Feeding practices of low birth weight Brazilian infants and associated factors / Práticas alimentares de lactentes brasileiros nascidos com baixo peso e fatores associados

ABSTRACT OBJECTIVE To characterize complementary feeding and to analyze the influence of individual and contextual factors on dietary practices of low birth weight infants. METHODS This cross-sectional study included 2,370 low birth weight infants aged 6 to 12 months included in the Breastfeeding Prevalence Survey in Brazilian Municipalities (2008), which covered the 26 state capitals, the Federal District and 37 municipalities. Dietary practices were assessed using two indicators: I) dietary diversity, characterized by the consumption of five food groups: meat, beans, vegetables, fruit and milk; II) consumption of ultra-processed foods, characterized by the ingestion of at least one of the following foods on the day prior to the survey: soda, or processed juice, or cookie, cracker and crisps. The covariates of interest were the socioeconomic characteristics of infants, mothers and health services. The contextual factor was the "municipal prevalence of child undernutrition." The individualized effect of the study factors on outcomes was assessed by multilevel Poisson regression. RESULTS Approximately 59% of infants consumed ultra-processed foods, while 29% had diverse feeding. Mothers living in municipalities with child undernutrition prevalence below 10%, with higher education and working outside the home were more likely to offer dietary diversity. Consumption of ultra-processed foods was higher among infants living in municipalities with child undernutrition prevalence below 10%, whose mothers were younger and multiparous. CONCLUSIONS The low prevalence of diverse feeding combined with the high prevalence of ultra-processed food consumption characterizes the low quality of feeding of low birth weight Brazilian infants. Individual and contextual factors impact the feeding quality of this population, suggesting the need for effective strategies to increase the consumption of fresh and minimally processed foods and decrease the consumption of ultra-processed foods by this vulnerable population.

RESUMO OBJETIVO Caracterizar a alimentação complementar e analisar a influência de fatores individuais e contextuais sobre práticas alimentares de lactentes que nasceram com baixo peso. MÉTODOS Este estudo transversal incluiu 2.370 lactentes nascidos com baixo peso e com idade entre 6 e 12 meses incluídos na Pesquisa de Prevalência de Aleitamento Materno em Municípios Brasileiros (2008), que abrangeu as 26 capitais, o Distrito Federal e mais 37 municípios. As práticas alimentares foram avaliadas usando dois indicadores: i) diversidade alimentar, caracterizada pelo consumo dos cinco grupos alimentares: carnes, feijão, legumes e verduras, frutas e leite; ii) consumo de alimentos ultraprocessados, caracterizado pela ingestão de pelo menos um dos seguintes alimentos no dia anterior à pesquisa: refrigerante, ou suco industrializado, ou bolacha, biscoito e salgadinho. As covariáveis de interesse corresponderam às características socioeconômicas, dos lactentes, das mães e dos serviços de saúde. O fator contextual foi a "prevalência municipal de desnutrição infantil". O efeito individualizado dos fatores de estudo sobre os desfechos foi avaliado mediante regressão de Poisson com estrutura multinível. RESULTADOS Aproximadamente 59% dos lactentes consumiram alimentos ultraprocessados, enquanto 29% apresentaram diversidade alimentar. Mães que residiam em municípios com prevalência de desnutrição infantil inferior a 10%, com maior nível de escolaridade e que trabalhavam fora de casa foram mais propensas a oferecer diversidade alimentar. O consumo de alimentos ultraprocessados foi maior entre lactentes residentes em municípios com prevalência de desnutrição infantil inferior a 10%, cujas mães eram mais jovens e multíparas. CONCLUSÕES A baixa prevalência de alimentação diversa aliada à alta prevalência do consumo de alimentos ultraprocessados caracteriza a baixa qualidade da alimentação dos lactentes brasileiros com baixo peso ao nascer. Fatores individuais e contextuais impactam a qualidade da alimentação dessa população, sugerindo a necessidade de adoção de estratégias eficazes para aumentar o consumo de alimentos in natura e minimamente processados e diminuir o consumo de alimentos ultraprocessados por esta população vulnerável.

Alimentos cariogénicos ofertados y consumidos en cantinas escolares de la ciudad de Asunción y Gran Asunción / Cariogenic foods offered and consumed in school canteens in the city of Asunción and Great Asunción

Los alimentos cariogénicos son aquellos que contienen un alto porcentaje de azúcares fermentables como la sacarosa y carbohidratos, son alimentos de consistencia blanda, que se depositan con facilidad en las superficies retentivas de los dientes. La dieta cariogénica constituye un promotor primordial para la caries dental. La vida escolar juega vital importancia en la formación de hábitos alimenticios porque niños y adolescentes pasan muchas horas de su tiempo diario en este entorno. En el ambiente escolar, la cantina es considerada como un espacio donde es posible observar los hábitos alimenticios de los alumnos. En muchos países, latinoamericanos y europeos los servicios de alimentación disponibles en las cantinas escolares, están reglamentados desde el punto de vista nutricional y sanitario. En Paraguay, el Ministerio de Educación y Cultura, a través de su resolución Nº 12774/03 establece que estas cantinas deben estar manejadas por personal capacitado en cuanto a venta de alimentos saludables, manipulación y almacenamiento de los mismos, basándose en el Código Sanitario. Con el objetivo de determinar alimentos cariogénicos consumidos y ofertados en 40 cantinas escolares de escuelas públicas y privadas de Asunción y Gran Asunción, en el año 2012, se realizó un estudio observacional descriptivo de corte transversal con componente analítico. Los datos fueron obtenidos a través de un cuestionario y observación de los hábitos alimenticios de 1566 niños en los recreos, para luego ser asentados en las fichas elaboradas para el efecto. Se obtuvo como resultado que del 94% de los alimentos cariogénicos ofertados en las cantinas privadas, 48% era de alto grado de cariogenicidad y 56% de los mismos eran ofertados por las cantinas de escuelas públicas. El 99,49% de los niños consumió alimentos cariogénicos. Al aplicar la prueba exacta de Fischer se observó que existe diferencia significativa en el consumo de alimentos cariogénicos....

Comparação entre suplementos homólogos do leite humano e um suplemento comercial para recém-nascidos de muito baixo peso / Comparison between homologous human milk supplements and a commercial supplement for very low birth weight infants

OBJETIVOS: Descrever a metodologia de preparo de dois aditivos, líquido e em pó, derivados do leite humano e comparar a constituição com aditivo comercial FM85®. MÉTODOS: Foram utilizadas 40 amostras de leite humano para o preparo dos suplementos líquido e em pó. Ambos passaram por três fases de preparo: desnate, evaporação e retirada da lactose. Após essas fases, o suplemento líquido está pronto, e o em pó necessita da quarta fase - a liofilização. Em cada amostra dos suplementos líquido e em pó, foram adicionados, respectivamente, 80 mL (grupo I) e 100 mL (grupo II) de pool de leite humano de banco. Para comparação, 20 amostras de 100 mL do pool foram acrescidas de 5 g do suplemento FM85® (Nestlé) (grupo III). Realizaram-se análises de hidratos de carbono, proteína, lipídios, cálcio, fósforo, sódio, osmolalidade e conteúdo calórico, considerando diferença significativa p < 0,05. RESULTADOS: Os grupos I, II e III mostraram, respectivamente, os seguintes resultados: proteínas = 1,81, 2,38 e 1,96 g/dL (p < 0,001); hidratos de carbono = 6,70, 7,25 e 10,06 g/dL (p = 0,006); gordura = 3,75, 3,75 e 3,73 g/dL (p = 0,96); cálcio = 36,92, 44,75 e 79,37 mg/dL (p = 0,001); fósforo = 20,02, 23,28 e 56,30 mg/dL (p = 0,02); sódio = 14,32, 14,40 e 20,33 mEq/L (p = 0,143); osmolalidade = 391,45, 412,47 e 431, 00 mOsmol/kgH2O (p = 0,074); e conteúdo calórico = 67,78, 72,27 e 81,65 kcal (p = 0,001). CONCLUSÃO: Os aditivos estudados diferem significativamente do aditivo comercial FM85® em alguns de seus constituintes, e a sua constituição pode ou não atender às quantidades de nutrientes propostas pelas recomendações mais recentes.

OBJECTIVES: To describe the methodology for the preparation of two additives derived from human milk, liquid and powdered, and to compare this composition with the commercial additive FM85®. METHODS: For the preparation of the liquid and powdered supplements, 40 samples of human milk were used. Both supplements have been through three preparation phases: skimming, evaporation and lactose removal. After these phases, the liquid supplement is ready, and the powdered requires a fourth phase - lyophilization. To each sample of the liquid and powdered supplements were added, respectively, 80 mL (group I) and 100 mL (group II) of pooled banked human milk. For comparison, 20 samples of 100 mL of the pool were added to 5 g of the FM85® supplement (Nestlé) (group III). Analyses of carbohydrates, protein, lipids, calcium, phosphorus, sodium, osmolality and caloric content were performed, considering a significant difference p < 0.05. RESULTS: Groups I, II, and III showed, respectively, the following results: protein = 1.81, 2.38 and 1.96 g/dL (p < 0.001); carbohydrates = 6.70, 7.25 and 10.06 g/dL (p = 0.006); fat = 3.75, 3.75 and 3.73 g/dL (p = 0.96); calcium = 36.92, 44.75 and 79.37 mg/dL (p = 0.001); phosphorus = 20.02, 23.28 and 56.30 mg/dL (p = 0.02); sodium = 14.32, 14.40 and 20.33 mEq/L (p = 0.143); osmolality = 391.45, 412.47 and 431.00 mOsmol/kgH2O (p = 0.074); and caloric content = 67.78, 72.27 and 81.65 kcal (p = 0.001). CONCLUSION: The studied additives differ significantly from the commercial additive FM85® in some of its components, and its composition may or may not meet the quantity of nutrients suggested by the most recent recommendations.

¿Son eficaces las leches antirreflujo para el tratamiento de los síntomas ocasionados por el reflujo gastroesofásico? / Are anti-reflux formulas efficient for the treatment of symptoms caused by gastroesophageal reflux?

Introducción: El reflujo gastroesofágico es una patología frecuente en la consulta ambulatoria pediátrica. Esta revisión trata de realizar un abordaje completo del tema considerando las controversias que aún existen sobre la indicación de las leches AR. Objetivos: Evaluar la evidencia existente sobre la eficacia de las leches antirreflujo para el tratamiento de los síntomas del RGE fisiológico (vómitos, regurgitaciones) para poder recomendar o desaconsejar su uso en la práctica diaria. Material y métodos: Se realizó una revisión sistemática, utilizando las bases de datos Medline, LILACS, y Cochrane. Se utilizaron las Guías JAMA para el análisis. Se limitó la búsqueda en inglés/español, en niños/lactantes. Desde 1994 hasta 2010. Quedando ésta búsqueda actualizada hasta enero 2010. Criterios de inclusión de los estudios: ECA, niños sanos de 1 mes a 2 años. Resultados: Se analizaron 6 artículos de un total de 12, debido a que los elegidos cumplían con los criterios de inclusión;. Se excluyeron seis estudios: dos debido a que no fueron ECA ( Borrelli 1997; Chevallier 1998;), uno debido a que trató a recién nacidos ( Heacock 1992), uno debido a que comparó dos alimentos espesados diferentes (Ramirez-Mayas 2000), uno debido a que el resultado del estudio no fue un resultado de revisión primario o secundario (Fabiani 2000) y uno debido a que trató a adultos (Waterhouse 2000). Conclusiones: Las leches antirreflujo son eficaces para disminuir los síntomas de RGE como vómitos y regurgitaciones, pero no mejoran los valores de la Phmetria (Indice de Reflujo). Por otro lado, se contraindican en la ERGE o esofagitis ya que al espesar su contenido, disminuye el aclaramiento esofágico perpetuando el tiempo de permanencia del alimento y aumentando el daño a la mucosa. Las calorías aportadas por las leches AR son las necesarias para el crecimiento de los lactantes, mientras que el espesamiento de la leche con cereal de arroz genera mayor aporte de energía (AU)

Introduction: Gastroesophageal reflux (GER) is a common finding in pediatric outpatients. The present review tries to offer a comprehensive approach of GER considering the controversies that still exists on the indication of AR formulas. Objectives: To assess the existing evidence on the efficacy of anti-reflux formulas for the treatment of the symptoms of physiologic GER (vomiting, regurgitations) in order to recommend or advise against its use in the daily practice. Material and Methods: A systematic search was performed in Medline, LILACS, and Cochrane databases. JAMA Guides were used for analysis. The search was limited to English/Spanish, in children/infants between 1994 and 2010. The search was updated until January 2010. Inclusion criteria for the studies were: RCT and healthy children between 1 month and 2 years of age. Results: Six studies of a total of 12 met the inclusion criteria. Six studies were excluded for the following reasons: two were not RCTs ( Borrelli 1997; Chevallier 1998;), one was a study in newborns ( Heacock 1992), one compared two different thickened formulas (Ramirez-Mayans 2000), one because the study was not the result of a primary or secondary review (Fabiani 2000), and one because the study was performed in adult subjects (Waterhouse 2000). Conclusions: Antireflux formulas are efficient in reducing symptoms of GER, such as vomiting and regurgitations, but do not improve Ph-metry values (Reflux Index). On the other hand, AR formulas are contraindicated in GERD and esophagitis as the thickened formula diminishes esophageal clearance prolonging the permanence of the food and increasing the damage to the mucosa. Calories provided by AR formulas are necessary for the growth of the infants while rice-cereal thickening increases energy intake (AU)

"Cariogenic potential of homemade weaning diet v/s commercial formula feeds" an in-vitro study.

The universal phenomenon of introducing weaning diet to the growing child sets its onset by the age of 4-6 months. This preliminary diet of the child governs his or her dental health in the long run. The main objective of this study is to investigate the histopathological and clinical invasion of deciduous teeth exposed to both the homemade weaning diet and commercial formula feeds. The study also aims at motivating the consumption of the most appropriate diet for the weaning baby. Extracted deciduous teeth were incubated with the test solutions of homemade diet and commercial formula feeds for the period of 6 weeks. Fewer carious invasion both clinically and histopathologically were seen in homemade feeds. Thus, homemade diet can be a strong candidate for the status of 'THE IDEAL WEANING FOOD'.

Prevalence of wheeze among preschool children in Basra governonate, southern Iraq

A community-based survey was carried out in Basra governorate, Iraq, to estimate the prevalence of wheeze among children under 5 years old and to identify possible risk factors. It was found that 15.8% of the 424 preschool children enrolled in the study had a history of wheeze. More wheezy children lived in the city [16.3%] than in the rural area [15.0%]. Family history of asthma in first-degree relatives was significantly associated with wheeze [44.8% of children with wheeze versus 15.1% without wheeze]. Other household factors-parents' low educational level, formula or supplemental feeding as a baby, overcrowding, smoking at home, pet ownership and using kerosene-were associated with wheeze, but the results were not statistically significant. The role of environmental factors and feeding patterns needs to be further evaluated

IDDM and early exposure of infant to cow's milk and solid food.

Associations studies were attempted between the type of feeding, duration, and time of starting of solid foods in infancy and the incidence of insulin-dependent diabetes mellitus (IDDM). The study subjects comprised 52 IDDM patients and 52 control subjects matched for sex, age, social status, country, geographical location and selected from pediatric departments of different hospitals in Tehran. Diabetic children (21 boys, 31 girls) were of the ages of 1.5 to 14 years. Information about the pattern of their feeding at the first two years of life were collected through questionnaires administered to the mothers. The questionnaire was designed to evaluate the duration of complete or partial breast-feeding and the age at which dietary products containing cow's milk were introduced into the diet. A large proportion of the diabetic children rather than the control children had been breast-fed, and the risk of IDDM among children who had not been breast-fed was below unity. No significant difference in the duration of breast-feeding was observed between diabetic and control group. Our data do not support the existence of a protective effect of breast-feeding on the risk of IDDM, nor do the data indicate that early exposure to cow's milk and dairy products has any influence on the development of IDDM.

Hazard analysis and critical control points of weaning foods.

Hazards and critical control points were identified during the preparation, feeding and storage of weaning foods fed to the children (6-24 months) belonging to low income group (LIG) families using survey methods, spot and indepth observations and microbial analysis. High microbial counts were obtained for the weaning food samples procured from the families that were rated as poor for both personal hygiene and environmental sanitation. Food samples that were held at ambient temperature (25-35 degrees C) showed high counts of coliforms, AMCC, yeast and mold, Staphylococcus aureus and Bacillus cereus. Spice mixtures and mop samples also revealed high counts for all these organisms. Coliforms were not isolated from the water samples of all the 10 households. However, a high count of Bacillus cereus (10(3-5)/ml) was observed in water samples of two selected households. The hazards and critical control points identified were high initial contamination of raw foods, poor environmental sanitation and personal hygiene, feeding of overnight moist foods stored at ambient temperature and insufficient steaming of these foods.

Modified food starches in baby foods.

Modified food starches were developed as a stabilizer, providing desirable consistency, texture, and storage ability. They are used primarily in strained and junior foods and, to a minor extent, in infant formulas. However, despite the fact that there is an increasing tendency to introduce solid foods to infants at a very early age, there is few long-term studies to delineate the effect of starch feeding on the growth of young infants. Modified food starches used by the food industry for infants and young children are of concern and there is an urgent need for additional data regarding their bioavailability, effect on nutrient absorption, intestinal changes, and toxic, mutagenic, and carcinogenic effects. Therefore, the inclusion of modified food starches should be used prudently and sparingly.

Cólico infantil / Infant colic

Al revisar la literatura, encontramos que hay varias teorías implicadas en el síndrome de "cólico infantil". Tanto las causas gastrointestinales como las de interacción, comportamiento y temperamento han sido consideradas. Se han revisado recomendaciones para el manejo y tratamiento basado en ambas teorías. Estas han probado ser útiles y exitosas en muchos casos. Finalmente, reconocemos la necesidad de más investigación en el futuro en torno a esta condición