Muriel Bauermann Gubert

Consumo alimentar entre crianças brasileiras com idade de 6 a 59 meses

The aim of this study was to assess food consumption in Brazilian children 6 to 59 months of age by region of the country and area of residence. This was a descriptive cross-sectional study of 4,322 children in the National Demographic and Health Survey (2006-2007). The data showed low daily consumption of leafy vegetables (12.7%), vegetables (21.8%), and meat (24.6%) and high consumption (1-3 times a week) of soft drinks (40.5%), fried foods (39.4%), salty snacks (39.4%), and sweets (37.8%). Comparing the regions of Brazil, children in the South, Southeast, and Central-West consumed more rice, bread, potatoes, beans, greens, vegetables, and meat, but they also ate more foods not recommended for their age, like sweets and soft drinks (soda). Rural children showed lower consumption of foods recommended for their age and also those not recommended for their age, as compared to their urban counterparts. According to this study, food consumption in these young children fails to meet the recommendations for healthy eating in this age bracket.

Estimativas de insegurança alimentar grave nos municípios Brasileiros

Prevalence of severe food insecurity was estimated for Brazilian municipalities based on the 2004 National Household Sample Survey (PNAD). First, a logistic regression model was developed and tested with this database. The model was then applied to the 2000 census data, generating severe food insecurity estimates for the Brazilian municipalities, which were subsequently analyzed according to the proportion of families exposed to severe food insecurity. Severe food insecurity was mainly concentrated in the North and Northeast regions, where 46.1% and 65.3% of municipalities showed high prevalence of severe food insecurity, respectively. Most municipalities in the Central West region showed intermediate prevalence of severe food insecurity. There was wide intra-regional variation in severe food insecurity, while the South of Brazil showed the most uniform distribution. In conclusion, Brazil displays wide inter and intra-regional variations in the occurrence of severe food insecurity. Such variations should be identified and analyzed in order to plan appropriate public policies.

Early cow's milk consumption among Brazilian children: results of a national survey ☆

OBJECTIVE to assess the intake, frequency, and type of milk consumed by Brazilian children younger than 60 months of age. METHODS this was a cross-sectional study, which used secondary data from the National Demographic and Health Survey of 2006-2007. Data from 4,817 children under the age of 60 months were used. All analyses were performed with expanded samples. The dietetic survey assessed the previous days consumption, and estimates were made through univariate analysis, presented as a percentage. RESULTS on the day prior to the survey, breast milk was consumed by 91% of the children younger than six months of age, by 61.5% of the children aged 6 to 12 months, and by 34.8% of the children aged 13 to 24 months. Among the children who had received other types of milk, cows milk was consumed by 62.4% of the children younger than six months, by 74.6% of the children aged 6 to 12 months, and by approximately 80% of the children older than 12 months. Infant formulas were consumed by 23% of the children younger than six months of age, by 9.8% of the children aged 6 to 12 months, and by less than 1% of the older children. Soy milk consumption varied from 14.6% to 20% among the investigated ages. Non-breast milk consumption before the age of six months was more frequent in children living in the Northeastern and Southern regions. CONCLUSION the results of the present study demonstrated that most children received cows milk prematurely as a substitute for breast milk, highlighting the importance of the development of public policies to promote, protect, and support breastfeeding in all regions of Brazil, aiming at reversing the observed scenario.

Aleitamento materno em crianças menores de 2 anos e situação domiciliar quanto à segurança alimentar e nutricional

OBJECTIVE To investigate the association between household food and nutrition security status and breastfeeding among children under 2 years old. METHODS Data were analyzed from 1,635 children under 2 years old who had participated in the Brazilian National Demographic and Health Census in 2006. The outcome (breastfeeding) was evaluated according to data on the childrens food intake on the day before the interview and food insecurity was assessed using the Brazilian Food Insecurity Scale. RESULTS Approximately 58% of children were breastfeeding and 47% were living in households with food insecurity. There was an association between breastfeeding and households in a state of food insecurity, but only for children older than 12 months. In this age group, breastfeeding prevalence was higher (41%) among children living in households with food and nutrition insecurity than among those who lived in households considered secure (29%). There were no associations between food insecurity and breastfeeding in the first year of life or early introduction of foods other than breastmilk. CONCLUSION Food insecurity is associated with a higher prevalence of breastfeeding in the second year of life.

Perfil da alimentação oferecida em instituições geriátricas do Distrito Federal

OBJECTIVE: To evaluate institutional feeding, meal production facilities and the inclusion of healthcare professionals in elderly homes of Distrito Federal. METHODS: This is a descriptive and cross-sectional study that was carried out in five elderly homes. Two hundred forty-four seniors were included, corresponding to 25% of the institutionalized seniors in Distrito Federal in 2002. The meal production facility was evaluated based on its hygienic and environmental-structural conditions. The inclusion of healthcare professionals among the staff of the elderly homes, the number of meals offered daily, the meal consistency options and the presence of a printed weekly menu were investigated. A qualitative evaluation of the nutritional adequacy of the institutional feeding was done based on the Food Guide Pyramid recommendations. RESULTS: Precarious hygienic and environmental-structural conditions were identified. Healthcare professionals were scarce in all homes. Most homes offered five daily meals with two consistency options: normal and semi-liquid. Only two homes had a printed weekly menu. The nutritional evaluation of meals showed that the most inadequate percentages of food groups offered were vegetables, with a median offer of only 53% of the recommendation, followed by fruits, with 60% of the recommendation. The offered percentage of the oil and fat group was considered excessive (120% of the recommendation). CONCLUSION: Abundant inadequate factors in meal production facilities, the poor inclusion of healthcare professionals and the imbalance in the food groups offered point to a worrying situation for the quality of life of institutionalized seniors in Distrito Federal.

Qualidade das informações sobre aleitamento materno e alimentação complementar em sites brasileiros de profissionais de saúde disponíveis na internet

OBJECTIVES: to analyze the information available on internet sites regarding maternal breast feeding and complementary feeding according to the recommendations of the Brazilian Ministry of Health. METHODS: a cross-sectional study was carried out using a sample of 103 sites for professional healthcare workers. Information was analyzed on maternal breast feeding (MB) and complementary feeding (CF). The information was quantified and analyzed qualitatively. RESULTS: the recommendations for MB were: that it should be exclusive up to the 6th month of life (64.1%); that no water or tea should be added (31.1%); that it should last for two years or more (36.9%); and that bottles and/or pacifiers should not be used (33%). For CF, the term weaning was used (30.1%), it was recommended that solid feeding begin in the 6th month of life (47.9%), involving fruit pulp (11.6%) or juice (9.7%); and soup (14.6%). According to the qualitative analysis, incorrect information included recommending the consumption of meat in the 12th month of life, regular meals, the introduction of solid food in the 7th month and the consumption of cows milk in the 6th month. CONCLUSIONS: most of the information on breast feeding accords with the advice of the Brazilian Ministry of Health, but is not sufficient to encourage breast feeding. The information on complementary feeding mostly diverges from the official recommendations.

Becoming Breastfeeding Friendly Index: Development and application for scaling-up breastfeeding programmes globally

Global efforts to further improve exclusive breastfeeding rates have not been successful, in part because effective scaling-up frameworks and roadmaps have not been developed. The Becoming Breastfeeding Friendly (BBF) toolbox includes an evidence-based index, the BBF Index (BBFI), to guide the development and tracking of large scale, well-coordinated, multisector national breastfeeding promotion programmes. This paper describes the development of the BBFI, which is grounded in the Breastfeeding Gear Model complex adaptive systems framework. The BBFI was developed by the BBF Steering Committee in collaboration with a high-level Technical Advisory Group following the Delphi consensus methodology. Key benchmarks and definitions were informed by evidence-based health, nutrition, and newborn survival initiatives identified from the academic and grey literature. The BBFI consists of 8 gears (54 benchmarks): Advocacy (4); Political Will (3); Legislation and Policies (10); Funding and Resources (4); Training and Program Delivery (17); Promotion (3); Research and Evaluation (10); and Coordination, Goals, and Monitoring (3). Scores are generated for 8 gear scores plus a total country score to gauge the scaling-up enabling environment. The BBFI provides an evidence-based index to assist countries in (a) assessing their readiness to scale up breastfeeding programmes and (b) tracking scaling-up progress.

Understanding the double burden of malnutrition in food insecure households in Brazil.

Household food insecurity (HFI) has been associated with both obesity among mothers and undernutrition among children. However, this association has not been well investigated in mother/child pairs living in the same household. The objective of this study was to examine the relationship of coexistence of maternal overweight and child stunting with HFI in Brazil. We conducted secondary data analyses of the 2006 Brazilian National Demographic and Health Survey. We analyzed the nutritional status of 4299 pairs of 15-49-year-olds mothers and their children under 5 years of age. The double burden of malnutrition (DBM) was defined as the presence of an overweight mother and a stunted child in the same household. HFI was measured with the Brazilian HFI Measurement Scale. The association between DBM and HFI was examined with hierarchical multivariable logistic regression analyses. Severe HFI was associated with DBM after adjusting for macroeconomic and household level socio-economic and demographic variables (Adjusted OR: 2.65 - CI: 1.17-8.53). Findings suggest that policies and programmes targeting HFI are needed to prevent the coexistence of child chronic undernutrition and maternal overweight/obesity in the same household. These investments are likely to be highly cost-effective as stunting has been identified as one of the major risk factors for poor child development and adult overweight/obesity and a strong risk factor for the development of costly chronic diseases including type 2 diabetes and cardiovascular disease.

Household food insecurity, nutritional status and morbidity in Brazilian children

OBJECTIVE To identify the association of household food insecurity (HFI) with anthropometric status, the risk of vitamin A deficiency and anaemia, morbidities such as cough and fever, and hospitalizations for diarrhoea and pneumonia in children under 5 years old. DESIGN Cross-sectional study using data from the 2006 Brazilian Demographic and Health Survey. HFI was measured with the Brazilian Food Insecurity Measurement Scale (EBIA). Vitamin A deficiency and anaemia were assessed in blood samples. Child morbidities were reported by the childs mother and included cough, fever, and hospitalizations for diarrhoea and pneumonia. Regression results were expressed as unadjusted and adjusted OR and corresponding 95 % CI for severe food insecurity, with statistical significance set at P<0·05. SETTING Nationally representative survey. SUBJECTS Children (n 4064) under 5 years old. RESULTS There was no association between HFI and vitamin A deficiency, pneumonia, wasting or overweight. The prevalence of cough, fever, hospitalization for diarrhoea and stunting were associated with degree of HFI severity. There was a significant association of morbidities and stunting with severe food insecurity (v. food secure). After controlling for confounders, the association between severe food insecurity (v. food secure/rest of food insecurity categories) and the prevalence of common morbidities remained strong, showing that severely food-insecure children had a greater likelihood of experiencing cough (adjusted OR=1·79) and of being hospitalized for diarrhoea (adjusted OR=2·55). CONCLUSIONS Severe HFI was associated with cough and severe diarrhoea among Brazilian children.

Análise dos pareceres conclusivos dos Conselhos de Alimentação Escolar sobre a execução do Programa Nacional de Alimentação Escolar

OBJECTIVE: This study analyzed the conclusive reports of the Brazilian School Food Council on the implementation of the National School Food Program. METHODS: This quantitative and qualitative study analyzed 4,256 reports in the quantitative phase and 2,299 reports in the qualitative phase. The reports were issued in 2009. A total of 4,135 annual synthetic statements on physical and financial implementation of the Program were also analyzed. The reports were analyzed in the qualitative phase by content analysis. RESULTS: Quantitative analysis showed that the implementing party provided no consideration for food purchase in 24.4% (n=1,009) of the locations, and 78.7% (n=3,348) of the reports were signed by a single council member. Qualitative analysis of the reports showed that 64.5% (n=1,483) of the locations were under a central management and that 23.9% (n=549) of the implementing parties purchased food with their own funds. Most auctions were open ascending price auctions (32.7%, n=751) and only 4.9% (n=112) of the reports disclosed buying foods from family farms. The main council responsibilities are analyzing the expense reports (59.1%, n=1,359) and following menu development (36.5%, n=838). CONCLUSION: Execution of the different parts of the National School Food Program was evidenced by analyzing the School Food Council reports and annual synthetic statements, which characterized them as program-monitoring tools. The findings may help to support the strategies used for improving the quality of school food and strengthening the School Food Council.