Ankyloglossia and Breastfeeding Duration: A Multicenter Birth Cohort Study.

Background and Objective: The prevalence of ankyloglossia and its impact on breastfeeding practices may be overestimated, leading to surgical overtreatment in newborns. The study was conducted to estimate the prevalence of ankyloglossia in the first year of life and investigate the association with exclusive and total breastfeeding duration in different regions of Brazil. Materials and Methods: This multicenter prospective cohort study involved the recruitment of mother-infant pairs soon after childbirth in public hospitals in three state capitals in Brazil. Interviews were held with the mothers after birth, at 6 and 12 months to collect sociodemographic variables and data on exclusive and total breastfeeding duration. At 12 months of age, the children were submitted to a dental examination for classification of the lingual frenulum using the Bristol Tongue Assessment Tool. Data analysis involved Poisson regression with robust variance, with the calculation of unadjusted and adjusted relative risk (RR). Results: The final sample was composed of 293 children. The prevalence of defined and suspected ankyloglossia was 1% and 4.8%, respectively, totaling 5.8% (confidence interval [95% CI]: 3.1-8.5). No significant difference was found in the prevalence of exclusive and total breastfeeding at 1, 4, and 6 months between children with defined/suspected ankyloglossia and those without ankyloglossia. The multivariable analysis showed that the probability of the child achieving 6 months of breastfeeding did not differ between groups (RR = 0.98; 95% CI: 0.79-1.23; p = 0.907). Conclusion: The prevalence of defined ankyloglossia was very low and defined/suspected ankyloglossia was not associated with exclusive or total breastfeeding duration. Clinical Trial Registration: Registered with clinicaltrials.gov (n° NCT03841123).

Breastfeeding Protects from Overjet in Adolescence by Reducing Pacifier Use: A Birth Cohort Study.

Increased dental overjet in adolescence is a clinically relevant outcome associated with the complexity and high cost of treatment, indicating the need for prevention strategies. We investigated the long-term impact of breastfeeding and pacifier use on increased overjet (IOVJ) in permanent dentition. A prospective cohort nested in a randomized controlled trial was conducted from birth to 12 years of age (n = 214). Breastfeeding and pacifier use were recorded monthly until 12 months. Overjet was assessed at age 12 years. We employed a causal mediation analysis using parametric regression models assuming no interaction between breastfeeding and pacifier usage. We found a total protective effect of breastfeeding on IOVJ (OR 0.49; 95% CI 0.28-0.96), where 63.1% were mediated by pacifier use (OR 0.61; 95% CI 0.44-0.87). Breastfeeding directly decreased the odds of IOVJ by 20%; however, the confidence interval included the null estimate (OR 0.81; 95% CI 0.41-1.60). In conclusion, breastfeeding protects by half of the IOVJ in adolescence through reducing pacifier use. Oral and general health professionals should collaborate to support WHO breastfeeding guidelines during individual patient counseling. Guidelines for practice, policy or public information require messages that include a common risk approach to oral and general health.

Consumption of ultraprocessed food is associated with higher blood pressure among 6-year-old children from southern Brazil.

Ultraprocessed foods (UPF) consumption plays a critical role in the development of chronic diseases, but evidence of their effect on children's health is limited. We hypothesized that the consumption of UPF can influence blood pressure levels in 6-year-old children. This study is a secondary analysis of a randomized field trial in Brazil that is registered at clinicaltrial.gov (NCT00635453). Dietary intake was obtained using 2 multiple-pass 24-hour recalls when 305 children were 3 and 6 years old. We classified foods according to the NOVA system and determined the percentage of total energy intake derived from ultraprocessed foods. We collected anthropometric measures from and evaluated systolic and diastolic blood pressures of 6-year-old children. Linear regression analysis was used to assess the association between UPF consumption and blood pressure levels. UPF represented 40.3% (interquartile range, 34.1-48.5) of the total energy intake at 3 years and 45.2% (interquartile range, 41.5-53.2) at 6 years. The adjusted linear regression analyses showed that systolic blood pressure was associated with UPF consumption at 6 years (P = .05), birth weight (P = .02), waist circumference (P < .01), and physical activity (P = .04), whereas diastolic blood pressure was associated with UPF consumption at 3 and 6 years (P = .01 and P < .01, respectively), birth weight (P = .05), and waist circumference (P < .01). Our data suggest that UPF consumption played a role in increasing 6-year-old children's blood pressure. These results reinforce the importance of effective strategies to prevent the excessive consumption of UPF in childhood.

Sodium Intake Tracked from Infancy and Salt Taste Preference during Adolescence: Follow-up of a Randomized Controlled Field Trial in Brazil.

Background: Effective interventions to promote healthy sodium intakes require understanding factors driving liking for salt taste. Objectives: To examine effects of an early feeding intervention among low-income mothers on their children's energy and sodium intake and salt taste preferences at 12 years; and to identify age-related changes in dietary sodium sources. Methods: Secondary analyses were conducted on dietary intake and taste preference data collected from children in a longitudinal trial (NCT00629629). Mothers randomized to the intervention group received counseling on healthy eating practices for 1 year postpartum; the control group received no counseling. Two-day dietary recalls were obtained at 1 year (intervention end) and at 4-, 8-, and 12-year follow-up visits, from which foods were categorized as unprocessed, processed, or ultra-processed. At the 12-year visit, children's most preferred concentration of salt was measured using a validated, forced-choice, paired-comparison tracking method, and pubertal stage was self-assessed. Results: The intervention group had reduced energy intake compared with controls in all food categories at 1 year (P = 0.04) but not at the other time points. Sodium intake from processed foods increased from 4 to 12 years and from ultra-processed foods from 1 to 4; intake from unprocessed foods decreased from 1 to 8 year (all P < 0.01). At 12 years, children in early stages of puberty (Tanner stages 1-3; P = 0.04) or in the ≥75th percentile of sodium intake (P < 0.01) preferred significantly higher concentrations of salt than the other children. Conclusions: Both dietary intake of sodium and early puberty were associated with preferences for higher salt concentrations. Childhood and adolescence are important periods for understanding how experience and growth shape diet by changing salt taste. Clinical Trial Registration: This manuscript reports secondary analysis of data collected in trial NCT00629629 (2001-3) and follow-up [https://clinicaltrials.gov/ct2/show/NCT00629629?term=NCT00629629&draw=2&rank=1].

Primary Dentition Caries Patterns as Predictors of Permanent Dentition Caries: A Prospective Cohort Study.

The aims of this study were to estimate the risk of caries in the permanent teeth at 12 years of age and to describe the diagnostic accuracy of caries patterns in the primary dentition at age 4 years to predict caries at age 12 years. A prospective cohort study followed children from birth to age 12 years in the city of São Leopoldo, Brazil. Sociodemographic variables were collected at birth, and dental caries was measured at 4 and 12 years of age (n = 204). At 4 years, children were classified according to the presence of caries (cavitated and non-cavitated lesions), number of lesions, affected segment (anterior or posterior), and affected surface (occlusal, smooth, or proximal). Prediction of permanent dentition caries occurrence (DMFT ≥1) (primary outcome) involved Poisson regression with robust variance and standard diagnostic accuracy measures. The prevalences of caries at age 4 years (including non-cavitated lesions) and 12 years were 61.8% and 42.2%, respectively. All caries patterns in the primary dentition were associated with caries in the permanent dentition. In multivariable analysis, the strongest associations were carious lesions on the primary posterior teeth (RR 2.2; 95% CI 1.5-3.2) and occlusal surfaces (RR 2.1; 95% CI 1.4-3.0). Among patterns evaluated, the presence of any tooth with caries (cavitated or non-cavitated) had the highest sensitivity (73%), but any tooth with cavitated decay had the highest accuracy (67%). In conclusion, any dental caries experience in early childhood is strongly predictive of dental caries experience in early adolescence. Primary dentition carious lesions on the posterior teeth or occlusal surfaces and the presence of cavitated lesions were stronger predictors.

Vitamin A deficiency and associated risk factors in children aged 12-59 months living in poorest municipalities in the South Region of Brazil.

OBJECTIVE: To estimate the prevalence of vitamin A deficiency (VAD) in children and associated risk factors. DESIGN: Analysis of data from a cross-sectional multicentre study performed in the primary care units of the municipalities from January to June 2015. The children's legal guardians answered a socio-economic questionnaire, and the children's blood samples were obtained by venipuncture. Plasma retinol was determined by HPLC. Plasma retinol values of <0·70 µmol/l were considered VDA. Poisson multiple regression with robust variance was used. Values of P < 0·05 were considered significant. The data were analysed in the SPSS software, 21.0. SETTING: Forty-eight poorest municipalities in the South Region of Brazil. PARTICIPANTS: Children (n 1503) aged 12-59 months. RESULTS: The prevalence of VAD in the sample was 1·9 % (95 % CI (0·5, 6·8)). The following risk factors were associated with the outcome in the final explanatory model: family received Bolsa Familia program benefits (PR = 3·19; 95 % CI (1·69, 6·02)), child was not being breastfed (PR = 5·22; 95 % CI (1·68, 16·18)) and stunting (PR = 4·75; 95 % CI (2·10, 10·73)). CONCLUSIONS: VAD did not represent a public health problem for children living in socio-economically vulnerable municipalities in the South Region of Brazil, suggesting a new panorama of this nutritional deficiency even in regions of low socio-economic conditions in these three states. Thus, in view of the current nutritional transition scenario, it is necessary to continuously monitor and improve public policies related to vitamin A supplementation in the country.

Influências sociais nas práticas alimentares da dupla mãe-filho nos primeiros seis meses de vida / Social influences on the feeding practices of the mother-child couple in the first six months of life

Resumo A dupla mãe-filho está inserida em um sistema social que gera diversas influências nas práticas alimentares, inclusive nos primeiros seis meses de vida, período em que é preconizado o aleitamento materno exclusivo pela Organização Mundial da Saúde. Objetivo: Compreender o conjunto de influências sociais que incidem nas práticas alimentares adotadas pela nutriz e para o seu filho nos primeiros seis meses de vida. Método: Estudo qualitativo, com abordagem metodológica de análise descrito por Minayo e alicerçado na fenomenologia social de Alfred Schütz. Participaram oito duplas mãe-filho recrutados de dois hospitais públicos de Salvador-BA com a Iniciativa Hospital Amigo da Criança. Realizou-se entrevista semiestruturada no domicílio das mães aos seis meses de vida da criança no período de junho a agosto de 2019. Resultados: Emergiram três tipificações: o fazer "correto" nos primeiros seis meses de vida da criança; as ações de cuidados com as práticas alimentares da mulher-mãe que amamenta; e o mundo social da dupla mãe-filho. Conclusão: para a tomada de decisão sobre as práticas alimentares da nutriz, a mãe exerceu mais influência; já para a criança, a nutriz considerou as orientações recebidas pelos profissionais de saúde.

Abstract The mother-child pair is inserted in a social system that generates different influences on eating practices, including in the first six months of life, a period in which exclusive breastfeeding is recommended by the World Health Organization. Objective: To understand the set of social influences that affect the eating habits adopted by the nursing mother and her child in the first six months of life. Method: Qualitative study, with a methodological analysis approach described by Minayo and based on the social phenomenology of Alfred Schütz. Eight mother-child pairs recruited from two public hospitals in Salvador-BA with the Amigo da Criança Hospital Initiative participated. A semi-structured interview was carried out at the mothers' homes when the child was six months old, from June to August 2019. Results: Three typifications emerged: doing "correctly" in the first six months of the child's life; care actions with the feeding practices of the woman-mother who breastfeeds; and the social world of the mother-son duo. Conclusion: For decision-making about the nursing mother's eating practices, the mother exerted more influence; for the child, the nursing mother considered the guidelines received by health professionals.

Impact of maternal dietary counseling in the first year of life on DNA methylation in a cohort of children.

Epigenetic modifications established during prenatal and early life, including DNA methylation, have been suggested as potential mediators of the interaction between environmental exposures during the perinatal period and adult metabolic health adverse outcomes, especially cardiometabolic complications and overweight. The effect of a dietary intervention in the first year of life on global methylation levels in leukocyte samples from a cohort of children born between 2001 and 2002 in southern Brazil was examined. Overall methylation measurements were performed using enzyme-linked immunosorbent assays on DNA samples from 237 children at 4 years old. Mean methylation values were higher in the intervention group (mean: 2.20 ± 1.31%) than in the control group (mean: 1.65 ± 1.11%; P = 0.001). It was observed that nutritional counseling in the first year increased breastfeeding duration and stimulated the development of healthier eating habits. Therefore, these factors might have contributed to increase global DNA methylation. The findings of the present study reinforce the notion that performing nutritional interventions in the early stages of life is important and provide further evidence of the interaction between the environment and epigenetic traits.

Primary Health Care Intervention Reduces Added Sugars Consumption During Childhood.

OBJECTIVE: To investigate the effectiveness of a training program for health workers regarding infant feeding practices to reduce sugar consumption in children. DESIGN: A cluster randomized trial was conducted at 20 health centers in southern Brazil randomly assigned to an intervention (n = 9) or control (n = 11) group. PARTICIPANTS: The 715 pregnant women enrolled were assessed when their children were aged 6 months, 3 years, and 6 years. INTERVENTION: A training session for primary care workers based on the Brazilian National Guidelines for Children. MAIN OUTCOME MEASURE: Mothers were asked when sugar was first offered to children. Added sugars intake was obtained from dietary recalls. ANALYSIS: The effectiveness of the intervention was modeled using generalized estimation equations and Poisson regression with robust variance. RESULTS: Children attending intervention health centers had a 27% reduced risk of sugar introduction before 4 months of age (relative risk, 0.73; 95% confidence interval [CI], 0.61-0.87) as well as lower added sugars consumption (difference, -6.36 g/d; 95% CI, -11.49 to -1.23) and total daily energy intake (difference, -116.90 kcal/d; 95% CI, -222.41 to -11.40) at 3 years of age. CONCLUSIONS AND IMPLICATIONS: Health care worker training in infant feeding guidelines may be an effective intervention to delay the introduction of added sugars and lower the subsequent intake of added sugars in infants and toddlers.

Early-Life Patterns of Sugar Consumption and Dental Caries in the Permanent Teeth: A Birth Cohort Study.

Early-life family conditions may presage caries development in childhood. The aim of this study was to evaluate associations between patterns of sugar consumption in early childhood and permanent dentition caries at age 6 years. A cohort enrolled women accessing prenatal care at public health clinics in Porto Alegre, Brazil. Sociodemographic, anthropometric, and dietary data were collected during pregnancy and 6-month, 12-month, and 3-year follow-ups. Calibrated dental examinations occurred at ages 3 and 6 years. Multivariable logistic regression analysis was performed in series to quantify associations between early-life variables and permanent dentition caries. At age 6 years, 7.9% of children (21/266) had ≥1 caries lesion on permanent teeth (first molars). In unadjusted models, gestational weight gain, sweet food introduction (age 6 months), household sugar purchases (age 3 years), and caries (age 3 years) were positively associated with permanent dentition caries (age 6 years). In multivariable models, each 1-kg increase in gestational weight gain (odds ratio [OR]: 1.08; 95% confidence interval [CI]: 1.01, 1.16) and each 1-item increase in sweet food consumption at age 6 months (OR: 1.27; 95% CI: 1.02, 1.59) remained statistically significantly associated with permanent molar caries. Findings from this cohort study suggest family and child factors that long predate the permanent dentition, including sugar-related behaviors, predict future dental status, and may inform prevention strategies.

Impact of promoting healthy infant feeding practices on energy intake and anthropometric measures of children up to 6 years of age: A randomised controlled trial.

BACKGROUND: The first 2 years of life are the window of opportunity to promote healthy feeding practices. Thus, the present study aimed to assess the impact of a health workers training in infant dietary guidelines on energy intake and anthropometric measurement into childhood. METHODS: Cluster randomised field trial (NCT00635453) was conducted in Porto Alegre, Brazil. Healthcare centres were randomised into intervention (n = 9) and control (n = 11) groups. In intervention sites, health workers were trained to promote healthy feeding practices based on the Brazilian guideline for children's nutrition. Pregnant women who were in the last trimester of pregnancy were registered as potential mothers who would receive dietary counselling from the health workers. Energy and macronutrient intake and anthropometric measurements were obtained from children at ages 6 months, 12 months, 3 years and 6 years from low-income families. RESULTS: At age 3 years, intervention group had lower consumption of energy [-92.5 kcal; 95% confidence interval (CI) = -153.5 to -31.5], carbohydrates (-11.9 g; 95% CI = -19.9 to -2.3), and total fat (-3.9 g; 95% CI = -6.2 to -1.2), compared to the control group. At 6 years of age, children in the intervention group had lower waist circumference (-1.3 cm; 95% CI = -2.7 to -0.0), triceps (-1.3 mm; 95% CI = -2.5 to -0.0) and subscapular skinfolds (-1.3 mm; 16 95% CI = -2.6 to -0.0) thickness measurements compared to those in the control group. CONCLUSIONS: The health workers training to promote infant healthy feeding practices resulted in lower energy, carbohydrates and fat intake at 3 years and lower waist circumference, triceps and subscapular skinfolds measurements at 6 years.

Exploring the risk factors for early-life sugar consumption: A birth cohort study.

BACKGROUND: Sugar consumption in early childhood is the primary cause of negative health outcomes, including early childhood caries. AIM: To investigate risk factors associated with early-life sugar consumption. DESIGN: Explanatory variables were collected at baseline of a birth cohort in Porto Alegre, Southern Brazil. At six months of age, data were collected on child feeding practices, including the number of foods and beverages containing sugar. Multivariate Poisson regression analysis with robust variance was performed. RESULTS: Virtually all children (98.3%) had consumed sugar by the age of 6 months. Multivariable analysis showed that the number of sweet items was significantly larger in children whose mothers were less than 20 years of age (MR = 1.19; 95% CI: 1.05-1.36), those from non-nuclear families (MR = 1.12; 95% CI: 1.04-1.20), those whose mothers had less than eight years of schooling (MR = 1.34; 95% CI: 1.20-1.50) and those whose mothers smoked (MR = 1.23; 95% CI: 1.13-1.35). Moreover, the number of sweet items was significantly lower among children who breastfed in the first hour of life (MR = 0.85; 95% CI: 0.76-0.95). CONCLUSION: Sugar consumption begins very early, especially in children with no access to breastfeeding in the first hours of life and those from younger, less educated, and smoking mothers.

Breastfeeding in the First Hours of Life Protects Against Pacifier Use: A Birth Cohort Study.

Objective: To investigate risk factors for pacifier use in the first year of life. Materials and Methods: A prospective cohort study was conducted with children enrolled at birth in Porto Alegre, Southern Brazil, whose mothers underwent prenatal care at primary care units. Soon after the birth of the children, data were collected on anthropometrics, type of childbirth, and time until breastfeeding on the first day of life. At 6 and 12 months of age, data were collected on breastfeeding practices and whether the child had used a pacifier in the previous 6 months. Statistical analysis involved the use of Poisson regression with robust variance. Results: The incidence of pacifier use in the first year of life was 60% (317/532). The multivariable analysis showed that pacifier use in the first year of life was 33% higher when the mother was younger than 18 years of age (relative risk [RR] = 1.33; confidence interval [95% CI]: 1.01-1.76). Infants who breastfed in the first 30 minutes after birth had a 25% lower risk of pacifier use in the first year of life (RR = 0.75; 95% CI: 0.60-0.94), and those who breastfed between 30 minutes and 6 hours after birth had an 18% lower risk (RR = 0.82; 95% CI: 0.69-0.97) compared to those who took longer to begin breastfeeding or did not breastfeed. Conclusions for Practice: Breastfeeding soon after being born protected against pacifier use in the first year of life. This finding suggests pathways to improve child health, especially in the prenatal period and with an emphasis on pregnant adolescents.

Longitudinal associations between ultra-processed foods and blood lipids in childhood.

Emerging evidence suggests that the consumption of ultra-processed foods (UPF) plays a role in the development of chronic diseases, but evidence of their influence in children is limited. Our objective was to study longitudinal trends of UPF intake and determine their impact on blood lipids in young children. The present study was a follow-up of a randomised field trial of children (n 308) from Porto Alegre, Brazil. Dietary intake was collected using two 24-h recalls at 3 and 6 years of age, and consumption of UPF was classified according to the NOVA system, a food classification based on the extent and purpose of industrial food processing. At age 6 years, blood tests were performed to measure lipid profile. Contribution of UPF to total energy intake increased by 10 % during the follow-up period, from 43·4 % at 3 years to 47·7 % at 6 years of age. Linear regression models showed that children in the highest tertile of UPF consumption at age 3 years had higher levels of total cholesterol (TC; ß 0·22 mmol/l; 95 % CI 0·04, 0·39) and TAG at age 6 years (ß 0·11 mmol/l, 95 % CI 0·01, 0·20) compared with those in the lowest tertile. A positive dose-response was observed for an absolute increment of 10 % of UPF on TC (ß 0·07 mmol/l, 95 % CI 0·00, 0·14) and TAG (ß 0·04 mmol/l, 95 % CI 0·01, 0·07). Based on our data, consumption of UPF increased significantly over time and was associated with higher blood lipid levels in children from a low-income community. Our findings highlight the need for effective strategies to minimise the consumption of UPF in early life.

Family Health Strategy associated with increased dental visitation among preschool children in Brazil.

BACKGROUND: Early-life dental service utilization could improve child dental health. AIM: Identify contextual, socioeconomic, and child characteristics associated with dental visitation by age 3 years. DESIGN: Within a Brazilian birth cohort (N = 435), multivariable regression models were fitted to identify independent predictors of having made a dental visit at age 3 years. Contextual variables considered included health center type (Traditional vs. Family Health Strategy, which perform home visits) and composition of oral health teams at the heath center where mothers accessed prenatal care. RESULTS: Dental visitation was positively associated with Family Health Strategy health centers (36% vs. 23%) and with higher maternal education and family social class. Visitation was lowest among families served by a health center without a dentist, but number of dentists and oral health team composition were not associated with visitation among facilities with ≥1 dentists. Dental visitation was not statistically significantly associated with caries experience but was higher if parents reported worse oral health-related quality of life. The vast majority of dental decay remained untreated. CONCLUSIONS: Dental visits were underutilized, and socioeconomic inequalities were evident. Dental visitation was more common when mothers received prenatal care at Family Health Strategy health centers, suggesting a possible oral health benefit.

Evaluation of association of DRD2 TaqIA and -141C InsDel polymorphisms with food intake and anthropometric data in children at the first stages of development.

The reward sensation after food intake may be different between individuals and variants in genes related to the dopaminergic system may indicate a different response in people exposed to the same environmental factors. This study investigated the association of TaqIA (rs1800497) and -141C InsDel (rs1799732) variants in DRD2/ANKK1 gene with food intake and adiposity parameters in a cohort of children. The sample consisted of 270 children followed until 7 to 8 years old. DNA was extracted from blood and polymorphisms were detected by PCR-RFLP analysis. Food intake and nutritional status were compared among individuals with different SNP genotypes. Children carrying the A1 allele (TaqIA) had higher energy of lipid dense foods (LDF) when compared with A2/A2 homozygous children at 7 to 8 years old (GLM p=0.004; Mann Whitney p=0.005). No association was detected with -141C Ins/Del polymorphism. To our knowledge, this is the first association study of the DRD2 TaqIA and -141C Ins/Del polymorphism with food intake and anthropometric parameters in children. DRD2 TaqIA polymorphism has been associated with a reduction in D2 dopamine receptor availability. Therefore, the differences observed in LDF intake in our sample may occur as an effort to compensate the hypodopaminergic functioning.