Fernanda Rauber

Consumption of ultra-processed food products and its effects on children's lipid profiles: A longitudinal study

BACKGROUND AND AIMS Cardiovascular disease development is related to known risk factors (such as diet and blood lipids) that begin in childhood. Among dietary factors, the consumption of ultra-processing products has received attention. This study investigated whether childrens consumption of processed and ultra-processing products at preschool age predicted an increase in lipid concentrations from preschool to school age. METHODS AND RESULTS Cohort study conducted with 345 children of low socioeconomic status from São Leopoldo, Brazil, aged 3-4 years and 7-8 years. Blood tests were done to measure lipid profile. Dietary data were collected through 24-h recalls and the childrens processed and ultra-processing product intake was assessed. Linear regression analysis was used to assess the relationship between processed and ultra-processed product intake at 3-4 years on changes in lipid concentrations from preschool to school age. The percentage of daily energy provided by processed and ultra-processed products was 42.6 ± 8.5 at preschool age and 49.2 ± 9.5 at school age, on average. In terms of energy intake, the main products consumed were breads, savoury snacks, cookies, candy and other sweets in both age groups. Ultra-processed product consumption at preschool age was a predictor of a higher increase in total cholesterol (β = 0.430; P = 0.046) and LDL cholesterol (β = 0.369; P = 0.047) from preschool to school age. CONCLUSION Our data suggest that early ultra-processed product consumption played a role in altering lipoprotein profiles in children from a low-income community in Brazil. These results are important to understanding the role of food processing and the early dietary determinants of cardiovascular disease.

Maternal Dietary Counseling in the First Year of Life Is Associated with a Higher Healthy Eating Index in Childhood

Food preferences are established in early childhood and track later in life. Therefore, it is important to promote healthy feeding practices as early as possible. A randomized field trial was conducted with 500 mother-child pairs from a low-income area of São Leopoldo, State of Rio Grande do Sul, Brazil, to evaluate the impact of a nutritional intervention in the first year of life on the dietary quality of 3- to 4-y-old children. Mother-child pairs were randomized either to intervention and control groups and dietary counseling was provided for mothers in the intervention group during 10 home visits in the course of the first year of life. These visits were carried out by fieldworkers who counseled the mothers about the Ten Steps for Healthy Feeding from Birth to Two Years of Age, based on the WHO guidelines. Dietary intake was assessed at 3-4 y of age for 345 children using two 24-h food recalls. Overall diet quality was determined by the Healthy Eating Index. The prevalence of poor diet in the intervention group was lower compared with the control group [relative risk (RR) = 0.30; 95% CI = 0.13-0.71). The number of children who achieved the 75th percentile for the vegetable and fruit component score was higher in the intervention than in control group (RR = 1.95; 95% CI = 1.31-2.89 and RR = 1.49; 95% CI = 1.07-2.07, respectively). Such data provide evidence that dietary counseling for mothers during the first year of life improves the overall dietary quality of children in a low-income population.

Long-term effectiveness of maternal dietary counseling in a low-income population: a randomized field trial.

OBJECTIVE: To assess the impact of dietary counseling given to mothers during the first year of infants’ lives on food consumption, nutritional status, and lipid profile of the children up to 7 to 8 years old. METHODS: The randomized trial was conducted with 500 mothers who gave birth to full-term infants with birth weight ≥2500 g between October 2001 and June 2002 in São Leopoldo, Brazil. Mothers were randomly assigned to intervention (n = 200) and control groups (n = 300) and those in the intervention group received counseling on breastfeeding and complementary feeding by 12 fieldworkers on 10 home visits during the first year of children’s lives. Blinded fieldworkers assessed dietary and anthropometric data at 12 to 16 months, 3 to 4 years, and 7 to 8 years and lipid profiles at 3 to 4 years and 7 to 8 years old. The lipid profile was the primary outcome. RESULTS: Of the 500 recruited children, 397 underwent the 12- to 16-month, 354 the 3- to 4-year, and 315 the 7- to 8-year assessment. The energy-dense foods intake was significantly lower in the intervention group at 12 to 16 months and 3 to 4 years old. At 3 to 4 years, serum lipid levels did not differ between groups. At 7 to 8 years, high-density lipoprotein levels were 0.11 mmol/L higher (0.00 to 0.20), and triglycerides concentration was 0.13 mmol/L lower (−0.25 to −0.01) in intervention children but only among the girls. Overweight/obesity rates did not differ between groups. CONCLUSIONS: Dietary counseling for mothers during infancy decreased the energy-dense foods consumption and improved lipid profile.

Diet quality from pre-school to school age in Brazilian children: a 4-year follow-up in a randomised control study.

A previous study demonstrated that dietary counselling for mothers during the first year of life improved overall diet quality of children at pre-school age in a low-income population. Thus, the objective of the present study was to assess the long-term effect of this intervention on diet quality of children at school age and examine the tracking of dietary intake throughout childhood. The present study was a follow-up of a randomised controlled trial with children who were assessed at 3-4 years (n 345) and 7-8 years (n 307) of age. We collected two 24 h dietary recalls and assessed diet quality using the Healthy Eating Index (HEI). Analyses were performed by group using a paired t test and a Students t test for independent samples. Diet quality did not differ between the intervention and control groups at 7-8 years of age (HEI score 65·2 (SD 9·5) v. 64·9 (SD 8·5)). Regarding changes in diet quality from pre-school to school age, we observed the tracking of diet quality in the control group and the loss of the intervention effect in the intervention group. In both groups, the score for fruit and milk intake decreased, while that for saturated fat and dietary variety intake increased. The score for the intakes of grains, meat and legumes, and total fat remained constant for all children. The present data provide evidence that diet quality tracks during childhood since the total HEI score did not differ over time in the control group. The decrease in score for some HEI components did not affect the overall diet quality due to the increase in score for other HEI components.

Positive impact of child feeding training program for primary care health professionals: a cluster randomized field trial

OBJECTIVE To assess the impact of a child feeding training program for primary care health professionals about breastfeeding and complementary feeding practices. METHODS Cluster-randomized field trial conducted in the city of Porto Alegre, (RS), Brazil. Twenty primary health care centers (HCC) were randomized into intervention (n = 9) and control (n = 11) groups. The health professionals (n = 200) at the intervention group centers received training about healthy feeding practices. Pregnant women were enrolled at the study. Up to six months of childs age, home visits were made to obtain variables related to breastfeeding and introduction of foods. RESULTS 619 children were evaluated: 318 from the intervention group and 301 from the control group. Exclusive breastfeeding prevalence in the first (72.3 versus 59.4%; RR = 1.21; 95%CI 1.08 - 1.38), second (62.6 versus 48.2%; RR = 1.29; 95%CI 1.10 - 1.53), and third months of life (44.0% versus 34.6%; RR = 1.27; 95%CI 1.04 - 1.56) was higher in the intervention group compared to the control group. The prevalence of children who consumed meat four or five times per week was higher in the intervention group than in the control group (36.8 versus 22.6%; RR = 1.62; 95%CI 1.32 - 2.03). The prevalence of children who had consumed soft drinks (34.9 versus 52.5%; RR = 0.66; 95%CI 0.54 - 0.80), chocolate (24.5 versus 36.7% RR = 0.66 95%CI 0.53 - 0.83), petit suisse (68.9 versus 79.7; 95%CI 0.75 - 0.98) and coffee (10.4 versus 20.1%; RR = 0.51; 95%CI 0.31 - 0.85) in their six first months of life was lower in the intervention group. CONCLUSION The training of health professionals had a positive impact on infant feeding practices, contributing to the promotion of child health.

Impacto da atualização de profissionais de saúde sobre as práticas de amamentação e alimentação complementar

O objetivo foi avaliar o impacto da atualizacao de profissionais de saude em relacao aos Dez Passos da Alimentacao Saudavel para Criancas Menores de Dois Anos sobre as praticas alimentares no primeiro ano de vida. Participaram do estudo unidades basicas de saude (UBS) do Municipio de Porto Alegre, Rio Grande do Sul, Brasil, randomizadas em controle (n = 11) e intervencao (n = 9). Unidades de saude que possuem servico de saude comunitaria como Estrategia Saude da Familia (ESF) foram incluidas como um cluster de intervencao (n = 12). As praticas alimentares das criancas incluidas no estudo foram avaliadas quando elas tinham 6 (n = 918) e 12 meses (n = 799) de idade. Os resultados mostraram que o tempo medio de duracao do aleitamento materno exclusivo foi significativamente maior nos dois grupos que receberam a intervencao (2,56 ± 1,91 mes nas US-ESF e 2,32 ± 1,63 mes nas UBS-intervencao) comparados as UBS-controle (1,91 ± 1,60 meses). Houve impacto positivo na qualidade da alimentacao complementar das criancas atendidas nos servicos de saude que participaram da intervencao, especialmente naqueles com ESF.This study aimed to evaluate the impact on feeding practices for infants (<1 year of age) resulting from update training for health workers in the Ten Steps to Healthy Feeding of Children Under Two. Health Care Centers (HCC) in Porto Alegre, Rio Grande do Sul State, Brazil, were randomized into a control group (n=11) and an intervention group (n=9). Health centers organized according to Brazils Family Health Program (FHP) were included as an intervention cluster (n=12). Infant feeding practices were evaluated at the health centers at 6 months (n=918) and again at 12 months of age (n=799). The results showed that mean duration of exclusive breastfeeding was significantly longer in the two groups that received the intervention (2.56±1.91 months in the FHP intervention and 2.32±1.63 months in the HCC intervention) compared to the HCC control group (1.91±1.60 months). There was a positive impact on the quality of complementary feeding of infants treated at the health centers that participated in the intervention, especially those with the FHP.

Ganho de peso excessivo na gestação é fator de risco para o excesso de peso em mulheres

PURPOSE: To evaluate weight retention 12 months postpartum and factors associated among women who had received prenatal care at Health Care Centers in Porto Alegre, southern Brazil. METHODS: Pregnant women in the last trimester were identified at 20 Health Care Centers. Socioeconomic, demographic and anthropometrics data were obtained. Six and 12 months after delivery, the women received home visits for anthropometric measures. The gestational weight gain was defined by pre-pregnancy Body Mass Index (BMI). Weight retention was defined as the difference between pre-gestational weight and weight at postpartum. Data were analyzed using McNemars Test, ANOVA with Bonferroni correction and multiple linear regression. RESULTS: Of the 715 pregnant women recruited, 545 were assessed 12 months after delivery. Women were more likely to be overweight 12 months postpartum compared to the pre-pregnancy period (52.9 versus 36.7%) and weight retention during the 12 months postpartum was more than 10 kg in 30.7% of the women. Weight retention in the postpartum period was higher among women who were overweight (9.9±7.7 kg) compared to those who were of normal weight during the pre-pregnancy period (7.6±6.2 kg). Pre-pregnancy BMI, gestational weight gain, and maternal age were associated with gestational weight retention 12 months postpartum (p<0.001). CONCLUSION: Adequate prenatal care is necessary to minimize the adverse effects of excessive weight gain during pregnancy on womens health.

Ultra-Processed Food Consumption and Chronic Non-Communicable Diseases-Related Dietary Nutrient Profile in the UK (2008–2014)

We described the contribution of ultra-processed foods in the U.K. diet and its association with the overall dietary content of nutrients known to affect the risk of chronic non-communicable diseases (NCDs). Cross-sectional data from the U.K. National Diet and Nutrition Survey (2008–2014) were analysed. Food items collected using a four-day food diary were classified according to the NOVA system. The average energy intake was 1764 kcal/day, with 30.1% of calories coming from unprocessed or minimally processed foods, 4.2% from culinary ingredients, 8.8% from processed foods, and 56.8% from ultra-processed foods. As the ultra-processed food consumption increased, the dietary content of carbohydrates, free sugars, total fats, saturated fats, and sodium increased significantly while the content of protein, fibre, and potassium decreased. Increased ultra-processed food consumption had a remarkable effect on average content of free sugars, which increased from 9.9% to 15.4% of total energy from the first to the last quintile. The prevalence of people exceeding the upper limits recommended for free sugars and sodium increased by 85% and 55%, respectively, from the lowest to the highest ultra-processed food quintile. Decreasing the dietary share of ultra-processed foods may substantially improve the nutritional quality of diets and contribute to the prevention of diet-related NCDs.

Healthy Eating Index Measures Diet Quality of Brazilian Children of Low Socioeconomic Status

Objective: This study aimed to assess the adaptation of the Healthy Eating Index (HEI) to Brazilian dietary recommendations for children aged 3 to 4 years (n = 345) and 7 to 8 years (n = 307). Methods: Dietary data were collected using two 24-hour recalls and diet quality was evaluated according to the adapted HEI. Results: The mean HEI score was 65.7 ± 11.2 at 3 to 4 years and 65.0 ± 8.8 at 7 to 8 years. The HEI correlated positively with dietary variety and food groups (grains, vegetables, fruits, and meat/beans), except for milk at 3 to 4 years, and negatively with sodium, total fat, and saturated fat intake. HEI score was moderately to strongly associated with dietary fiber and several micronutrients. Conclusions: The HEI as adapted to Brazilian dietary guidelines can be used to determine diet quality in preschool- and school-aged children in Brazil.

Produtos processados e ultraprocessados e ingestão de nutrientes em crianças

Objetivo: Avaliar a ingestao de produtos alimenticios processados e ultraprocessados entre criancas de baixa condicao socioeconomica e sua influencia na ingestao de energia, macronutrientes, sodio e fibras. Materiais e Metodos: Estudo transversal com dados de criancas de 7-8 anos que participaram de um ensaio de campo randomizado realizado em Sao Leopoldo/RS. Foram coletados dados socioeconomicos e familiares e realizados dois inqueritos recordatorios de 24 horas. A avaliacao do consumo de produtos alimenticios pelas criancas foi obtida por meio da classificacao dos alimentos que considera o grau de processamento utilizado na producao. A quantidade em gramas e a estimativa da energia proveniente dos produtos alimenticios foram obtidas e os tercis do percentual de energia total da dieta proveniente desses produtos foram utilizados nas analises. Resultados: Foram avaliados os dados de 307 criancas. A media de energia da dieta proveniente de produtos alimenticios processados e ultraprocessados representou 48,6% da energia total consumida pelas criancas. Entre as criancas no maior tercil de percentual de energia da dieta proveniente destes produtos alimenticios, o consumo de energia, carboidratos, gorduras totais, saturadas e sodio foi maior que nos demais tercis, enquanto o consumo de proteinas e fibras foi menor (p<0,05). Conclusao: Entre criancas escolares de baixa condicao socioeconomica, o consumo de produtos alimenticios processados e ultraprocessados representaram aproximadamente 50% da energia diaria consumida, sugerindo risco para desenvolvimento de obesidade e doencas associadas visto que o consumo desses produtos foi associado a dietas com mais energia, gorduras e sodio e menor teor de proteinas e fibras.