Estimated energy and nutrient intake in complementary feeding methods in Brazilian infants: randomized clinical trial.

Inadequate nutrient intake during complementary feeding (CF) can affect healthy infant growth and development. A randomized clinical trial was conducted to examine the energy and nutrient intake in Brazilian children randomly assigned to three distinct CF methods. Mother-infant pairs participated in the study, with mothers receiving interventions in one of three CF approaches: (A) strict Parent-Led Weaning (PLW); (B) strict Baby-Led Introduction to Solids (BLISS); and (C) a mixed method. Assessments were made at 5.5 months, nine months, and 12 months of the child's age. Food consumption was measured through 24-h dietary recalls at nine and 12 months, with intake estimates calculated using the Brazilian Food Composition Table. Means or medians of energy and nutrients were compared between groups using ANOVA with Tukey's post hoc test or the Kruskal-Wallis test. A total of 115 infants were evaluated at nine months, and 102 at 12 months. Children in the PLW, BLISS, and mixed method groups exhibited comparable dietary intakes of energy, macronutrients, and micronutrients at both nine and 12 months. Infants following PLW, BLISS, and mixed methods demonstrated similar levels of energy and nutrient intake, underscoring the effectiveness of these strategies in ensuring comparable nutrient intake during the critical phase of CF.Trial registration The trial was registered in the Brazilian Registry of Clinical Trials (ReBEC) with identifier [RBR-229scm U1111-1226-9516], [ https://ensaiosclinicos.gov.br/rg/RBR-229scm ]. The full data of the first registration was on 24/09/2019.

Adherence to different complementary feeding methods in the first year of life: A randomized clinical trial.

BACKGROUND: Infant-guided methods, such as Baby-Led Introduction to SolidS (BLISS), encourage children to feed themselves from the same food consumed by their family since the beginning of the introduction of complementary foods, in opposition to the Parent-Led Weaning (PLW) method, which proposes foods mashed with a fork and given by parents. Adherence to child-guided methods is low due to a lack of confidence in the children's ability to feed themselves. This study aimed to assess adherence to three methods of food introduction: PLW, BLISS, or mixed (PLW and BLISS) at seven, nine, and 12 months of age. METHODS: A randomized clinical trial was conducted with mother-infant pairs undergoing intervention at 5.5 months of age. Data were presented in absolute numbers and percentages and analyzed using the Chi-Square test. RESULTS: The sample was constituted of 139 mother-infant pairs: 45 (32%) used PLW, 48 (35%) used BLISS, and 46 (33%) used the mixed method. Adherence to the method at seven, nine, and 12 months of age children was 34.1% (n = 45), 28.5% (n = 37), and 34.1% (n = 46), respectively. The mixed method presented significantly higher adherence results: 69.0% (n = 29) at seven months, 55.8% (n = 24) at nine months, and 78.6% (n = 33) at 12 months (p<0.001). Among the sample that unfollowed the proposed method, those who used PLW and BLISS migrated mostly to the mixed method at 12 months, 60.0% (n = 27) and 72.9% (n = 35) of them, respectively, because of the feeding mode and 97.8% (n = 44) and 100.0% (n = 48) because of food consistency. CONCLUSION: Complementary feeding in a mixed method presented higher adherence at seven, nine, and 12 months of age of children, which shows the feasibility of this approach to guide families in the introduction of complementary feeding.

Choking, gagging and complementary feeding methods in the first year of life: a randomized clinical trial.

OBJECTIVE: Compare the occurrence of choking and gagging in infants subjected to three complementary feeding (CF) methods. METHODS: Randomized clinical trial with mother-infant pairs, allocated according to the following methods of CF: a) Parent-Led Weaning (PLW) - group control, b) Baby-Led Introduction to SolidS (BLISS), and c) mixed (initially BLISS and if the infant presents a lack of interest or dissatisfaction, PLW), with the last two methods guided by the infant. Mothers received nutritional intervention on CF and prevention of choking and gagging according to the method at 5.5 months of age and remained in follow-up until 12 months. Frequencies of choking and gagging were collected by questionnaire at nine and 12 months. The comparison between groups was performed using the analysis of variance test (p < 0.05). RESULTS: 130 infants were followed, and 34 (26.2%) children presented choking between six and 12 months of age, 13 (30.2%) in PLW, 10 (22.2%) BLISS, and 11 (26.2%) mixed method, no significative difference between methods (p > 0.05). The choking was caused mainly by the semi-solid/solid consistency. Moreover, 100 (80%) infants aged from six to 12 months presented gagging and their characteristics were not statistically different among groups (p > 0.05). CONCLUSION: Infants following a baby-led feeding method that includes advice on minimizing choking risk do not seem more likely to choke than infants following traditional feeding practice that includes advice on minimizing choking risk.

Síntomas de estreñimiento funcional y métodos de alimentación complementaria: ensayo clínico aleatorizado / Functional constipation symptoms and complementary feeding methods: A randomized clinical trial

Introducción: El objetivo del estudio fue investigar el impacto de diferentes métodos de alimentación complementaria en la prevalencia de síntomas de estreñimiento funcional en lactantes a los 12 meses de edad. Materiales y métodos: Ensayo clínico aleatorizado realizado en díadas madre-lactante sometidas a intervención a los 5,5 meses del nacimiento, con asignación aleatoria a uno de los tres métodos de introducción de sólidos: destete dirigido por la madre, o parent-led weaning (PLW), método Baby-Led Introduction to Solids (BLISS) dirigido por el lactante, y mixto. Los síntomas de estreñimiento se evaluaron a los 12 meses mediante un cuestionario en línea basado en los criterios diagnósticos de Roma IV y adaptado a la muestra. Los análisis se realizaron mediante la prueba χ2 y los datos se expresaron como frecuencias absolutas y porcentajes. El proyecto fue aprobado por el comité de ética del Hospital de Clínicas de Porto Alegre con el número 2019-0230. Resultados: Se analizaron los datos de 135 lactantes, 45 asignados al método PLW, 48 al BLISS y 42 al método mixto. La prevalencia de síntomas de estreñimiento fue del 49,6% en la muestra global (n=67), siendo del 60% (n=27) en el método PLW, 47,9% (n=23) en el BLISS y 40,5% (n=17) en el mixto. No hubo asociación entre los síntomas de estreñimiento funcional y el método de introducción de la alimentación complementaria (p=0,183). Conclusiones: La prevalencia de estreñimiento y sus síntomas fue alta en la población estudiada. La prevalencia de los síntomas de estreñimiento funcional no se asoció con el método de alimentación complementaria. (AU)

Introduction: The aim of the study was to investigate the impact of different complementary feeding methods on the prevalence of functional constipation symptoms in infants at 12 months of age. Material and methods: Randomized clinical trial in mother–infant dyads that underwent the intervention at 5.5 months post birth, randomly allocated to one of three complementary food introduction methods: PLW (parent-led weaning), baby-led introduction to solids (BLISS) and a mixed approach. The symptoms of constipation were assessed at 12 months with an online questionnaire based on the Rome IV diagnostic criteria and adapted to our sample. The data were summarised as absolute frequencies and percentages and compared by means of the χ2 test. The project was approved by the ethics committee of the Hospital de Clínicas de Porto Alegre under number 2019-0230. Results: We analysed data corresponding to 135 infants, 45 allocated to PLW, 48 to BLISS and 42 to the mixed approach. The prevalence of constipation symptoms was 49.6% in the overall sample (n=67), 60% (n=27) in the PLW group, 47.9% (n=23) in the BLISS group and 40.5% (n=17) in the mixed approach group. We found no association between functional constipation symptoms and the method used to introduce complementary foods (P=.183). Conclusions: The prevalence of functional constipation symptoms was high in the study population. The presence of constipation symptoms was not associated with the complementary feeding approach. (AU)

Can the complementary feeding method be a strategy to reduce the offer of ultra-processed foods?

OBJECTIVE: To verify the prevalence of the offer of ultra-processed foods (UPFs), and to analyze their associated factors in the child's first year of life. METHODS: Cross-sectional study with 119 mother-infant pairs. At 5.5 months of the child, the mothers received guidance on complementary feeding (CF) according to three methods: Parent-Led Weaning (PLW), Baby-Led Introduction to SolidS (BLISS), or mixed (a combination of PLW and BLISS). At nine and 12 months, the mothers answered a questionnaire about the offer of UPFs. The NOVA classification, which classifies foods according to the nature, extent, and purposes of the industrial processes to which they are subjected, was used to list the UPFs. Descriptive statistics and multivariate Poisson regression, following a multilevel hierarchical model according to the proximity to the outcome, were used to estimate the association between dependent and independent variables. RESULTS: The prevalence of UPF consumption was 63% (n = 75) in the first year of life. Receiving guidance on healthy CF in the BLISS method showed to be a protective factor for offering UPFs (RR 0.72; CI95 0.52-0.99). Attending less than six prenatal consultations was a risk factor for the UPFs provision (RR 1.39; CI95 1.07-1.80). CONCLUSION: The prevalence of UPFs offered in the first year of life in this study can be considered high, and future interventions aimed at avoiding UPFs offered in this population should consider the CF method.

Functional constipation symptoms and complementary feeding methods: A randomized clinical trial.

INTRODUCTION: The aim of the study was to investigate the impact of different complementary feeding methods on the prevalence of functional constipation symptoms in infants at 12 months of age. MATERIAL AND METHODS: Randomized clinical trial in mother-infant dyads that underwent the intervention at 5.5 months post birth, randomly allocated to one of three complementary food introduction methods: PLW (parent-led weaning), Baby-led Introduction to SolidS (BLISS) and a mixed approach. The symptoms of constipation were assessed at 12 months with an online questionnaire based on the Rome IV diagnostic criteria and adapted to our sample. The data were summarised as absolute frequencies and percentages and compared by means of the χ2 test. The project was approved by the ethics committee of the Hospital de Clínicas de Porto Alegre under number 2019-0230. RESULTS: We analysed data corresponding to 135 infants, 45 allocated to PLW, 48 to BLISS and 42 to the mixed approach. The prevalence of constipation symptoms was 49.6% in the overall sample (n = 67), 60% (n = 27) in the PLW group, 47.9% (n = 23) in the BLISS group and 40.5% (n = 17) in the mixed approach group. We found no association between functional constipation symptoms and the method used to introduce complementary foods (P = .183). CONCLUSIONS: The prevalence of functional constipation symptoms was high in the study population. The presence of constipation symptoms was not associated with the complementary feeding approach.

Breastfeeding duration and eating behavior in early childhood: a systematic review / Duração da amamentação e comportamentos alimentares na primeira infância: uma revisão sistemática

Abstract Objectives: to analyze the influence of breastfeeding duration on eating behavior in children aged two to six years. Methods: this review was conducted by PRISMA guidelines. SciELO, Lilacs, Embase, and PubMed databases were researched by using a specific syntax, for studies published from 2000 to 2020. The Joanna Briggs Institute Critical Appraisal checklist was used to assess the risk of study bias. Results: a total of 26,211 articles were identified, of which seven were included in the study. The results showed a significant association in four studies. All authors used their own questionnaires to assess breastfeeding exposure; there was no standard classification of exclusive and total breastfeeding duration. The breastfeeding duration was associated with reduced food neophobia, lower scores on the food responsiveness subscale, and lower 'picky eating' behavior. Validated instruments were predominantly used to assess the outcome of eating behavior; however, this assessment was not similar between studies. Conclusion: a significant association was observed between breastfeeding duration and eating behavior in children aged two to six years. Further research should be conducted to describe the mechanisms involved in this association.

Resumo Objetivos: analisar a influência da duração do aleitamento materno no comportamento alimentar em crianças de dois a seis anos. Métodos: esta revisão foi conduzida de acordo com as diretrizes PRISMA. As bases de dados SciELO, Lilacs, Embase e PubMed foram pesquisadas usando uma sintaxe específica, para estudos publicados de 2000 a 2020. O Joanna Briggs Institute Critical Appraisal checklist foi utilizado para avaliar o risco de viés do estudo. Resultados: foram identificados 26.211 artigos, dos quais sete foram incluídos no estudo. Os resultados mostraram associação significativa em quatro estudos. Todos os autores usaram seus próprios questionários para avaliar a exposição à amamentação; não havia uma classificação padrão de duração do aleitamento materno exclusivo e total. A duração do aleitamento materno foi associada à redução da neofobia alimentar, menores escores na subescala de responsividade alimentar e menor comportamento alimentar exigente. Instrumentos validados foram usados predominantemente para avaliar o resultado do comportamento alimentar, no entanto, essa avaliação não foi semelhante entre os estudos. Conclusão: observou-se associação significativa entre a duração da amamentação e o comportamento alimentar em crianças de dois a seis anos. Mais pesquisas devem ser realizadas para descrever os mecanismos envolvidos nesta associação.

Adherence to different methods for introducing complementary food to 7-month-old babies: a randomized clinical trial / Adesão a diferentes métodos de introdução da alimentação complementar aos 7 meses de vida: um ensaio clínico randomizado

Abstract Objective: To assess the adherence to three methods of food introduction for 7-month-old babies. Methods: This is a randomized clinical trial conducted with mother-infant pairs, submitted to the intervention with five and a half months of age and three different methods for food introduction according to randomization: Parent-Led Weaning (PLW), Baby-Led Introduction to SolidS (BLISS), or mixed (specially developed for this study). Adherence to the method was assessed at the seventh month of age, via telephone call to the caregiver by a researcher blinded to the method. The analyses were performed using the Chi-Square test and data are presented in absolute numbers and percentages. Results: A total of 139 mother-infant pairs were evaluated; 46 of them were allocated to the PLW method; 47, to the BLISS; and 46, to the mixed. At seven months of age, 60 (43.2%) mothers reported that the infants were following the proposed feeding method. When analyzing each approach, the mixed method showed a higher likelihood of adherence (71.7%, n=33), followed by the PLW method (39.1%, n=18) and by the BLISS (19.2%, n=9) (p<0.001). Among the sample that did not follow the proposed method, those that had been randomized to the PLW and BLISS methods mostly migrated to the mixed method (92.9%; n=26 and 92.1%; n=35, respectively) (p<0.001). Conclusions: Complementary feeding in a mixed approach obtained greater adherence in 7-month-old babies.

RESUMO Objetivo: Avaliar a adesão a três métodos de introdução alimentar aos 7 meses de vida. Métodos: Ensaio clínico randomizado com pares mães-lactentes submetidos à intervenção aos 5 meses e meio de vida sobre três diferentes métodos de introdução alimentar, conforme randomização: tradicional, Baby-Led Introduction to SolidS (introdução de sólidos guiada pelo bebê, em português) ou misto (criado especialmente para este estudo). A adesão ao método foi avaliada aos 7 meses em ligação telefônica feita para o cuidador por pesquisador cego em relação ao método. As análises foram realizadas por teste do qui-quadrado e os dados apresentados em número absoluto e percentual. Resultados: Foram avaliados 139 pares mães-lactentes, 46 alocados no método tradicional, 47 no Baby-Led Introduction to SolidS e 46 no misto. Aos 7 meses, 60 (43,2%) mães relataram que seus lactentes seguiam o método alimentar proposto. Analisando-se cada abordagem, o método misto apresentou maior probabilidade de adesão (71,7%, n=33), seguido do tradicional (39,1%, n=18) e de introdução de sólidos guiada pelo bebê (19,2%, n=9) (p<0,001). Da amostra que não seguiu o método proposto, aqueles que haviam sido randomizados para os métodos tradicional e de introdução de sólidos guiada pelo bebê migraram majoritariamente para o misto (92,9%; n=26 e 92,1%; n=35, respectivamente) (p<0,001). Conclusões: A alimentação complementar em abordagem mista obteve maior adesão aos 7 meses de idade.

Can the complementary feeding method be a strategy to reduce the offer of ultra-processed foods?

Abstract Objective To verify the prevalence of the offer of ultra-processed foods (UPFs), and to analyze their associated factors in the child's first year of life. Methods Cross-sectional study with 119 mother-infant pairs. At 5.5 months of the child, the mothers received guidance on complementary feeding (CF) according to three methods: Parent-Led Weaning (PLW), Baby-Led Introduction to SolidS (BLISS), or mixed (a combination of PLW and BLISS). At nine and 12 months, the mothers answered a questionnaire about the offer of UPFs. The NOVA classification, which classifies foods according to the nature, extent, and purposes of the industrial processes to which they are subjected, was used to list the UPFs. Descriptive statistics and multivariate Poisson regression, following a multilevel hierarchical model according to the proximity to the outcome, were used to estimate the association between dependent and independent variables. Results The prevalence of UPF consumption was 63% (n = 75) in the first year of life. Receiving guidance on healthy CF in the BLISS method showed to be a protective factor for offering UPFs (RR 0.72; CI95 0.52-0.99). Attending less than six prenatal consultations was a risk factor for the UPFs provision (RR 1.39; CI95 1.07-1.80). Conclusion The prevalence of UPFs offered in the first year of life in this study can be considered high, and future interventions aimed at avoiding UPFs offered in this population should consider the CF method.

Choking, gagging and complementary feeding methods in the first year of life: a randomized clinical trial

Abstract Objective: Compare the occurrence of choking and gagging in infants subjected to three complementary feeding (CF) methods. Methods: Randomized clinical trial with mother-infant pairs, allocated according to the following methods of CF: a) Parent-Led Weaning (PLW) — group control, b) Baby-Led Introduction to SolidS (BLISS), and c) mixed (initially BLISS and if the infant presents a lack of interest or dissatisfaction, PLW), with the last two methods guided by the infant. Mothers received nutritional intervention on CF and prevention of choking and gagging according to the method at 5.5 months of age and remained in follow-up until 12 months. Frequencies of choking and gagging were collected by questionnaire at nine and 12 months. The comparison between groups was performed using the analysis of variance test (p < 0.05). Results: 130 infants were followed, and 34 (26.2%) children presented choking between six and 12 months of age, 13 (30.2%) in PLW, 10 (22.2%) BLISS, and 11 (26.2%) mixed method, no significative difference between methods (p > 0.05). The choking was caused mainly by the semi-solid/solid consistency. Moreover, 100 (80%) infants aged from six to 12 months presented gagging and their characteristics were not statistically different among groups (p > 0.05). Conclusion: Infants following a baby-led feeding method that includes advice on minimizing choking risk do not seem more likely to choke than infants following traditional feeding practice that includes advice on minimizing choking risk.

Marcadores de consumo alimentar e diversidade alimentar mínima em diferentes métodos de introdução alimentar: um ensaio clínico randomizado / Food consumption markers and minimum dietary diversity in different complementary feeding methods: a randomized clinical trial

Objetivo: Avaliar os marcadores de consumo alimentar e a diversidade alimentar mínima em lactentes de 12 meses de vida expostos a diferentes métodos de introdução alimentar. Métodos: Ensaio clínico randomizado com pares mãe-lactente submetidos à intervenção sobre introdução alimentar em três métodos: Método tradicional (MT), Baby-led Introduction to SolidS (BLISS) e misto (combinação das duas técnicas). Os marcadores de consumo alimentar foram avaliados por questionário online aos 12 meses com base nos alimentos consumidos no dia anterior, utilizando os marcadores de consumo alimentar para menores de 2 anos do Sistema de Vigilância Alimentar e Nutricional. O estudo foi aprovado no comitê de ética. Resultados: Aos 12 meses foram avaliadas 136 crianças: 45 alocadas no MT, 48 no BLISS e 43 no misto. Os alimentos com maior prevalência de consumo foram: leite materno103 (75,7%), frutas, legumes e verduras 122 (89,7%), carnes ou ovos 135 (99,3%), feijão 115 (84,6%), cereais ou tubérculos 135 (99,3%). Alimentos ultraprocessados que estiveram presentes na dieta dos lactentes foram hambúrguer ou salsichas 3 (2,2%), bebidas açucaradas 2 (1,5%), macarrão instantâneo 4 (2,9%) e biscoito recheado 2 (1,5%).Não foram encontradas diferenças entre os métodos de introdução da alimentação complementar. A diversidade alimentar mínima esteve presente na alimentação de 22 lactentes (16,2%), sendo: 6 (13,3%) no MT, 8 (16,7%) no BLISS e 8 (18,6%) no misto (p=0,793). Conclusão: Leite materno,frutas, legumes e verduras, carne, feijão e arroz estiveram presentes na alimentação da maioria dos lactentes; no entanto, a prevalência de diversidade alimentar mínima foi baixa.O consumo de alimentos ultraprocessados também esteve presente na alimentação dos lactentes. Registro Brasileiro de Ensaios Clínicos (ReBEC) identificação RBR-229scm.

Objective: To evaluate food consumption markers and minimum dietary diversity in 12-month-old infants exposed to different methods of food introduction. Methods: A randomized clinical trial with mother-infant pairs undergoing intervention on food introduction in three methods: Parent-Led Weaning (PLW), Baby-Led Introduction to SolidS (BLISS), and mixed (combination of the two techniques). Food consumption markers were evaluated by an online questionnaire at 12 months based on food consumed the previous day, using food consumption markers for children under 2 years of the Food and Nutrition Surveillance System. The study was approved by the ethics committee. Results: At 12 months, 136 children were evaluated: 45 allocated to PLW, 48 to BLISS, and 43 to mixed. The foods with the highest prevalence of consumption were breast milk 103 (75.7%), vegetables 122 (89.7%), meat 135 (99.3%), beans 115 (84.6%), rice, potatoes, or yam 135 (99.3%). Ultra-processed foods were present in the diet of infants, including hamburgers or sausages 3 (2.2%), sweetened beverages 2 (1.5%), instant noodles 4 (2.9%), and sandwich cookies 2 (1.5 %). No differences were found between the methods of introducing complementary feeding. The minimum dietary diversity was present in the diet of 22 infants (16.2%), being: 6 (13.3%) in the PLW, 8 (16.7%) in the BLISS, and 8 (18.6%) in the mixed (p=0.793). Conclusion: Breast milk, vegetables, meat, beans, and rice were present in the diet of most infants; however, the prevalence of minimal dietary diversity was low. The consumption of ultra-processed foods was also present in the diet of infants. Brazilian Registry of Clinical Trials (ReBEC) identification RBR-229scm.

Complementary feeding methods and introduction of ultra-processed foods: A randomized clinical trial.

Introduction: Complementary feeding (CF) is defined as a period when foods, other than milk, are introduced to the infant's diet. Unfortunately, frequent consumption of ultra-processed foods (UPF) has become highly prevalent early in an infant's life. The aim was to verify the association of CF methods with the introduction of UPF in early childhood. Methods: This randomized clinical trial involved pairs of mother-infants, allocated in groups receiving different CF interventions: strict Parent-Led Weaning (PLW); strict Baby-Led Introduction to SolidS (BLISS), or mixed-method. The intervention consisted of a counseling session on healthy eating at the child's 5.5 months of age. A structured questionnaire was created based on the NOVA classification for the definition of UPF and applied at 9 and 12 months. The effect of the CF method intervention was measured by a survival curve for UPF offered for the first time in early childhood between groups. Cox regression was used to estimate its magnitude. The primary analysis was done in three groups (PLW, BLISS, and Mixed) and the secondary analysis was done in two groups (PLW, and BLISS + Mixed). Results: A total of 139 mother-infant pairs were eligible and 129 followed the study. The prevalence of infants who were exposed to UPF in early childhood was 58.9% (n = 76), being 71.4% in the PLW group, 53.3% in the BLISS group, and 52.4% in the Mixed group, without differences between them (p = 0.133). The PLW group intervention had a greater chance of exposure to ice cream or popsicles (p = 0.032) and sweet crackers (p = 0.009), compared with the other two CF groups. The Cox regression did not find significant differences between the three groups. However, the regression with two groups estimated a 38% reduction in the offer of UPF in the BLISS + Mixed group intervention (p = 0.049). Discussion: The CF intervention promoting greater infant autonomy (BLISS and Mixed) was associated with a reduction in the offer of UPF in early childhood. This knowledge may contribute to supporting strategies aimed at reducing UPF consumption by the young infant. Brazilian registry of clinical trials ReBEC: [https://ensaiosclinicos.gov.br/rg/RBR-229scm], identifier [RBR-229scm U1111-1226-9516].

Adherence to different methods for introducing complementary food to 7-month-old babies: a randomized clinical trial.

OBJECTIVE: To assess the adherence to three methods of food introduction for 7-month-old babies. METHODS: This is a randomized clinical trial conducted with mother-infant pairs, submitted to the intervention with five and a half months of age and three different methods for food introduction according to randomization: Parent-Led Weaning (PLW), Baby-Led Introduction to SolidS (BLISS), or mixed (specially developed for this study). Adherence to the method was assessed at the seventh month of age, via telephone call to the caregiver by a researcher blinded to the method. The analyses were performed using the Chi-Square test and data are presented in absolute numbers and percentages. RESULTS: A total of 139 mother-infant pairs were evaluated; 46 of them were allocated to the PLW method; 47, to the BLISS; and 46, to the mixed. At seven months of age, 60 (43.2%) mothers reported that the infants were following the proposed feeding method. When analyzing each approach, the mixed method showed a higher likelihood of adherence (71.7%, n=33), followed by the PLW method (39.1%, n=18) and by the BLISS (19.2%, n=9) (p<0.001). Among the sample that did not follow the proposed method, those that had been randomized to the PLW and BLISS methods mostly migrated to the mixed method (92.9%; n=26 and 92.1%; n=35, respectively) (p<0.001). CONCLUSIONS: Complementary feeding in a mixed approach obtained greater adherence in 7-month-old babies.

Crescimento no Primeiro Ano de Vida de Crianças Expostas ao HIV não Infectadas: um Estudo de Coorte Retrospectivo / Growth in the First Year of Life of HIV-Exposed Uninfected Children: a Retrospective Cohort Study

Introdução: O crescimento de crianças expostas ao HIV não infectadas pode ser prejudicado pela exposição intrauterina à terapia antirretroviral. O objetivo deste estudo é descrever o crescimento no primeiro ano de vida de crianças expostas ao HIV não infectadas. Métodos: Estudo de coorte retrospectivo realizado com crianças expostas ao HIV não infectadas nascidas e acompanhadas no Hospital de Clínicas de Porto Alegre. Foram coletados dados referentes a condições socioeconômicas, perinatais, peso e comprimento no primeiro ano de vida. Para avaliação do crescimento, as médias de Escore-Z de peso, comprimento e índice de massa corporal para idade (P/I, C/I e IMC/I, respectivamente) ao nascimento, aos quatro e aos doze meses foram comparadas através da análise de Equações de Estimativas Generalizadas (GEE). Resultados: 39 crianças foram incluídas no estudo. A média de Escore-Z de IMC/I ao nascimento foi 0,03 (-0,24 a 0,30), aos quatro de 0,34 (0,00 a 0,68) e aos 12 meses de 0,73 (0,45 a 1,01). Houve diferença significativa entre o nascimento e aos doze meses (p=0,002). Conclusão: Os resultados sugerem que crianças expostas ao HIV não infectadas apresentam crescimento adequado no primeiro ano de vida e curva ascendente ao longo do tempo.

Introduction: The growth of uninfected HIV-exposed children can be impaired by intrauterine exposure to antiretroviral therapy. The aim of this study is to describe the growth in the first year of life of uninfected HIV-exposed children. Methods: A retrospective cohort study conducted with uninfected HIV-exposed children born and followed up at the Hospital de Clínicas de Porto Alegre. Data regarding socioeconomic status, perinatal information, and weight and length in the first year of life were collected. To assess growth, the Z-score means of weight, length and body mass index for age (W/A, L/A and BMI/A, respectively) at birth, at 4 months and at 12 months were compared through analysis of Generalized Estimating Equations (GEE). Results: Thirty-nine children were included in the study. The mean Z-Score of BMI/A at birth was 0.03 (-0.24 to 0.30), at 4 months 0.34 (0.00 to 0.68) and at 12 months 0.73 (0.45 to 1.01). There was a significant difference between birth and at 12 months (p=0.002). Conclusion: The results suggest that uninfected HIV-exposed children show adequate growth in the first year of life and an ascending curve over time.

Complementary feeding methods in the first year of life: a study protocol for a randomized clinical trial.

BACKGROUND: The traditional spoon-feeding approach to introduction of solid foods during the complementary feeding period is supported by consensus in the scientific literature. However, a method called Baby-Led Introduction to SolidS (BLISS) has been proposed as an alternative, allowing infants to self-feed with no adult interference. To date, there have been no trials in the Brazilian population to evaluate the effectiveness of BLISS in comparison to the traditional approach. METHODS/DESIGN: To evaluate and compare three different complementary feeding methods. Data on 144 mother-child pairs will be randomized into intervention groups by methods: (A) strict Parent-Led Weaning; (B) strict Baby-Led Introduction to SolidS; and (C) a mixed method. Prospective participants from Porto Alegre, Brazil, and nearby cities will be recruited through the Internet. The interventions will be performed by nutritionists and speech therapists, at 5.5 months of age of the child, at a private nutrition office equipped with a test kitchen where meals will be prepared according to the randomized method. The pairs will be followed up at 7, 9, and 12 months of age. Data will be collected through questionnaires designed especially for this study, which will include a 24h child food recall, questionnaires on the child's and parents' eating behavior, oral habits, eating difficulties, and choking prevalence. At 12 months of age, children will undergo blood collection to measure hemoglobin, ferritin, and C-reactive protein, saliva collection for analysis of genetic polymorphisms, and oral examination. Anthropometric parameters (child and maternal) will be measured at the baseline intervention, at a 9 month home visit, and at the end-of-study visit at the hospital. The primary outcome will be child growth and nutritional status z-scores at 12 months; secondary outcomes will include iron status, feeding behavior, acceptability of the methods, dietary variety, choking, eating behaviors, food preferences, acceptance of bitter and sweet flavors, suction, oral habits, oral hygiene behavior, dental caries, gingival health status, and functional constipation. DISCUSSION: The trial intends to ascertain whether there are potential advantages to the BLISS complementary feeding method in this specific population, generating data to support families and healthcare providers. TRIAL REGISTRATION: Brazilian Clinical Trials Registry (ReBEC): RBR- 229scm number U1111-1226-9516 . Registered on September 24, 2019.

Fatores de risco para o desenvolvimento de doença cardiovascular em pacientes com depressão em um hospital do sul do Brasil / l Risk factors for the development of cardiovascular disease in patients with depression in a hospital in Southern Brazil

Introdução: A associação entre depressão e fatores de risco cardiovascular é recorrente. O aumento de risco em deprimidos está relacionado à fatores como obesidade, sedentarismo, dislipidemia, alcoolismo e tabagismo. O objetivo deste trabalho foi identificar a presença de fatores de risco para o desenvolvimento de doenças cardiovasculares em pacientes com quadro de depressão internados em um hospital do sul do Brasil. Métodos: Estudo transversal que envolveu adultos de ambos os sexos internados por episódio depressivo. O estado nutricional foi avaliado pelas medidas antropométricas de peso, altura e circunferência da cintura. Um questionário foi aplicado englobando perfil sociodemográfico, histórico familiar de doenças, consumo de produtos de tabaco e de álcool, atividade física, além do questionário autoaplicável para medida da severidade da depressão. Para avaliação do risco cardiovascular global, foi calculado o escore de Framingham. Os testes qui-quadrado de Pearson (χ2 ) ou exato de Fisher foram utilizados para testar a associação entre as variáveis categóricas, considerando o nível de significância quando p ≤ 0,05 e IC95%. Resultados: Foram avaliados 54 indivíduos, predominantemente mulheres (n = 32), com idade média de 40,2 ± 10,8 anos. A depressão foi classificada como grave na maioria dos pacientes (n = 29). Fatores de risco relacionados ao nível de atividade física (sedentarismo), dislipidemia e estado nutricional (sobrepeso e obesidade) estiveram presentes em 81,5%, 73,1% e 66,7% da amostra, respectivamente. Percentual de risco obtido por meio do escore de Framingham foi encontrado acima do normal em 42,9% dos indivíduos. Depressão leve associou-se positivamente aos pacientes com magreza/eutrofia e, ao serem estratificados como severos e não-severos, o primeiro grupo teve associação positiva com histórico familiar de excesso de peso e hipertensão. Conclusões: Diversos fatores de risco cardiovascular foram encontrados, alertando para a importância do cuidado integral da saúde do paciente e avaliação destes indicadores. (AU)

Introduction: The association between depression and cardiovascular risk factors is recurrent. Increased risk of depression is related to factors such as obesity, sedentary lifestyle, dyslipidemia, alcoholism, and smoking. The aim of this study was to identify the presence of risk factors for the development of cardiovascular disease in patients with depression admitted to a hospital in southern Brazil. Methods: A cross-sectional study involving adults of both sexes hospitalized for a depressive episode. Nutritional status was assessed by the anthropometric measurements of weight, height and waist circumference. A questionnaire was applied covering sociodemographic data, family history of diseases, consumption of tobacco and alcohol products, and physical activity, in addition to a self-administered questionnaire to measure the severity of depression. The Framingham risk score was calculated for global cardiovascular risk evaluation. Pearson's chi-square test (χ2 ) or Fisher's exact Test were used to test the association between categorical variables, considering the level of significance at p ≤ 0.05 and 95% CI. Results: Fifty-four individuals were evaluated, most were women (n = 32), with a mean age of 40.2 ± 10.8 years were evaluated. Depression was classified as severe in most patients (n = 29). Risk factors related to the physical activity level (sedentary lifestyle), dyslipidemia and nutritional status (overweight and obesity) were present in 81.5%, 73.1% and 66.7% of the sample, respectively. Percentage of risk obtained by the Framingham risk score was found above normal in 42.9% of the individuals. Mild depression was positively associated with thin/eutrophic patients and, when stratified as severe and non-severe, the first group had a positive association with family history of overweight and hypertension. Conclusions: Several cardiovascular risk factors were found, alerting to the importance of integral health care for patients and evaluation of these indicators. (AU)