Food Parenting Practices Promoted by Childcare and Primary Healthcare Centers in Chile: What Influences Do These Practices Have on Parents? A Qualitative Study.

Chile, like many other countries in the world, is experiencing a high prevalence of childhood overweight. Among the factors influencing children's eating behaviors are the food parenting practices promoted by community organizations. More information is needed on the influences of these recommendations on the parenting practices of parents of preschoolers. This study examined what types of food parenting practices are promoted in childcare and primary healthcare centers and how these recommendations influence subsequent parental behavior. Interviews using photo-elicitation were conducted with 25 parents of Chilean preschoolers. The interviews were analyzed using inductive thematic analysis. Five themes were identified to describe food parenting practices promoted by community organizations and the influences that these practices had on parents of preschoolers. Healthcare centers were found to educate parents and provided a structured feeding. However, parents found their advice regarding dietary restriction challenging to follow. Childcare centers also provided information about healthy diet, food monitoring, and diversifying the child's diet in a way that was perceived as adequate. While childcare centers encouraged structured and autonomous food parenting practices in a positive and supportive manner, healthcare centers tended to provide more restrictive guidance that posed challenges for parents struggling with preschool nutritional care.

Indulgent Feeding Style Moderates the Association of Food Responsiveness to Body Mass Index Z-scores of Preschoolers.

OBJECTIVE: To investigate the moderating role of caregiver feeding styles in the association between preschool children's food-approaching eating behaviors and body mass index (BMI) z-scores. METHODS: This cross-sectional study examined 81 caregiver-preschooler dyads from low-income neighborhoods in Santiago, Chile. Moderated multiple linear regression analyses were used to determine the moderating effect of the indulgent feeding style in the relation between eating behaviors and BMI z-scores of preschool children. RESULTS: The indulgent caregiver feeding style moderated the association between food responsiveness and BMI z-scores of preschoolers. In an indulgent feeding style, food responsiveness was associated with higher child BMI z-scores (ß = 0.50; P < 0.001). There was no interaction between enjoyment of food and feeding styles in relation to children's BMI z-scores (ß = 0.17; P = 0.58). CONCLUSIONS AND IMPLICATIONS: An indulgent feeding style can be a risk factor for unhealthy weight outcomes in food responsive preschoolers, but not in those who enjoy food. Educating indulgent parents in the feeding context, and prioritizing children with food-approaching behaviors who are sensitive to external food cues may be effective for approaching childhood obesity.

Family influences on food choices and nutrition: What does the literature say?

ABSTRACT The prevention of diseases related to nutrition requires an approach that considers aspects that transcend the individual level in understanding food decisions. In this context, the family as an interpersonal determinant of eating behavior is gaining importance in developing behavioral change interventions that seek better nutritional health. This manuscript aims to describe the current evidence of how family variables influence its members' food choices and nutritional status. Specifically, we present evidence on family functioning, parental feeding styles, and family meals, as they are recent topics of interest in the area. The evidence shows that a better or balanced family functioning or some of its components (communication, conflicts, cohesion, among others); a parental feeding style that demands but listens to the requirements from children; and a higher frequency of family meals are associated with a lower Body Mass Index (BMI) and healthier eating habits, especially in children and adolescents. A deep understanding of family variables could guide weight management interventions and provide information that could explain why some interventions work and others do not.

RESUMEN La prevención de enfermedades relacionadas con la nutrición requiere de un enfoque que considere aspectos que transciendan el nivel individual en el entendimiento de las decisiones alimentarias. En este contexto, la familia como un determinante interpersonal de las conductas alimentarias, está ganando importancia en el desarrollo de intervenciones de cambio conductual que buscan una mejor salud nutricional. Este artículo tiene como objetivo describir la evidencia actual de cómo variables familiares influyen en las elecciones alimentarias y el estado nutricional de sus miembros. Específicamente, presentamos evidencia sobre el funcionamiento familiar, los estilos parentales de alimentación y las comidas familiares, ya que son temas recientes de interés en el área. La evidencia muestra que un mejor o equilibrado funcionamiento familiar o de algunos de sus componentes (comunicación, conflictos, cohesión, entre otros); un estilo parental que exige, pero escucha los requerimientos de los niños; y una mayor frecuencia de comidas familiares se asocian con un menor Índice de Masa Corporal (IMC) y hábitos alimentarios más saludables, especialmente en niños y adolescentes. Una comprensión profunda de las variables familiares podría orientar las intervenciones de control de peso y brindar información que explicaría por qué algunas intervenciones funcionan y otras no.

Exploring parents' perspectives on feeding their young children: a qualitative study using photo-elicitation in Chile.

OBJECTIVE: Childhood obesity is considered one of the most important public health problems around the world. Chile is currently one of the Latin American countries with a high prevalence of childhood obesity. Given that parents' food parenting practices shape their children's lifelong eating habits, addressing those practices is key to curbing later problems of obesity. However, studies of the influences on Chilean parents' food parenting practices are scarce. Hence, this study explores factors that influence food parenting practices of preschool-aged children in Chile. DESIGN: Qualitative research, using interviews with the photo-elicitation technique. SETTING: Metropolitan Region, Chile. PARTICIPANTS: Twenty-five parents from families recruited from public childcare centres. RESULTS: Through a thematic analysis with an inductive approach, we identified five themes that influence food parenting practices: (1) parents' previous experiences and how they determine their current goals and beliefs; (2) responses to the child's characteristics; (3) the influences of other family members, especially grandparents; (4) parents' nutritional knowledge; and (5) living contexts, especially limited budgets and lack of time. CONCLUSIONS: The study reveals multilevel influences, which converge at the family level, on food parenting practices. A family-centrerd approach that addresses the mentioned influences is necessary to improve the management of the childhood obesity problem in Chile.

Food Parenting Practices and Feeding Styles and Their Relations with Weight Status in Children in Latin America and the Caribbean.

While a growing body of literature looks at the associations between food parenting practices, and feeding styles, and child's weight status in developed countries, little is known for less developed countries, in general, and the Latin America and the Caribbean (LAC) region, in particular. This study systemically reviews and synthesizes existing evidence on the associations between child caregivers' food parenting practices and feeding styles and 2 to 12-year-old child weight status. Keywords were used to search in PubMed, Web of Science, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature. Among the ten eligible articles, all of them reported significant associations between food parenting practices and feeding styles and child weight status. Existing studies have limitations, mainly related to cross-sectional convenience samples, which limit the generalization of the results. Additionally, small sample, heterogeneous feeding measures and weight related outcomes were other limitations. Future research is needed to understand caregiver-child interactions in the food situation and its link to child weight status in 2 to 12-year-old children in areas of LAC with diverse forms of malnutrition and contextual factors of countries.

Influencias familiares en las prácticas de alimentación materna a niños preescolares de familias vulnerables de la Región Metropolitana de Chile / Family influences on maternal feeding practices of preschool children from vulnerable families in the Metropolitan Region of Chile

Objetivo: Explorar las influencias de integrantes del grupo familiar en las prácticas de alimentación de madres hacia preescolares, en familias de barrios vulnerables en la Región Metropolitana de Santiago, Chile. Diseño: Estudio cualitativo. Lugar: Nueve jardines infantiles de la Región Metropolitana, Santiago, Chile. Participantes: Veinticuatro madres y un padre de hijos preescolares. Método: Se realizaron 25 entrevistas semiestructuradas con técnica de foto-elicitación y su posterior análisis temático inductivo de las influencias familiares. Resultados: Las participantes describieron que las influencias familiares sobre las prácticas de alimentación que aplicaban en sus hijos preescolares dependían de la estructura familiar y de la cercanía entre familiares. Algunas de estas influencias afectan directamente la conducta alimentaria del niño, especialmente en familiares que cohabitan juntos, mientras que otras estaban mediadas por las relaciones generadas entre padres y otros miembros de la familia. El padre, en familias biparentales, y abuelos del preescolar son los familiares más influyentes. Los padres participan en la alimentación del niño y generalmente se alinean a las prácticas de alimentación con la madre. Los abuelos enriquecen la experiencia alimentaria de preescolares ofreciendo preparaciones caseras, expresando afecto con los alimentos, incluso opciones poco saludables, y apoyando a padres a diversificar y estructurar la alimentación del niño. Conclusiones: El impacto de familiares y sus dinámicas en las prácticas alimentarias parentales y la alimentación de preescolares varían según la cercanía o cohabitación entre familiares. El desarrollo de estrategias de prevención y tratamiento de obesidad infantil debería considerar un enfoque familiar en familias vulnerables.(AU)

Objective: To explore family members’ influences on mothers’ feeding practices of preschoolers in Chilean families residing in vulnerable neighborhoods from the Metropolitan Region of Santiago, Chile. Design: Qualitative study. Location: Nine child care centers in Región Metropolitana, Santiago, Chile. Participants: Twenty-four mothers and one father of preschool children. Method: Photo-elicitation techniques were applied to 25 semi-structured interviews and their subsequent inductive thematic analysis of family influences. Results: The participants described that the family influences on their feeding practices depended on the family structure and the interpersonal closeness between relatives. Some influences directly affected child eating behavior, especially in relatives who live together, while others were mediated by the relationships generated between parents and other members of the family. Fathers, in two-parent families, and grandparents are the most influential relatives on the participants’ feeding practices. Generally, fathers participated and were in line with the mother's feeding practices of their children. Grandparents enriched their grandchildren's eating experiences by offering homemade preparations, expressing affection with food, including unhealthy options, and supporting parents to diversifying and structuring feeding practices. Conclusions: According to their interpersonal closeness or cohabitation, parental feeding practices and child eating behaviors were impacted by family members and their dynamics. The development of strategies to prevent and treat childhood obesity should consider a family approach in vulnerable families.(AU)

[Family influences on maternal feeding practices of preschool children from vulnerable families in the Metropolitan Region of Chile]. / Influencias familiares en las prácticas de alimentación materna a niños preescolares de familias vulnerables de la Región Metropolitana de Chile.

OBJECTIVE: To explore family members' influences on mothers' feeding practices of preschoolers in Chilean families residing in vulnerable neighborhoods from the Metropolitan Region of Santiago, Chile. DESIGN: Qualitative study. LOCATION: Nine child care centers in Región Metropolitana, Santiago, Chile. PARTICIPANTS: Twenty-four mothers and one father of preschool children. METHOD: Photo-elicitation techniques were applied to 25 semi-structured interviews and their subsequent inductive thematic analysis of family influences. RESULTS: The participants described that the family influences on their feeding practices depended on the family structure and the interpersonal closeness between relatives. Some influences directly affected child eating behavior, especially in relatives who live together, while others were mediated by the relationships generated between parents and other members of the family. Fathers, in two-parent families, and grandparents are the most influential relatives on the participants' feeding practices. Generally, fathers participated and were in line with the mother's feeding practices of their children. Grandparents enriched their grandchildren's eating experiences by offering homemade preparations, expressing affection with food, including unhealthy options, and supporting parents to diversifying and structuring feeding practices. CONCLUSIONS: According to their interpersonal closeness or cohabitation, parental feeding practices and child eating behaviors were impacted by family members and their dynamics. The development of strategies to prevent and treat childhood obesity should consider a family approach in vulnerable families.

Weight Matters-Factors Influencing Eating Behaviors of Vulnerable Women.

Women from low socioeconomic backgrounds are more affected by obesity than men. The influence of weight as a determinant of women's eating behaviors has seldom been studied, especially in Latin America. In this study, we analyzed the food choices of vulnerable women according to their weight status. We conducted photo-elicitation interviews with 31 women from low-income neighborhoods in Santiago, Chile. Weight and height were measured and participants were divided into normal weight (n = 9), overweight (n = 15), and obese groups (n = 7) according to World Health Organization (WHO) body mass index (BMI) categories (p < 0.001). Quantitative and qualitative approaches were used for the analysis. Women in overweight and obese groups described more about their families, temporality, financial issues, and food perception. When weight groups were analyzed separately, more factors explaining eating behaviors were found (mental and physical health, body dissatisfaction, gender role, and obstacles for eating healthy) in the obese group. Results suggest that women with obesity or overweight based their diets on more internal and external factors than did normal weight women. This study contributes to our understanding of why changing behaviors can be difficult in women with obesity. Health care providers should consider these factors in the implementation of programs to address the need for a healthy diet for overweight and obese women.

The photo-elicitation of food worlds: A study on the eating behaviors of low socioeconomic Chilean women.

Traditional methods for studying eating behaviors include quantitative methods such as 24-h dietary recalls or food frequency questionnaires. Recently, visual methods such as photo-elicitation (PE) have been recognized as useful for studying and understanding eating behaviors. PE has been defined as the use of images during an interview. The goals of this study are to demonstrate the potential of PE for exploring the eating behaviors of Chilean women of low socioeconomic status and to show the advantages and disadvantages of PE from the participants' points of view. The study included 31 participants who were asked to take pictures that represented what they considered important to them in their "food world". The pictures were developed and participants were invited to participate in an individual interview. Participants were able to talk about their eating behaviors and those of their families, the factors influencing those behaviors, their dietary knowledge and skills, and their reflections on their diet using the photographs. PE proved to be a feasible research technique for the studied population, and was well received and enjoyed by the participants. The participants perceived a few barriers with PE, such as forgetting to take pictures or not having ideas for new pictures. Nevertheless, PE allowed researchers to obtain rich information about eating behaviors, and can therefore be a useful method for working with populations of underserved areas. The PE data that this study collected could be used to create or improve interventions promoting healthy eating within the studied population.

Promotoras and the Semantic Gap Between Latino Community Health Researchers and Latino Communities.

Promotoras are identified as a unique group of community health workers adept at reducing health disparities. This qualitative study was conducted to better understand perceptions of the term promotora, broadly used in research but not well documented in everyday Latina vocabulary. Six focus groups to better understand perceptions of the term promotora were conducted with 36 Latina women living in three nonmetropolitan areas in Illinois. Results suggest that Latina participants in the study do not understand the meaning of "promotora" in the same way as it is used in the literature. Latina participants understood "promotoras" as referring to people who sell or deliver information, or organize events in the community that are not necessarily related to health events or community health work. Furthermore, they usually understood the term to refer to paid work rather than volunteering. Results underscore the importance of being sensitive to Latinas' perceptions of community health terminology by assessing their context, needs, and expectations. These findings call researchers' attention to the need to educate certain Latino communities about the concept of promotoras, with implications for the implementation and dissemination of promotora-led community health programs, as the semantic discrepancy could affect the recruitment of promotoras as well as community participation in the programs they deliver.

Variaciones en la composición proteica de la leche materna madura durante el almacenamiento por congelación / Changes in protein composition of mature breast milk during storage by freezing

Introducción: La leche materna es el alimento ideal para niños desde el nacimiento hasta los seis meses de edad. Muchas madres interrumpen la lactancia materna por diversas causas, por lo que la administración de leche materna procedente de bancos de leche surge como alternativa a ser evaluada. Objetivo: Determinar las variaciones en la composición proteica de la leche materna durante el almacenamiento bajo congelación. Materiales y Métodos: Fueron colectadas 31 muestras de leche madura de mujeres entre 17 a 35 años. Las muestras se almacenaron en congelación (–20°C), durante períodos de 15, 30, 60, y 90 días. Una alícuota de cada muestra fue analizada como control basal. La concentración de proteínas totales (g/dl) fue determinada por el método de Lowry, se transformó en g/día y calculó las calorías proteicas, considerando el consumo de 850 ml de leche. Se caracterizaron las fracciones proteicas de la leche con la técnica de electroforesis en geles de poliacrilamida (SDS-PAGE). Resultados: Los resultados mostraron una concentración proteica de 1,58 g/dl al inicio y de 1,61 g/dl a los 90 días. No se encontraron variaciones significativas al comparar el contenido de proteínas, ni en el aporte proteico y calórico de la leche durante el almacenamiento bajo congelación (P>0,05). El perfil electroforético sólo demostró variaciones en fracciones proteicas de bajo peso molecular. Conclusiones: La estabilidad de los componentes proteicos ratifica como segura la forma de almacenamiento de la leche materna humana bajo congelación por un período de 3 meses en bancos de leche.

Introduction: Breast milk is the ideal food for children from birth to age six months. For various reasons many mothers stop breastfeeding early, for which reason supply of breast milk from milk banks is an alternative that should be evaluated. Objective: To determine variations in protein composition of breast milk during frozen storage. Materials and Methods: We collected 31 samples of mature milk of women between ages 17 and 35. Samples were stored frozen (-20° C) for periods of 15, 30, 60, and 90 days. An aliquot of each sample was analyzed for baseline control. Total protein concentration (g/dl) was determined by Lowry method and protein calories as g/day were calculated based on a consumption of 850 ml of milk. Protein fractions of milk were determined by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). Results: Results showed a protein concentration of 1.58 g/dl at baseline and 1.61 g/dl at 90 days. Comparison found no significant differences in protein content or protein and calorie value of the milk during frozen storage (P>0.05). The electrophoretic profile showed changes only in low molecular weight protein fractions. Conclusions: The stability of the protein components demonstrates safe storage of frozen human milk in milk banks for a period of 3 months.

Efecto de un producto lácteo con probióticos y prebióticos sobre la función digestiva de sujetos sanos y constipados / Effect of a milk product containing probiotics and prebiotics on the digestive function of healthy and constipated subjects

Constipation is a complex disorder, which affects an important part of the population and results in an increase of gastrointestinal symptoms and in lower stool frequency. The addition of soluble fibers (prebiotics) and probiotic in foodstuffs has been proposed as a useful tool to improve digestive wellbeing of affected individuals. The aim of this study was to evaluate the effect of the daily consumption of Minishot, a milk drink with prebiotics (inulin I polydextrose) and probiotics (Bifidobacterium lactis BB12), on the digestive comfort of healthy and constipated subjects. We conducted a randomized, controlled, double blind clinical trial in 33 healthy subjects and 64 constipated subjects (< 3 stools I week). Subjects underwent a one-week observation period followed by two periods of two weeks of consumption of Minishot or placebo, separated between them by a two-week washout period. The volunteers recorded daily in a table the presence and severity of distracters and digestive symptoms and the number and consistency of stools. Neither Minishot nor the placebo affected the digestive wellbeing or the stool frequency and consistency in the control subjects. In the constipated subjects, both consumption of Minishot and the placebo improved digestive comfort and stool frequency. However, compared with the placebo, Minishot significantly decreased the frequency of hard stools and the proportion of subjects emitting them, and increased the frequency of normal stools.

La constipación es un trastorno complejo que afecta una parte importante de la población. El consumo de prebióticos y probióticos ha sido propuesta como una herramienta para mejorar el bienestar digestivo de las personas afectadas. El objetivo del estudio fue evaluar el efecto del consumo diario de una bebida láctea con inulina/polidextrosa y Bifidobacterium lactis Bbl2, Minishot, sobre el bienestar digestivo de sujetos sanos o constipados. Se realizó un ensayo clínico randomizado, controlado y en doble ciego en 33 sujetos sanos y 64 sujetos constipados (< 3 deposiciones / semana). Después de una semana de observación, cada sujeto tuvo 2 periodos de 2 semanas de consumo de Minishot o del placebo, espaciados entre si por 2 semanas de reposo. Los voluntarios registraron diariamente la presencia e intensidad de síntomas digestivos y el número y consistencia de deposiciones. El consumo de Minishot no afecto en forma importante el bienestar digestivo de los sujetos sanos ni alteró la frecuencia y consistencia de sus deposiciones. En los sujetos constipados, tanto el consumo de Minishot como del placebo mejoraron el bienestar digestivo y la frecuencia de deposición. Comparado con el placebo, el consumo de Minishot disminuyó significativamente la frecuencia de deposiciones muy duras y la proporción de sujetos emitiéndolas, y aumento la frecuencia de deposiciones normales/blandas y la proporción de sujetos emitiéndolas.