Priscila Maximino

Nutritional risk among Brazilian children 2 to 6 years old: A multicenter study

OBJECTIVE To estimate the nutritional risk in children 2 to 6 y old. METHODS The sample consisted of 3058 children enrolled in public and private schools in nine Brazilian cities. The assessment of nutrient intake was based on 1-d data combining direct individual weighing of foods and a food diary. A second evaluation of food consumption was conducted in a subsample to estimate the usual intake. RESULTS There was low prevalence of inadequate intake of vitamin B6 (<0.001%), riboflavin (<0.001%), niacin (<0.001%), thiamin (<0.001%), folate (<0.001%), phosphorus (<0.1%), magnesium (<0.1%), iron (<0.5%), copper (<0.001%), zinc (<0.5%), and selenium (<0.001%). However, 22% of children younger than 4 y and 5% of children older than 4 y consumed fiber quantities larger than the adequate intake. Approximately 30% of the sample consumed more saturated fat than recommended. The prevalence of inadequate vitamin E intake ranged from 15% to 29%. More than 90% of the children had an inadequate vitamin D intake. In children older than 4 y, the prevalence of inadequate calcium intake was approximately 45%. Sodium intake was higher than the upper intake level in 90% of children younger than 4 y and 73% of children older than 4 y. CONCLUSIONS The prevalence of inadequate dietary intake was low for most nutrients. However, fiber, calcium, and vitamin D and E intakes were lower than recommended. Moreover, children consumed large amounts of sodium and saturated fat.

Obesogenic environment – intervention opportunities

OBJECTIVES To evaluate environmental obesogenic-related factors, such as physical activity in neighborhoods and schools, nutritional behavior, and intervention programs. SOURCES Critical analysis of literature with personal point of view from infant obesity experts and political advisors for public intervention. DATA SYNTHESIS Although obesity is a public health problem affecting several age groups, it is among children and adolescents that it plays a more important role, due to treatment complexity, high likelihood of persistence into adulthood, and association with other non-transmissible diseases while still in early age. Environment is a main component of the genesis and outcomes in the near future or long term. Modification of intake with high-density food, meal skipping, and high intake of saturated fat, sugar, and salt, associated to high levels of sedentarism are main causes of obesity. CONCLUSION Intervention opportunities are related to modifications in political, environmental, and individual settings. School and physical activities in the educational environment are intertwined with nutrition intervention in continuous education. A critical review of some different scenarios in Latin American countries is presented.

O papel do fonoaudiólogo no diagnóstico e tratamento multiprofissional da criança com dificuldade alimentar: uma nova visão

O presente artigo relata o caso clinico de paciente de dois anos e seis meses atendida por equipe multidisciplinar. A paciente apresentou dificuldades alimentares caracterizadas por recusa alimentar, tempo prolongado das refeicoes, defesa sensorio-oral, reflexo de vomito anteriorizado e dificuldade mastigatoria. Nao se alimentava sozinha, nem participava das refeicoes em familia. Apresentava refluxo gastroesofagico, alergia a proteina do leite de vaca e tosse seguida por vomito. Nao apresentou comprometimento pondero-estatural. Foi utilizado o Programa de Refeicao Compartilhada. Apos acompanhamento medico, a conduta de trabalho foi definida e iniciada pelo trabalho sensorio-oral, seguido do trabalho com a mastigacao, associados ao trabalho de orientacao familiar. A paciente passou a realizar as refeicoes com a familia e participar das rotinas sociais de alimentacao. O tempo de refeicao foi reduzido e a recusa alimentar eliminada. Os aspectos sensorio-motores-orais melhoraram significantemente. Apos a alta e reavaliacao em tres meses, apresentou melhora no refluxo gastro-esofagico e a medicacao foi suprimida. A nutricionista iniciou a introducao de derivados do leite, com boa aceitacao por parte da paciente. O programa utilizado mostrou-se eficaz para o diagnostico e tratamento da dificuldade alimentar apresentada pela paciente. A equipe multidisciplinar foi capaz de ter uma visao ampliada da dificuldade alimentar apresentada pela paciente, compreendendo as questoes motoras, orais, orgânicas e nutricionais da alimentacao da crianca inseridas no seu contexto familiar.

Fatty acid intake and metabolic syndrome among overweight and obese women

OBJECTIVE To examine relations between fatty acids intake and metabolic syndrome (MetS) status among overweight and obese women (n = 223). METHODS This was a cross-sectional study. The physical and laboratory tests included anthropometry, body composition evaluation and measurements of blood pressure, fasting blood glucose, insulinemia and lipid profiles. A three-day food diary was used to evaluate fatty acids consumption. Statistical analysis included χ2 test and odds ratio measurements. RESULTS The women had 35.2 (6.9) years old and 15.2% presented MetS. Women with MetS presented higher serum levels of very low-density lipoprotein cholesterol, triglycerides, glucose and insulin in addition to higher diastolic blood pressure in comparison to women without MetS. Overweight women with MetS consumed higher amounts of monounsaturated fatty acids - 24.3 g (24.7 - 36.4) versus overweight women without MetS - 23.9 g (23.8 - 26.8), polyunsaturated fatty acids - 16.7 g (14.6 - 21.1) versus overweight women without MetS - 13.6 g (13.8 - 15.8) and linoleic fatty acids - 15.9 g (6.5) versus overweight women without MetS - 13.1 g (5.1). Among obese women with MetS, higher intake of linoleic fatty acids was also noted - 17.6 g (6.1) versus obese women without MetS - 14.3 g (6.6) in addition to higher consumption of trans fatty acids - 4.7 g (4.8 - 6.3) versus obese women without MetS - 3.9 g (2.9 - 4.6). Increased quartiles of monounsaturated, polyunsaturated, linoleic and trans fatty acid intake were significantly associated with a greater occurrence of MetS. CONCLUSION Lipid intake may be related to MetS, although other factors also need to be considered, such as lifestyle, genetics and metabolism.

O PEDIATRA DEVE INVESTIGAR SINTOMAS DE TRANSTORNOS OBSESSIVOS COMPULSIVOS EM CRIANÇAS COM DIFICULDADES ALIMENTARES

ABSTRACT Objective: To review current evidence on the relationship between obsessive-compulsive disorder and feeding difficulties. Methods: Review the Science Direct and PubMed databases between 2007 and 2017 in English, Portuguese and Spanish. The search terms, used in association, were “obsessive compulsive disorder” and “picky eating/feeding difficulty”. Cohort, case control and cross sectional studies were included that analyzed children, adolescents and/or adults of any sample size from any country in the world. Opinion articles were excluded. Results: Around 245 articles were selected, and only 4 were included in this review, according to previous criteria. Results from the studies essentially described that there is indeed a difference in “picky” behaviors between subjects with and without obsessive-compulsive disorder. Patients with obsessive-compulsive disorder tend to have exacerbated symptoms of disgust, anxiety and a higher eating behavior inflexibility score. Conclusions: Obsessive-compulsive disorder and feeding difficulties patients share common symptoms. The present study alerts health professionals who follow patients with feeding difficulties as to the importance of investigating possible psychiatric comorbidities.

Does family mealtime have a protective effect on obesity and good eating habits in young people? A 2000-2016 review

Objetivos: revisar a prevalência da prática de refeições em família e seu impacto no IMC e no comportamento alimentar durante a infância e adolescência. Métodos: revisão nas bases Bireme / Lilacs / Scielo / Cochrane e Pubmed, entre 2000 a 2016, com descritores “refeição em família”, “comportamento”, “alimentação ou dieta ou ingestão alimentar” e “criança/adolescentes”; realizada por dois examinadores independentes e segundo etapas sistemáticas, em inglês e português. Foram selecionados trabalhos que apresentassem a prevalência e/ou discussão de relações entre variáveis nutricionais. Foram encontrados 2319 artigos, dos quais 15 foram selecionados, todos na língua inglesa: revisões sistemáticas (n=2), estudos transversais (n=8), estudos longitudinais (n=8); todos com crianças (n=5), adolescentes (n=6) e ambos (n=5). Resultados: a média de compartilhamento de refeições foi de 1x/dia, com prevalência de 27 a 81%. A maioria dos estudos (n=13) descreveu impacto benéfico sobre o IMC, maior consumo de FLV, proteínas, fontes de cálcio e menor consumo de doces e bebida adoçadas, união familiar e auto regulação do apetite. Conclusões: a realização das refeições em família diariamente exerce efeito benéfico sobre o estado nutricional e comportamento alimentar de crianças e adolescentes. Palavraschave Refeições, Criança, Adolescente, Nutrição, Comportamento alimentarObjectives: to review the prevalence of family meals and its impact on BMI and eating habits during childhood and adolescence. Methods: reviews are from Bireme / Lilacs / Scielo / Cochrane and Pubmed, between 2000-2016 with descriptors “family meal or mealtime”, “behavior”, “nutrition or diet or consumption or eating”, and “child or children or adolescence”; performed by two independent examiners, according to the systematic steps in English and Portuguese. The articles were selected based on prevalence and/ or discussion between nutritional variables. 2,319 articles were found, which 15 were selected all in English: systematic reviews (n=2), crosssectional studies (n=8), longitudinal studies (n=8); all related to children (n=5), adolescents (n=6) and both (n=5). Results: the mean of shared meals was 1x/day, with a prevalence of 27 to 81%. Most studies (n=13) reported the beneficial impact on BMI, higher consumption of fruit and vegetables, protein, calcium and a lower consumption of sweets and sugar sweetened beverages, family union and self-regulation of appetite. Conclusions: having daily family mealtime has beneficial effect on the nutritional status and children and adolescents’ eating behavior.

Delayed Development of Feeding Skills in Children with Feeding Difficulties—Cross-sectional Study in a Brazilian Reference Center

Background Delays in gross motor development, sensory processing issues, and organic and behavioral problems are known to interfere in the development of feeding skills (FS); and—therefore—in the success of the process of feeding a child. Children with feeding difficulties (FD) commonly present inadequacy of FS. Objectives Assessment of five FS in Brazilian children with FD, and search of associations with types of FD. Methods Cross-sectional study with 70 children below 10 years old. Data were obtained from medical records: age, gender, age at texture transitions, feeding phase (breastfeeding, weaning to solids or full solids) at first complaint; characteristics of the meal (duration, environment, and shared meals with adults), self-feeding practices, use of feeding equipment and bottle, mouthing, feeding position and FD diagnosis. Skills were categorized according to standards for age. Chi-Square, Anova Test (or non-parametric equivalent) and Multinomial logistic regression tests were used, with a significance level of 5%. Results There was no difference in FS (p > 0.05) or in the number of FS inadequateness (p = 0.84) according to FD diagnosis. The majority (94%) of children presented at least one delayed development of FS; 1/3 presented delays in more than half of the FS. The most prevalent inadequacies in FS were inadequate feeding position (73.5%), prolonged bottle feeding (56.9%), and inadequate self-feeding practices (37.9%). Feeding complaints first appeared at 10.9 ± 11.4 months, and picky eating was the most prevalent type of FD (37.1%). Most children were fed in inadequate environments (55.2%), without the company of adults (78%). Transition to solid foods occurred at 16 ± 5.6 months. Multinomial logistic regression showed no difference in likelihood of presenting any type of FD compared to picky eating, according to FS. Age at texture transition both from breastfeeding to complementary feeding (p = 0.95), and from complementary feeding to solid foods (p = 0.43) did not vary according to FD diagnosis. Conclusion FS development or number of FS inadequateness did not vary according to FD diagnosis. Identification of these inadequacies could help the discussion for multi-professional treatment of patients with FD.