Gisele Ane Bortolini

Impacts of the 10 Steps to Healthy Feeding in Infants: a randomized field trial

This study assesses the impact of an intervention known as the Ten Steps to Healthy Feeding: A Nutritional Guide for Children under Two on nutritional conditions and infant health in low-income families. Two hundred newborns were randomized to the intervention group and three hundred to the control group. Parents of the intervention group received nutritional orientation during the childs first year of life. Both groups received visits at 6 and 12 months and routine follow-up by their pediatricians. The results (n = 397) showed that the intervention was associated with a higher proportion of exclusive breastfeeding at 4 months (RR = 1.58; 95%CI: 1.21-2.06) and 6 months (RR = 2.34; 95%CI: 1.37-3.99) and breastfeeding at 12 months (RR = 1.26; 95%CI: 1.02-1.55) and a lower proportion of children with diarrhea (RR = 0.68; 95%CI: 0.51-0.90), respiratory problems (RR = 0.63; 95%CI: 0.46-0.85), use of medication (RR = 0.56; 95%CI: 0.34-0.91), and dental caries (RR = 0.56; 95%CI: 0.32-0.96) in the 12-16 month bracket. The intervention had no effect on the occurrence of anemia, hospitalization, or nutritional status. The results suggest that the nutritional orientation program led to positive changes in infant feeding practices and health conditions, but that it was insufficient to prevent iron deficiency anemia.

Baixa escolaridade como fator limitante para o combate à anemia entre gestantes

OBJETIVOS: avaliar o impacto sobre os niveis de hemoglobina entre gestantes submetidas a suplementacao com sulfato ferroso e orientacoes alimentares. METODOS: foram avaliadas 197 gestantes acompanhadas no pre-natal de uma unidade de saude. O grupo intervencao foi composto por 105 gestantes com idade gestacional inicial entre a 14a e a 20a semana de gravidez, as quais receberam prescricao de 60 mg de ferro elementar por dia, por meio de sulfato ferroso, orientacoes alimentares e dosagem de hemoglobina realizada com fotometro portatil. A partir de 34 semanas gestacionais esse grupo foi reavaliado quanto a hemoglobina e realizado consumo alimentar de frequencia semiquantitativo. O grupo controle foi avaliado transversalmente e era formado por 92 gestantes com idade gestacional superior a 34 semanas. Considerou-se anemia quando a hemoglobina foi inferior a 11 g/dL As gestantes de ambos os grupos foram pesadas e medidas, sendo o diagnostico nutricional determinado pelo IMC pre-gestacional. Foi realizada analise multivariada por meio de regressao logistica utilizando modelo hierarquico. RESULTADOS: a prevalencia de anemia ao final do terceiro trimestre, no grupo intervencao, foi de 31,6%, e no grupo controle, 26,1% (p=0,43). O uso do suplemento de ferro foi referido por 65% das gestantes do grupo intervencao, sendo que 67,7% interromperam o uso em algum momento. Os motivos principais foram: esquecimento (43,2%) e enjoo e/ou vomito (27,2%). Gestantes com escolaridade inferior a 8 anos de estudo apresentaram 3 vezes mais risco na ocorrencia de anemia no terceiro trimestre. CONCLUSOES: o uso de sulfato ferroso nao mostrou-se associado a menor prevalencia de anemia. Os resultados sugerem que sao necessarias mudancas estruturais nas condicoes socioeconomicas para se modificar o quadro atual quanto a anemia ferropriva.

Prevalência de compulsão alimentar entre universitárias de diferentes áreas de estudo

INTRODUCCION: La compulsion alimentaria (CA) entre mujeres viene siendo considerada como factor de riesgo para el diagnostico de trastornos alimentares mas graves. El objetivo del presente estudio ha sido investigar la prevalencia de CA entre universitarias y su asociacion con el IMC (indice de masa corporea) y edad. MATERIAL Y METODO: Se evaluaron 491 estudiantes universitarias, con edad entre 17 y 55 anos, de tres areas de estudio (exactas, salud y humanidades) de la Universidade do Vale do Rio dos Sinos (UNISINOS), ubicada en el municipio de Sao Leopoldo (RS, Brasil). Para evaluar la frecuencia de CA, se utilizo el cuestionario autoaplicable Escala de Compulsion Alimentaria Periodica (ECAP). Las medidas de peso y estructura han sido autoinformadas. RESULTADOS: La prevalencia de CA entre las universitarias estudiadas ha sido de 18,1%. La frecuencia de IMC > 25 kg/m2 ha sido de 11,4% y 75,8% de ellas tenian mas de 20 anos de edad. Se observo una asociacion significativa entre IMC y CA en el grupo general, siendo que el 54,5% de las universitarias con exceso de peso u obesidad presentaron CA (p < 0,001), y la edad no ha sido asociada a la presencia de CA. Sin embargo, en el area de salud, las estudiantes con edad igual o menor a 20 anos presentaron mayor frecuencia de CA (p < 0,05) y, en el area de humanas, el resultado ha sido inverso (p < 0,05). CONCLUSION: El cuestionario autoaplicable ECAP revelo elevada prevalencia de CA entre mujeres universitarias, mostrando asociacion con exceso de peso. Investigaciones futuras son necesarias, con el objetivo de confirmar esos resultados y evaluar la presencia de otros trastornos alimentares.Introduction: Binge eating (BE) among women has been regarded as a risk factor for the diagnosis of more severe eating disorders. The present study aimed to investigate the prevalence of BE among female university students and its association with body mass index (BMI) and age. Material and methods: The study evaluated 491 female university students aged between 17 and 55 years in three fields of knowledge (exact sciences, health and humanities) at the Universidade do Vale do Rio dos Sinos (Unisinos), located in São Leopoldo (Brazil). A self-

Biodisponibilidade do ferro como fator de proteção contra anemia entre crianças de 12 a 16 meses

OBJECTIVE This study investigates the nutritional factors that determine the absence of anemia in infants from families with a low socioeconomic background submitted to a nutrition intervention program, as well as iron intake according to recommendations. METHODS The study included 369 children from a cohort of inhabitants of São Leopoldo, state of Rio Grande do Sul, Brazil, who were randomized at birth into an intervention group and into a control group. The intervention group had nutritional guidance in the first year of life, with monthly follow-up home visits, whereas the control group was visited at 6 and 12 months, without nutritional intervention. At the end of the first year of life, a 24-hour recall was used. Anemia was diagnosed based on a hemoglobin level less than 11 g/dL. The childrens diets were classified according to iron bioavailability. RESULTS The prevalence of anemia amounted to 63.7% in this study. The proportion of children with adequate iron intake relative to the recommendations was statistically higher in the nonanemic group (26.8%) than in the anemic one (17.7%). Nonanemic children had a greater intake of iron (p = 0.019), vitamin C (p = 0.001), energy density at dinner (p = 0.006), iron density per 1,000 calories (p = 0.045); and 16.3% of them had a diet with high iron bioavailability (p = 0.002). CONCLUSIONS A diet with high iron bioavailability protects children from anemia and can be used as an intervention measure by basic health services and by the municipal departments of childrens education.

Maternal Dietary Counseling Reduces Consumption of Energy-Dense Foods among Infants: A Randomized Controlled Trial

OBJECTIVE To evaluate the impact of a dietary counseling in reducing the intake of energy-dense foods by infants. DESIGN A randomized controlled trial. SETTING AND PARTICIPANTS São Leopoldo, Brazil. Mothers and infants of a low-income-group population were randomized into intervention (n = 163) and received dietary counseling during 10 home visits, or control (n = 234) groups. MAIN OUTCOMES MEASURES Child consumption of sugar-dense (SD) and lipid-dense (LD) foods at 12 to 16 months. ANALYSIS The effect of the intervention was expressed by relative risks and 95% confidence intervals. Poisson regression analysis was used to determine the association between exclusive breastfeeding and the energy-dense foods intake. RESULTS A smaller proportion of infants from the intervention group consumed candy, soft drinks, honey, cookies, chocolate, and salty snacks. In the intervention group, there was a reduction of 40% and 50% in the proportion of infants who consumed LD and SD foods, respectively. Being breastfed up to 6 months reduced the risk for consumption of LD and SD foods by 58% and 67%, respectively. CONCLUSIONS AND IMPLICATIONS Dietary counseling to mothers may be effective in reducing the consumption of energy-dense foods among infants, and it is helpful in improving early dietary habits.

Depressão e suas implicações no aleitamento materno

OBJECTIVE: This study aimed at verifying the incidence of depressive symptoms in a group of mothers of children between 12 and 16 months in the municipality of Sao Leopoldo (RS, Brazil) and their associations with breast feeding and overall child development. METHOD: This study included 263 mothers who delivered at a hospital providing services to a population of low socioeconomic level. Depressive symptoms were assessed using Beck Depression Inventory. RESULTS: It was observed that 35.7% of mothers presented depressive symptoms. As to classification, 18.3% had mild, 11% moderate and 6.5% severe depression. Mothers without partners (prevalence ratio - PR = 1.70; IC95% = 1.20-2.38) and mothers from non-nuclear families presented more depressive symptoms (PR = 1.38; IC95% = 0.99-1.92). Exclusive breast feeding at 6 (PR = 1.86; IC95% = 0.94-3.68) and 12 months (PR = 1.80; IC95% = 1.26-2.58) was more frequent in the group of mothers without depressive symptoms. CONCLUSION: More attention should be given to womens mental health, considering the high prevalence of depressive symptoms in this population and the strong association with less breastfeeding time.

Nutritional errors in the first months of life and their association with asthma and atopy in preschool children

OBJECTIVE To evaluate the impact of exclusive breastfeeding and introduction of cows milk in the first year of life on the diagnosis of asthma, wheezing, and atopy in children aged 3 to 4 years. METHODS This is a cohort study nested in a randomized field trial investigating the effectiveness of dietary guidelines during the first year of life of children in the city of São Leopoldo, southern Brazil. Children who had their diet monitored during the first year of life, in a primary study, were revisited three years later, when their parents answered a questionnaire related to respiratory problems, applied during home visits by trained interviewers. Children were also skin-prick tested to assess responses to common environmental allergens. RESULTS Of the 397 children followed during the first year of life, 354 were reassessed between 3 and 4 years of age. Prevalence of wheezing, evaluated for the 12 months prior to questionnaires, was 21.3%, while prevalence of asthma and atopy was 5.5 and 28.7%, respectively. Children fed cows milk previous to being four months of life were significantly more likely to have asthma between three and four years of age (OR 3.22; 95%CI 1.05-9.80). In the same line, exclusive breastfeeding for a period shorter than six months was marginally associated with atopy. CONCLUSIONS The early introduction of cows milk was an important risk factor for triggering asthma/wheeze symptoms at the age of 4 years. Exclusive breastfeeding for longer than six months was also potentially associated with protection against the development of atopy. The results of this study suggest that dietary interventions during the first year of life have the potential to reduce the impact of asthma, and possibly, atopy.

Effect of Providing Multiple Micronutrients in Powder through Primary Healthcare on Anemia in Young Brazilian Children: A Multicentre Pragmatic Controlled Trial.

Background Multiple micronutrients in powder (MNP) are recommended by WHO to prevent anemia in young children. However, evidences for its effectiveness in different populations and improvements in other outcomes (e.g. linear growth and vitamin A deficiency) are scarce. Methods A multicentre pragmatic controlled trial was carried out in primary health centres. At study baseline, a control group (CG) of children aged 10- to 14 months (n = 521) was recruited in the routine healthcare for assessing anemia, anthropometric and micronutrient status. At the same time, an intervention group (IG) of infants aged 6- to 8 months (n = 462) was recruited to receive MNP daily in complementary feeding over a period of 60 days. Both study groups were compared when the IG infants reached the age of the CG children at enrolment. Results In CG, the prevalence of anemia [hemoglobin (Hb) < 110 g/L], iron deficiency (ID, plasma ferritin < 12 μg/L or TfR > 8.3 mg/L), and vitamin A deficiency (VAD, serum retinol < 0.70μmol/L) were 23.1%, 37.4%, and 17.4%, respectively. Four to six months after enrolment, when the IG participants had the same age of the controls at the time of testing, the prevalence of anemia, ID and VAD in IG were 14.3%, 30.1% and 7.9%, respectively. Adjusting for city, health centre, maternal education, and age, IG children had a lower likelihood of anemia and VAD [Prevalence Ratio (95% CI) = 0.63 (0.45, 0.88) and 0.45 (0.29, 0.69), respectively] when compared with CG children. The adjusted mean distributions of Hb and length-for-age Z-scores improved by 2 SE in the IG compared to CG children. Conclusions MNP effectively reduced anemia and improved growth and micronutrient status among young Brazilian children. Trial Registration Registro Brasileiro de Ensaios Clinicos RBR-5ktv6b

Erro alimentar nos primeiros meses de vida e sua associação com asma e atopia em pré-escolares

OBJECTIVE: To evaluate the impact of exclusive breastfeeding and introduction of cows milk in the first year of life on the diagnosis of asthma, wheezing, and atopy in children aged 3 to 4 years. METHODS: This is a cohort study nested in a randomized field trial investigating the effectiveness of dietary guidelines during the first year of life of children in the city of Sao Leopoldo, southern Brazil. Children who had their diet monitored during the first year of life, in a primary study, were revisited three years later, when their parents answered a questionnaire related to respiratory problems, applied during home visits by trained interviewers. Children were also skin-prick tested to assess responses to common environmental allergens. RESULTS: Of the 397 children followed during the first year of life, 354 were reassessed between 3 and 4 years of age. Prevalence of wheezing, evaluated for the 12 months prior to questionnaires, was 21.3%, while prevalence of asthma and atopy was 5.5 and 28.7%, respectively. Children fed cows milk previous to being four months of life were significantly more likely to have asthma between three and four years of age (OR 3.22; 95%CI 1.05-9.80). In the same line, exclusive breastfeeding for a period shorter than six months was marginally associated with atopy. CONCLUSIONS: The early introduction of cows milk was an important risk factor for triggering asthma/wheeze symptoms at the age of 4 years. Exclusive breastfeeding for longer than six months was also potentially associated with protection against the development of atopy. The results of this study suggest that dietary interventions during the first year of life have the potential to reduce the impact of asthma, and possibly, atopy.

Consumo precoce de alimentos não recomendados por lactentes do sul do Brasil

Objective: To evaluate the consumption of non-recommended foods among children under the primary care assistance service in the city of Porto Alegre, RS. Materials and Methods: The sample included children living in the territory of twenty health care centers. The mothers of the 6 to 9 months old children answered to a structured questionnaire confirming if the children had already eaten some specific foods. Afterwards, at 12 to 15 months, another investigation related to the children´s food consumption during the last month was conducted. Results: Soft drink, candies and cookies were consumed by, approximately, 40% of the children at 6 to 9 months and 80% at 12 to 15 months. The consumption prevalence of table sugar, petit suisse and jelly was above 70% at both moments. Fried foods and chocolate were consumed by more than 80% of the children at 12 to 15 months old. Conclusion: The results of this study show a high consumption prevalence of non-recommended foods among children under two years old, emphasizing the importance of improving dietary counseling skills of primary care workers.