Fatores associados à introdução alimentar precoce em um município baiano / Factors associated with early food introduction in a municipality of baiano

Introdução: a introdução alimentar precoce é uma prática frequente no Brasil, envolta por diversos fatores de ordem social, cultural, econômica, familiar, emocional, bem como relacionados às condições de vida e assistência à saúde. Objetivo: identificar os principais fatores que se associam a introdução precoce de alimentos em crianças de zero a seis meses de vida, atendidas na Atenção Primária à Saúde de um município do Sudoeste da Bahia. Metodologia: estudo transversal, realizado com 75 mães e crianças atendidas na rede de saúde de Jequié, Bahia, no período de março a agosto de 2018. Empregou-se Regressão de Poisson com variância Robusta para avaliar a associação. Resultados: a prevalência da introdução alimentar precoce na população em estudo foi de 64%, sendo o leite de vaca, água/chá e fórmula infantil os alimentos mais prevalentes. Observou-se que a variável uso de chupeta (RP=1,21; IC95%= 1,02-1,43) apresentou associação positiva com a introdução alimentar precoce, enquanto que as variáveis uso de mamadeira (RP= 0,08; IC95%= 0,02-0,28) e orientações sobre amamentação (RP= 0,77; IC95%= 0,63-0,95) apresentaram associação negativa e inversa com o desfecho estudado. Conclusão: apesar da superioridade do leite materno sobre outras formas de nutrir as crianças menores de seis meses, os resultados deste estudo revelaram elevada prevalência de introdução alimentar precoce na população estudada e sua associação com o uso de chupetas. Sugere-se que ações de promoção e proteção da amamentação exclusiva aconteçam desde o pré-natal, evidenciando também os riscos da introdução alimentar precocemente.

Introduction: the early introduction of food is a frequent practice in Brazil, involved by several factors of social, cultural, economic, family, emotional, as well as related to living conditions and health care. Objective: to identify the main factors associated with the early introduction of food in children from zero to six months of life, attended in primary health care in a municipality in southwestern Bahia. Methodology: cross-sectional study, conducted with 75 mothers and children assisted in the health network of Jequié, Bahia, in the period from March to August 2018. Poisson Regression with Robust variance was employed to evaluate the association. Results: the prevalence of early food introduction in the study population was 64%, with cow's milk, water/tea and infant formula being the most prevalent foods. It was observed that the variable pacifier use (PR = 1.21; 95%CI = 1.02-1.43) showed a positive association with early feeding, while the variables bottle use (PR = 0.08; 95%CI = 0.02-0.28) and breastfeeding orientation (PR = 0.77; 95%CI = 0.63-0.95) showed a negative and inverse association with the studied outcome. Conclusion: despite the superiority of breast milk over other forms of feeding children under six months of age, the results of this study revealed a high prevalence of early introduction of food in the studied population and its association with the use of pacifiers. It is suggested that actions to promote and protect exclusive breastfeeding take place since the prenatal period, also highlighting the risks of introducing food early.

Pioneros catalanes en la maternización de la leche de vaca / Catalan pioneers in humanizing cow´s milk

Se reúnen datos de carácter histórico relacionados con los inicios de la introducción y desarrollo de leches maternizadas en nuestro país, que tuvieron lugar durante los años de transición del siglo XIX al XX. En este proceso, destacan de forma muy especial las aportaciones de Luis Soldevila Casas y de los médicos Pau Ferrer Piera i Salvador Soler Farnés. Los productos diseñados y registrados por estos personajes estaban inspirados, básicamente, en los métodos denominados entonces laboratory milk (mezclas) y top milk (fraccionamiento). La vida comercial de estos productos fue muy corta o, incluso, inexistente (AU)

Historic data on the introduction and development of humanized milk that took place in our country during the transition from 19th to 20th century has been compiled. In this process, the contributions of Luis Soldevila Casas and the doctors Pau Ferrer Piera and Salvador Soler Farnés are highly remarkable. The products designed and registered by them were mainly inspired in the processes then known as «Laboratory milk» (blends) and «Top milk» (fractionation). But the shelf life of these products was very short, or they never existed (AU)

Double-blind, placebo-controlled food challenges in Brazilian children: Adaptation to clinical practice

Background: A double-blind, placebo-controlled food challenge (DBPCFC) is considered the gold standard for diagnosing food allergy, but because of methodological difficulties it is rarely conducted in clinical practice, especially in paediatric patients. The purpose of the study was to propose a DBPCFC protocol that is adapted to our conditions for the diagnosis of an IgE-mediated cow's milk allergy (CMA) in a Brazilian reference centre for paediatric allergies. Methods: This study includes the experimental phase (choice of materials, adjustments made to protocols described in the literature) and the test execution phase. DBPCFCs were performed in 58 patients aged 1–15years who were separated into two groups: Group 1 (n=39), sex 1.6 M:F, 5.3years median age, suggestive history of IgE-mediated CMA; and Group 2 (n=19), sex 1.4 M:F, 8.3years median age with symptoms not associated with milk ingestion and laboratory data not compatible with IgE-mediated CMA. Results: The materials were standardised for testing: containers and disposable products, low-lactose cow's milk (CM) and vehicles, such as natural fruit juice, vegetable soup and soybean-based beverages. Each DBPCFC was performed in a single day with two blind, randomised phases with a 2-h interval between them. The milk doses were gradually increased and offered in regular intervals of 15–30min. Following negative or inconclusive results, patients underwent an open oral challenge test with 200mL of low-lactose CM. Conclusions: The proposed adaptation for the DBPCFC allowed to implement this important test for the diagnosis of IgE-mediated CMA in a reference centre for paediatric allergies. It was considered feasible and safe if performed in an appropriate setting with physician supervision(AU)