Improving the Nutritional Status of Socially Vulnerable Children in Manaus, Brazilian Amazon, through a Food Supplementation Programme.

Information on the effects of government nutrition programmes provided to socially vulnerable children to improve their nutritional status is scarce. We analysed the effectiveness of a nutritional programme, including food supplementation with infant formula, on the evolution of the weight and height of socially vulnerable children from Manaus in the Brazilian Amazon. This study included 7752 children aged 12-24 months admitted to the programme between 2017 and 2020. Weight and height measurements at admission and every three months thereafter were extracted from the programme database. Weight-for-age, weight-for-height, body mass index-for-age (BMI/A), and height-for-age z-scores were analysed using a multilevel linear regression model, which showed a statistically significant decrease in nutritional deficits toward nutritional recovery at follow-up. The programme's effectiveness was evaluated in 1617 children using a paired analysis comparing data from between 12 and 15 months of age at admission and follow-up after 6-9 months. Children admitted with wasting presented an increase in the BMI/A z-score, whereas children admitted with a risk of being overweight and obese had a statistically significant decrease in the BMI/A z-score. Children admitted with stunted growth also showed increased height-for-age z-scores. The nutrition programme was effective for children experiencing wasting and reducing excess weight.

Mothers' sociodemographic factors and use of health professionals for child feeding advice.

This study examined sociodemographic factors associated with mothers seeking child feeding advice from health professionals (HPs). Cross-sectional analysis of survey data from linked randomized controlled trials was conducted. Surveys asked which sources of feeding information mothers used when their child was 6 months and 5 years old. Logistic regression was used to examine associations between sociodemographic characteristics and use of information from HPs. Here, 947 and 405 mothers completed 6-month and 5-year surveys, respectively. At 6 months, multiparous mothers were less likely to seek advice from child and family health nurses (CFHNs) (adjusted odds ratio [AOR]: 0.558, 95% confidence interval [95% CI]: 0.416-0.749) and other HPs (AOR: 0.706, 95% CI: 0.542-0.919), unmarried mothers were less likely to seek advice from other HPs (AOR: 0.582, 95% CI: 0.342-0.990). At 5 years, mothers with household income ≥$80,000 p.a. were less likely to seek advice from CFHNs (AOR: 0.514, 95% CI: 0.302-0.875) and working mothers less likely to seek advice from general practitioners (GPs) (AOR: 0.581, 95% CI: 0.374-0.905). Mothers born in Australia were less likely to seek information from CFHNs (AOR: 0.462, 95% CI: 0.257-0.833) and GPs (AOR: 0.431, 95% CI: 0.274-0.677). There was a greater likelihood that multiparous mothers (AOR: 2.114, 95% CI: 1.272-3.516) and mothers of children whose fathers had not attended university (AOR: 2.081, 95% CI: 1.256-3.449) had never sought advice from CFHNs, and that mothers who had not attended university (AOR: 1.769, 95% CI: 1.025-3.051), multiparous (AOR: 1.831, 95% CI: 1.105-3.035) and employed (AOR: 2.058, 95% CI: 1.135-3.733) mothers had never sought advice from other HPs. Understanding sociodemographic factors associated with seeking child feeding advice from HPs may inform priorities for engaging families in health promotion.

Digestive perianastomotic ulcerations after intestinal resection in children.

Digestive perianastomotic ulceration (DPAU) is a rare complication after intestinal resection and anastomosis occurring at or near the anastomosis site. The purpose of this review is to summarize the characteristics of DPAU, including the etiology, diagnosis and differential diagnosis, clinical manifestations, treatment, and future research. All recent literature on DPAU was searched in PubMed, Embase, and Cochrane and then reviewed. The clinical manifestations of DPAU are mainly gastrointestinal symptoms such as bloody stool and chronic anemia. The diagnosis of DPAU is difficult. Specific diseases, such as Crohn's disease, must be ruled out before a diagnosis can be made. In addition, there are no clear treatment guidelines due to the high degree of heterogeneity in response to drugs and surgery. It is recommended to adjust medication in time and combine various treatment methods. In addition, the mechanism that causes DPAU is not well understood; however, several possible mechanisms have been proposed, such as scar tissue ischemia and underlying diseases. Moreover, there is a high risk of relapses, and a long-term follow-up is necessary. Numerous issues remain to be solved in this area; therefore, more randomized controlled trials and studies should be carried out to further understand this disease.

Cost-effectiveness of infant hypoallergenic formulas to manage cow's milk protein allergy in France.

Background: Clinician's choice of hypoallergenic formulas in the first-line management of cow's milk protein allergy (CMPA) should be informed by evidence on clinical efficacy and cost-effectiveness. Objective: We compare the cost-effectiveness of amino acid-based formula (AAF), extensively hydrolyzed casein formula with Lactobacillus rhamnosus Gorbach Goldin (EHCF+LGG), extensively hydrolyzed whey formula (EHWF), and rice hydrolyzed formula (RHF) in non-breastfed children in France. Methods: Immunotolerance and atopic manifestations' prevalence were based on a prospective non-randomized study with a 36-month follow-up. Resource utilization was sourced from a survey of French clinicians, and unit costs were based on national data. Costs and health consequences were discounted at 2.5% annually. Results were reported using the Collective and French National Health Insurance perspectives. Results: Children receiving EHCF+LGG were predicted to require less healthcare resources, given their reduced prevalence of CMPA symptoms at 3 years. In the base case, EHCF+LGG led to savings of at least €674 per child compared to AAF, EHWF, and RHF at 3 years, from both perspectives. Nutrition had the highest economic burden in CMPA, driven by hypoallergenic formulas and dietetic replacements costs. Results were robust to one-way and probabilistic sensitivity analyses. Conclusions: EHCF+LGG was associated with more symptom-free time, higher immune tolerance, and lower costs.

Patterns in Mothers' Recollection of Health Care Providers' Young Child Feeding Recommendations.

OBJECTIVE: Characterize feeding guidance mothers recall receiving from their child's health care provider (HCP). DESIGN: Cross-sectional study of mothers participating in the 2017-2019 National Survey of Family Growth. PARTICIPANTS: US mothers reporting (n = 1,302) information about their youngest child (aged 6 months to 5 years). VARIABLES MEASURED: Weighted percentage of mothers who recalled their child's HCP discussing 6 different feeding topics by demographic characteristics. ANALYSIS: Logistic regression assessing the relationship between recall of feeding guidance and demographics. RESULTS: In this sample, 36.9% of mothers (95% confidence interval, 32.3-41.4) recalled HCPs recommending solid food before 6 months old (34.6% at 4-5 months, and 2.3% before 4 months). Mothers who were older or had a higher education level were more likely than their counterparts to recall their HCP discussing several of the feeding topics examined. CONCLUSION AND IMPLICATIONS: Mothers reported high recollection of early childhood nutrition guidance from their HCP; however, certain topics (eg, appropriate timing of solid food introduction) could be prioritized, and some subpopulations may need additional focus to improve receipt of messages. A better understanding of variability in recall of feeding guidance could provide information for interventions to address barriers to receiving and retaining guidance.

Determinants of exclusive breastfeeding among Haitian children under 6 months of age.

Objective: To identify the determinants of exclusive breastfeeding (EBF) among children under 6 months of age from three regions in the South and Grand'Anse Departments of Haiti. Methods: Data were pooled from three cross-sectional surveys conducted yearly from 2017 to 2019 with the guardians of 638 children under 6 months of age. A non-quantitative 24-hour dietary recall was used to assess EBF the day before the survey. Using unadjusted and adjusted prevalence ratios, associations were assessed between EBF and several explanatory factors: infant's age and sex; maternal age, educational attainment, mid-upper arm circumference (MUAC), dietary diversity, number of children under 5 years of age, responsibility for the main or secondary source of income of the household, initiation of breastfeeding within one hour, knowledge of EBF duration; household severe food insecurity, socioeconomic status, dependency ratio, region, and residential zone (urban/rural). Results: Prevalence of EBF was 68% in the study sample. From the fully adjusted model, prevalence of EBF was statistically significantly higher among younger infants, mothers with larger MUAC, who met or exceeded Minimum Dietary Diversity for Women (MDD-W), who initiated breastfeeding within one hour, who were knowledgeable of the recommendations for EBF duration, and living in the Jérémie region. Conclusions: The main determinants of EBF identified in this study attest to the importance of breastfeeding mothers' access to nutritious food for the practice and maintenance of EBF and the need for geographically equitable access to health services and education that support breastfeeding.

Association between dietary and suicidal behaviors in adolescents in Korea based on the Youth Risk Behavior Survey (2015-2020).

OBJECTIVES: This study explored the association between dietary and suicidal behaviors of Korean adolescents and investigated differences in this association in children of immigrant parents. METHODS: The sample (n=368,138) was collected from the Korea Youth Risk Behavior Survey from 2015 to 2020. Participants who agreed to provide family information (n=313,689) were classified according to their parents' nationality. The study variables were 11 self-reported dietary behaviors, and their composite dietary behaviors (i.e., nutrient deprivation and unhealthy food consumption) that resulted from principal component analysis. The association between study variables and suicide-related outcomes (i.e., suicidal ideation, suicide planning, and suicide attempts) was analyzed by multiple logistic regression with adjustment for covariates. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated. RESULTS: Participants who skipped key meals and foods were more likely to have attemped suicide (aOR [95% CI]: skipping breakfast ≥5 days/wk, 1.28 [1.21 to 1.35]; consuming fruits <1 times/wk: 1.42 [1.32 to 1.52]; consuming vegetables <1 times/wk: 1.72 [1.53 to 1.93]; consuming milk <3 times/wk: 1.07 [0.99 to 1.16]). The associations were prominent in third culture kids (TCKs) (aOR [95% CI]: 2.23 [1.61 to 3.09]; 2.32 [1.61 to 3.35]; 2.63 [1.50 to 4.60]; 1.69 [1.09 to 2.63], respectively). Participants who consumed unhealthy foods (fast food, caffeinated and sugary drinks) more frequently were more likely to have attempted suicide (aOR, 1.55; 95% CI, 1.38 to 1.73). This association was also more prominent in TCKs (aOR, 2.08; 95% CI, 1.08 to 4.01). CONCLUSIONS: Our findings indicate a positive association between unfavorable dietary behaviors and outcomes related to suicide, and this association appears to be notable in adolescents with immigrant parents.

Obesity prevention practices in early care and education settings: an adaptive implementation trial.

BACKGROUND: Despite the potential for Early Care and Education (ECE) settings to promote healthy habits, a gap exists between current practices and evidence-based practices (EBPs) for obesity prevention in childhood. METHODS: We will use an enhanced non-responder trial design to determine the effectiveness and incremental cost-effectiveness of an adaptive implementation strategy for Together, We Inspire Smart Eating (WISE), while examining moderators and mediators of the strategy effect. WISE is a curriculum that aims to increase children's intake of carotenoid-rich fruits and vegetables through four evidence-based practices in the early care and education setting. In this trial, we will randomize sites that do not respond to low-intensity strategies to either (a) continue receiving low-intensity strategies or (b) receive high-intensity strategies. This design will determine the effect of an adaptive implementation strategy that adds high-intensity versus one that continues with low-intensity among non-responder sites. We will also apply explanatory, sequential mixed methods to provide a nuanced understanding of implementation mechanisms, contextual factors, and characteristics of sites that respond to differing intensities of implementation strategies. Finally, we will conduct a cost effectiveness analysis to estimate the incremental effect of augmenting implementation with high-intensity strategies compared to continuing low-intensity strategies on costs, fidelity, and child health outcomes. DISCUSSION: We expect our study to contribute to an evidence base for structuring implementation support in real-world ECE contexts, ultimately providing a guide for applying the adaptive implementation strategy in ECE for WISE scale-up. Our work will also provide data to guide implementation decisions of other interventions in ECE. Finally, we will provide the first estimate of relative value for different implementation strategies in this setting. TRIAL REGISTRATION: NCT05050539 ; 9/20/21.

Determinants of exclusive breastfeeding among Haitian children under 6 months of age / Los determinantes de la lactancia materna exclusiva en menores de 6 meses de edad en Haití / Determinantes do aleitamento materno exclusivo entre crianças haitianas com menos de 6 meses de idade

ABSTRACT Objective. To identify the determinants of exclusive breastfeeding (EBF) among children under 6 months of age from three regions in the South and Grand'Anse Departments of Haiti. Methods. Data were pooled from three cross-sectional surveys conducted yearly from 2017 to 2019 with the guardians of 638 children under 6 months of age. A non-quantitative 24-hour dietary recall was used to assess EBF the day before the survey. Using unadjusted and adjusted prevalence ratios, associations were assessed between EBF and several explanatory factors: infant's age and sex; maternal age, educational attainment, mid-upper arm circumference (MUAC), dietary diversity, number of children under 5 years of age, responsibility for the main or secondary source of income of the household, initiation of breastfeeding within one hour, knowledge of EBF duration; household severe food insecurity, socioeconomic status, dependency ratio, region, and residential zone (urban/rural). Results. Prevalence of EBF was 68% in the study sample. From the fully adjusted model, prevalence of EBF was statistically significantly higher among younger infants, mothers with larger MUAC, who met or exceeded Minimum Dietary Diversity for Women (MDD-W), who initiated breastfeeding within one hour, who were knowledgeable of the recommendations for EBF duration, and living in the Jérémie region. Conclusions. The main determinants of EBF identified in this study attest to the importance of breastfeeding mothers' access to nutritious food for the practice and maintenance of EBF and the need for geographically equitable access to health services and education that support breastfeeding.

RESUMEN Objetivo. Determinar cuáles son los determinantes de la lactancia materna exclusiva en menores de 6 meses de edad de tres regiones de los departamentos Sur y Grand'Anse de Haití. Métodos. Se agruparon los datos de tres encuestas transversales realizadas anualmente entre 2017 y 2019 a representantes de 638 bebés menores de 6 meses de edad. Se empleó una descripción no cuantitativa de los alimentos consumidos en las últimas 24 horas para evaluar la lactancia materna exclusiva el día anterior a la encuesta. Mediante cocientes de prevalencia ajustados y no ajustados, se evaluó la relación entre la lactancia materna exclusiva y varios factores explicativos: sobre el lactante: edad y sexo; sobre la madre: edad, nivel educativo, circunferencia del brazo media, diversidad alimentaria, número de hijos menores de 5 años y responsabilidad como fuente principal o secundaria de ingresos del hogar; inicio de la lactancia materna en un plazo de una hora después del nacimiento y conocimiento sobre la duración de la lactancia materna exclusiva; inseguridad alimentaria grave en el hogar, situación socioeconómica y tasa de dependencia; y región y zona residencial (urbana/rural). Resultados. La prevalencia de la lactancia materna exclusiva fue de 68 % en la muestra del estudio. A partir del modelo totalmente ajustado, la prevalencia de la lactancia materna exclusiva fue significativamente mayor desde un punto de vista estadístico en los bebés más pequeños, las madres con una mayor circunferencia del brazo media, la que cumplieron o excedieron la Diversidad Alimentaria Mínima para las Mujeres, las que iniciaron la lactancia materna dentro de una hora después del parto, las que conocían bien las recomendaciones sobre la duración de la lactancia materna exclusiva y las que vivían en la región de Jérémie. Conclusiones. Los principales determinantes de la lactancia materna exclusiva identificados en este estudio confirman la importancia de que las madres lactantes tengan acceso a alimentos nutritivos para la práctica y el mantenimiento de la lactancia materna exclusiva, así como la necesidad de disponer de un acceso geográfico equitativo a los servicios de salud y la educación que respaldan la lactancia materna.

RESUMO Objetivo. Identificar os determinantes do aleitamento materno exclusivo (AME) entre crianças com menos de 6 meses de idade de três regiões dos departamentos Sul e Grand'Anse do Haiti. Métodos. Agruparam-se dados de três pesquisas transversais realizadas anualmente, de 2017 a 2019, com pais e responsáveis de 638 crianças com menos de 6 meses de idade. Um recordatório alimentar não quantitativo de 24 horas foi utilizado para avaliar o AME no dia anterior à pesquisa. Usando taxas não ajustadas e ajustadas de prevalência, avaliou-se a associação entre AME e diversos fatores explicativos: idade e sexo do bebê; idade da mãe, seu nível de escolaridade, circunferência do braço (CB), diversidade da dieta, número de filhos com menos de 5 anos, responsabilidade pela fonte primária ou secundária de renda da família, início do aleitamento materno na primeira hora, conhecimento sobre a duração do AME; insegurança alimentar domiciliar grave, status socioeconômico, índice de dependência, região e zona residencial (urbana/rural). Resultados. A prevalência de AME na amostra do estudo foi de 68%. Com base no modelo totalmente ajustado, a prevalência do AME foi maior, de forma estatisticamente significante, entre bebês mais jovens, mães com maior CB, que atendiam ou excediam a Diversidade Alimentar Mínima para Mulheres (MDD-W), que começaram a amamentar na primeira hora, que estavam familiarizadas com as recomendações sobre a duração do AME e que moravam na região de Jérémie. Conclusões. Os principais determinantes de AME identificados neste estudo atestam a importância do acesso das lactantes a alimentos nutritivos para a prática e a continuidade do AME, e a necessidade de acesso geograficamente equitativo a educação e serviços de saúde que apoiem o aleitamento materno.

Association of Diet, Physical Activity Guidelines and Cardiometabolic Risk Markers in Children.

The aim was to identify different dietary and physical activity (PA) patterns in 5- to 14-year-old children with a high prevalence of overweight and obesity using cluster analysis based on their adherence to the Spanish Society of Community Nutrition dietary guidelines and levels of PA, and to determine their associations with age, sex, body composition, and cardiometabolic risk markers. In 549 children, hierarchical cluster analysis was used to identify subgroups with similar adherence to dietary recommendations and level of PA. Three clusters were identified: Cluster 1, with the lowest level of vigorous PA and adherence to dietary recommendations; Cluster 2, with the lowest levels of moderate and vigorous PA and the highest adherence to dietary recommendations; and Cluster 3, with the highest level of PA, especially vigorous PA and a medium level adherence to dietary recommendations. Cluster 3 had lower total body fat and higher lean body mass percentages than Cluster 2. Cluster 2 had lower high-density lipoprotein cholesterol and higher low-density lipoprotein cholesterol levels than Cluster 1. The results from our study suggest that it is important to consider adherence to PA recommendations together with adherence to dietary guidelines to understand patterns of obesogenic habits in pediatric populations with high prevalence of overweight and obesity.

Toddler milk perceptions and purchases: the role of Latino ethnicity.

OBJECTIVES: Toddler milk (i.e. a nutrient-fortified milk-based drink marketed for children 12-36 months old) is increasingly being marketed in the USA despite not being recommended for young children. There is evidence of targeted toddler milk marketing to Latinos in the USA. This study aimed to explore toddler milk perceptions and behaviours among Latino and non-Latino parents. DESIGN: An online survey assessed toddler milk perceptions, behaviours and interpretations of nutrition-related claims. Multivariable logistic and linear regression explored socio-demographic correlates of parent reported past purchases and perceived healthfulness. SETTING: Online. PARTICIPANTS: National convenience sample of 1078 US parents of children aged 2-12 years (48 % Latino). RESULTS: About half of parents (51 %) had previously purchased toddler milk and few (11 %) perceived toddler milk as unhealthy. Latino parents were more likely to have purchased toddler milk than non-Latino parents (P < 0·001), but there were no differences in perceived product healthfulness (P = 0·47). Compared to parents born in the USA, parents living in the USA 10 years or less were more likely to have purchased toddler milk (P < 0·001) and perceive toddler milk as healthier (P = 0·002). Open-ended interpretations of claims were primarily positive, suggesting 'health halo' effects. CONCLUSIONS: Common misperceptions about toddler milk healthfulness suggest stronger labelling regulations are needed. Greater reported purchases by Latino parents and recent immigrants warrant further investigation.

Parental Perceptions and Exposure to Advertising of Toddler Milk: A Pilot Study with Latino Parents.

Marketing of toddler milk (i.e., typically sugar-sweetened nutrient-fortified milk-based drinks marketed for children 12-36 months) is an emerging public health problem in the US. The American Academy of Pediatrics recommends against the consumption of toddler milk because it often contains added sugar and can displace nutrient-dense foods. Studies have not examined toddler milk perceptions among Latinos, an important gap given Latino children in the US are at high risk of having poor diet quality, and toddler milk is extensively advertised on Spanish-language TV. This study used an online survey of a convenience sample of 58 Latino parents to examine parents' experiences with toddler milk, understand their perceptions of the healthfulness and the nutrition-related claims on toddler milk, and describe their exposure to toddler milk advertising. Nearly half (44%) of parents in the sample reported purchasing toddler milk. When asked to provide open-ended interpretations of claims on toddler milk, almost all parents gave positive answers, suggesting potential "health halo" effects of the claims. More than half (56%) of parents reported seeing toddler milk advertisements, most commonly on Spanish-language TV. The misperceptions about toddler milk identified should be explored in further research using larger, more representative samples.

Association between breastfeeding and overweight/obesity in schoolchildren aged 7-14 years / Associação entre aleitamento materno e sobrepeso/obesidade em escolares de 7-14 anos

ABSTRACT Objective: To evaluate the prevalence of breastfeeding (BF) and the association between occurrence/duration of BF and overweight/obesity in schoolchildren aged 7-14 years. Methods: This is a cross-sectional study, conducted in 2012-2013, on schoolchildren aged 7-14 years from Florianópolis, Santa Catarina, Southern Brazil. Weight and height were measured according to procedures of the World Health Organization. Breastfeeding and sociodemographic data were obtained from a questionnaire responded by parents/guardians. BF was categorized as a dichotomous variable (yes/no) and according to duration (months). Nutritional status was evaluated according to the Z score of the body mass index per age for sex and it was categorized into two groups: normal weight (<Z score+1) and overweight/obesity (≥Z score+1). The adjusted analysis was performed by logistic regression in two age strata (age groups of 7-10 and 11-14 years). Results: 6.6% of schoolchildren had never breastfed; 16.8% had been breastfed for ≤3 months; 16.7%, for 4-6 months; and 59.9%, for ≥7 months. No statistically significant differences were found in the occurrence and duration of BF between the age groups. The prevalence of overweight/obesity was 34.2%. For age groups (7-10 and 11-14 years), the prevalence of overweight/obesity was 36.7% and 29.8%, respectively. Chance of overweight/obesity for the age group of 7-10 years was lower among schoolchildren who were breastfed (OR=0.54; 95%CI 0.33-0.88), when compared with those who never breastfed. When categorized, the chance of overweight/obesity in the age group of 7-10 years was lower for duration of BF ≤3 months (OR=0.41; 95%CI 0.20-0.83), and 4-6 months (OR=0.48; 95%CI 0.28-0.82) when compared with children who never breastfed. Conclusions: BF for at least six months was associated with a lower chance of overweight/obesity for schoolchildren aged 7-10 years. No association was found for schoolchildren aged 11-14 years.

RESUMO Objetivo: Investigar prevalência e duração de aleitamento materno (AM) e sua associação com sobrepeso/obesidade em escolares de 7-14 anos. Métodos: Estudo transversal, realizado em 2012-2013, com escolares de 7-14 anos de Florianópolis, Santa Catarina. Peso e altura foram mensurados segundo preconizado pela Organização Mundial da Saúde (OMS). Dados sociodemográficos e sobre AM foram obtidos por questionários enviados aos responsáveis/cuidadores. A variável amamentação foi analisada como dicotômica (sim/não) e por duração (em meses). O perfil antropométrico foi avaliado por escore Z do índice de massa corporal (IMC) para a idade, segundo sexo, categorizado em: normal (<escore Z+1) e sobrepreso/obesidade (≥escore Z+1). Análises ajustadas foram realizadas (regressão logística) em dois estratos etários (7-10 e 11-14 anos). Resultados: 6,6% dos escolares nunca tinham sido amamentados, 16,8% foram amamentados por ≤3 meses, 16,7% por 4-6 meses e 59,9% por ≥7 meses. Não houve diferença estatística de ocorrência/duração de AM entre os grupos etários. A prevalência de sobrepeso/obesidade foi 34,2%. Nos grupos etários (7-10 e 11-14 anos), a prevalência foi 36,7% e 29,8%, respectivamente. A chance de sobrepeso/obesidade nos escolares de 7-10 anos foi menor entre aqueles que tinham sido amamentados (OR=0,54; IC95% 0,33-0,88), comparando com os nunca amamentados. Quando categorizada, a chance de ter sobrepeso/obesidade nos escolares de 7-10 anos foi menor quando a duração do AM foi ≤3 meses (OR=0,41; IC95% 0,20-0,83) e 4-6 meses (OR=0,48; IC95% 0,28-0,82), em comparação à ausência de AM. Conclusões: AM por pelo menos seis meses foi associado com menor chance de sobrepeso/obesidade para escolares de 7-10 anos. Não foi observada associação para o grupo 11-14 anos.

Optimizing Child Nutrition Education With the Foodbot Factory Mobile Health App: Formative Evaluation and Analysis.

BACKGROUND: Early nutrition interventions to improve food knowledge and skills are critical in enhancing the diet quality of children and reducing the lifelong risk of chronic disease. Despite the rise of mobile health (mHealth) apps and their known effectiveness for improving health behaviors, few evidence-based apps exist to help engage children in learning about nutrition and healthy eating. OBJECTIVE: This study aimed to describe the iterative development and user testing of Foodbot Factory, a novel nutrition education gamified app for children to use at home or in the classroom and to present data from user testing experiments conducted to evaluate the app. METHODS: An interdisciplinary team of experts in nutrition, education (pedagogy), and game design led to the creation of Foodbot Factory. First, a literature review and an environmental scan of the app marketplace were conducted, and stakeholders were consulted to define the key objectives and content of Foodbot Factory. Dietitian and teacher stakeholders identified priority age groups and learning objectives. Using a quasi-experimental mixed method design guided by the Iterative Convergent Design for Mobile Health Usability Testing approach, five app user testing sessions were conducted among students (ages 9-12 years). During gameplay, engagement and usability were assessed via direct observations with a semistructured form. After gameplay, qualitative interviews and questionnaires were used to assess user satisfaction, engagement, usability, and knowledge gained. RESULTS: The environmental scan data revealed that few evidence-based nutrition education apps existed for children. A literature search identified key nutrients of concern for Canadian children and techniques that could be incorporated into the app to engage users in learning. Foodbot Factory included characters (2 scientists and Foodbots) who initiate fun and engaging dialogue and challenges (minigames), with storylines incorporating healthy eating messages that align with the established learning objectives. A total of five modules were developed: drinks, vegetables and fruit, grain foods, animal protein foods, and plant protein foods. Seven behavior change techniques and three unique gamified components were integrated into the app. Data from each user testing session were used to inform and optimize the next app iteration. The final user testing session demonstrated that participants agreed that they wanted to play Foodbot Factory again (12/17, 71%), that the app is easy to use (12/17, 71%) and fun (14/17, 88%), and that the app goals were clearly presented (15/17, 94%). CONCLUSIONS: Foodbot Factory is an engaging and educational mHealth intervention for the Canadian public that is grounded in evidence and developed by an interdisciplinary team of experts. The use of an iterative development approach is a demonstrated method to improve engagement, satisfaction, and usability with each iteration. Children find Foodbot Factory to be fun and easy to use, and can engage children in learning about nutrition.

Transtorno do espectro autista: uma revisão sistemática sobre aspectos nutricionais e eixo intestino-cérebro / Autism spectrum disorder: a systematic review about nutritional aspects and gut-brain axis

O número de indivíduos diagnosticados com o transtorno do espectro autista (TEA) registrou aumento evidente na última década. Os principais sintomas, apresentados pelo portador, são neurológicos e digestórios, estando às intervenções nutricionais dentre as terapêuticas mais promissoras para amenizar a sintomatologia clínica. Assim, objetivou-se revisar sistematicamente os estudos sobre distúrbios alimentares e do trato gastrointestinal apresentado pelo indivíduo portador do TEA, a fim de compreender como o comportamento alimentar influência na etiopatogênese e manifestações clínicas da doença, com foco no eixo intestinocérebro. Para isso realizou-se uma revisão sistemática, seguindo as diretrizes PRISMA. A partir de uma busca estruturada e abrangente em bases de dados eletrônicas, 23 estudos foram recuperados e incluídos na revisão. Os critérios de inclusão definiam ser artigos originais relacionando o TEA com alterações nutricionais e/ou com o eixo intestino-cérebro. Após análise da composição da microbiota intestinal, os estudos mostraram um quadro de desequilíbrio. Foram encontradas, também, alterações na barreira de muco e permeabilidade intestinal e alterações em proteínas envolvidas na digestão e absorção de alimentos. Dietas restritivas e a modulação da microbiota, com uso de probióticos e de antibióticos específicos, são apresentadas como estratégias terapêuticas adjuvantes promissoras. Conclui-se que o eixo intestino-cérebro está envolvido tanto na etiologia, quanto nas manifestações clínicas do TEA. Porém, não sendo certo se alterações intestinais são causa ou consequência das alterações neurológicas. Até o presente momento, a comunidade científica não tem conclusões suficientes para indicar o uso de dietas restritivas, e uso de probióticos e de antibióticos como terapêutica para o TEA.

The number of individuals diagnosed with autism spectrum disorder (ASD) had an evident increase in the last decade. The primary symptoms exhibited amongst these patients were mostly digestive and neurological disorders; with nutritional interventions being one of the most promising therapies to assuage this clinical symptomology. As such, following the PRISMA guidelines, we systematically reviewed the research studies apropos of the ASD patients manifesting said digestive disorders, to comprehend how dietary behavior can influence the etiopathogenesis and clinical manifestations of the disease, with primary focus on the gut-brain axis. From a comprehensive and structured search through electronic databases, 23 studies were retrieved and admitted in this review. The inclusion criteria defined that there be original articles consociating ASD with nutritional disorders and/or with the gut-brain axis. These studies analyzed the composition of the intestinal flora of diagnosed patients, subsequently discerning cases of varying imbalances. Alterations in the gene expression of the proteins involved in the digestion and absorption of food, the mucous barrier and the intestinal permeability were described. Accordingly, restrictive diets and the modulation of the microbiota by administering specific anti- & probiotics were initially identified as promissory therapies. In conclusion, the gut-brain axis was observed to be a determinant factor in both the etiology and clinical symptomology of ASD - though it is still debatable the correlation of intestinal alterations with neurological changes. At present, there is no concrete scientific proof accrediting to restrictive diets and the use of specific anti- & probiotics, as successful treatments for ASD.

Variation in Nutritional Quality of School Lunches With Implementation of National School Lunch Program Guidelines.

BACKGROUND: School lunches must meet National School Lunch Program (NSLP) requirements to receive reimbursement. In this study, we sought to determine whether there are significant differences in nutrient content and nutritional quality between 2 menus meeting NSLP requirements. METHODS: A cross-sectional content analysis compared 6 weeks of a typical school lunch menu (TM) from an actual school district to a best practice school lunch menu (BPM) created by a registered dietitian based on Child and Adult Care Food Program (CACFP) best practices and Dietary Guidelines for Americans (DGA) healthy meal pattern recommendations. Daily nutrient content was determined using nutrient analysis software. Nutritional quality was computed using Healthy Eating Index (HEI) 2010. RESULTS: For nutrients required for analysis, the BPM was lower in calories, saturated fat, and sodium and higher in protein, carbohydrate, and fiber (ps < .01). For other nutrients of concern, the BPM was higher in vitamin A, vitamin D, phosphorus, and magnesium (ps < .01). The BPM had higher HEI scores for nutritional quality (p < .001). CONCLUSIONS: Results indicate the possibility for significant variation in nutritional quality of NSLP-qualifying lunches. Using CACFP best practices and DGA recommendations may significantly impact school lunch dietary quality.

Incentivizing healthy eating in children: An investigation of the "ripple" and "temporal" effects of a reward-based intervention.

Although previous studies have established the effectiveness of using small reward-based incentives in inducing the choice and consumption of healthier foods among children, little is known about their impact outside of experimental settings or their effectiveness over time when administered daily. This paper presents the results of a field experiment conducted to provide insight on these matters. The study employs a removed treatment within-subject design and was conducted at a summer program catering to low-income children between the ages of 5 and 12. The month long experiment-wherein participants were offered a small prize for choosing a fruit cup for dessert after lunch in lieu of cookies-involved 23 children between the ages of 5 and 8. Corroborating existing studies, the introduction of small reward-based incentives in this context was found to induce large increases in the number of children choosing the healthy dessert options after lunch, but disaggregating the results by week and day suggests that their impact diminished over time. Attempts to ascertain their effect outside of experimental settings did not indicate that the introduction of rewards had any adverse effects, but also did not provide definitive conclusions.

Factors associated with anemia in children under three years of age in Perú: analysis of the Encuesta Demográfica y de Salud Familiar, ENDES, 2007-2013.

INTRODUCTION: Despite the reduction of poverty in Perú, the prevalence of anemia in the country remains high.  OBJECTIVE: To identify socio-demographic, child and maternal-child care factors associated with anemia in children between 6 and 35 months in Perú.  MATERIALS AND METHODS: We conducted an analytical and descriptive study that included registered data from the national survey on demography and family health, 2007-2013, on children between 6 and 35 months old, including the measurement of blood hemoglobin. Anemia was confirmed by hemoglobin-altitude corrected values below 11 mg/dl. We used multivariate logistic regression models to assess potential associated factors for anemia.  RESULTS: Anemia prevalence was high (47.9%). Twelve factors were independently associated with anemia in children: Socio-demographic factors such as living outside Lima and Callao, in a low socioeconomic household, and having an adolescent mother with low education level; child-related factors as being male, younger than 24 months of age, and having fever in the previous two weeks, and maternal-child care factors such as lack of prenatal control in the first trimester of pregnancy, lack or short period of iron supplementation during pregnancy, house delivery, anemia detection at the moment of the survey, and lack of intestinal anti-parasite preventive treatment in the child.  CONCLUSIONS: The analysis of survey data provided valuable information about factors associated with anemia in children between 6 and 35 months, which can be used to increase the coverage and effectiveness of maternal-child care practices.

Dietary and economic effects of eliminating shortfall in fruit intake on nutrient intakes and diet cost.

BACKGROUND: Children in the United States do not consume the recommended amounts of fruit. The economic and dietary consequences of meeting the shortfall in fruit consumption have not been evaluated. METHODS: Analyses were based on a nationally representative sample of 4-18 year-old children (n = 2,647) from the 2009-2010 National Health and Nutrition Examination Survey (NHANES). The shortfall in total fruit consumption for each child was estimated based on the USDA MyPlate recommendations. The potential impact of filling the shortfall in total fruit consumption was projected with whole fruit alone (WF model) or a combination of 100 % fruit juice and whole fruit (FJ + WF model). Juice consumption was capped using American Academy of Pediatrics (AAP) standards. The USDA national food prices database was used to estimate the cost of meeting the dietary recommendations for fruit. Selected nutrient and mineral intakes, as well as daily diet cost were estimated after eliminating the shortfall in fruit consumption. RESULTS: Among all children, vitamin C (+22.8 mg [95 % CI 21.4, 24.1] in the WF model and +48.1 mg [95 % CI 45.2, 51.1] in the FJ + WF model) and potassium intakes (+203 mg [95 % CI 190, 215] in WF and +263 mg [95 % CI 248, 280] in FJ + WF) were increased in both models. The FJ + WF model resulted in a marginal increase in dietary fiber (e.g., a relative change less than 10 %), while the WF model resulted in a meaningful increase in dietary fiber (e.g., a relative change greater than 10 %; +2.2 g [95 % CI 2.1, 2.3]). Conversely, the WF model resulted in only a marginal increase in calcium, while the FJ + WF model resulted in a meaningful increase in calcium (+85 mg [95 % CI 79, 89]). Calories were increased in all models (+4.5 % [95 % CI 4.1, 4.9 %] for FJ + WF and +3.5 % [95 % CI 3.2, 3.7 %] for WF). Meeting the fruit shortfall with whole fruit alone increased estimated diet costs by 9.9 % (+$0.44/d [95 % CI 0.42, 0.47]), while the fruit juice/whole fruit combination increased diet costs by 5.2 % (+$0.23/d [95 % CI 0.22, 0.25]). CONCLUSIONS: Meeting fruit consumption guidelines without a substantial increase in diet costs may be a challenge. Combining whole fruit with 100 % fruit juice capped at AAP standards may be one approach to meeting fruit recommendations within cost constraints. Identifying approaches to increasing whole fruit consumption in as cost-neutral a fashion as possible should be a priority.

Factores asociados con la anemia en niños menores de tres años en Perú: análisis de la Encuesta Demográfica y de Salud Familiar, 2007-2013 / Factors associated with anemia in children under three years of age in Perú: analysis of the Encuesta Demográfica y de Salud Familiar, ENDES, 2007-2013

Introducción. A pesar de la disminución de la pobreza en Perú, la prevalencia de la anemia infantil en el país continúa siendo alta. Objetivo. Determinar los factores sociodemográficos y las características del cuidado materno-infantil asociadas con la anemia en niños de seis a 35 meses de edad en Perú. Materiales y métodos. Se hizo un estudio observacional que incluyó los datos sobre hemoglobina sanguínea registrados en la Encuesta Demográfica y de Salud Familiar (ENDES), 2007-2013, en niños entre los seis y los 35 meses de edad. Mediante un análisis multivariado de regresión logística, se identificaron los factores asociados con la anemia, definida como una hemoglobina corregida por altitud, menor de 11 mg/dl. Resultados. La prevalencia de anemia fue alta (47,9 %). Se identificaron doce factores asociados con la anemia: factores sociodemográficos como vivir fuera de Lima y Callao; en un hogar con bajo nivel socioeconómico; tener una madre adolescente y con bajo nivel educativo; ser de sexo masculino con edad menor de 24 meses y antecedentes de fiebre reciente, y factores relacionados con el cuidado materno-infantil como la falta de control prenatal en el primer trimestre, la falta de suplemento de hierro durante el embarazo o administrado durante un periodo breve, parto en el domicilio, diagnóstico de anemia en la madre en el momento de la encuesta y ausencia de tratamiento antiparasitario preventivo en el niño. Conclusiones. La ENDES proporcionó información valiosa sobre los factores asociados con la anemia en niños de seis a 35 meses, cuyo conocimiento debe mejorar la cobertura y la efectividad de prácticas adecuadas de cuidado materno-infantil.

Introduction: Despite the reduction of poverty in Perú, the prevalence of anemia in the country remains high. Objective: To identify socio-demographic, child and maternal-child care factors associated with anemia in children between 6 and 35 months in Perú. Materials and methods: We conducted an analytical and descriptive study that included registered data from the national survey on demography and family health, 2007-2013, on children between 6 and 35 months old, including the measurement of blood hemoglobin. Anemia was confirmed by hemoglobin-altitude corrected values below 11 mg/dl. We used multivariate logistic regression models to assess potential associated factors for anemia. Results: Anemia prevalence was high (47.9%). Twelve factors were independently associated with anemia in children: Socio-demographic factors such as living outside Lima and Callao, in a low socioeconomic household, and having an adolescent mother with low education level; child-related factors as being male, younger than 24 months of age, and having fever in the previous two weeks, and maternal-child care factors such as lack of prenatal control in the first trimester of pregnancy, lack or short period of iron supplementation during pregnancy, house delivery, anemia detection at the moment of the survey, and lack of intestinal anti-parasite preventive treatment in the child. Conclusions: The analysis of survey data provided valuable information about factors associated with anemia in children between 6 and 35 months, which can be used to increase the coverage and effectiveness of maternal-child care practices.