Sarah Warkentin

Peso ao nascer de crianças brasileiras menores de dois anos

Low birth weight is associated with increased risk of dying in the first year of life. This study was motivated by recent changes in the determination of birth weight patterns with the advent of the perinatal epidemiological transition. We analyzed data from the Brazilian National Survey of Demographic and Health of Children and Women including only children < 24 months. Prevalence of low birth weight in Brazil was 6.1%. Risk factors included female gender, residence in the South and Southeast geographic regions, low maternal education, and maternal smoking. The low birth weight profile changed, with higher prevalence in more economically developed regions, reflecting the neonatal epidemiological transition determined by changes in patterns of childbirth care and incorporation of perinatal life support technologies, in addition to the previously known biological risks associated with poverty and misinformation.O baixo peso ao nascer tem grande relacao com risco de morrer no primeiro ano de vida. Estudos mostram sua associacao com problemas de desenvolvimento na infância e doencas na vida adulta. Dada a importância desse indicador, o objetivo deste estudo foi investigar os fatores sociais, demograficos, biologicos e ambientais envolvidos na sua determinacao. Analisaram-se dados da Pesquisa Nacional de Demografia e Saude da Crianca e da Mulher (PNDS-2006), incluindo apenas criancas menores de 24 meses de vida. A prevalencia de baixo peso ao nascer no Brasil foi de 6,1%. Os fatores de risco identificados foram sexo feminino, residir nas macrorregioes Sul e Sudeste e ser filho de maes com baixa escolaridade ou tabagistas. Houve mudancas no perfil do baixo peso ao nascer, com maior prevalencia em regioes mais desenvolvidas economicamente, refletindo a transicao epidemiologica perinatal, caracterizada por mudancas nos padroes de assistencia ao parto e incorporacao dos avancos tecnologicos na assistencia perinatal, alem de fatores de risco biologicos conhecidos associados a pobreza e a desinformacao.

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.

Exclusive breastfeeding duration and determinants among Brazilian children under two years of age

OBJECTIVE: The present study described the duration and identified the determinants of exclusive breastfeeding. METHODS: The study used data from the Pesquisa Nacional de Demografia e Saude da Crianca e da Mulher 2006 (National Demographic and Health Survey on Women and Children 2006). Data were collected using questionnaires administered by trained professionals and refer to a subsample of 1,704 children aged less than 24 months. The estimated durations of exclusive breastfeeding are presented according to socioeconomic, demographic and epidemiological variables. Kaplan Meier estimator curves were used to produce valid estimates of breastfeeding duration and the Coxs proportional hazards model was fitted to identify risks. RESULTS: The median estimated duration of exclusive breastfeeding was 60 days. The final Cox model consisted of mothers age <20 years (hazard ratio=1.53, 95% confidence interval=1.11-1.48), use of pacifier (hazard ratio=1.53, 95% confidence interval=1.37-1.71), not residing in the countrys southeast region (hazard ratio=1.22, 95% confidence interval=1.07-1.40) and socioeconomic status (hazard ratio=1.28, 95% confidence interval=1.06-1.55). CONCLUSION: The Kaplan Meier estimator corrected the underestimated duration of breastfeeding in the country when calculated by the current status methodology. Despite the national efforts done in the last decades to promote breastfeeding, the results indicate that the duration of exclusive breastfeeding is still half of that recommended for this dietary practice to promote health. Ways to revert this situation would be ongoing educational activities involving the educational and health systems, associated with advertising campaigns on television and radio mainly targeting young mothers with low education level and low income, identified as those at high risk of weaning their children early.

Birth weight in Brazilian children under two years of age

Low birth weight is associated with increased risk of dying in the first year of life. This study was motivated by recent changes in the determination of birth weight patterns with the advent of the perinatal epidemiological transition. We analyzed data from the Brazilian National Survey of Demographic and Health of Children and Women including only children < 24 months. Prevalence of low birth weight in Brazil was 6.1%. Risk factors included female gender, residence in the South and Southeast geographic regions, low maternal education, and maternal smoking. The low birth weight profile changed, with higher prevalence in more economically developed regions, reflecting the neonatal epidemiological transition determined by changes in patterns of childbirth care and incorporation of perinatal life support technologies, in addition to the previously known biological risks associated with poverty and misinformation.O baixo peso ao nascer tem grande relacao com risco de morrer no primeiro ano de vida. Estudos mostram sua associacao com problemas de desenvolvimento na infância e doencas na vida adulta. Dada a importância desse indicador, o objetivo deste estudo foi investigar os fatores sociais, demograficos, biologicos e ambientais envolvidos na sua determinacao. Analisaram-se dados da Pesquisa Nacional de Demografia e Saude da Crianca e da Mulher (PNDS-2006), incluindo apenas criancas menores de 24 meses de vida. A prevalencia de baixo peso ao nascer no Brasil foi de 6,1%. Os fatores de risco identificados foram sexo feminino, residir nas macrorregioes Sul e Sudeste e ser filho de maes com baixa escolaridade ou tabagistas. Houve mudancas no perfil do baixo peso ao nascer, com maior prevalencia em regioes mais desenvolvidas economicamente, refletindo a transicao epidemiologica perinatal, caracterizada por mudancas nos padroes de assistencia ao parto e incorporacao dos avancos tecnologicos na assistencia perinatal, alem de fatores de risco biologicos conhecidos associados a pobreza e a desinformacao.

Prevalence and Determinants of Vitamin A Deficiency among Brazilian Children under 2 Years of Age from the 2006 National Demographic Health Survey

Background Vitamin A deficiency is prevalent among infants, primarily in undeveloped communities, compromising immune system competence and raising morbidity and mortality rates. Understanding the risk factors associated with vitamin A deficiency is essential to create informed health policies. Objective To identify and quantify risk factors for vitamin A deficiency in a probabilistic sample of children under 2 years of age participating in a national survey in Brazil and to provide a comprehensive risk factor model to inform health strategies and policies. Methods We analyzed data from a cross-sectional study of 1,436 children from the 2006 Brazilian National Survey on Demography and the Health of Women and Children. Vitamin A deficiency was defined as retinol levels below 0.70 μg/dL. Results The prevalence of vitamin A deficiency was estimated at 16.1% (95% CI, 12.7 to 20.2). The Poisson regression model identified three risk factors for vitamin A deficiency: urban residence (prevalence ratio [PR] = 1.47, p = .023), no consumption of animal meat within the past week (PR = 1.41, p = .031), and a mother older than 25 years (PR = 1.31, p = .048). Conclusions Strategies to control infant vitamin A deficiency should include health promotion and nutrition education for families from all socioeconomic levels. Improvements in lifestyle quality, based on adequate food consumption by all infants, must be achieved by communities, especially in urban areas and for older mothers.

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.