Laís Amaral Mais

Validation of the comprehensive feeding practices questionnaire in parents of preschool children in Brazil

BackgroundRecent national surveys in Brazil have demonstrated a decrease in the consumption of traditional food and a parallel increase in the consumption of ultra-processed food, which has contributed to a rise in obesity prevalence in all age groups. Environmental factors, especially familial factors, have a strong influence on the food intake of preschool children, and this has led to the development of psychometric scales to measure parents’ feeding practices. The aim of this study was to test the validity of a translated and adapted Comprehensive Feeding Practices Questionnaire in a sample of Brazilian preschool-aged children enrolled in private schools.MethodsA transcultural adaptation process was performed in order to develop a modified questionnaire (43 items). After piloting, the questionnaire was sent to parents, along with additional questions about family characteristics. Test-retest reliability was assessed in one of the schools. Factor analysis with oblique rotation was performed. Internal reliability was tested using Cronbach’s alpha and correlations between factors, discriminant validity using marker variables of child’s food intake, and convergent validity via correlations with parental perceptions of perceived responsibility for feeding and concern about the child’s weight were also performed.ResultsThe final sample consisted of 402 preschool children. Factor analysis resulted in a final questionnaire of 43 items distributed over 6 factors. Cronbach alpha values were adequate (0.74 to 0.88), between-factor correlations were low, and discriminant validity and convergent validity were acceptable.ConclusionsThe modified CFPQ demonstrated significant internal reliability in this urban Brazilian sample. Scale validation within different cultures is essential for a more comprehensive understanding of parental feeding practices for preschoolers.

Validation of the Comprehensive Feeding Practices Questionnaire among Brazilian Families of School-Aged Children

Introduction Children’s eating behaviors are influenced by parents, who are the first nutritional educators. The comprehensive feeding practices questionnaire (CFPQ) was developed to measure feeding practices among parents, but has not yet been validated in Brazil, where child obesity rates are steeply increasing. The aim of the study was to test the validity of the CFPQ among Brazilian parents of school-aged children and propose a new version of the instrument. Methods Transcultural adaptation included translation into Portuguese, back translation, content validity, testing for semantic equivalence, and piloting. Questionnaire data were obtained for 659 parents of 5- to 9-year olds. Confirmatory and exploratory factor analyses and psychometric analyses (tests for internal consistency, factor correlations, item-discriminant and convergent validity, and test–retest reliability) were conducted. Results Confirmatory factor analysis demonstrated a poor fit of the data to the original 12-factor model. Exploratory factor analysis generated a 6-factor model composed of 42 items: healthy eating guidance, monitoring, restriction for weight control, restriction for health, emotion regulation/food as reward, and pressure. This factor solution was supported by internal consistency tests (α = 0.71–0.91) and factor correlations (ρ = −0.16 to 0.32). Item-discriminant and convergent validity tests showed that parents who used coercive practices had more overweight children and were more concerned about their child’s weight (ρ = 0.09–0.40). Test–retest reliability was acceptable (intraclass correlation coefficient = 0.45–0.77). Conclusion Since parental practices are highly culturally and age group sensitive, it is essential to conduct careful evaluations of questionnaires when introduced into specific age groups within new cultural settings. This modified six-factor model of the CFPQ is valid to measure parental feeding behaviors of school-aged children in urban Brazilian settings.

Factors associated with parental underestimation of child's weight status

OBJECTIVE The aim of this study was to examine the prevalence of parental misperception of child weight status, and identify socioeconomic, anthropometric, behavioral and dietary factors associated with underestimation. METHOD Cross-sectional study. Data was collected in 14 Brazilian private schools. Parents of children aged 2-8 years (n=976) completed a self-reported questionnaire assessing their perception of their childs weight status, and sociodemographic, anthropometric, behavioral and dietary information. To measure the agreement between parental perception about child weight status and actual child weight status, the Kappa coefficient was estimated, and to investigate associations between parental underestimation and independent variables, chi-squared tests were performed, followed by multiple logistic regression, considering p≤0.05 for statistical significance. RESULTS Overall, 48.05% of the parents incorrectly classified their childs weight. Specifically, 45.08% underestimated their childs weight status, with just 3% of parents overestimating. Children with higher body mass index (OR=2.03; p<0.001) and boys (OR=1.70; p<0.001) were more likely to have their weight status underestimated by parents. CONCLUSION Since awareness of weight problems is essential for prevention and treatment, clinical practitioners should help parents at high risk of misperception to correctly evaluate their childs weight status.

Diagnóstico das práticas de alimentação complementar para o matriciamento das ações na Atenção Básica

Timely and appropriate complementary feeding is essential for the healthy growth and development of children, and Primary Health Care, especially the Family Health Support Nuclei, are the ideal location for developing relevant actions during this period. A cross-sectional study that applied a questionnaire to mothers and anthropometric evaluation for 324 children sought to develop an index of complementary feeding inadequacies and to study its association with social, economic, clinical, epidemiological and nutritional variables. For quantification of feeding inadequacies, an index using the Delphi method was created. High frequencies were observed for all inadequacies, especially for late introduction of solids (80.2%), early introduction of sugar/thickeners (78.1%) and liquids (73.5%). The most significant results of these associations were early weaning of exclusive (p = 0.000) and total (p = 0.005) breastfeeding, absence of partner (p = 0.001) and the mother supporting the family financially (p = 0.025). The use of this index identifies higher-risk situations for developing a nutritional assistance action plan, especially when it comes to promoting matrix model work.

A inserção do nutricionista na Atenção Básica: uma proposta para o matriciamento da atenção nutricional

Nutritionists were integrated into the Family Health Support Centers back in 2008. Focusing on the development of technical and pedagogical support and assistance to Family Health Teams, the aim of this study was to develop a proposal for a matrix model for nutrition aimed at women and children in the Family Health Strategy. The study was conducted in a Basic Health Unit and was divided into Cycle I, including interviews with families of 0 to 6-year-old children to establish the confines of the territory; and Cycles II and III, with the development of intersectorial field activities to promote food and nutritional security based on matrix support. Following the diagnosis of social vulnerability, childrens nutritional risk, indicators of early weaning and inadequate food intake, actions were developed in order to propose a matrix model of nutritional measures in three scenarios, namely at the community, family and individual level. Among the activities that were developed, the main ones included cooking classes, prenatal care, and the training of Community Health Agents. This study tested ways to develop nutritional care by broadened clinical action and territory recognition, seeking to enhance the activities of nutritionists as health educators.Nutritionists were integrated into the Family Health Support Centers back in 2008. Focusing on the development of technical and pedagogical support and assistance to Family Health Teams, the aim of this study was to develop a proposal for a matrix model for nutrition aimed at women and children in the Family Health Strategy. The study was conducted in a Basic Health Unit and was divided into Cycle I, including interviews with families of 0 to 6-year-old children to establish the confines of the territory; and Cycles II and III, with the development of intersectorial field activities to promote food and nutritional security based on matrix support. Following the diagnosis of social vulnerability, childrens nutritional risk, indicators of early weaning and inadequate food intake, actions were developed in order to propose a matrix model of nutritional measures in three scenarios, namely at the community, family and individual level. Among the activities that were developed, the main ones included cooking classes, prenatal care, and the training of Community Health Agents. This study tested ways to develop nutritional care by broadened clinical action and territory recognition, seeking to enhance the activities of nutritionists as health educators.

Maternal pressure to eat: Associations with maternal and child characteristics among 2-to 8-year-olds in Brazil

Maternal pressure for the child to eat may have counterproductive effects on childs eating behavior, such as impairing their ability to self-regulate intake and generating greater refusal of the pressured foods. Associated factors with this feeding practice are still poorly studied. The aim of this study was to investigate the relationship between the use of pressure to eat by mothers and anthropometric, sociodemographic and behavioral characteristics of mothers and their children. Nine hundred and twenty seven mothers of 2-to-8-year-old children participated in the study. The maternal use of pressure to eat was measured using the Brazilian version of the Comprehensive Feeding Practices Questionnaire (CFPQ) along with supplementary questions on maternal responsibility and concern about child feeding and child weight status, and anthropometric and sociodemographic information. Data was analyzed using descriptive, bivariate and multivariate analyses. The final multivariate logistic regression model revealed that maternal use of pressure to eat was independently associated with maternal greater concern about the child eating too little when the mother was not around (OR = 2.40, p ≤ 0.001), and child (OR = 0.86, p = 0.008) and mother lower BMI weight (OR = 0.93, p = 0.001). The results found in this study point out to the importance of interventions in the routine of pediatric health services, directed to the maternal behavior of pressure for the child to eat. The actions should mainly consider maternal concerns about child feeding, and maternal and child weight status. These findings also contribute to the expansion of data in the literature on the factors associated with this food practice and for future research on the subject. The results found in this study are risk factors for maternal practice of pressure to eat and support the construction of new ways to deepen the knowledge of the subject in future research, such as the influence of mother and child weight and subjective aspects in the practice of pressure to eat.

Maternal restrictive feeding practices for child weight control and associated characteristics

OBJECTIVE To identify associations between maternal restrictive feeding practices for child weight control and sociodemographic, behavioral, dietetic, and anthropometric characteristics. METHODS Cross-sectional study with mothers of children aged 2-8 years. Maternal feeding practices were measured by the Comprehensive Feeding Practices Questionnaire, in private schools in Brazil. Bivariate and multivariate associations were performed, using nonparametric analyses to estimate odds ratios and significance levels. RESULTS Maternal restrictive feeding practices for weight control were independently associated with the mothers perception of her child being a little overweight/overweight/obese (OR=4.61, p=0.001), greater concern about the childs overweight (OR=2.61, p<0.001), childs overweight/obesity/severe obesity (OR= 2.18, p<0.001), and the childs greater intake of ultra-processed foods (OR=1.40, p=0.026). CONCLUSION In this study, the risk variables identified for the use of the maternal restrictive feeding practices to control the childs weight can be used to provide education and guidance interventions in health and education networks directed to groups with similar characteristics to those of the studied population.

Parents Matter: Associations of Parental BMI and Feeding Behaviors With Child BMI in Brazilian Preschool and School-Aged Children

Background: Brazil is undergoing nutritional transition and rates of obesity in preschool and school-aged children are increasing. Excess weight in the first years of life could predict excess weight in adulthood, making it essential to study risk factors in this population. Objective: Our goal was to investigate associations of parent feeding behaviors, as well as more distal familial influences including family SES and maternal and paternal weight, with BMI z-score in preschool and school-aged children in a Brazilian sample. Methods: Cross-sectional study. Data were collected in 14 Brazilian private schools. Parents of children aged 2–8 years (n = 1,071) completed a questionnaire assessing parent feeding behaviors, as well as sociodemographic and anthropometric information. Hierarchical linear regression models were fitted to investigate relationships between parent and child characteristics and child BMI z-score in preschool (2–5 years, n = 397) and school-aged (6–8 years, n = 618) children. Results: Final models indicated that higher maternal BMI and “restriction for weight control” were associated with higher child BMI z-score in both age groups (excessive weight, i.e., BMI ≥ +1 z-score, in preschoolers and school-aged children: 24.4 and 35.9%, respectively). In preschoolers only, “healthy eating guidance” and “pressure” were associated with lower child BMI z-score. For school-aged children, male sex, higher father BMI, and “restriction for health” were associated with higher child BMI z-score. Conclusions: Parent feeding behaviors and parent weight, as well as child sex, are associated with child BMI z-score, with evidence for differential relationships in preschool and school-aged children. Optimal obesity prevention and treatment strategies may differ by child age.

Parental Feeding Practices among Brazilian School-Aged Children: Associations with Parent and Child Characteristics

Background Children’s eating behavior, food intake, and weight status are highly influenced by parents, who shape their food environment via parental feeding practices. The aim of this study was to investigate associations between sociodemographic, anthropometric, and behavioral/attitudinal characteristics of parents and their 5- to 9-year-old children and a range of positive (“healthy eating guidance,” “monitoring”) and potentially negative (“restriction for weight control,” “restriction for health,” “emotion regulation/food as reward,” and “pressure”) parental feeding practices. Methods Parents completed a questionnaire assessing parental and child characteristics. Parental feeding practices were measured using a Brazilian adaptation of the Comprehensive Feeding Practices Questionnaire. To test associations between parent and child characteristics and parental feeding practices, we ran bivariate logistic regression models with parent and child characteristics as independent variables and high (above median) scores on individual parental feeding practices as outcome variables. We then conducted multivariate logistic regression models containing all parent and child characteristics, controlling for child age and maternal education. Results Lower parental perceived responsibility for child feeding, higher child use of screen devices, and higher child ultra-processed food intake were associated with lower scores on “healthy eating guidance” and “monitoring.” Higher parental perceived responsibility for child feeding and concern about child overweight were associated with higher scores on “restriction for weight control” and “restriction for health.” Parental perceptions of low weight and concern about child underweight, and higher perceived responsibility for child feeding, were associated with higher scores on “pressure.” Greater intake of ultra-processed foods and lower maternal age were associated with higher scores on “emotion regulation/food as reward.” Conclusion Parental concerns and perceptions relating to child weight were predictive of potentially negative feeding practices. Higher scores on potentially negative feeding practices, and lower scores on positive parent feeding practices, were associated with poorer child diet and higher use of screen devices. Parental engagement in the feeding interaction predicted greater adoption of both potentially negative and positive feeding practices. These results support the need for policies and programs to educate parents about child feeding and help motivated parents to promote healthy lifestyles in their children.