Evidence-based psychotherapy for treatment of anorexia nervosa in children and adolescents: systematic review

Abstract Background: Efficacy studies on the treatment of anorexia nervosa (AN) in childhood and adolescence are scarce and systematic reviews are almost non-existent. Objective: Systematic review of the literature regarding the modalities of psychological intervention based on evidence used in the treatment of AN in childhood and adolescence. Methods: The research was carried out in the databases: PubMed, PsycINFO and Cochrane, using the combined keywords: anorexia nervosa and evidence-based therapy. Articles published between 1990 and 2015 were assessed. Results: Of the 139 eligible articles, 14 were selected, of which 10 (71.4%) were conducted in the United States and England. The sample ranged from 9 to 167 participants. Randomized Clinical Trial represented the most frequent design (n = 9; 63.4%), with more than half of the interventions structured in 20 or more sessions (n = 9, 64.3%). Nine types of treatments were tested, with the most tested being Family-Based Treatment (FBT) (n = 7; 50%). Interventions involving the family seem to be more effective, however, the rates for complete remission are modest. Discussion: Although evidence of efficacy was verified in the treatments analyzed, the limited number of studies, the various methodological limitations and the methodological heterogeneity between studies make the findings inconclusive.

Sociodemographic, anthropometric and behavioural risk factors for ultra-processed food consumption in a sample of 2-9-year-olds in Brazil.

OBJECTIVE: The present study aimed to identify food patterns among 2-9-year-olds and investigate sociodemographic, anthropometric and behavioural predictors of less healthy dietary patterns. DESIGN: Cross-sectional study. Parents of 2-9-year-olds completed an FFQ and factor analysis was applied to identify dietary patterns. Parents also completed questionnaires assessing sociodemographic, anthropometric and behavioural characteristics of parents and children, including parental feeding practices. SETTING: Participants were recruited from private schools of Campinas and São Paulo, SP, Brazil, between April and June 2014. SUBJECTS: Parents of 2-9-year-olds (n 929). RESULTS: Two dietary patterns emerged: 'traditional food' and 'ultra-processed food'. Lower maternal education (OR=2·05, P=0·010) and higher maternal weight status (OR=1·43, P=0·044) were associated with a greater likelihood of the ultra-processed food pattern. Lower perceived parental responsibility for adequacy of food group intake (OR=2·41, P=0·020), and lower scores on the parental feeding practices of 'Healthy Eating Guidance' (OR=1·83, P<0·001) and 'Monitoring' (OR=2·52, P<0·001), were also associated with the presence of this pattern, as was higher child's screen use during mealtimes (OR=1·61, P=0·004). CONCLUSIONS: The present study is the first to evaluate associations between less healthy dietary patterns of Brazilian 2-9-year-olds and parental feeding practices. Our findings highlight sociodemographic, anthropometric and behavioural factors within families that could be used to target tailored policies to at-risk populations.

Fatores associados ao consumo de bebidas açucaradas entre pré-escolares brasileiros: inquérito nacional de 2006 / Factors associated with the consumption of soft drinks among Brazilian preschool children: national survey of 2006

Resumo O crescente consumo de bebidas açucaradas como os refrigerantes ou sucos artificiais está associado à prevalência de obesidade no Brasil e no mundo. Este estudo se propõe a conhecer a frequência de consumo destas bebidas entre crianças brasileiras de 24 a 59 meses e investigar associações com variáveis demográficas, socioeconômicas e nutricionais. Utilizando dados da Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher − 2006, o padrão alimentar foi obtido com o questionário de frequência de alimentos e bebidas nos sete dias anteriores à data da entrevista e a antropometria usou medidas de peso e de estatura das crianças. Entre os pré-escolares, 37,3% consumiram refrigerantes e sucos artificiais 4 dias ou mais por semana. Os fatores que apresentaram associação estatisticamente significante com consumo frequente de BA foram residir em regiões de maior desenvolvimento econômico do país, em áreas urbanas, pertencer ao estrato de maior poder aquisitivo, mães que assistiam TV regularmente e excesso de peso da criança, estavam associados ao consumo de refrigerantes e sucos artificiais em 4 ou mais dias por semana. Novos estudos são necessários para a compreensão da real contribuição das bebidas açucaradas na epidemia de obesidade infantil.

Abstract The rising consumption of sweetened beverages such as soft drinks or artificial juices is associated with the prevalence of obesity in Brazil and around the world. This study seeks to verify the frequency of consumption of these beverages among Brazilian children aged 24-59 months and to investigate the association of soft drinks with demographic, socioeconomic and nutritional variables. Using data from the National Survey on Demography and Health of Women and Children − 2006, the eating habits were obtained using the food and drink frequency questionnaire for the seven days preceding the interview, and anthropometry recorded the weight and height of children. Among preschoolers, 37.3% consumed soft drinks and artificial juices 4 or more days per week. The factors significantly associated with frequent consumption of soft drinks were living in regions of higher economic development of the country, in urban areas, belonging to the higher income bracket, with mothers watching TV regularly and excess weight of the child, were associated with consumption of soft drinks and artificial juices 4 or more days per week. Further studies are needed to understand the effective contribution of soft drinks on the epidemic of childhood obesity.

[Factors associated with the consumption of soft drinks among Brazilian preschool children: national survey of 2006]. / Fatores associados ao consumo de bebidas açucaradas entre pré-escolares brasileiros: inquérito nacional de 2006.

The rising consumption of sweetened beverages such as soft drinks or artificial juices is associated with the prevalence of obesity in Brazil and around the world. This study seeks to verify the frequency of consumption of these beverages among Brazilian children aged 24-59 months and to investigate the association of soft drinks with demographic, socioeconomic and nutritional variables. Using data from the National Survey on Demography and Health of Women and Children - 2006, the eating habits were obtained using the food and drink frequency questionnaire for the seven days preceding the interview, and anthropometry recorded the weight and height of children. Among preschoolers, 37.3% consumed soft drinks and artificial juices 4 or more days per week. The factors significantly associated with frequent consumption of soft drinks were living in regions of higher economic development of the country, in urban areas, belonging to the higher income bracket, with mothers watching TV regularly and excess weight of the child, were associated with consumption of soft drinks and artificial juices 4 or more days per week. Further studies are needed to understand the effective contribution of soft drinks on the epidemic of childhood obesity.

[Socio-demographic and nutritional characteristics of Brazilian children under 2 years of age who were beneficiaries of conditional cash transfer programs in 2006]. / Características sociodemográficas e nutricionais de crianças brasileiras menores de 2 anos beneficiárias de programas de transferência condicionada de renda em 2006.

The conditional cash transfer programs (PTCR) seek to combat poverty and hunger and to ensure food security. Children under the age of two of beneficiary families are more vulnerable to environmental conditions. This study seeks to describe this population according to socio-economic, demographic and nutritional variables. Secondary data from the National Survey on Demography and Health of Women and Children (PNDS-2006) were used. Data were described using mean and standard deviations. Associations were described using the chi-square test with confidence intervals of 95%. Of the 1735 children, 29.4% were PCTR beneficiaries with average family income of R$430.20 and average benefits of R$75. Among those living in the Northeast or in the rural area of the country, one in every three received benefits. Among those experiencing severe food insecurity, 52.3% were PTCR beneficiaries. Children from socio-economic classes D and E and whose mothers had less than four years education were associated with PTCR. Among the nutritional disorders of child beneficiaries, overweight for age prevailed. Of those who ceased exclusive breastfeeding in less than two months, 31.2% were beneficiaries. The need for preventive nutritional education was identified in order to optimize the use of benefits.

Características sociodemográficas e nutricionais de crianças brasileiras menores de 2 anos beneficiárias de programas de transferência condicionada de renda em 2006 / Socio-demographic and nutritional characteristics of Brazilian children under 2 years of age who were beneficiaries of conditional cash transfer programs in 2006

Programas de transferência condicionada de renda (PTCR) visam o combate à pobreza e à fome e a garantia da segurança alimentar. Crianças menores de 2 anos de famílias beneficiárias são mais vulneráveis às condições ambientais. Este estudo objetiva caracterizar esta população segundo variáveis socioeconômicas, demográficas e nutricionais. Utilizaram-se dados secundários da Pesquisa Nacional de Demografia e Saúde da Crian ça e da Mulher (PNDS-2006). Descreveram-se os dados em média e desvios-padrão. Para as associações utilizou-se o teste qui-quadrado e intervalos de confiança de 95%. Das 1735 crianças 29,4% eram beneficiárias de PTCR com renda média familiar de R$430,20 e valor médio dos benefícios de R$75. Dentre as que residiam no Nordeste ou na região rural do país, uma em cada três recebiam PTCR. Entre as que viviam em insegurança alimentar grave, 52,3% pertenciam a PTCR. Classes econômicas D e E e baixa escolaridade materna associaram-se a PTCR. Entre os desvios nutricionais das crianças beneficiárias, prevaleceu o peso elevado para idade. Das que interromperam o aleitamento materno exclusivo antes dos dois meses, 31,2% eram de PTCR. Identifica-se a necessidade de educação nutricional preventiva a fim de otimizar a utilização do benefício.

The conditional cash transfer programs (PTCR) seek to combat poverty and hunger and to ensure food security. Children under the age of two of beneficiary families are more vulnerable to environmental conditions. This study seeks to describe this population according to socio-economic, demographic and nutritional variables. Secondary data from the National Survey on Demography and Health of Women and Children (PNDS-2006) were used. Data were described using mean and standard deviations. Associations were described using the chi-square test with confidence intervals of 95%. Of the 1735 children, 29.4% were PCTR beneficiaries with average family income of R$430.20 and average benefits of R$75. Among those living in the Northeast or in the rural area of the country, one in every three received benefits. Among those experiencing severe food insecurity, 52.3% were PTCR beneficiaries. Children from socio-economic classes D and E and whose mothers had less than four years education were associated with PTCR. Among the nutritional disorders of child beneficiaries, overweight for age prevailed. Of those who ceased exclusive breastfeeding in less than two months, 31.2% were beneficiaries. The need for preventive nutritional education was identified in order to optimize the use of benefits.