Ankyloglossia and Breastfeeding Duration: A Multicenter Birth Cohort Study.

Background and Objective: The prevalence of ankyloglossia and its impact on breastfeeding practices may be overestimated, leading to surgical overtreatment in newborns. The study was conducted to estimate the prevalence of ankyloglossia in the first year of life and investigate the association with exclusive and total breastfeeding duration in different regions of Brazil. Materials and Methods: This multicenter prospective cohort study involved the recruitment of mother-infant pairs soon after childbirth in public hospitals in three state capitals in Brazil. Interviews were held with the mothers after birth, at 6 and 12 months to collect sociodemographic variables and data on exclusive and total breastfeeding duration. At 12 months of age, the children were submitted to a dental examination for classification of the lingual frenulum using the Bristol Tongue Assessment Tool. Data analysis involved Poisson regression with robust variance, with the calculation of unadjusted and adjusted relative risk (RR). Results: The final sample was composed of 293 children. The prevalence of defined and suspected ankyloglossia was 1% and 4.8%, respectively, totaling 5.8% (confidence interval [95% CI]: 3.1-8.5). No significant difference was found in the prevalence of exclusive and total breastfeeding at 1, 4, and 6 months between children with defined/suspected ankyloglossia and those without ankyloglossia. The multivariable analysis showed that the probability of the child achieving 6 months of breastfeeding did not differ between groups (RR = 0.98; 95% CI: 0.79-1.23; p = 0.907). Conclusion: The prevalence of defined ankyloglossia was very low and defined/suspected ankyloglossia was not associated with exclusive or total breastfeeding duration. Clinical Trial Registration: Registered with clinicaltrials.gov (n° NCT03841123).

Early ultra-processed foods consumption and hyperactivity/inattention in adolescence

ABSTRACT OBJECTIVE To investigate the relationship between childhood consumption of ultra-processed foods and symptoms of hyperactivity/inattention in adolescents from São Leopoldo, a city in southern Brazil. METHODS Data were collected at four distinct stages: when participants were 12-16 months old in 2001 and 2002 and later when they were 3-4, 7-8, and 12-13 years old. During the interview at 12-16 months, mothers were asked about the introduction of sugar in their child's diet. Two 24-hour recall surveys were conducted with children aged 3-4, 7-8, and 12-13 years to assess their consumption of ultra-processed foods. At the age of 12-13 years, the participants completed the Hyperactivity/Inattention subscale of the Strengths and Difficulties Questionnaire (SDQ), which screens for mental health problems. RESULTS Among the 173 adolescents, 22.5% exhibited hyperactivity symptoms. The consumption of ultra-processed foods in grams, kilocalories, and as a percentage of energy intake at 3-4 years old were found to be predictors of hyperactivity/inattention symptoms (RR: 0.81, 95%CI: 0.69-0.95; RR: 1.01, 95%CI: 1.00-1.02; RR: 1.02, 95%CI:1.01-1.02; RR: 1.25, 95%CI:1.04-1.51, respectively). CONCLUSION The consumption of ultra-processed foods at an early age was associated with hyperactivity and inattention symptoms in adolescence.

Breastfeeding Protects from Overjet in Adolescence by Reducing Pacifier Use: A Birth Cohort Study.

Increased dental overjet in adolescence is a clinically relevant outcome associated with the complexity and high cost of treatment, indicating the need for prevention strategies. We investigated the long-term impact of breastfeeding and pacifier use on increased overjet (IOVJ) in permanent dentition. A prospective cohort nested in a randomized controlled trial was conducted from birth to 12 years of age (n = 214). Breastfeeding and pacifier use were recorded monthly until 12 months. Overjet was assessed at age 12 years. We employed a causal mediation analysis using parametric regression models assuming no interaction between breastfeeding and pacifier usage. We found a total protective effect of breastfeeding on IOVJ (OR 0.49; 95% CI 0.28-0.96), where 63.1% were mediated by pacifier use (OR 0.61; 95% CI 0.44-0.87). Breastfeeding directly decreased the odds of IOVJ by 20%; however, the confidence interval included the null estimate (OR 0.81; 95% CI 0.41-1.60). In conclusion, breastfeeding protects by half of the IOVJ in adolescence through reducing pacifier use. Oral and general health professionals should collaborate to support WHO breastfeeding guidelines during individual patient counseling. Guidelines for practice, policy or public information require messages that include a common risk approach to oral and general health.

Primary Dentition Caries Patterns as Predictors of Permanent Dentition Caries: A Prospective Cohort Study.

The aims of this study were to estimate the risk of caries in the permanent teeth at 12 years of age and to describe the diagnostic accuracy of caries patterns in the primary dentition at age 4 years to predict caries at age 12 years. A prospective cohort study followed children from birth to age 12 years in the city of São Leopoldo, Brazil. Sociodemographic variables were collected at birth, and dental caries was measured at 4 and 12 years of age (n = 204). At 4 years, children were classified according to the presence of caries (cavitated and non-cavitated lesions), number of lesions, affected segment (anterior or posterior), and affected surface (occlusal, smooth, or proximal). Prediction of permanent dentition caries occurrence (DMFT ≥1) (primary outcome) involved Poisson regression with robust variance and standard diagnostic accuracy measures. The prevalences of caries at age 4 years (including non-cavitated lesions) and 12 years were 61.8% and 42.2%, respectively. All caries patterns in the primary dentition were associated with caries in the permanent dentition. In multivariable analysis, the strongest associations were carious lesions on the primary posterior teeth (RR 2.2; 95% CI 1.5-3.2) and occlusal surfaces (RR 2.1; 95% CI 1.4-3.0). Among patterns evaluated, the presence of any tooth with caries (cavitated or non-cavitated) had the highest sensitivity (73%), but any tooth with cavitated decay had the highest accuracy (67%). In conclusion, any dental caries experience in early childhood is strongly predictive of dental caries experience in early adolescence. Primary dentition carious lesions on the posterior teeth or occlusal surfaces and the presence of cavitated lesions were stronger predictors.

Vitamin A deficiency and associated risk factors in children aged 12-59 months living in poorest municipalities in the South Region of Brazil.

OBJECTIVE: To estimate the prevalence of vitamin A deficiency (VAD) in children and associated risk factors. DESIGN: Analysis of data from a cross-sectional multicentre study performed in the primary care units of the municipalities from January to June 2015. The children's legal guardians answered a socio-economic questionnaire, and the children's blood samples were obtained by venipuncture. Plasma retinol was determined by HPLC. Plasma retinol values of <0·70 µmol/l were considered VDA. Poisson multiple regression with robust variance was used. Values of P < 0·05 were considered significant. The data were analysed in the SPSS software, 21.0. SETTING: Forty-eight poorest municipalities in the South Region of Brazil. PARTICIPANTS: Children (n 1503) aged 12-59 months. RESULTS: The prevalence of VAD in the sample was 1·9 % (95 % CI (0·5, 6·8)). The following risk factors were associated with the outcome in the final explanatory model: family received Bolsa Familia program benefits (PR = 3·19; 95 % CI (1·69, 6·02)), child was not being breastfed (PR = 5·22; 95 % CI (1·68, 16·18)) and stunting (PR = 4·75; 95 % CI (2·10, 10·73)). CONCLUSIONS: VAD did not represent a public health problem for children living in socio-economically vulnerable municipalities in the South Region of Brazil, suggesting a new panorama of this nutritional deficiency even in regions of low socio-economic conditions in these three states. Thus, in view of the current nutritional transition scenario, it is necessary to continuously monitor and improve public policies related to vitamin A supplementation in the country.

Influências sociais nas práticas alimentares da dupla mãe-filho nos primeiros seis meses de vida / Social influences on the feeding practices of the mother-child couple in the first six months of life

Resumo A dupla mãe-filho está inserida em um sistema social que gera diversas influências nas práticas alimentares, inclusive nos primeiros seis meses de vida, período em que é preconizado o aleitamento materno exclusivo pela Organização Mundial da Saúde. Objetivo: Compreender o conjunto de influências sociais que incidem nas práticas alimentares adotadas pela nutriz e para o seu filho nos primeiros seis meses de vida. Método: Estudo qualitativo, com abordagem metodológica de análise descrito por Minayo e alicerçado na fenomenologia social de Alfred Schütz. Participaram oito duplas mãe-filho recrutados de dois hospitais públicos de Salvador-BA com a Iniciativa Hospital Amigo da Criança. Realizou-se entrevista semiestruturada no domicílio das mães aos seis meses de vida da criança no período de junho a agosto de 2019. Resultados: Emergiram três tipificações: o fazer "correto" nos primeiros seis meses de vida da criança; as ações de cuidados com as práticas alimentares da mulher-mãe que amamenta; e o mundo social da dupla mãe-filho. Conclusão: para a tomada de decisão sobre as práticas alimentares da nutriz, a mãe exerceu mais influência; já para a criança, a nutriz considerou as orientações recebidas pelos profissionais de saúde.

Abstract The mother-child pair is inserted in a social system that generates different influences on eating practices, including in the first six months of life, a period in which exclusive breastfeeding is recommended by the World Health Organization. Objective: To understand the set of social influences that affect the eating habits adopted by the nursing mother and her child in the first six months of life. Method: Qualitative study, with a methodological analysis approach described by Minayo and based on the social phenomenology of Alfred Schütz. Eight mother-child pairs recruited from two public hospitals in Salvador-BA with the Amigo da Criança Hospital Initiative participated. A semi-structured interview was carried out at the mothers' homes when the child was six months old, from June to August 2019. Results: Three typifications emerged: doing "correctly" in the first six months of the child's life; care actions with the feeding practices of the woman-mother who breastfeeds; and the social world of the mother-son duo. Conclusion: For decision-making about the nursing mother's eating practices, the mother exerted more influence; for the child, the nursing mother considered the guidelines received by health professionals.

Impact of maternal dietary counseling in the first year of life on DNA methylation in a cohort of children.

Epigenetic modifications established during prenatal and early life, including DNA methylation, have been suggested as potential mediators of the interaction between environmental exposures during the perinatal period and adult metabolic health adverse outcomes, especially cardiometabolic complications and overweight. The effect of a dietary intervention in the first year of life on global methylation levels in leukocyte samples from a cohort of children born between 2001 and 2002 in southern Brazil was examined. Overall methylation measurements were performed using enzyme-linked immunosorbent assays on DNA samples from 237 children at 4 years old. Mean methylation values were higher in the intervention group (mean: 2.20 ± 1.31%) than in the control group (mean: 1.65 ± 1.11%; P = 0.001). It was observed that nutritional counseling in the first year increased breastfeeding duration and stimulated the development of healthier eating habits. Therefore, these factors might have contributed to increase global DNA methylation. The findings of the present study reinforce the notion that performing nutritional interventions in the early stages of life is important and provide further evidence of the interaction between the environment and epigenetic traits.

Primary Health Care Intervention Reduces Added Sugars Consumption During Childhood.

OBJECTIVE: To investigate the effectiveness of a training program for health workers regarding infant feeding practices to reduce sugar consumption in children. DESIGN: A cluster randomized trial was conducted at 20 health centers in southern Brazil randomly assigned to an intervention (n = 9) or control (n = 11) group. PARTICIPANTS: The 715 pregnant women enrolled were assessed when their children were aged 6 months, 3 years, and 6 years. INTERVENTION: A training session for primary care workers based on the Brazilian National Guidelines for Children. MAIN OUTCOME MEASURE: Mothers were asked when sugar was first offered to children. Added sugars intake was obtained from dietary recalls. ANALYSIS: The effectiveness of the intervention was modeled using generalized estimation equations and Poisson regression with robust variance. RESULTS: Children attending intervention health centers had a 27% reduced risk of sugar introduction before 4 months of age (relative risk, 0.73; 95% confidence interval [CI], 0.61-0.87) as well as lower added sugars consumption (difference, -6.36 g/d; 95% CI, -11.49 to -1.23) and total daily energy intake (difference, -116.90 kcal/d; 95% CI, -222.41 to -11.40) at 3 years of age. CONCLUSIONS AND IMPLICATIONS: Health care worker training in infant feeding guidelines may be an effective intervention to delay the introduction of added sugars and lower the subsequent intake of added sugars in infants and toddlers.

Early-Life Patterns of Sugar Consumption and Dental Caries in the Permanent Teeth: A Birth Cohort Study.

Early-life family conditions may presage caries development in childhood. The aim of this study was to evaluate associations between patterns of sugar consumption in early childhood and permanent dentition caries at age 6 years. A cohort enrolled women accessing prenatal care at public health clinics in Porto Alegre, Brazil. Sociodemographic, anthropometric, and dietary data were collected during pregnancy and 6-month, 12-month, and 3-year follow-ups. Calibrated dental examinations occurred at ages 3 and 6 years. Multivariable logistic regression analysis was performed in series to quantify associations between early-life variables and permanent dentition caries. At age 6 years, 7.9% of children (21/266) had ≥1 caries lesion on permanent teeth (first molars). In unadjusted models, gestational weight gain, sweet food introduction (age 6 months), household sugar purchases (age 3 years), and caries (age 3 years) were positively associated with permanent dentition caries (age 6 years). In multivariable models, each 1-kg increase in gestational weight gain (odds ratio [OR]: 1.08; 95% confidence interval [CI]: 1.01, 1.16) and each 1-item increase in sweet food consumption at age 6 months (OR: 1.27; 95% CI: 1.02, 1.59) remained statistically significantly associated with permanent molar caries. Findings from this cohort study suggest family and child factors that long predate the permanent dentition, including sugar-related behaviors, predict future dental status, and may inform prevention strategies.

Exploring the risk factors for early-life sugar consumption: A birth cohort study.

BACKGROUND: Sugar consumption in early childhood is the primary cause of negative health outcomes, including early childhood caries. AIM: To investigate risk factors associated with early-life sugar consumption. DESIGN: Explanatory variables were collected at baseline of a birth cohort in Porto Alegre, Southern Brazil. At six months of age, data were collected on child feeding practices, including the number of foods and beverages containing sugar. Multivariate Poisson regression analysis with robust variance was performed. RESULTS: Virtually all children (98.3%) had consumed sugar by the age of 6 months. Multivariable analysis showed that the number of sweet items was significantly larger in children whose mothers were less than 20 years of age (MR = 1.19; 95% CI: 1.05-1.36), those from non-nuclear families (MR = 1.12; 95% CI: 1.04-1.20), those whose mothers had less than eight years of schooling (MR = 1.34; 95% CI: 1.20-1.50) and those whose mothers smoked (MR = 1.23; 95% CI: 1.13-1.35). Moreover, the number of sweet items was significantly lower among children who breastfed in the first hour of life (MR = 0.85; 95% CI: 0.76-0.95). CONCLUSION: Sugar consumption begins very early, especially in children with no access to breastfeeding in the first hours of life and those from younger, less educated, and smoking mothers.

Breastfeeding in the First Hours of Life Protects Against Pacifier Use: A Birth Cohort Study.

Objective: To investigate risk factors for pacifier use in the first year of life. Materials and Methods: A prospective cohort study was conducted with children enrolled at birth in Porto Alegre, Southern Brazil, whose mothers underwent prenatal care at primary care units. Soon after the birth of the children, data were collected on anthropometrics, type of childbirth, and time until breastfeeding on the first day of life. At 6 and 12 months of age, data were collected on breastfeeding practices and whether the child had used a pacifier in the previous 6 months. Statistical analysis involved the use of Poisson regression with robust variance. Results: The incidence of pacifier use in the first year of life was 60% (317/532). The multivariable analysis showed that pacifier use in the first year of life was 33% higher when the mother was younger than 18 years of age (relative risk [RR] = 1.33; confidence interval [95% CI]: 1.01-1.76). Infants who breastfed in the first 30 minutes after birth had a 25% lower risk of pacifier use in the first year of life (RR = 0.75; 95% CI: 0.60-0.94), and those who breastfed between 30 minutes and 6 hours after birth had an 18% lower risk (RR = 0.82; 95% CI: 0.69-0.97) compared to those who took longer to begin breastfeeding or did not breastfeed. Conclusions for Practice: Breastfeeding soon after being born protected against pacifier use in the first year of life. This finding suggests pathways to improve child health, especially in the prenatal period and with an emphasis on pregnant adolescents.

Family Health Strategy associated with increased dental visitation among preschool children in Brazil.

BACKGROUND: Early-life dental service utilization could improve child dental health. AIM: Identify contextual, socioeconomic, and child characteristics associated with dental visitation by age 3 years. DESIGN: Within a Brazilian birth cohort (N = 435), multivariable regression models were fitted to identify independent predictors of having made a dental visit at age 3 years. Contextual variables considered included health center type (Traditional vs. Family Health Strategy, which perform home visits) and composition of oral health teams at the heath center where mothers accessed prenatal care. RESULTS: Dental visitation was positively associated with Family Health Strategy health centers (36% vs. 23%) and with higher maternal education and family social class. Visitation was lowest among families served by a health center without a dentist, but number of dentists and oral health team composition were not associated with visitation among facilities with ≥1 dentists. Dental visitation was not statistically significantly associated with caries experience but was higher if parents reported worse oral health-related quality of life. The vast majority of dental decay remained untreated. CONCLUSIONS: Dental visits were underutilized, and socioeconomic inequalities were evident. Dental visitation was more common when mothers received prenatal care at Family Health Strategy health centers, suggesting a possible oral health benefit.

Infant Feeding Practices and the Effect in Reducing Functional Constipation 6 Years Later: A Randomized Field Trial.

OBJECTIVE: The aim of this study is to assess the impact of health worker training on infant feeding practices on the prevalence of functional constipation (FC) among children at 6 years of age. METHODS: Cluster randomized field trial conducted in Porto Alegre, Brazil. Health centers were randomly allocated into intervention (n = 9) or control (n = 11) groups. In intervention sites, health workers joined training sessions on the "Ten Steps for Healthy Feeding for Children from Birth to Two Years of age". Pregnant women in the last trimester of both groups were identified, invited to participate and enrolled in the study as the potential mothers to receive the dietary counseling provided by the health workers. At 6 years of age, the prevalence of FC was evaluated based on Rome III, defined by 2 or more of the following: infrequent defecation, fecal incontinence, history of retentive posturing, or/and history of painful defecation. RESULTS: Among 387 mother-child pairs (206 intervention, 181 control) evaluated at 6 years of age, the prevalence of FC was lower in the intervention group compared with the control group (15.0% vs 23.9%, respectively). The probability of being constipated was 38% lower in the intervention group (PR = 0.62; 95% CI 0.44-0.87; P < 0.01). CONCLUSION: The health workers training to promote the "Ten Steps" was an effective way to reduce the prevalence of constipation among children at 6 years of age.

Introduction of inappropriate complementary feeding in the first year of life and associated factors in children with low socioeconomic status. / Introdução de alimentos não recomendados no primeiro ano de vida e fatores associados em crianças de baixo nível socioeconômico.

The study aimed to identify factors associated with the introduction of inappropriate complementary feeding in the first year of life in children living in municipalities (counties) with low socioeconomic statusl. This was a cross-sectional multicenter study in 1,567 children 12 to 59 months of age in 48 municipalities participating in the Brazil Without Poverty plan in the South of Brazil. A structured questionnaire was applied to the children's parents to obtain socio-demographic information and the age at which inappropriate complementary foods were introduced for the first time in complementary feeding. Prevalence of introduction of sugar before four months of age was 35.5% (n = 497; 95%CI: 33.1-38.0). The prevalence rates for the introduction of cookies/crackers, creamy yogurt, and jelly before six months of age were 20.4% (n = 287; 95%CI: 18.3-22.3), 24.8% (n = 349; 95%CI: 22.4-27.1), and 13.8% (n = 192; 95%CI: 12.0-15.7), respectively. Associations were identified between low maternal schooling (PR = 1.25; 95%CI: 1.03-1.51) and low monthly family income (PR = 1.22; CI95%: 1.01-1.48) and the introduction of inappropriate complementary feeding. The study identified the introduction of inappropriate complementary feeding in the first year of life among children in municipalities with high socioeconomic vulnerability in the South of Brazil, associated with low maternal schooling and low monthly family income.

Identificar os fatores associados à introdução de alimentos não recomendados no primeiro ano de vida, entre crianças residentes em municípios de baixo nível socioeconômico. Estudo multicêntrico transversal com 1.567 crianças de 12 a 59 meses de idade residentes em 48 municípios participantes do plano Brasil Sem Miséria da Região Sul do Brasil. Aplicou-se questionário estruturado aos responsáveis pelas crianças para a obtenção das informações sociodemográficas e idade na qual alimentos não recomendados foram introduzidos pela primeira vez na alimentação complementar. A prevalência de introdução de açúcar antes dos quatro meses de idade da criança foi de 35,5% (n = 497; IC95%: 33,1-38,0). As prevalências de introdução de biscoito doce/salgado, queijo petit suisse e gelatina antes do sexto mês de vida da criança foram de 20,4% (n = 287; IC95%: 18,3-22,3), 24,8% (n = 349; IC95%: 22,4-27,1) e 13,8% (n = 192; IC95%: 12,0-15,7), respectivamente. Identificou-se associação entre a menor escolaridade materna (RP = 1,25; IC95%: 1,03-1,51) e a menor renda mensal familiar (RP = 1,22; IC95%: 1,01-1,48) com a introdução de alimentos não recomendados. Verificou-se a introdução de alimentos não recomendados no primeiro ano de vida entre crianças residentes em municípios de alta vulnerabilidade socioeconômica da Região Sul do Brasil, e esta prática associou-se à menor escolaridade materna e menor renda familiar mensal.

El estudio tuvo como fin identificar los factores asociados a la introducción de alimentos no recomendados durante el primer año de vida, entre niños residentes en municipios con un bajo nivel socioeconómico. Se trata de un estudio multicéntrico transversal con 1.567 niños de 12 a 59 meses de edad, residentes en 48 municipios participantes en el plan Brasil Sin Miseria de la región Sur de Brasil. Se aplicó un cuestionario estructurado a los responsables de los niños para la obtención de la información sociodemográfica y la edad en la que los alimentos no recomendados se introdujeron por primera vez en la alimentación complementaria. La prevalencia de introducción del aúcar, antes de los cuatro meses de edad del niño, fue de un 35,5% (n = 497; IC95%: 33,1-38,0). Las prevalencias de la introducción de galletas dulce/saladas, queso petit suisse y gelatina antes del sexto mes de vida del niño fueron de un 20,4% (n = 287; IC95%: 18,3-22,3), un 24,8% (n = 349; IC95%: 22,4-27,1) y un 13,8% (n = 192; IC95%: 12,0-15,7), respectivamente. Se identificó una asociación entre la menor escolaridad materna (RP = 1,25; IC95%: 1,03-1,51) y la menor renta mensual familiar (RP = 1,22; IC95%: 1,01-1,48), con la introducción de alimentos no recomendados. Se verificó la introducción de alimentos no recomendados durante el primer año de vida entre niños residentes en municipios de alta vulnerabilidad socioeconómica de la región Sur de Brasil, y esta práctica se asoció a una menor escolaridad materna y una menor renta familiar mensual.

Feeding frequency in infancy and dental caries in childhood: a prospective cohort study.

OBJECTIVES: Feeding patterns in infancy are plausible contributors to dental caries later in childhood, yet relatively few cohort studies have examined potential dietary risk factors at this age. This study aimed to investigate the associations between feeding frequency at age 12 months and caries prevalence at age 3 years. METHODS: In this prospective birth cohort of 345 Brazilian children, all foods and drinks consumed at age 12 months, including bottle-use and breastfeeding, were recorded using two 24-hour infant dietary recalls with mothers. The prevalence of early childhood caries (ECC) and severe ECC (S-ECC) at age 38 months were compared in groups defined according to 12-month feeding frequency, using regression models to adjust for sociodemographic characteristics and total carbohydrate intake. RESULTS: Independent of other variables, compared with children with infrequent bottle-use and breastfeeding at 12 months, at 38 months the ECC prevalence was 1.8-times higher in children breastfed more than three times/day (P = 0.001), 1.4-times higher in children bottle-fed more than three times/day (P = 0.07) and 1.5-times higher with combined high frequency of bottle and breastfeeding together (P = 0.04), but the association with consumption of other foods or drinks more than five times/day [risk ratio (RR) = 1.2; P = 0.10] was not statistically significant. Prevalence of S-ECC was significantly associated with frequent breastfeeding (RR = 2.4; P < 0.001) and with greater frequency of consumption of other foods or drinks (RR = 1.7, P = 0.001). CONCLUSIONS: High-frequency feeding in late infancy, including both bottle use and breastfeeding, were positively associated with dental caries in early childhood, suggesting possible early-life targets for caries prevention.