Ingestão de açúcar por crianças com dificuldades alimentares menores de 2 anos - estudo em um centro de referência brasileiro / Sugar intake by children with eating difficulties under2 years of age - study in a Brazilian reference center

Introdução: os primeiros anos de vida são essenciais para o crescimento e o desenvolvimento. A criança já nasce com a preferência pelo sabor doce, e ao consumir preparações açucaradas, propicia--se uma alimentação de baixa qualidade nutricional. O objetivo do estudo é descrever a ingestão de alimentos que contenham açúcar por crianças com dificuldades alimentares menores de 2 anos atendidas em um centro especializado. Material e métodos: trata-se de um estudo observacional retrospectivo, com dados obtidos do prontuário de crianças de ambos os sexos, atendidas no Centro de Excelência em Nutrição e Dificuldades Alimentares (CENDA), localizado no município de São Paulo. Dentre os alimentos consumidos foram selecionados aqueles que continham açúcar de adição em sua composição. Para categorizar os alimentos foi usada a classificação da What We Eat in America (WWEIA). Resultados: participaram do estudo 31 crianças com dificuldades alimentares, 77,4% apresentaram consumo de pelo menos um alimento contendo açúcar. Os alimentos mais consumidos foram biscoitos e brownies, bolos e tortas, milk-shakes e outras bebidas lácteas. Discussões e Conclusão: a fase de alimentação complementar pode se tornar um grande desafio para os pais e cuidadores, a mesma foi o ponto de partida para a maioria das crianças com dificuldade alimentares. O aprendizado do comer é um processo complexo que exige aquisição de habilidades na oferta de alimentos adequados e variados, contudo, o contexto se torna favorável com as práticas inadequadas, sendo uma delas a permissão do consumo de alimentos e produtos adoçados pelas mesmas.

Introduction: the first years of life are essential for growth and development. Children are born with a preference for sweet tastes, and through sugary consumption, they are provided with a diet of low nutritional quality. The objective of the study is to describe the intake of foods containing sugar by children with eating difficulties under 2 years of age treated in a specialized center. Material and methods: this is a retrospective observational study, with data obtained from the medical records of children of both sexes, attended at the Center for Excellence in Nutrition and Eating Difficulties (CENDA), located in the city of São Paulo. Among the foods consumed, those that contained added sugar in their composition were selected. To categorize foods, the What We Eat in America (WWEIA) classification was used. Results: 31 children with eating difficulties participated in the study, 77.4% consumed at least one food containing sugar. The most consumed foods were cookies and brownies, cakes and pies, milkshakes and other dairy drinks. Discussions and Conclusion: the complementary feeding phase can become a great challenge for parents and caregivers, as it was the starting point for the majority of children with eating difficulties. Learning to eat is a complex process that requires the acquisition of skills in offering adequate and varied foods. However, the context becomes favorable to inappropriate practices, one of which is allowing the consumption of sweetened foods and products, for the same reasons.

Transgenerational transmission of eating habits

Abstract Objective To investigate the relationship between the biopsychosocial environment and eating habits and behaviors that lead to the selection and consumption of certain food from the earliest stages of life. To clarify whether there is an interaction between genetic and epigenetic factors, and how they shape eating habits. Data source A narrative review based on research in PubMed and Web of Science electronic databases was carried out over the last 10 years, searching the title and summary fields using the keywords Children OR adolescents Feeding Behavior eating OR Dietary Habits OR Eating Behavior OR Eating Habits OR Children obesity. Data synthesis The generational transmission of eating habits is related to the home, community, and school environments, mainly during the first years of life, and can exert the modulation of habits during all stages of life. During childhood, the family's role in consolidating eating habits is very broad and ranges from choosing foods to prioritizing family meals, including the lifestyle. Conclusions Eating habits are transmitted from parents to children in different ways: environmental, emotional, social, and educational. In cases of obesity, a greater association of genetic influence can be observed.

Association between parental feeding styles, body mass index, and consumption of fruits, vegetables and processed foods with mothers´ perceptions of feeding difficulties in children.

BACKGROUND: Feeding difficulties (FDs) are complex phenomena influenced by parental factors, feeding behaviour, and cultural factors. However, studies of the influences of these factors on FDs incidence are scarce. Thus, this study aimed to identify the associations between mothers' perceptions of FDs in children and parental feeding styles, body mass index, and the consumption of fruits, vegetables and processed foods. METHOD: Two hundred and fifty-seven mothers of children aged 1 to 6 years and 11 months participated in this cross-sectional study and self-completed electronic questionnaires on sociographic variables, parental feeding styles, the consumption of fruits, vegetables and processed foods and FDs. Nutritional status was classified by body mass index (kg/m2). RESULTS: The prevalence of FDs in children was 48.2%, and the mean age was 43.8 (± 17.6) months. The indulgent parental feeding style was the most common (40.1%), followed by the authoritative (31.1%), authoritarian (23.7%), and uninvolved (5.1%) styles. An indulgent parental feeding style (OR: 4.66; 95% CI: 2.20-9.85), a high body mass index (OR: 1.35; 95% CI: 1.09-1.68), and the consumption of processed foods (OR: 5.21; 95% CI: 2.85-9.53) were positively associated with increased odds of the absence of FDs in children. The associations of authoritarian and uninvolved parental feeding styles and the consumption of fruits and vegetables with FDs in children were not significant. CONCLUSION: This study identified multiple factors that are possibly associated with feeding behaviours in young children. However, further studies need to be undertaken to evaluate how such behaviours affect FDs.

Transgenerational transmission of eating habits.

OBJECTIVE: To investigate the relationship between the biopsychosocial environment and eating habits and behaviors that lead to the selection and consumption of certain food from the earliest stages of life. To clarify whether there is an interaction between genetic and epigenetic factors, and how they shape eating habits. DATA SOURCE: A narrative review based on research in PubMed and Web of Science electronic databases was carried out over the last 10 years, searching the title and summary fields using the keywords Children OR adolescents Feeding Behavior eating OR Dietary Habits OR Eating Behavior OR Eating Habits OR Children obesity. DATA SYNTHESIS: The generational transmission of eating habits is related to the home, community, and school environments, mainly during the first years of life, and can exert the modulation of habits during all stages of life. During childhood, the family's role in consolidating eating habits is very broad and ranges from choosing foods to prioritizing family meals, including the lifestyle. CONCLUSIONS: Eating habits are transmitted from parents to children in different ways: environmental, emotional, social, and educational. In cases of obesity, a greater association of genetic influence can be observed.

How parents' feeding styles, attitudes, and multifactorial aspects are associated with feeding difficulties in children.

BACKGROUND: Parental complaints about feeding difficulties (FD) during childhood are frequent in pediatrics. Behavioral factors about children's feeding and parental aspects are fundamental in solving these problems, but research in this area lacks information considering the joint presence of fathers and mothers. Thus, this study aimed to investigate the features of children, parents and mealtime practices related to FD reported by fathers and mothers and to identify parenting styles, mealtime actions, practices and factors associated with FD in children. METHODS: 323 parents (226 mothers and 97 fathers) of children aged 1 to 7 years were recruited in the emergency waiting room at Sabará Hospital Infantil, in São Paulo, Brazil, and self-completed electronic questionnaires on parenting style (Caregiver's Feeding Styles Questionnaire), parents' mealtime actions (Parent Mealtime Action Scale), socioeconomic information, personal and children's health data and routine meal practices. RESULTS: The prevalence of FD in children was 26.6%. Indulgent parenting style was the most frequent (44.2%), followed by authoritarian (25.1%), authoritative (23.8%), and uninvolved (6.9%) styles. Most parents (75.8%) reported presence during meals, and 83.6% used distractions. Regression analyses after adjustments showed, as factors associated with FD, female children (OR: 2.06; 95%CI: 1.19-3.58), parents' FD history (OR: 3.16; 95%CI: 1.77-5.64), and greater frequency of parents' behavior of offering many food options (OR: 2.69; 95%CI: 1.18-6.14). Parents with indulgent styles had decreased chances of reporting FD in their children (OR: 0.13; 95%CI: 0.06-0.27). Furthermore, the practice of children sharing the family menu (OR: 0.43; 95%CI: 0.18-0.99) and higher frequency of parents' behavior of setting snack limits (OR: 0.44; 95%CI: 0.23-0.85) were inversely associated with FD. CONCLUSIONS: This study reinforces the multifactorial aspects involved in the feeding difficulties context. It points out the importance of expanding knowledge of the individual role of fathers and mothers to compose a scenario that can guide future studies and interventions. TRIAL REGISTRATION: CAAE #99221318.1.0000.5567 with registration number 2,961,598.

Position statement on nutrition therapy for overweight and obesity: nutrition department of the Brazilian association for the study of obesity and metabolic syndrome (ABESO-2022).

Obesity is a chronic disease resulting from multifactorial causes mainly related to lifestyle (sedentary lifestyle, inadequate eating habits) and to other conditions such as genetic, hereditary, psychological, cultural, and ethnic factors. The weight loss process is slow and complex, and involves lifestyle changes with an emphasis on nutritional therapy, physical activity practice, psychological interventions, and pharmacological or surgical treatment. Because the management of obesity is a long-term process, it is essential that the nutritional treatment contributes to the maintenance of the individual's global health. The main diet-related causes associated with excess weight are the high consumption of ultraprocessed foods, which are high in fats, sugars, and have high energy density; increased portion sizes; and low intake of fruits, vegetables, and grains. In addition, some situations negatively interfere with the weight loss process, such as fad diets that involve the belief in superfoods, the use of teas and phytotherapics, or even the avoidance of certain food groups, as has currently been the case for foods that are sources of carbohydrates. Individuals with obesity are often exposed to fad diets and, on a recurring basis, adhere to proposals with promises of quick solutions, which are not supported by the scientific literature. The adoption of a dietary pattern combining foods such as grains, lean meats, low-fat dairy, fruits, and vegetables, associated with an energy deficit, is the nutritional treatment recommended by the main international guidelines. Moreover, an emphasis on behavioral aspects including motivational interviewing and the encouragement for the individual to develop skills will contribute to achieve and maintain a healthy weight. Therefore, this Position Statement was prepared based on the analysis of the main randomized controlled studies and meta-analyses that tested different nutrition interventions for weight loss. Topics in the frontier of knowledge such as gut microbiota, inflammation, and nutritional genomics, as well as the processes involved in weight regain, were included in this document. This Position Statement was prepared by the Nutrition Department of the Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO), with the collaboration of dietitians from research and clinical fields with an emphasis on strategies for weight loss.

Fatores associados aos tipos de dificuldades alimentares em crianças entre 0 e 10 anos de idade: um estudo retrospectivo em um centro de referência brasileiro / Factors associated with the different types of feeding difficulties in children aged 0 to 10 years: a retrospective study in a Brazilian reference center

Objetivo: identificar fatores associados à prevalência dos diferentes tipos de dificuldades alimentares em crianças com idade entre 0 e 10 anos. Métodos: trata-se de um estudo observacional retrospectivo com dados de crianças de 0 a 10 anos diagnosticadas com alguma dificuldade alimentar, atendidas em um centro de referência localizado no município de São Paulo, SP, Brasil. A presença da dificuldade alimentar foi analisada de acordo com o diagnóstico multidisciplinar, o aparecimento da queixa, os dados sobre a gestação e a amamentação, o estilo parental, a presença de causas orgânicas e as complicações associadas. Os dados foram tabulados no programa Microsoft Excel e as análises estatísticas foram realizadas no programa IBM SPSS Statistics 21 através de frequências absolutas e relativas, média, desvio padrão, teste do qui-quadrado e Kruskall-Wallis com o teste de post-hoc de Dunn. Resultados: foram avaliados 166 pacientes com um predomínio do sexo masculino, em idade pré-escolar e nascidos a termo. O diagnóstico mais prevalente foi de seletividade alimentar, sem doenças orgânicas ou reações associadas. Os diagnósticos de dificuldade alimentar apresentaram associação estatisticamente significativa com idade, idade gestacional de nascimento, idade e fase da alimentação de aparecimento da queixa. Conclusões: os fatores que apresentaram associação com os diferentes tipos de dificuldade alimentar foram a idade, a idade gestacional de nascimento e a idade e fase da alimentação de aparecimento da queixa. O presente estudo permite iniciar um direcionamento mais específico de ações de orientação e de prevenção de dificuldade alimentar. Dessa forma, destaca-se a importância da realização de estudos desse cunho.

Aims: To identify factors associated with the prevalence of different types of feeding difficulties in children aged 0 to 10 years. Methods: This is a retrospective observational study with data from children aged 0-10 years diagnosed with some feeding difficulty, attended at a reference center located in the city of São Paulo, Brazil. The presence of feeding difficulty was analyzed according to the multidisciplinary diagnosis, appearing of the complaint, information about pregnancy and breastfeeding, parenting style, presence of organic causes and associated complications. Data were tabulated using Microsoft Excel software and statistical analyzes were performed using IBM SPSS Statistics 21 using absolute and relative frequencies, mean, standard deviation, chi-square test and Kruskall-Wallis test associated with Dunn post-hoc test. Results: 166 patients were analysed, with male, preschool age and full-term predominance. The most prevalent diagnosis was picky eating, with no associated organic diseases or reactions. Diagnoses of feeding difficulty were statistically significant associated with age, gestational age at birth, age and feeding phase of onset of the complaint. Conclusions: The factors that were associated with the different types of feeding difficulty were age, gestational age at birth, age and feeding phase of emergence of the complaint. The present study allows us to initiate a more specific direction of orientation actions and prevention of feeding difficulties, thus highlighting the importance of conducting studies of this nature.

Crianças com dificuldades alimentares apresentam um consumo excessivo de bebidas açucaradas / Children with feeding difficulties present an excessive consume of sugar-sweetened beverages

Introdução: O consumo excessivo de bebidas açucaradas na infância é uma preocupação no acompanhamento das dificuldades alimentares, visto que pode gerar inadequações do estado nutricional. Objetivo: Estimar o perfil do consumo de alimentos de consistência líquida em crianças com dificuldades alimentares atendidas em um centro especializado e, verificar a associação entre a quantidade ingerida e a contribuição energética de bebidas açucaradas e idade e índice de massa corporal por idade. Métodos: Estudo transversal com 119 crianças de 0 a 18 anos, realizado em ambulatório especializado no atendimento de dificuldades alimentares. Os dados foram coletados de prontuários e diário alimentar. Resultados: A maioria da amostra era do gênero masculino (66,1%), considerada eutrófica quanto ao IMC/idade (77,3%), com média de idade de 4,1 anos (± 3,25). Houve diferença estatisticamente significativa para ingestão total de sucos, sendo que os meninos tiveram maior média de ingestão. A média de contribuição energética tanto para o sexo masculino quanto para o feminino é maior em relação ao consumo de leite. No entanto, não houve diferenças estatisticamente significativas entre os resultados (p > 0,05). Foram encontradas correlações muito fracas ou fracas entre volume ingerido e contribuição energética de bebidas açucaradas e idade e índice de massa corporal por idade. Conclusão: Crianças com dificuldades alimentares apresentam consumo elevado de bebidas açucaradas, havendo maior ingestão de sucos por crianças do sexo masculino e o leite foi o líquido que apresentou maior contribuição energética na dieta total deles. As associações encontradas entre volume consumido e contribuição energética de bebidas, idade e índice de massa corporal são fracas ou muito fracas não correspondendo à correlação entre as mesmas.

Introduction: Excessive consumption of sugar-sweetened beverages during childhood is a problem in the follow-up of children with feeding difficulties, as it can lead to inadequate nutritional status. Objective: To estimate the food consumption profile of liquid consistency in children with feeding difficulties attended at a specialized center in order to verify consumed amount and energy contribution of sugar-sweetened beverages and age and body mass index by age. Methods: A cross-sectional study was carried out with 119 children aged 0 to 18 years at an outpatient clinic specialized in feeding difficulties. Data were collected from medical records and dietary records. Results: Most of the sample was male (66.1%) and considered eutrophic for BMI/age (77.3%), with a mean age of 4.1 years (± 3,25). There was a statistically significant difference regarding the total amount of juice intake, and boys had a higher mean intake. Mean energy intakes for both males and females are higher in relation to milk consumption. However, there were no statistically significant differences between the results (p> 0.05). Weak correlations were found between ingested volume and energy contribution of sugar-sweetened beverages and age and body mass index by age. Conclusion: Children with feeding difficulties have high consumption of sugar-sweetened beverages, with a higher juice intake by male children. Milk was the liquid that presented the highest energy contribution in their total diet. The associations found between the volume consumed and the energy contributions of beverages, age, and body mass index were weak or very weak, not corresponding to the correlation between them.

O pediatra deve investigar sintomas de transtornos obsessivos compulsivos em crianças com dificuldades alimentares? / Should pediatricians investigate the symptoms of obsessive-compulsive disorder in children with feeding difficulties?

RESUMO Objetivo: Revisar evidências atuais da relação entre transtorno obsessivo compulsivo e dificuldades alimentares. Métodos: Revisão das bases Science Direct e PubMed no período entre 2007 e 2017 em inglês, português e espanhol, com os termos em associação "transtorno obsessivo compulsivo" e "picky eating/dificuldade alimentar". Foram selecionados apenas estudos de coorte, caso controle ou transversal, realizados em qualquer país, com crianças, adolescentes e/ou adultos e de qualquer tamanho amostral. Foram excluídos os artigos de opinião. Resultados: Cerca de 245 artigos foram selecionados e apenas 4 foram incluídos no estudo, segundo critérios de seleção. Os trabalhos descrevem essencialmente que há diferença no comportamento seletivo entre os sujeitos com e sem transtorno obsessivo compulsivo, com tendência para exacerbação de sintomas como nojo, ansiedade e escore de inflexibilidade de comportamento alimentar nos pacientes com esse transtorno. Conclusões: Existem sintomas compartilhados entre transtorno obsessivo compulsivo e dificuldade alimentar. O estudo alerta aos profissionais que acompanham pacientes com dificuldades alimentares para a importância da investigação de possíveis comorbidades psiquiátricas.

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.

SHOULD PEDIATRICIANS INVESTIGATE THE SYMPTOMS OF OBSESSIVE-COMPULSIVE DISORDER IN CHILDREN WITH FEEDING DIFFICULTIES? / O PEDIATRA DEVE INVESTIGAR SINTOMAS DE TRANSTORNOS OBSESSIVOS COMPULSIVOS EM CRIANÇAS COM DIFICULDADES ALIMENTARES?

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.

OBJETIVO: Revisar evidências atuais da relação entre transtorno obsessivo compulsivo e dificuldades alimentares. MÉTODOS: Revisão das bases Science Direct e PubMed no período entre 2007 e 2017 em inglês, português e espanhol, com os termos em associação "transtorno obsessivo compulsivo" e "picky eating/dificuldade alimentar". Foram selecionados apenas estudos de coorte, caso controle ou transversal, realizados em qualquer país, com crianças, adolescentes e/ou adultos e de qualquer tamanho amostral. Foram excluídos os artigos de opinião. RESULTADOS: Cerca de 245 artigos foram selecionados e apenas 4 foram incluídos no estudo, segundo critérios de seleção. Os trabalhos descrevem essencialmente que há diferença no comportamento seletivo entre os sujeitos com e sem transtorno obsessivo compulsivo, com tendência para exacerbação de sintomas como nojo, ansiedade e escore de inflexibilidade de comportamento alimentar nos pacientes com esse transtorno. CONCLUSÕES: Existem sintomas compartilhados entre transtorno obsessivo compulsivo e dificuldade alimentar. O estudo alerta aos profissionais que acompanham pacientes com dificuldades alimentares para a importância da investigação de possíveis comorbidades psiquiátricas.

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.

Does family mealtime have a protective effect on obesity and good eating habits in young people? A 2000-2016 review / Fazer refeições em família tem efeito protetor para a obesidade e bons hábitos alimentares na juventude? Revisão de 2000 a 2016

Abstract Objectives: 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), cross-sectional 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.

Resumo 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.

Obesogenic environment – intervention opportunities / Ambiente obesogênico - oportunidades de intervenção

ABSTRACT 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.

RESUMO Objetivos: Avaliar os fatores relacionados ao ambiente obesogênico, como atividade física nos bairros e nas escolas, comportamento nutricional e programas de intervenção. Fontes: Análise crítica da literatura com ponto de vista de especialistas em obesidade infantil e conselheiros políticos de intervenções públicas. Resumo dos dados: Embora a obesidade seja um problema de saúde pública que afeta diversas faixas etárias, é entre crianças e adolescentes que ela desempenha um papel mais importante devido à complexidade do tratamento, à alta probabilidade de persistência na vida adulta e à associação com outras doenças não transmissíveis com início precoce. O ambiente é um componente principal da gênese e dos resultados no futuro próximo ou em um prazo mais longo. A modificação do consumo de alimentos de alta densidade, pular refeições e o alto consumo de gordura saturada, açúcar e sal, associados aos altos níveis de sedentarismo, são as principais causas da obesidade. Conclusão: As oportunidades de intervenção estão relacionadas a modificações nos cenários político, ambiental e individual. Atividades escolares e físicas no ambiente educacional são intercaladas com intervenção alimentar em uma educação contínua. Uma análise crítica de alguns cenários diferentes é apresentada em países latino-americanos.

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.

Como acompanhar a criança com dificuldade alimentar em escopo multidisciplinar?: Protocolo de atendimento multiprofissional na infância e adolescência - estudo piloto / How to monitor children with feeding dif fi culties in a multidisciplinary scope?: Multidisciplinary care protocol for children and adolescents ­ pilot study

OBJECTIVES: To present the results of the implementation of a multidisciplinary approach to feeding difficulties in childhood and adolescence in a reference service METHODS: The protocol was designed for outpatient patients aged from zero to 19 years old, with complaints of feeding difficulties and without psychiatric diagnoses, with signed parental consent. The protocol consists of paediatrician, speech therapist and nutritionist assessment in the same appointment, with common observation of evaluations and following multidisciplinary discussion. Diagnoses were categorized according Kerzner et al , and parenting styles according to Hughes20. Statistical analysis was conducted via SPSS v21 through frequency distribution (%), mean ± standard deviation, Chi-square test and ANOVA. Significance level was considered at 5% RESULTS: Sample consisted of 56 children, 67.9% of males, most (75%) younger than 5 years old. The most frequent diagnosis was selectivity (30%). There was association between diagnoses and organic diseases in 30%. Start of complaints occurred at 18 months old. Speech-therapy alterations were detected mostly in speech (29%) and oral-motor skills (32%). Anthropometric assessment showed average normal growth patterns and average dietary assessment of protein intake derived from dairy products was above recommendations (18g/day CONCLUSIONS: Results herein justify the presence of the multidisciplinary team in monitoring feeding difficulties in childhood and adolescence, and highlight the importance of longitudinal research nationwide

OBJETIVO: Apresentar os resultados da implantação do serviço de referência em atendimento multidisciplinar exclusivo para dificuldades alimentares na infância e adolescência MÉTODO: Protocolo idealizado para assistência ambulatorial de pacientes entre zero e 19 anos com queixas de dificuldades alimentares, sem diagnósticos psiquiátricos e com consentimento dos pais por escrito. O protocolo consiste no atendimento de pediatra, fonoaudióloga e nutricionista na mesma consulta, com observação dos atendimentos e discussão multiprofissional posterior. Os diagnósticos foram categorizados segundo Kerzner et al, e estilos parentais segundo Hughes et al20. A análise estatística foi realizada via SPSS v21, através de frequência de distribuição (%), média ± desvio padrão, teste Qui-quadrado e ANOVA. Foi considerado nível de significância em 5% RESULTADOS: Obteve-se amostra final de 56 crianças, 67,9% do sexo masculino, menores de 5 anos (75%). O diagnóstico mais frequente foi o de seletividade alimentar (30%). Em 30% dos casos houve associação a alterações orgânicas. O aparecimento da queixa ocorreu, em média, aos 18 meses. Foram detectadas alterações fonoaudiológicas na fala (29%) e motricidade oral (32%). A avaliação antropométrica revelou média de eutrofia, e a dietética identificou ingestão de proteínas lácteas acima das recomendações (18g/dia CONCLUSÕES: Os resultados justificam a necessidade da equipe multiprofissional no acompanhamento da dificuldade alimentar na infância e adolescência, e evidenciam a importância da continuidade do tema em pesquisas longitudinais em âmbito nacional

Fatty acid intake and metabolic syndrome among overweight and obese women / Ingestão de ácidos graxos e síndrome metabólica entre mulheres com sobrepeso e obesidade

ABSTRACT: 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.

RESUMO: Objetivo: Examinar as associações existentes entre ingestão de ácidos graxos e a síndrome metabólica (SM) entre mulheres com sobrepeso e obesidade (n = 223). Métodos: Trata-se de estudo transversal. Os testes físicos e laboratoriais incluíram antropometria, avaliação da composição corporal e mensuração da pressão arterial, glicemia de jejum, insulinemia e perfil lipídico. Registros alimentares de três dias foram utilizados para avaliação do aporte de ácidos graxos na dieta. Análises estatísticas contemplaram teste do χ2 e estimação de odds ratio . Resultados: As mulheres apresentavam 35,2 (6,9) anos de idade e a prevalência de SM foi de 15,2%. Mulheres com SM apresentaram níveis séricos mais elevados de VLDL-c (very low-density lipoprotein cholesterol ), triglicérides, glicose e insulina, além de maior medida de pressão arterial diastólica em relação às não portadoras da síndrome. Mulheres com sobrepeso e SM apresentaram maior consumo de ácido graxo monoinsaturado - 24,3 g (24,7 - 36,4) versus mulheres com sobrepeso sem SM - 23,9 g (23,8 - 26,8), poli-insaturado - 16,7 g (14,6 - 21,1) versus mulheres com sobrepeso sem SM - 13,6 g (13,8 - 15,8) e linoleico - 15,9 g (6,5) versus mulheres com sobrepeso sem SM - 13,1 g (5,1). Nas obesas, as mulheres com SM também apresentaram maior ingestão de ácido graxo linoleico - 17,6 g (6,1) versus mulheres obesas sem SM - 14,3 g (6,6), além de maior consumo de gorduras trans - 4,7 g (4,8 - 6,3) versus mulheres obesas sem SM - 3,9 g (2,9 - 4,6). Quartis mais elevados da ingestão de ácidos graxos monoinsaturados, poli-insaturados, linoleico e trans foram significativamente associados a grande ocorrência de SM. Conclusão: A ingestão de lipídeos parece se associar à ocorrência de SM, embora outros fatores também devam ser considerados, tais como estilo de vida, genética e metabolismo.

O papel do fonoaudiólogo no diagnóstico e tratamento multiprofissional da criança com dificuldade alimentar: uma nova visão / The role of the speech language pathologist in the diagnosis and multidisciplinary treatment of children with feeding difficulties: a new vision

O presente artigo relata o caso clínico de paciente de dois anos e seis meses atendida por equipe multidisciplinar. A paciente apresentou dificuldades alimentares caracterizadas por recusa alimentar, tempo prolongado das refeições, defesa sensório-oral, reflexo de vômito anteriorizado e dificuldade mastigatória. Não se alimentava sozinha, nem participava das refeições em família. Apresentava refluxo gastroesofágico, alergia a proteína do leite de vaca e tosse seguida por vômito. Não apresentou comprometimento pondero-estatural. Foi utilizado o Programa de Refeição Compartilhada. Após acompanhamento médico, a conduta de trabalho foi definida e iniciada pelo trabalho sensório-oral, seguido do trabalho com a mastigação, associados ao trabalho de orientação familiar. A paciente passou a realizar as refeições com a família e participar das rotinas sociais de alimentação. O tempo de refeição foi reduzido e a recusa alimentar eliminada. Os aspectos sensório-motores-orais melhoraram significantemente. Após a alta e reavaliação em três meses, apresentou melhora no refluxo gastro-esofágico e a medicação foi suprimida. A nutricionista iniciou a introdução de derivados do leite, com boa aceitação por parte da paciente. O programa utilizado mostrou-se eficaz para o diagnóstico e tratamento da dificuldade alimentar apresentada pela paciente. A equipe multidisciplinar foi capaz de ter uma visão ampliada da dificuldade alimentar apresentada pela paciente, compreendendo as questões motoras, orais, orgânicas e nutricionais da alimentação da criança inseridas no seu contexto familiar.

The article reports the case study of a two year and six month old female patient, attended by a multidisciplinary team. Patient presented feeding difficulties such as food refusal, long lasting meals, oral-sensory defensiveness, anterior vomiting reflex and difficulties in chewing. She did not feed herself nor took part in family mealtimes. Presented gastro esophageal reflux, allergy to cow's milk protein and coughs followed by vomiting, without impairment of weight or height. The Mealtime Partners Program was method of treatment choice. After treatment of medical issues, the working method was established and initiated with oral sensory development, followed by chewing development and associated to family counseling. Patient started having meals with the family and taking part in social mealtime routines. Duration of meals diminished and food refusal was eliminated. Motor-oral system patterns improved significantly. Reassessment in 3 months showed reduction in gastroesophageal reflux symptoms and medication was removed. The nutritionist introduced dairy products with good acceptance. The Mealtime Partners Program, proved to be effective in the diagnosis and treatment of the feeding difficulties presented. The multidisciplinary team had a broad view of feeding difficulties presented by the patient, comprising motor, oral, organic and nutritional issues of feeding regarding the child's family background.

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.

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.