Introdução de alimentos complementares no primeiro ano de vida em coorte prospectiva de lactentes
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Data
2021-08-02
Autores
Almeida, Maiara Aparecida Mialich
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Universidade Estadual Paulista (Unesp)
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Introdução: A Organização Mundial de Saúde e o Ministério da Saúde brasileiro recomendam aleitamento materno exclusivo até a criança completar seis meses de idade, quando deve ser iniciada a introdução gradativa de novos alimentos, de preferência sólidos, fase chamada de alimentação complementar. A introdução da alimentação complementar inoportuna (precoce ou tardia) e com alimentos não recomendados (leite de vaca ou fórmula láctea, alimentos ultraprocessados e bebidas adoçadas, entre outros) configura-se, no cenário nacional e internacional, como relevante problema de saúde pública cujos determinantes e repercussões merecem investigação, com vistas à definição de intervenções para sua superação. Objetivos: Analisar a introdução da alimentação complementar no primeiro ano de vida, fatores a ela associados e suas repercussões sobre o estado nutricional e situação de aleitamento materno do lactente. Especificamente, objetivou-se: 1- Identificar padrões de idade de introdução da alimentação complementar no primeiro ano de vida e fatores associados; 2- Investigar a presença de associação entre padrões de idade da introdução da alimentação complementar no primeiro ano de vida e o estado nutricional dos lactentes aos 12 meses; 3- Investigar a presença de associação entre padrões de idade da introdução da alimentação complementar e interrupção do aleitamento materno no segundo semestre de vida. Métodos: Os dados são provenientes de estudo de coorte prospectiva de base populacional realizado no município de Botucatu/SP, Estudo CLaB. Foram recrutados 656 recém-nascidos acompanhados até completarem doze meses. Entrevistas com as mães ocorreram no primeiro mês e aos dois, três, quatro, seis, nove e doze meses de idade do lactente, momentos em que foram obtidos dados sobre alimentação e aferidas medidas antropométricas dos lactentes. Na primeira entrevista foram obtidos dados socioeconômicos e demográficos maternos, história obstétrica e dados do lactente, ao nascimento. Foram utilizadas as seguintes análises: Cluster K-means para identificação dos padrões de idade de introdução da alimentação complementar e modelos de regressão logística binária para identificação das associações. A análise de cluster classificou os lactentes acompanhados ao longo do primeiro ano de vida de acordo com a idade média em que cada alimento foi introduzido na dieta, gerando três grupos de lactentes diferentes quanto ao tempo de introdução de alimentos. Na investigação das variáveis associadas aos padrões adotou-se o formato de variável dummy (0 e 1), como um desfecho dicotômico: lactente pertence/não pertence ao padrão em foco. A investigação da associação entre padrões (padrão 1, padrão 2 e padrão 3) e os desfechos - presença de excesso de peso aos 12 meses e interrupção do aleitamento materno entre seis e 12 meses de idade - foi feita levando-se em consideração modelos teóricos de determinação para seleção de possíveis confundidores. Resultados: Os resultados geraram três artigos. Artigo 1- A idade média em que ocorreu a introdução dos alimentos complementares variou entre 76 dias, no caso da fórmula láctea, sendo esse o alimento introduzido mais cedo, e 314 dias, no caso dos biscoitos simples/pão. Alimentos doces, farinhas lácteas, achocolatados e iogurtes foram introduzidos próximos aos 180 dias, assim como leguminosas e carnes. Foram identificados três padrões: padrão 1, mais frequente em filhos de multíparas e que amamentaram por mais tempo, caracterizou-se por menor proporção de crianças que receberam fórmula infantil e maior que receberam leite de vaca. No padrão 2, os alimentos ofertados mais cedo foram fórmula láctea (61 dias) e água/chá (75 dias). Esse padrão se caracterizou pelo elevado percentual de crianças que receberam tanto leite de vaca (93%), quanto fórmula láctea (100%), que receberam farinha láctea/achocolatados (90,4%) e biscoitos recheados/doces/guloseimas (87,3%). O terceiro padrão caracterizou-se pela introdução precoce de fórmulas lácteas e menor frequência de lactentes recebendo produtos ultraprocessados, com chance mais alta de pertencer a esse padrão em filhos de mães adolescentes. Conclui-se que existem três diferentes padrões de idade de introdução da alimentação complementar, sendo que o pertencimento a cada um deles é influenciado pela paridade e idade materna. Artigo 2- A proporção de lactentes com excesso de peso aos doze meses de idade foi elevada nos três padrões: 35,5% no padrão 1, 41,7% no padrão 2 e 42,4% no padrão 3. Não foi identificada associação entre os padrões de idade de introdução da alimentação complementar e a presença de excesso de peso aos 12 meses de idade. Artigo 3-. Foram identificadas pequenas diferenças entre os três padrões de idade da introdução da alimentação complementar no percentual de lactentes completamente desmamados aos 12 meses de idade. Também, observaram-se diferenças entre as mães que mantiveram o bebê em aleitamento materno até doze meses e aquelas que não o fizeram. Entre as mães adolescentes, não brancas, e que tinham trabalho remunerado no momento do parto e não usufruíram de licença maternidade, houve menor proporção de lactentes desmamados antes dos 12 meses. As análises múltiplas mostraram ausência de associação entre pertencimento a um dos três padrões de idade da introdução da alimentação complementar e a interrupção do aleitamento materno entre seis e 12 meses de idade. Conclusões: Foram identificados três padrões distintos de idade da introdução da alimentação complementar na coorte estudada, nenhum deles perfeitamente alinhado às recomendações nacionais e internacionais. Fatores socioeconômicos e demográficos maternos têm associação com os padrões de idade de introdução da alimentação complementar. Não foram identificadas associações entre o pertencimento a cada um dos três diferentes padrões e o estado nutricional do lactente e a interrupção do aleitamento materno entre seis e 12 meses de idade.
Background: The World Health Organization and the Brazilian Ministry of Health recommend exclusive breastfeeding up to six months of age, when the gradual introduction of new foods, preferably solid, should begin, a phase called complementary feeding. The introduction of inappropriate complementary feeding (early or late) and with non-recommended foods (cow's milk or infant formula, ultra-processed foods and sugary drinks, among others) is configured, in the national and international scenario, as a relevant public health problem. and repercussions deserve investigation in order to define actions to overcome them. Aim: To analyze the introduction of complementary feeding in the first year of life, the factors associated with it and its impact on the infant's nutritional status and breastfeeding situation. Specifically, it aimed to: 1- Identify age patterns of introduction of complementary feeding in the first year of life and associated factors; 2- Investigate the presence of an association between the age pattern of introduction of complementary feeding in the first year of life and the nutritional status of infants at 12 months of age; 3- Investigate the presence of an association between the age patterns of introduction of complementary feeding and the interruption of breastfeeding in the second semester of life. Methods: Data are from a population-based prospective cohort study conducted in the city of Botucatu/SP, CLaB Study. A total of 656 newborns were recruited and followed up until they were twelve months old. Interviews with the mothers took place in the first month and at the infant's two, three, four, six, nine and twelve months of age, when data on feeding and anthropometric measurements of the infants were obtained. In the first interview, maternal socioeconomic and demographic data, obstetric history and infant data at birth were obtained. The following analyzes were used: Cluster K-means to identify age patterns of introduction of complementary foods and binary logistic regression models to identify associations. Cluster analysis classified infants followed during the first year of life according to the average age at which each food was introduced in the diet, generating three groups of infants that were different in terms of time of food introduction. In the investigation of the variables associated with the patterns, the dummy variable format (0 and 1) was adopted, as a dichotomous outcome: infant belongs/does not belong to the pattern in focus. The investigation of the association between patterns (pattern 1, pattern 2 and pattern 3) and outcomes - presence of overweight at 12 months and interruption of breastfeeding between 6 and 12 months of age - was carried out taking into account theoretical models of determination for selection of possible confounders. Results: The results generated three articles. Article 1- The average age at which complementary foods were introduced ranged from 76 days, in the case of infant formula, which is the food introduced earlier, and 314 days, in the case of simple biscuits/bread. Sweet foods, dairy flours, chocolate drinks and yoghurt were introduced around 180 days, as well as legumes and meat. Three patterns were identified: pattern 1, more frequent in children of multiparous women and who breastfed for a longer time, characterized by a smaller proportion of children who received infant formula and a greater proportion of children who received cow's milk. In pattern 2, the foods offered earlier were infant formula (61 days) and water/tea (75 days). This pattern was characterized by the high percentage of children who received both cow's milk (93%) and infant formula (100%), who received milk flour/chocolate drinks (90.4%) and stuffed cookies/sweets/sweets (87, 3%). The third pattern was characterized by the early introduction of infants formulas and a lower frequency of infants receiving ultra-processed products, with a higher chance of belonging to this pattern in children of teenage mothers. It is concluded that there are three different age patterns at which complementary feeding is introduced, and membership in each of them is influenced by parity and maternal age. Article 2- The proportion of overweight infants at twelve months of age was high in the three patterns: 35.5% in pattern 1, 41.7% in pattern 2 and 42.4% in pattern 3. No association was identified between the age patterns of introduction of complementary feeding and the presence of overweight at 12 months of age. Article 3-. Small differences were identified between the three age patterns for the introduction of complementary feeding in the percentage of fully weaned infants at 12 months of age. Also, differences were observed between mothers who kept the baby on breastfeeding for up to twelve months and those who did not. Among adolescent, non-white mothers who had a paid job at the time of delivery and did not take maternity leave, there was a lower proportion of infants weaned before 12 months. Multiple analyzes showed no association between belonging to one of the three age patterns at the introduction of complementary feeding and interruption of breastfeeding between six and 12 months of age. Conclusions: Three distinct age patterns were identified for the introduction of complementary feeding in the studied cohort, none of them perfectly aligned with national and international recommendations. Maternal socioeconomic and demographic factors are associated with age patterns at which complementary feeding was introduced. No associations were identified between belonging to each of the three different patterns and the infant's nutritional status and interruption of breastfeeding between six and 12 months of age.
Background: The World Health Organization and the Brazilian Ministry of Health recommend exclusive breastfeeding up to six months of age, when the gradual introduction of new foods, preferably solid, should begin, a phase called complementary feeding. The introduction of inappropriate complementary feeding (early or late) and with non-recommended foods (cow's milk or infant formula, ultra-processed foods and sugary drinks, among others) is configured, in the national and international scenario, as a relevant public health problem. and repercussions deserve investigation in order to define actions to overcome them. Aim: To analyze the introduction of complementary feeding in the first year of life, the factors associated with it and its impact on the infant's nutritional status and breastfeeding situation. Specifically, it aimed to: 1- Identify age patterns of introduction of complementary feeding in the first year of life and associated factors; 2- Investigate the presence of an association between the age pattern of introduction of complementary feeding in the first year of life and the nutritional status of infants at 12 months of age; 3- Investigate the presence of an association between the age patterns of introduction of complementary feeding and the interruption of breastfeeding in the second semester of life. Methods: Data are from a population-based prospective cohort study conducted in the city of Botucatu/SP, CLaB Study. A total of 656 newborns were recruited and followed up until they were twelve months old. Interviews with the mothers took place in the first month and at the infant's two, three, four, six, nine and twelve months of age, when data on feeding and anthropometric measurements of the infants were obtained. In the first interview, maternal socioeconomic and demographic data, obstetric history and infant data at birth were obtained. The following analyzes were used: Cluster K-means to identify age patterns of introduction of complementary foods and binary logistic regression models to identify associations. Cluster analysis classified infants followed during the first year of life according to the average age at which each food was introduced in the diet, generating three groups of infants that were different in terms of time of food introduction. In the investigation of the variables associated with the patterns, the dummy variable format (0 and 1) was adopted, as a dichotomous outcome: infant belongs/does not belong to the pattern in focus. The investigation of the association between patterns (pattern 1, pattern 2 and pattern 3) and outcomes - presence of overweight at 12 months and interruption of breastfeeding between 6 and 12 months of age - was carried out taking into account theoretical models of determination for selection of possible confounders. Results: The results generated three articles. Article 1- The average age at which complementary foods were introduced ranged from 76 days, in the case of infant formula, which is the food introduced earlier, and 314 days, in the case of simple biscuits/bread. Sweet foods, dairy flours, chocolate drinks and yoghurt were introduced around 180 days, as well as legumes and meat. Three patterns were identified: pattern 1, more frequent in children of multiparous women and who breastfed for a longer time, characterized by a smaller proportion of children who received infant formula and a greater proportion of children who received cow's milk. In pattern 2, the foods offered earlier were infant formula (61 days) and water/tea (75 days). This pattern was characterized by the high percentage of children who received both cow's milk (93%) and infant formula (100%), who received milk flour/chocolate drinks (90.4%) and stuffed cookies/sweets/sweets (87, 3%). The third pattern was characterized by the early introduction of infants formulas and a lower frequency of infants receiving ultra-processed products, with a higher chance of belonging to this pattern in children of teenage mothers. It is concluded that there are three different age patterns at which complementary feeding is introduced, and membership in each of them is influenced by parity and maternal age. Article 2- The proportion of overweight infants at twelve months of age was high in the three patterns: 35.5% in pattern 1, 41.7% in pattern 2 and 42.4% in pattern 3. No association was identified between the age patterns of introduction of complementary feeding and the presence of overweight at 12 months of age. Article 3-. Small differences were identified between the three age patterns for the introduction of complementary feeding in the percentage of fully weaned infants at 12 months of age. Also, differences were observed between mothers who kept the baby on breastfeeding for up to twelve months and those who did not. Among adolescent, non-white mothers who had a paid job at the time of delivery and did not take maternity leave, there was a lower proportion of infants weaned before 12 months. Multiple analyzes showed no association between belonging to one of the three age patterns at the introduction of complementary feeding and interruption of breastfeeding between six and 12 months of age. Conclusions: Three distinct age patterns were identified for the introduction of complementary feeding in the studied cohort, none of them perfectly aligned with national and international recommendations. Maternal socioeconomic and demographic factors are associated with age patterns at which complementary feeding was introduced. No associations were identified between belonging to each of the three different patterns and the infant's nutritional status and interruption of breastfeeding between six and 12 months of age.
Descrição
Palavras-chave
Amamentação, Nutrição do lactente, Alimentação complementar, Saúde da criança, Breastfeeding, Infant nutrition, Complementary feeding, Child health