Maysa Helena de Aguiar Toloni

Introdução de alimentos industrializados e de alimentos de uso tradicional na dieta de crianças de creches públicas no município de São Paulo

OBJECTIVE: This study described and discussed the introduction of processed foods to the diets of children attending the nurseries of daycare centers, considering the recommendation of the Ministry of Health for a healthy diet. METHODS: This cross-sectional study included 270 children attending nurseries of eight public and not-for-profit daycare centers in Sao Paulo city. A pre-coded and structured 11-question questionnaire was used to evaluate the introduction of processed foods. For each type of food analyzed, the corresponding age in months was recorded as well as assessed as to whether it was in agreement with the 8th step of the Dietary Guide. The chi-square test was used for determining the associations. The studied variables were mothers age, education level and working status and family income. RESULTS: The results showed that approximately 2/3 of the studied children under 12 months of age were offered foods with obesogenic potential, such as instant noodles, snacks, sandwich cookies, powdered juice, soft drinks and candy/lollipop/chocolate bars. Children born to younger mothers, with low education level and lower income are most vulnerable to the feeding error of introducing processed foods prematurely. CONCLUSION: These results show that educational and preventive actions should be proposed to build healthy eating habits from childhood. Efficient and in-depth campaigns aiming at promoting the consumption of fruits and vegetables are also needed, taking into consideration the cultural, behavioral and emotional factors associated with diet.

Fatores de risco para perda ponderal de crianças frequentadoras de berçários em creches do município de São Paulo

Objective: To identify and quantify risk factors related to the aggravation of nutritional condition from birth until the date of the study. Methods: Cross-sectional study with 270 children attending nurseries of eight public and non-for-profit daycare centers in the city of Sao Paulo, Brazil. Ponderal loss was considered when children presented negative difference of Z score for weight-for-age (W/A) from birth until the date of the present inquiry. Chi-square was used to test associations and considered significant if p<0.05. Multivariate logistic regression model adjusted Odds Ratio estimates for confounding variables and/or covariables. Results: Anthropometric analysis showed 7.1% prevalence of malnutrition (W/A<-2 Z score) at birth and 4.4% by the time of measurement. Ponderal evolution with unfavorable Z score was present in 50.7% of studied children (n=137). In the bivariate analyses, the variables: birth weight (OR=5.35; p<0.001), anemia (OR=1.81; p=0.019) and age less than 19 months (OR=1.67; p=0.036) were statistically significant.

Erros alimentares na dieta de crianças frequentadoras de berçários em creches públicas no município de São Paulo, Brasil

OBJETIVO: Describir los errores alimentares presentes en la introduccion de la alimentacion complementar y en la oferta de leche no materna en ninos frecuentadores de guarderias publicas en el municipio de Sao Paulo. METODOS: Estudio descriptivo transversal, compuesto de 255 ninos en la franja de edad entre 5 y 29 meses. Los cuestionarios estructurados y precodificados, con preguntas abiertas y cerradas, fueron elaborados para la recoleccion de datos, que tuvo lugar entre abril y noviembre de 2007. Estos fueron transcriptos y analizados en el programa estadistico Epi-Info 2000. Las variables evaluadas fueron la introduccion de leche no materna, introduccion de alimentos y la consistencia inicial de la alimentacion complementaria. RESULTADOS: La introduccion de la leche no materna ocurrio en 40% de los ninos hasta 3 meses y en 78% de los ninos hasta 6 meses. A los 3 meses de edad, un 50% recibia liquidos no lacteos y un 15% papillas de frutas, legumbres, verduras y carnes. En la introduccion de la leche no materna, 68% de los bebes recibieron leche de vaca y 31%, formulas infantiles. Higado y pescado fueron los alimentos mas tardiamente ofrecidos. Respecto a la consistencia de las comidas ofrecidas, el 49% fue inadecuada. CONCLUSIONES: El hecho de que los ninos son frecuentadores de guarderias publicas senala la importancia de la capacitacion de los profesionales que ahi actuan, y que eventualmente son los responsables de la introduccion de la alimentacion complementar.Objective: To describe the dietary errors occurring when supplementary feeding is introduced and non-maternal milk is offered to children attending public daycare centers in the city of Sao Paulo, Brazil. Methods: Cross-sectional and descriptive study of 255 children aged between five to 29 months. Pre-coded and structured questionnaires with open and closed questions were developed for data collection that occurred between April and November 2007. Such data were transcribed and analyzed by Epi-Info 2000 statistical software. The analyzed variables were the introduction of non-maternal milk, the introduction of foods and the initial solidity of supplementary feeding. Results: The introduction of non-maternal milk occurred in 40% of children aged up to three months and in 78% up to six months. By the age of three months, approximately 50% received non-dairy liquids and 15%, strained fruits, vegetables, greens and meat. Regarding the introduction of non-maternal milk, 68% of babies received cow milk and 31%, infant formulas. Liver and fish were the latest foods to be offered. Regarding solidity of meals, 49% were inadequate. Conclusions: The fact that children attend public daycare centers points out the importance to properly qualify the professionals who work in such places and are eventually responsible for introducing the supplementary feeding.

Avaliação do consumo alimentar em creches públicas em São Paulo, Brasil

Objective: To evaluate the energy intake and dietary adequacy of children attending nurseries of public and not-for-profit daycare centers in the city of Sao Paulo, Brazil. Methods: Cross-sectional study conducted at 16 nurseries, attended by 236 children between the ages of 12 and 29 months. Data collection was carried out by the direct weighing method over three nonconsecutive days. The DietWin 2.0 Professional software was used for nutritional calculations. The adequacy of energy, protein, iron, vitamin A and vitamin C intake was calculated, also with the aforementioned software, using 2002 National Research Council Estimated Average Requirements as a reference. Adequate Intake (1999) was used as the reference for calcium intake, and Estimated Energy Requirements (2002), for evaluation of energy intake. Data were analyzed using the Epi-Info 3.4.3 software. Results: We identified deficiencies in energy, iron, and calcium intake (mean deficits of 49.78%, 81.67%, and 57.44% respectively), as well as excessive intake of protein (183.27%) and vitamins A and C (126.86% and 57.44% respectively). Regarding macronutrients, fat intake was also found to be inadequate. Endereco para correspondencia: Jose Augusto A. C. Taddei Rua Loefgreen, 1.647 – Vila Clementino CEP 04040-032 – Sao Paulo/SP E-mail: taddei.dped@epm.br; giovana_longo@yahoo.com.br Fonte financiadora: Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP), processo no 2006/02597-0 Conflito de interesse: nada a declarar Recebido em: 4/4/2011 Aprovado em: 9/8/2011OBJETIVO: Avaliar o consumo energetico e a adequacao da dieta de criancas frequentadoras de bercarios de creches publicas e filantropicas no municipio de Sao Paulo. METODOS: Estudo transversal em 16 bercarios, frequentados por 236 criancas com idades entre 12 e 29 meses. A coleta dos dados foi realizada pelo metodo de pesagem direta durante tres dias nao consecutivos. Para o calculo nutricional, foi utilizado o software DietWin Profissional 2.0®, sendo posteriormente calculada a adequacao do consumo de energia, proteina, ferro, vitamina A e vitamina C. Para o calculo de proteina, ferro, vitamina A e C, foi utilizada como referencia a necessidade media estimada (Estimated Average Requiremen) do National Research Council (2002). O calcio foi avaliado pela ingestao adequada (Adequate Intake, 1999). A avaliacao da ingestao de energia foi realizada com base na necessidade energetica estimada (Estimated Energy Requirement, 2002). Os dados foram analisados no programa Epi-Info 2000, versao 3.4.3. RESULTADOS: Foram identificados deficits medios para energia (49,78%), ferro (81,67%), calcio (57,44%), excessos de proteina (183,27%) e vitaminas A (126,86%) e C (57,44%). A distribuicao dos percentuais de adequacao dos macronutrientes mostrou-se inadequada para lipideos. CONCLUSOES: Embora os cardapios servidos em creches sejam planejados por nutricionistas, os resultados apontam possiveis falhas no processo da alimentacao infantil relacionadas a preparacao, porcionamento e/ou praticas de oferta dos alimentos. Tais achados reforcam a necessidade de acoes de educacao e supervisao em saude para garantir o fornecimento de alimentacao adequada a este grupo populacional.

Percepções de educadores de creches acerca de práticas cotidianas na alimentação de lactentes: impacto de um treinamento

O artigo apresenta a importância da capacitacao dos profissionais envolvidos com alimentacao das criancas em creches, para que estes oferecam alimentos adequados e promovam acoes para que os lactentes incorporem praticas alimentares saudaveis desde o nascimento. Desta forma, o objetivo do presente trabalho foi avaliar o impacto de um treinamento de educadores de creches nas percepcoes e praticas acerca da alimentacao infantil. Para avaliacao do impacto do treinamento foi utilizada abordagem qualitativa, com aplicacao da tecnica do grupo focal. Foram realizados 16 grupos, sendo oito com as creches expostas ao treinamento e oito com as nao-expostas, tendo em media de seis a 11 participantes por instituicao, os quais apresentavam idades entre 19 e 66 anos. O discurso das educadoras que participaram do treinamento esta pontuado de indicios de pequenas mudancas, ou pelo menos, de reconhecimento de que e preciso e possivel mudar. Destaca-se a relevância de elaborar e executar programas de treinamento e educacao nutricional para educadores de creches com supervisao continua dos efeitos da capacitacao como estrategia de saude infantil.

Consumption of industrialized food by infants attending child day care centers

Objective: To identify the age of introduction of petit suisse cheese and instant noodles in the diet of infants attending nurseries of public day care centers and to compare the nutritional composition of these foods with the healthy recommended diet (breast milk and salt meal) for this age, in order to estimate nutritional errors. Methods: Cross-sectional study of 366 children (from nine to 36 months old) who attended day care centers, whose mothers were interviewed about the age of introduction of those foods. The means of the nutrients indicated on the labels of the most consumed brands were considered. For the calculation of the percent composition of breast milk and salt meal, Tables of Food Composition were used. To assess the nutritional adequacy, we used the Dietary Reference Intakes by age group. The percentage of adequacy evaluation of the petit suisse cheese and the instant noodles nutritional compositions was made by comparing them with those of the human milk and the salt meal, respectively. Results: The petit suisse cheese and the instant noodles were consumed by 89.6 and 65.3% of the children in the first year of life. The percentages of adequacy for carbohydrates were more than twice and the percentages for sodium were 20 times higher than those found in the recommended foods. Conclusions: Both industrialized products are inappropriate for infants, emphasizing the need for adoption of norms that can inform health professionals, educators and parents about the risks of consumption.Objetivo: Identificar a idade de introducao do queijo petit suissee do macarrao instantâneo na dieta de lactentes matriculados em bercarios de creches publicas/filantropicas e comparar suas composicoes nutricionais com a alimentacao recomendada para a idade (leite materno e refeicao salgada), visando estimar erros nutricionais.Metodos:Estudo transversal com 366 criancas (de nove a 36 meses) de bercarios de creches, cujas maes foram entrevistadas sobre idade de introducao dos alimentos. Consideraram-se as medias de nutrientes indicadas nos rotulos das marcas mais consumidas. No calculo da composicao centesimal do leite materno e da refeicao salgada, utilizaram-se Tabelas de Composicao de Alimentos. Para avaliacao da adequacao nutricional, utilizaram-se as Recomendacoes de Ingestao Diaria por faixa etaria. A avaliacao dos percentuais de adequacao das composicoes nutricionais do petit suissee do macarrao instantâneo foi feita comparando-as com as do leite materno e da refeicao salgada, respectivamente.Resultados: O petit suisse e o macarrao instantâneo foram consumidos por 89,6 e 65,3% dos lactentes ainda no primeiro ano de vida. Os percentuais de adequacao para carboidrato foram superiores a duas vezes o recomendado e os percentuais de sodio, 20 vezes superiores aos encontrados nos alimentos recomendados.Conclusoes: Os dois produtos industrializados sao improprios para lactentes, ressaltando-se a necessidade de adocao de normatizacao que possa informar os profissionais de saude, os educadores e os pais sobre os riscos do consumo.

Traffic light labelling: traduzindo a rotulagem de alimentos

OBJECTIVE: This study presented an adaptation of the Traffic Light Labeling or Nutrition Traffic Light adopted in the United Kingdom and other countries in Europe to the regulations in force in Brazil and classified the processed food products sold in the country. METHODS: This tool uses traffic light colors to indicate the amount of total, saturated and trans fats, sugar, sodium and fiber present in 100g or 100mL of the product. The red light indicates that the nutrient is in excess; yellow means average and green means appropriate. For fibers, low content is indicated by the red light and proper content by green light. High prices are indicated by red light and low ones by green light. The adaptation and administration of these concepts for Brazilian consumers were based on norms established by the Brazilian National Sanitary Surveillance Agency Agencia Nacional de Vigilância Sanitaria and by the British Food Standards Agency. RESULTS: One hundred processed foods from a Brazilian supermarket website were classified. The selected foods were the first five to eight items shown on a page of each of the 17 food categories. The analysis showed that the amount of total and saturated fats and sodium are high and the amounts of trans fats and fibers are low. CONCLUSION: The use of this method allows consumers to easily pick healthier foods, alerting consumers about the disadvantages of processed foods with respect to their nutritional quality, and incentivizes companies to improve the nutritional composition of their foods in order to receive a higher number of green lights and smaller number of red lights. This helps to prevent poor food choices, obesity and non-communicable chronic diseases, which are the main causes of early disability and death in Brazil.

Consumo de alimentos industrializados por lactentes matriculados em creches

Objective: To identify the age of introduction of petit suisse cheese and instant noodles in the diet of infants attending nurseries of public day care centers and to compare the nutritional composition of these foods with the healthy recommended diet (breast milk and salt meal) for this age, in order to estimate nutritional errors. Methods: Cross-sectional study of 366 children (from nine to 36 months old) who attended day care centers, whose mothers were interviewed about the age of introduction of those foods. The means of the nutrients indicated on the labels of the most consumed brands were considered. For the calculation of the percent composition of breast milk and salt meal, Tables of Food Composition were used. To assess the nutritional adequacy, we used the Dietary Reference Intakes by age group. The percentage of adequacy evaluation of the petit suisse cheese and the instant noodles nutritional compositions was made by comparing them with those of the human milk and the salt meal, respectively. Results: The petit suisse cheese and the instant noodles were consumed by 89.6 and 65.3% of the children in the first year of life. The percentages of adequacy for carbohydrates were more than twice and the percentages for sodium were 20 times higher than those found in the recommended foods. Conclusions: Both industrialized products are inappropriate for infants, emphasizing the need for adoption of norms that can inform health professionals, educators and parents about the risks of consumption.Objetivo: Identificar a idade de introducao do queijo petit suissee do macarrao instantâneo na dieta de lactentes matriculados em bercarios de creches publicas/filantropicas e comparar suas composicoes nutricionais com a alimentacao recomendada para a idade (leite materno e refeicao salgada), visando estimar erros nutricionais.Metodos:Estudo transversal com 366 criancas (de nove a 36 meses) de bercarios de creches, cujas maes foram entrevistadas sobre idade de introducao dos alimentos. Consideraram-se as medias de nutrientes indicadas nos rotulos das marcas mais consumidas. No calculo da composicao centesimal do leite materno e da refeicao salgada, utilizaram-se Tabelas de Composicao de Alimentos. Para avaliacao da adequacao nutricional, utilizaram-se as Recomendacoes de Ingestao Diaria por faixa etaria. A avaliacao dos percentuais de adequacao das composicoes nutricionais do petit suissee do macarrao instantâneo foi feita comparando-as com as do leite materno e da refeicao salgada, respectivamente.Resultados: O petit suisse e o macarrao instantâneo foram consumidos por 89,6 e 65,3% dos lactentes ainda no primeiro ano de vida. Os percentuais de adequacao para carboidrato foram superiores a duas vezes o recomendado e os percentuais de sodio, 20 vezes superiores aos encontrados nos alimentos recomendados.Conclusoes: Os dois produtos industrializados sao improprios para lactentes, ressaltando-se a necessidade de adocao de normatizacao que possa informar os profissionais de saude, os educadores e os pais sobre os riscos do consumo.

Intake of protein, calcium and sodium in public child day care centers

OBJETIVO:Avaliar a ingestao de calcio, proteina e sodio e compara-la com a recomendada, em criancas que frequentam creches publicas.METODOS:Estudo transversal descritivo realizado em bercarios de sete creches publicas do municipio de Sao Paulo, que atendiam 366 criancas entre 12 e 36 meses, com coleta entre setembro a dezembro de 2010. Avaliou-se cada creche durante tres dias nao consecutivos, totalizando 42 dias e 210 refeicoes. O consumo alimentar foi avaliado por metodo de pesagem direta de alimentos. Para o calculo nutricional, utilizou-se o software DietWin Profissional 2.0(r) e a adequacao foi calculada segundo as recomendacoes do Programa Nacional de Alimentacao Escolar (PNAE) para energia, proteina, calcio e sodio. A relacao calcio/proteina e a densidade de calcio (mg/1.000kcal) tambem foram computadas.RESULTADOS:Constatou-se que o consumo de energia (406,4kcal), de proteina (18,2g) e de calcio (207,6mg) nao atingiu os valores recomendados em todas as creches estudadas, sendo que a ingestao de sodio ultrapassou em ate tres vezes a recomendacao. A relacao calcio/proteina de 11,7mg/g foi inferior a adequacao (20mg/g).CONCLUSOES:Ha inadequacao do consumo alimentar de calcio, proteina e sodio, em criancas inseridas no contexto de creches publicas.OBJECTIVE: To assess calcium, protein and sodium intake, of children that attend public day-care centers and to compare it with the recommended one. METHODS: Cross-sectional descriptive study in seven public day care centers of São Paulo city, Southeast Brazil, which enrolled 366 children between 12 and 36 months of age. The data collection occurred between September and December 2010. Each day care center was evaluated for three non-consecutive days, totaling 42 days and 210 meals. Dietary intake was assessed by a direct food weighing method. For the nutritional calculation, DietWin(r) Profissional 2.0 was used, and the adequacy was calculated according to the recommendations of the National School Feeding Program for energy, protein, calcium and sodium. The calcium/protein relation was also calculated, as well as calcium density (mg/1,000kcal). RESULTS: The energy (406.4kcal), protein (18.2g) and calcium (207.6mg) consumption did not reach the recommended values in all the evaluated day care centers. Sodium intake exceeded up to three times the recommendation. The calcium/protein ratio of 11.7mg/g was less than the adequate one (20mg/g). CONCLUSIONS: There was inadequacy of calcium, protein and sodium dietary intake, in children attending public day-care centers.

[Perceptions of day care center teachers about daily practices of infant feeding: the impact of training].

This article stresses the importance of the qualification of professionals involved in the feeding of children in daycare centers, such that they offer adequate food and programs are developed in order to foster healthy food habits in infants from birth. Thus, the scope of this paper was to evaluate the impact of a training program for these daycare teachers in their perceptions and practices in infant feeding. A qualitative approach was used to evaluate the impact of training, with the application of the focus group technique. Sixteen groups were created, eight of which were daycare centers with training and eight without training, the average number of participants being 6 to 11 per institution aged between 19 and 66. The discourse of the teachers who took part in the training program is replete with signs of small changes, or at least with the recognition that it is indeed necessary and possible to promote change. The importance of organizing and conducting training programs for the nutritional education of teachers in day care centers is emphasized, with the continuous supervision of the effects of the qualification as a strategy for infant health.