matrícula da criança em creche/escola. A prevalência geral de DAM foi de 63,4%, com menores prevalências entre crianças que residiam na Região Norte (54,8%), cujas maẽs ou cuidadores tinham de 0-7 anos de estudo (50,6%) e entre aquelas que viviam em situação de insegurança alimentar moderada ou grave (52,6%). Os alimentos ultraprocessados foram consumidos por 80,5% das crianças, com maior prevalência na Região Norte (84,5%). A prevalência de DAM sem alimentos ultraprocessados foi de 8,4%, sendo menos prevalente entre crianças cuja mãe ou cuidador era negro (3,6%) e entre aquelas cuja mãe ou cuidador tinha 8-10 anos de estudo (3,6%). Os grupos de alimentos do indicador DAM mais consumidos foram os cereais, raizes e tubérculos (90,2%), os derivados do leite (81%) e os dos alimentos ultraprocessados foram os biscoitos (51,3%) e os cereais instantâneos (41,4%). A onipresença de alimentos ultraprocessados na alimentação das crianças brasileiras e a baixa frequência de diversidade alimentar, especialmente entre as populações mais vulneráveis, indicam a necessidade de fortalecer políticas e programas para garantir uma nutrição infantil adequada e saudável.

Resumen: El objetivo del estudio fue estimar la prevalencia de diversidad alimentaria mínima (DDM) y consumo de alimentos ultraprocesados en niños de 6-23 meses según variables sociodemográficas. Se construyeron tres indicadores de alimentación complementaria de 4.354 niños de el Estudio Nacional de Alimentación y Nutrición Infantil (ENANI-2019) a partir de un cuestionario sobre el consumo de alimentos el día anterior a la entrevista: DDM, consumo de alimentos ultraprocesados y DDM sin consumo de alimentos ultraprocesados. Se calcularon la prevalencia y los IC95%, estratificados por macrorregión; raza/color de piel, situación educativa y laboral de la madre o cuidador; inscripción al Programa Bolsa Familia; seguridad alimentaria del hogar; saneamiento; e inscripción de niños en guarderías/escuelas. La prevalencia general de DDM fue del 63,4%, con prevalencias menores entre los niños que vivían en la Región Norte (54,8%), cuyas madres o cuidadores tenían entre 0-7 años de escolaridad (50.6%) y los que vivían en inseguridad alimentaria moderada o grave (52,6%). Los alimentos ultraprocesados fueron consumidos por el 80,5% de los niños, con mayor prevalencia en la Región Norte (84,5%). La prevalencia de DDM sin alimentos ultraprocesados fue del 8,4%, siendo menos prevalente entre niños de padres negros (3,6%) y con 8-10 años de escolaridad (3,6%). Los grupos de alimentos más consumidos del indicador DDM fueron los granos, raíces y tubérculos (90,2%), y los productos lácteos (81%) y los de alimentos ultraprocesados fueron las galletas (51,3%) y los cereales instantáneos (41,4%). La presencia ubicua de alimentos ultraprocesados en las dietas de los niños brasileños y la baja frecuencia diversidad dietética, especialmente entre las poblaciones más vulnerables, indican la necesidad de fortalecer políticas y programas para garantizar una nutrición infantil adecuada y saludable.

Effective interventions for the promotion of breastfeeding and healthy complementary feeding in the context of Primary Health Care / Intervenções efetivas para a promoção da amamentação e da alimentação complementar saudável no contexto da Atenção Primária à Saúde

Abstract Objective: To develop a rapid review on effective actions for the promotion of breastfeeding and healthy complementary feeding in primary health care and to summarize a list of actions and their elements for implementation. Data source: The review included systematic reviews on the effectiveness of interventions to promote breastfeeding and/or healthy complementary feeding for mothers and other caregivers, and/or professionals who work with this population, in comparison with any usual approach or none. Data synthesis: A total of 32 systematic reviews were included in the evidence synthesis. Ten types of interventions were evaluated in systematic reviews on promotion of breastfeeding and four types of interventions on promotion of healthy complementary feeding. The synthesis allowed six aspects to be discussed, and these must be considered to increase the chances of interventions' impact: type of intervention, target audience, timing of intervention, actors that can implement it, strategies and methods of intervention, and intensity of intervention. Conclusions: It was possible to assemble a list of actions whose effectiveness has already been demonstrated, providing elements for local adaptations. Evidence is expected to support and strengthen the implementation of programs aimed at promoting breastfeeding and complementary feeding in primary health care.

Resumo Objetivo: Desenvolver uma revisão rápida sobre intervenções efetivas para a promoção do aleitamento materno e da alimentação complementar saudável na Atenção Primária à Saúde e sintetizar um cardápio de ações e seus elementos para implementação. Fontes de dados: Foram incluídas revisões sistemáticas que avaliaram a efetividade de intervenções para promoção do aleitamento materno e/ou alimentação complementar saudável com mães e outros cuidadores e/ou profissionais que atuam com essa população em comparação com qualquer abordagem usual ou nenhuma. Síntese dos dados: Na síntese das evidências, foram incluídas 32 revisões sistemáticas. Nas revisões sistemáticas, foram avaliados dez tipos de intervenções no tema "promoção do aleitamento materno" e quatro tipos de intervenções no tema "promoção da alimentação complementar saudável". A síntese dos resultados permitiu discutir seis aspectos da implementação que devem ser considerados para aumentar as chances de impacto das intervenções: tipo de intervenção, público-alvo, momento da intervenção, atores que podem implementar, estratégias e métodos para conduzir a intervenção, e intensidade da intervenção. Conclusões: Os resultados permitiram apresentar um cardápio de ações cuja efetividade já foi demonstrada, fornecendo elementos para adaptações locais. Espera-se que as evidências apresentadas possam apoiar e fortalecer a implementação de programas de promoção do aleitamento materno e da alimentação complementar saudável na Atenção Primária à Saúde.

Marcadores de consumo alimentar e diversidade alimentar mínima em diferentes métodos de introdução alimentar: um ensaio clínico randomizado / Food consumption markers and minimum dietary diversity in different complementary feeding methods: a randomized clinical trial

Objetivo: Avaliar os marcadores de consumo alimentar e a diversidade alimentar mínima em lactentes de 12 meses de vida expostos a diferentes métodos de introdução alimentar. Métodos: Ensaio clínico randomizado com pares mãe-lactente submetidos à intervenção sobre introdução alimentar em três métodos: Método tradicional (MT), Baby-led Introduction to SolidS (BLISS) e misto (combinação das duas técnicas). Os marcadores de consumo alimentar foram avaliados por questionário online aos 12 meses com base nos alimentos consumidos no dia anterior, utilizando os marcadores de consumo alimentar para menores de 2 anos do Sistema de Vigilância Alimentar e Nutricional. O estudo foi aprovado no comitê de ética. Resultados: Aos 12 meses foram avaliadas 136 crianças: 45 alocadas no MT, 48 no BLISS e 43 no misto. Os alimentos com maior prevalência de consumo foram: leite materno103 (75,7%), frutas, legumes e verduras 122 (89,7%), carnes ou ovos 135 (99,3%), feijão 115 (84,6%), cereais ou tubérculos 135 (99,3%). Alimentos ultraprocessados que estiveram presentes na dieta dos lactentes foram hambúrguer ou salsichas 3 (2,2%), bebidas açucaradas 2 (1,5%), macarrão instantâneo 4 (2,9%) e biscoito recheado 2 (1,5%).Não foram encontradas diferenças entre os métodos de introdução da alimentação complementar. A diversidade alimentar mínima esteve presente na alimentação de 22 lactentes (16,2%), sendo: 6 (13,3%) no MT, 8 (16,7%) no BLISS e 8 (18,6%) no misto (p=0,793). Conclusão: Leite materno,frutas, legumes e verduras, carne, feijão e arroz estiveram presentes na alimentação da maioria dos lactentes; no entanto, a prevalência de diversidade alimentar mínima foi baixa.O consumo de alimentos ultraprocessados também esteve presente na alimentação dos lactentes. Registro Brasileiro de Ensaios Clínicos (ReBEC) identificação RBR-229scm.

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.

Validation of selected 2021 infant and young child feeding indicators for appropriate complementary feeding in relation to dietary adequacy and anthropometric status

@#Introduction: With the new set of 2021 infant and young child feeding (IYCF) indicators released by WHO and UNICEF, there is a need for its validation in the Philippine setting. The study evaluated the validity of cut-off points used for minimum dietary diversity and minimum feeding frequency in terms of micronutrient and energy intake adequacy, respectively, and minimum acceptable diet (MAD) in relation to anthropometric status. Methods: The study covered 8360 infants and young children aged 6-23.9 months with complete information on IYCF, anthropometric measurements, maternal information, and household characteristics from the 2018-2019 Expanded National Nutrition Survey (ENNS). Bivariate and correlation analyses using STATA version 15 (Corp LLC, Texas, USA 2017) were performed to determine the association of specific IYCF indicators: dietary diversity and feeding frequency with nutrient and energy intake adequacy, and MAD with anthropometric status. Sensitivity and specificity analyses were performed to evaluate the accuracy of dietary diversity score (DDS) and feeding frequency in identifying children with adequate nutrient and energy intakes, respectively. Results: Significant associations were found between DDS and micronutrient adequacy, and between feeding frequency and energy intake adequacy, regardless of breastfeeding status. A DDS of 5 and 6 and feeding frequency of 4-5 and 8 maximised sensitivity and specificity in identifying breastfed and non-breastfed children meeting 100% nutrient and energy adequacy, respectively. Conclusion: The selected 2021 complementary feeding indicators are practical guidelines to reflect dietary adequacy, but may not capture the entire process related to nutritional outcomes, especially stunting.

Adequacy of the content on infant feeding on popular websites regarding the recommendations of the Dietary Guidelines for Brazilian children under 2 years of age / Adequação do conteúdo sobre alimentação de lactentes em websites populares quanto às recomendações do Guia alimentar para crianças brasileiras menores de 2 anos

Abstract Objectives: to verify the adequacy of recommendations on food and nutrition for infants available on popular websites in relation to the "Twelve Steps for a Healthy Diet" from the Dietary guidelines for Brazilian children under 2 years of age. Methods: popular websites were searched via the Google platform to collect data about food recommendations for children under 2 years of age. The data was categorized according to criteria developed with the Guide: totally agree, partially agree, disagree, contradictory and absent. The websites were described according to the frequency of each step and the distribution in the categories. Results: 82 websites were included. Most frequent steps: 1 (84.1%), 2 (82.9%) and 4 (63.4%); least present: 8 (23.2%), 10 (19.5%), 11 (3.7%) and 12 (1.2%). The highest percentages of adequacy in relation to the Guide were steps 1 and 4 with 46.4% and 53.8%, respectively. Steps 3 (37.9%) and 7 (75.0%) had the highest percentages of disagreement or contradiction. Conclusions: there is proper information on the internet, however, these are mixed with missing, in disagreement, partially in agreement or contradictory information, which reinforces the importance of disseminating the recommendations of the Guide

Resumo Objetivos: analisar a adequação das recomendações sobre alimentação e nutrição de lactentes disponíveis em websites populares em relação aos "Doze passos para uma alimentação saudável" descritos no Guia alimentar para crianças brasileiras menores de dois anos. Métodos: websites populares foram buscados via plataforma Google para coleta de dados relativos às recomendações sobre alimentação de lactentes. As informações foram categorizadas segundo critérios desenvolvidos em relação à consonância com o Guia em: totalmente de acordo, parcialmente de acordo, em desacordo, contraditórias e ausentes. Os websites foram descritos e apresentados segundo frequência de cada passo e a distribuição segundo as categorias. Resultados: foram incluídos 82 websites. Passos mais presentes: 1 (84,1%), 2 (82,9%) e 4 (63,4%); passos menos presentes: 8 (23,2%), 10 (19,5%), 11 (3,7%) e 12 (1,2%). Os maiores percentuais de adequação em relação ao Guia foram os passos 1 e 4 com 46,4% e 53,8%, respectivamente. Os passos 3 (37,9%) e 7 (75,0%) apresentaram os maiores percentuais de desacordo ou contradição. Conclusões: identificou-se a presença de informações adequadas na internet, entretanto, estas se misturam com informações ausentes, em desacordo, parcialmente de acordo ou contraditórias, reforçando a importância da disseminação das recomendações do Guia.

Association between breastfeeding and complementary feeding in pre-pandemic and pandemic COVID-19 times: Maternar cohort study

Abstract Objective Evaluate the association between breastfeeding, exclusive breastfeeding at six months and the introduction of complementary feeding during the pre-pandemic and the COVID-19 pandemic periods. Methods Cohort study conducted with puerperal women and their newborns in the immediate postpartum period at a reference maternity hospital in Southern Brazil between 2018-2020. The COVID-19 pandemic period and the need to work outside the home during restricted circulation were the factors of exposure. The outcome evaluated was the weaning in the first six months (breastfeeding and exclusive breastfeeding) and the introduction of complementary feeding before the sixth month of life. Results 547 puerperal women and their newborns were included. During the COVID-19 pandemic, there was a higher risk to weaning of exclusive breastfeeding up until six months (RR 1.16; 95%CI 1.03-1.31) and introducing complementary feeding early (RR 1.40; 95%CI 1.01-1.96). The need to work outside the home during the COVID-19 pandemic increased the risk of not breastfeeding exclusively at the sixth month (RR 1.27; 95%CI 1.08-1.49). Conclusions The difficulties of the pandemic did reflect negatively on breastfeeding and complementary feeding practices. The pandemic was a risk factor for the early weaning of exclusive breastfeeding and the introduction of complementary feeding. However, not having to work outside the home during the pandemic period was a protective factor for exclusive breastfeeding at six months.

Estimated Deficits in Nutrient Intake of ICDS Beneficiaries Who Receive Take Home Ration at Two Districts in Karnataka

Background: The current estimates of energy and protein to bridge nutrient gap in the beneficiaries of the Integrated Child Development Services (ICDS) supplementary nutrition program use sub-optimal methodology for deficit calculation. Objective: To estimate the nutrient deficit and the risk of inadequate nutrient intake in beneficiaries of the ICDS, aged 6-36 months, using individual 24-hour diet recalls, from districts of Chitradurga and Davanagere in Karnataka. Study design: Cross-sectional design. Participants: Children (aged 6 to 36 months) registered as beneficiaries of the ICDS in these districts. Methods: Data were collected on socio-demographic factors, child feeding patterns, perception and usage of take home ration (THR), between August to October, 2019. Three non-consecutive days’ 24-hour diet recall data of children were obtained from mothers, and anthropometric measurements were taken. The proportion of children at risk of inadequate nutrient intakes was estimated using the probability approach. Assuming that 50% of a healthy population will be at risk of nutrient inadequacy such that intake and requirement distributions overlap, the proportion at actual risk of nutrient inadequacy (?50%) was calculated. Results: A combined district analysis showed a median energy deficit of 109 kcal and 161 kcal in children belonging to the age groups of 6-12 month and 13-36 month, respectively. The actual risk of inadequate intake for both age groups ranged between 12- 47% for fat and other micronutrient (iron, calcium, zinc, folate, vitamin B12 and vitamin A), despite breastfeeding, complementary feeding and reported THR use. Conclusion: Children who receive supplementary nutrition as part of the national program fail to meet their nutrient requirements that are essential for growth and development. The study results may help in strengthening the IYCF counselling and in modification of the existing THR, with quality and cost implications.

Assessment of Infant and Young Child Feeding Practices among Mothers of Paniya Tribal Children Aged 0–23 Months in Gudalur Block, Nilgiris District

Optimal infant and young child feeding practices(IYCFPs), despite being emphasized since 2003, are yet to be met in India. This study assessed these practices and their association with various factors among mothers of children aged 0–23 months in Paniya tribes in Nilgiris, Tamil Nadu. About 89.1% of the infants below six months were timely breastfed and 77.9% of them were exclusively breastfed, respectively. Complementary food was introduced to 25% of infants aged six to eight months. About 27.8% of them received a diverse diet. About 91.7% of them were fed egg and/or flesh food and 37% of them were fed vegetables and fruits. Illiterate mothers and mothers who had a vaginal delivery fed the infant optimally. The adherence to these practices was found to decrease gradually with an increase in the infant’s age. The prevalence of IYCFP is higher in the study population compared to the corresponding indicators for the district according to the National Family Health Survey‑5.

Prácticas maternas en alimentación complementaria en lactantes en zonas prevalentes de anemia en el norte del Perú

RESUMEN Objetivo: Valorar si las prácticas maternas en alimentación complementaria en lactantes de 4-8 meses de edad, son adecuadas en zonas prevalentes de anemia del norte de Perú. Métodos: Estudio descriptivo, transversal, en 206 madres de lactantes de 4-8 meses de edad en zonas de alta prevalencia de anemia del Distrito de Mórrope durante el 2018, mediante muestreo polietápico estratificado con la técnica de la entrevista, con cuestionario validado por expertos. Se usaron los programas Office Excel 2013 y SPSS v. 23, se utilizó la prueba Ji-cuadrado, con p( 0,05 como significativo. Resultados: Tenían entre 18 a 35 años de edad 90,7 % de las madres; 49,5 % instrucción primaria; 86,9 % amas de casa y 62,1% convivientes. Eran lactantes de 6 a 8 meses de edad 93,2 % Las madres de menores de 6 meses ofrecieron en mayor frecuencia papilla (75,6 %) y a partir de los 6 meses principalmente puré (59,4 %), alimentos ricos en hierro, como hígado y lentejas y como inhibidores de hierro infusiones como anís y manzanilla. La continuidad de la lactancia solo con leche materna fue 68,2 % en menores de 6 meses y 63,0 % a partir de los 6 meses. Conclusiones: Las prácticas maternas en alimentación complementaria en lactantes de 4-8 meses de edad en zonas prevalentes de anemia, Mórrope 2018, no son adecuadas. Las madres a partir de los 6 meses de edad introducen mayormente infusiones como anís y manzanilla que constituyen inhibidores de la absorción de hierro, lo que puede repercutir en la prevalencia de la anemia.

ABSTRACT Objective: Assess whether maternal practices in complementary feeding of infants aged 4-8 months are adequate in anemia´s prevalent areas in northern Peru. Methods: A descriptive, cross-sectional study was conducted in 206 mothers of infants aged 4-8 months in areas of high prevalence of anemia in the Mórrope District during 2018, using stratified polystage sampling with the interview technique, and with a questionnaire validated by experts. The Office Excel 2013 and SPSS v. 23 programs were used; also the Ji-square test was used, with p( 0.05 as significant. Results: 90.7% of the mothers were between 18 and 35 years old; 49.5% had primary education; 86.9% were housewives and 62.1% co-inhabitants. Mothers of children under 6 months of age gave more frequently porridge (75.6%) and from 6 months mainly puree (59.4%), foods rich in iron, more often liver and lentils and as iron inhibitors infusions such as anise and chamomile. The continuity of breastfeeding only with breast milk was of 68.2% in children under 6 months and 63.0% from 6 months. Conclusions: Maternal practices in complementary feeding in infants 4-8 months of age in anemia´s prevalent areas of (Mórrope 2018) are not adequate. Mothers mostly introduce from 6 months of age infusions such as anise and chamomile that are inhibitors of iron absorption, which can have an impact on the prevalence of anemia.

Evaluation of the complementary feeding practices, dietary intake, and nutritional status of infants on a cow's milk protein elimination diet

Abstract Objective: To evaluate the complementary feeding practices, food intake, and nutritional status of infants on a cow's milk protein elimination diet. Methods: A cross-sectional and observational study was conducted to compare infants aged 4-18 months who were on a cow's milk protein elimination diet with a control group of healthy infants without any dietary restrictions. General information on the child's health, demographic data, and food consumption were collected. Results: The study included 96 infants in the elimination diet group and 99 in the control group. In the elimination diet group, the median age (in months) of introduction of solid foods (5.0 × 4.0; p < 0.001) and water (5.5 × 4.0; p < 0.05) was later, consumption of soft drinks and industrialized cookies was less frequent (p < 0.05), and a lower index of complementary feeding inadequacies (2.75 × 3.50; p < 0.001) was observed. The elimination diet group presented lower individual values of Z scores for weight/age, weight/height, and body mass index/age, although they were fed with higher amounts of energy (117.4 × 81.3 kcal/kg of weight; p < 0.001) and macro-and micronutrients, except for vitamin A. In the elimination diet group, breast milk and its substitutes contributed to more than 67% of energy intake. Although calcium consumption was a deficit in 31.5% of the infants, none received supplementation. Conclusion: Infants on an elimination diet presented more adequate complementary feeding practices and higher nutritional intake, despite lower body weight values.

Aleitamento materno e introdução da alimentação complementar em crianças menores de dois anos atendidas em um ambulatório pediátrico / Breastfeeding and introduction of complementary foods in children under 2 years of age seen at a pediatric outpatient clinic

Introdução: As práticas alimentares têm papel determinante na saúde das crianças de zero a 24 meses, recomendando-se o aleitamento materno exclusivo (AME) nos primeiros seis meses de vida e complementado até dois anos ou mais. Este estudo teve como objetivo avaliar o aleitamento materno e a alimentação complementar das crianças entre zero e dois anos atendidas de 2012 a 2015 em um ambulatório pediátrico. Métodos: Estudo transversal, em que foram analisados todos os prontuários, sendo uma amostra total (n) de 576. Foi utilizado um formulário, desenvolvido pelos pesquisadores, com dados sociodemográficos e da alimentação. As categorias adotadas e relacionadas com as práticas de alimentação tiveram por base as recomendações do Ministério da Saúde no período estudado. Resultados: A prevalência de AME foi de 90,6%. A prevalência de AME aos seis meses de vida foi de 21,4%. O principal motivo do término do AME antes dos seis meses foi a "falta de orientação profissional". A prevalência de aleitamento materno após os seis meses de vida foi de 35,3%. O substituto do leite materno mais utilizado foi a fórmula infantil (67,3%), seguido pelo leite de vaca (18,9%). Quanto à oferta de alimentos complementares, a consistência pastosa foi a mais verificada (71,6%). Conclusão: Verificou-se que grande parte das crianças tem uma alimentação que não atende às recomendações do Ministério da Saúde, tendo riscos para o seu desenvolvimento, consequências a curto e longo prazo, e redução do vínculo mãe-criança. A orientação profissional nesse período tão delicado pode ajudar a modificar esse cenário.

Introduction: Nutrition practices have a determinant role in the health of children aged up to 24 months; exclusive breastfeeding (EB) is recommended in the first 6 months, to be continued along with complementary foods for up to 2 years or age or beyond. This study aimed to assess breastfeeding and complementary foods in children aged up to 2 years seen between 2012 and 2015 at a pediatric outpatient clinic. Methods: This is a cross-sectional study performed with data from 576 patients, analysed from the clinic's medical records. We used a form, constructed by the researchers, for collecting nutritional and sociodemographic data. Categories selected and associated with nutrition practices were based on recommendations by the Ministry of Health in the studied period. Results: The prevalence of EB was 90.6%. The prevalence of EB by 6 months of age was 21.4%. The main reason for interrupting EB before 6 months of age was "lack of professional guidance." The prevalence of breastfeeding after 6 months of age was 35.3%. The main breastfeeding alternative was infant formula (67.3%), followed by cow's milk (18.9%). As to the offer of complementary foods, these were pureed in most cases (71.6%). Conclusion: Most of the studied children had eating habits that did not meet the recommendations by the Ministry of Health, resulting in risks to their development, short- and long-term consequences, and prejudice to the mother-child bond. Professional guidance in such a delicate moment could help change this scenario.

Perfil de caries de la infancia temprana / Profile of early childhood caries

La Caries de la Infancia Temprana (CIT) se ha descrito como una patología de origen multifactorial en niños hasta los 71 meses de edad. Se considera como Ca-ries de la Infancia Temprana Severa (CITS) cuando a los 3 años el índice ceod es ≥ 4; a los 4 años, ≥ 5, y a los 5 años ≥ 6. La rehabilitación de las lesiones provo-cadas por esta patología puede ser compleja debido a la calidad y cantidad de estructura remanente y a la edad de los pacientes afectados. Objetivos: Estimar la frecuencia de CIT y CITS en niños menores a 72 me-ses que concurrieron para su atención, e identificar el tipo de práctica realizada, y la adhesión al trata-miento. Métodos: Diseño retrospectivo observacional sobre las historias clínicas de pacientes menores a 72 meses asistidos por los cursantes de la Especiali-zación en Odontopediatría, entre febrero 2021 y julio 2022. Resultados: La muestra quedó constituida por 101 niños, de 46+13,5 meses. El 91% presentó CITS. La totalidad de los pacientes mantuvieron lactancia nocturna prolongada después del año, siendo en el 72,3% a libre demanda durante el sueño, en un perío-do de 23+6 meses. Se registró un total de 1010 lesio-nes de caries. El 29,3% de los pacientes abandonaron el tratamiento. Conclusiones: La mayor parte de los niños presentaron Caries de la Infancia Temprana Severa, con altos valores de patología y lactancia noc-turna prolongada a libre demanda después del año Los tratamientos recomendados en estos casos son muy prolongados y requieren de prácticas invasivas, complejas y de alto costo, lo que provoca el abandono del tratamiento (AU)

Early childhood caries (ECC) is defined as a multifactorial disease in children 71 months of age or younger. When the dmft index is ≥4 (age 3), ≥5 (age 4), or ≥6 (age 5) it is referred to as Severe early childhood caries (SECC). Management of ECC is complex due to the quality and quantity of remaining structure of teeth at an early age. Objectives: To estimate the frequency of ECC and SECC in children < 72 months of age undergoing comprehensive treatment, to identify the type of treatment provided and treatment compliance. Methods: Retrospective observational design on dental records of patients under 72 months of age treated by Pediatric Dentistry Specialty Program students between February 2021 and July 2022. Results: The sample included 101 children, mean age 46+13.5 months, 91% of patients with SECC. All patients were fed nightly for over 1 year, 72.3% of whom were fed nightly on demand over a period of 23±6 months. A total of 1010 caries lesions were detected. 29.3% of children discontinued treatment. Conclusions: Most of the children presented severe early childhood caries with high values of pathology and prolonged nocturnal breastfeeding on demand after one year. The recommended treatments in these cases are very long and require invasive, complex and expensive practices, which causes abandonment of the treatment (AU)

Attitudes and practice of Turkish mothers with babies between 0-24 months regarding infant nutrition: the Iowa Infant Feeding Attitude Scale / Atitudes e aplicações de mães turcas sobre a nutrição do bebê entre 0-24 meses: Iowa Nutrição do Bebê Atitude

ABSTRACT Objective This study aims to evaluate the behaviors and attitudes of mothers with 0-24-month-old babies towards infant feeding, depending on their sociodemographic characteristics. Methods This is a cross-sectional study, which was carried out with 300 mothers. Demographic characteristics of the mothers, breastfeeding and complementary feeding practices, and the Iowa Infant Feeding Attitude Scale were collected. As for the statistical evaluation, Statistical Package for the Social Sciences version 22 statistical package program was used. For the statistical analysis; percentages, mean values, Independent T-Test, One-Way ANOVA, Chi-Square test, and multinomial regression models analysis were used. Results 79.7% of the mothers gave human milk to their infants as the first food after delivery, 36.9% gave only human milk for the first 6 months, 52.0% started complementary feeding at 4-6 months. Of the mothers with a mean The Iowa Infant Feeding Attitude Scale score of 64.38±8.43, 54.0% were positive towards breastfeeding. A significant relationship was found between education and income levels and Iowa Infant Feeding Attitude Scale scores level of the mothers, respectively (χ2=10.001, χ2=10.421, p<0.05). The mothers with a postgraduate degree as educational status (AOR=1.27, 95%CI:1.06-1.53) and mothers who had more income than expenditures (AOR=1.19, 95%CI:1.03-1.63) were associated with a higher positive towards of breastfeeding. Conclusion Although most of the mothers say that they have a positive attitude towards breastfeeding, the rate of those who only breastfeed for the first 6 months is low. As the education and income level of mothers increase, their positive attitude towards breastfeeding increases. Mothers should be informed to initiate and maintain successful breastfeeding.

RESUMO Objetivo Este estudo tem como objetivo avaliar os comportamentos e atitudes de mães com bebês de 0 a 24 meses em relação à alimentação infantil, em função de suas características sociodemográficas. Métodos Este estudo é um estudo transversal, realizado com 300 mães. Foram coletadas características demográficas das mães, práticas de amamentação e alimentação complementar e a Iowa Infant Feeding Attitude Scale. Quanto à avaliação estatística, foi utilizado o programa de pacote estatístico Statistical Package for the Social Sciences versão 22. Para a análise estatística; percentagens, valores médios, Teste T independente, Anova de uma via, teste do qui-quadrado e análise de modelos de regressão multinominal. Resultados 79,7% das mães deram leite materno como primeiro alimento após o parto, 36,9% deram apenas leite materno durante os primeiros 6 meses, 52,0% iniciaram a alimentação complementar aos 4-6 meses. Das mães com escore médio Iowa Infant Feeding Attitude Scale de 64,38±8,43, 54,0% eram positivas para amamentação. Encontrou-se relação significativa entre os níveis de escolaridade e renda e o nível dos Iowa Infant Feeding Attitude Scale escores das mães, respectivamente (χ2=10,001, χ2=10,421, p<0,05). Mães com pós-graduação (AOR=1,27, IC 95%: 1,06-1,53) e mães que tinham mais renda do que despesas (AOR=1,19, IC 95%: 1,03 -1,63) foram associadas a maior positividade para amamentação. Conclusão Embora a maioria das mães diga que têm uma atitude positiva em relação à amamentação, a taxa das que amamentam apenas nos primeiros 6 meses é baixa. À medida que aumenta a escolaridade e o nível de renda das mães, sua atitude positiva em relação à amamentação aumenta. As mães devem ser informadas para iniciar e manter a amamentação com sucesso.