Association between preterm infant size at 1 year and ADHD later in life: data from 1993 and 2004 Pelotas Birth Cohorts.

The objective of this study is to examine the association between preterm infants' size at 1 year and attention-deficit/hyperactivity disorder (ADHD) assessed categorically and dimensionally in childhood and adolescence. We studied infants born < 37 weeks' gestation from two Brazilian birth cohorts (n = 653). ADHD was evaluated using the Development and Well-Being Assessment (DAWBA) interview at the age of 6 years in one cohort and by a structured interview according to DSM-5 criteria at 18 years in the other one. The presence of child attention difficulties was measured by the Strengths and Difficulties Questionnaire (SDQ) at 6 and 11 years in the 2004 and 1993 cohorts, respectively. We estimated associations of weight, length, head circumference, and BMI z-scores at 1-year chronological age with ADHD using Poisson Regression Model; and with attention difficulties using Linear Regression, adjusting for covariates. Mean birth weight was 2500 g and gestational age was 34.5 weeks. The aggregated ADHD prevalence in the two cohorts was 2.7%, and the median score for attention difficulties was 3.0. We found that increased head circumference at 1 year was associated with a lower risk of ADHD diagnosis (RR = 0.7, 95% CI 0.4, 0.9; p = 0.04 per standard deviation difference) and with fewer dimensional attention symptoms. In sensitivity analysis with other mental disorders, head circumference was associated with depression, but not with anxiety. Our findings emphasize poor head growth in the first year of life as a potential determinant of attentional difficulties in the preterm infant population.

Effect of a healthy eating intervention in the first months of life on ultraprocessed food consumption at the age of 4-7 years: a randomised clinical trial with adolescent mothers and their infants.

This randomised clinical trial aimed to evaluate the effect of a pro-breast-feeding (BF) and healthy complementary feeding intervention performed during infants' first months of life on ultraprocessed food (UPF) consumption at 4-7 years. We enrolled 323 teenage mothers and their infants from South Brazil, 163 allocated to the intervention group and 160 to the control group. Intervention consisted of sessions on BF and healthy complementary feeding promotion and was carried out in the maternity ward and at home after delivery. Food consumption was assessed using three 24-h food recalls at child's age of 4-7 years. Foods were classified according to NOVA classification. Dietary contribution of UPF was adjusted for intra-individual variability by the SPADE method and categorised into tertiles. We used Poisson regression models with robust variance, adjusted for confounders, to estimate the effect of the intervention and duration of BF on the risk of high consumption of UPF. Our final analysis included 194 children, with mean age of 6·1 (sd 0·5) years. Mean dietary contribution of UPF was 38 % in the intervention group and 42·7 % in the control group, from total daily intakes. Results adjusted for BF duration, propensity score, income and total energy content demonstrated that the intervention reduced the risk of high consumption of UPF by 35 % (relative risk 0·65, 95 % CI 0·43, 0·98). BF duration was not associated with UPF consumption. The intervention was effective in reducing the risk of high UPF consumption at the age of 4-7 years.

Association between type of feeding at hospital discharge and nutritional status of Brazilian very preterm infants: a multicenter study.

OBJECTIVES: To examine trends over time in diet and size of very preterm infants, and associations of diet with size at hospital discharge/transfer. METHODS: The authors studied 4062 surviving very preterm infants born < 32 weeks' gestational age and < 1500 g between January 2012 and December 2020 from 12 Brazilian Neonatal Intensive Care Units. Diet type at discharge/transfer was classified as exclusive human milk, exclusive formula, or mixed. Outcomes were weight and head circumference at hospital discharge and the change in each from birth to discharge. The authors used linear regression to estimate adjusted associations of diet type with infant size, overall, and stratified by fetal growth category (small vs. appropriate for gestational age). The authors also examined trends in diet and infant size at discharge over the years. RESULTS: Infants' mean gestational age at birth was 29.3 weeks, and the mean birth weight was 1136 g. Diet at discharge/transfer was exclusive human milk for 22 %, mixed for 62 %, and exclusive formula for 16 %. Infant size in weight and head circumference were substantially below the growth chart reference for all diets. Infants fed human milk and mixed diets were lighter and had smaller heads at discharge/transfer than infants fed formula only (weight z: -2.0, -1.8, and -1.5; head z: -1.3, -1.2 and -1.1 for exclusive human milk, mixed and exclusive formula respectively). CONCLUSION: Results suggest high human milk use but gaps in nutrient delivery among hospitalized Brazilian very preterm infants, with little evidence of improvement over time.

Growth and Clinical Outcomes of Very Low-Birth-Weight Infants Receiving Acidified vs Nonacidified Liquid Human Milk Fortifiers.

BACKGROUND: Liquid human milk fortifiers are used commonly in neonatal intensive care. Use of an acidified HMF (A-HMF) is associated with transient metabolic acidosis, but whether growth outcomes differ between infants fed A-HMF vs nonacidified HMF (NA-HMF) remains unknown. METHODS: Retrospective cohort study of 255 infants born at <33 weeks' gestation and ≤1500 g who were receiving ≥75% fortified human milk on day of life 14, in a level III neonatal intensive care unit (NICU) from May 2015 to December 2018. Infants born before October 2017 (n = 165) received A-HMF, whereas infants born after October 2017 (n = 90) received NA-HMF. We used logistic regression to estimate odds of metabolic acidosis (serum bicarbonate <16 mEq/L in the first 21 days of life) in infants receiving A-HMF vs NA-HMF and linear mixed models to compare the mean size at discharge (weight, length, head z-scores) by HMF type. We adjusted models for confounders and accounted for the nonindependence of multiple births. RESULTS: Median gestational age was 28.7 weeks (range, 22.6-32.9) and birth weight 1.1 kg (range, 0.4-1.5). Infants receiving A-HMF had higher adjusted odds of metabolic acidosis than infants receiving NA-HMF (adjusted odds ratio, 2.7; 95% CI, 1.2-6.2). There were no differences between groups in size z-scores at discharge. CONCLUSIONS: In human-milkfed, very-low-birthweight infants, fortification with liquid A-HMF may contribute to metabolic acidosis in the first month of life, but this practice does not appear to impair growth through NICU discharge, compared with fortification with NA-HMF.

Human milk feeding and physical growth in very low-birth-weight infants: a multicenter study.

OBJECTIVES: Quantify associations of human milk feeding with in-hospital growth and examine differences by human milk type (maternal or donor). STUDY DESIGN: We included infants born <33 weeks' gestation and <1500 g from 9 Neonatal Intensive Care Units (n = 1429). We estimated associations of percent of visit days fed any human milk (maternal or donor) and percent of days fed donor milk with weight, length, and head z-scores at discharge or transfer using a linear mixed model, adjusting for birth size and other covariates. RESULTS: Any human milk feeding was not associated with growth outcomes. Infants fed donor milk on ≥50% of days had less favorable growth vs. those fed <50% [z-scores-weight: -1.1 vs. -0.7 (p = 0.04); length: -1.5 vs. -1.1 (p = 0.04); head -1.0 vs. -0.3 (p < 0.01)]. CONCLUSIONS: Fortified human milk was not associated with impaired growth compared with preterm formula.

Macronutrient Intake from Human Milk, Infant Growth, and Body Composition at Term Equivalent Age: A Longitudinal Study of Hospitalized Very Preterm Infants.

The variable macronutrient content of human milk may contribute to growth deficits among preterm infants in the neonatal intensive care unit (NICU). In a longitudinal study of 37 infants < 32 weeks gestation, we aimed to (1) determine the between-infant variation in macronutrient intake from human milk and (2) examine associations of macronutrient intake with growth outcomes. We analyzed 1626 human milk samples (median, 43 samples/infant) with mid infrared spectroscopy. Outcomes at term equivalent age were weight, length, head circumference, fat mass, and fat-free mass. Median (range) intakes from human milk were: protein 1.37 (0.88, 2.43) g/kg/day; fat 4.20 (3.19, 5.82) g/kg/day; carbohydrate 8.94 (7.72, 9.85) g/kg/day; and energy 82.5 (68.7, 99.3) kcal/kg/day. In median regression models adjusted for birth size and gestational age, and other covariates, greater intakes of fat and energy were associated with higher weight (0.61 z-scores per g/kg/day fat, 95% CI 0.21, 1.01; 0.69 z-scores per 10 kcal/kg/day, 95% CI 0.28, 1.10), whereas greater protein intake was associated with greater body length (0.84 z-scores per g/kg/day protein, 95% CI 0.09, 1.58). Higher fat intake was also associated with higher fat mass and fat-free mass. Macronutrient intakes from human milk were highly variable and associated with growth outcomes despite routine fortification.

Effect of Pattern and Duration of Breastfeeding on the Consumption of Fruits and Vegetables among Preschool Children.

BACKGROUND: The duration and pattern of breastfeeding can influence the consumption of fruits and vegetables in later childhood. OBJECTIVE: To investigate the association between pattern and duration of breastfeeding and consumption of fruits and vegetables in children aged between 4 and 7 years. METHODS: We conducted a secondary analysis using data from a former randomized clinical trial with 323 adolescent mothers, their children, and maternal grandmothers, when they cohabited. Information on infant feeding was collected monthly during the first 6 months of life, every two months until the child was 1 year old over and when children were between 4 and 7 years old. The associations between duration of breastfeeding and exclusive breastfeeding and consumption of fruits and vegetables were tested by a logistic regression model. RESULTS: Approximately 60% and 45% of children consumed fruits and vegetables, respectively, five or more times a week. Consumption of vegetables among 4-7-year-old children was higher in children who were breastfed for 12 months or longer (OR 2.7; 95%CI 1.49-4.93); however, exclusive breastfeeding duration did not have a significant association with consumption of vegetables (OR 1.5; 95%CI 0.70-3.04). There was no association between weekly consumption of fruits and duration of breastfeeding (OR 1.3; 95%CI 0.71-2.30) or exclusive breastfeeding (OR 0.7; 95%CI 0.34-1.44). CONCLUSIONS: Longer duration of breastfeeding was positively associated with consumption of vegetables in children aged 4-7 years; however, there was no association with consumption of fruits. Exclusive breastfeeding duration did not have influence on consumption of fruits or vegetables.

Adherence to dietary recommendations for preschoolers: clinical trial with teenage mothers.

OBJECTIVE: To assess the effect of educational dietary intervention offered in the child's first year of life, as well as teenage mothers and grandmothers in carrying out the dietary recommendations at four to seven years. METHODS: Randomized clinical trial initiated in 2006, in Porto Alegre, RS, involving 323 teenage mothers and grandmothers who cohabited. The intervention consisted of six counseling sessions on breastfeeding and healthy complementary feeding. The first session occurred in the maternity ward and the other ones in the households of mothers at seven, 15, 30, 60, and 120 days of the child's life. The information about the child's diet were obtained on a monthly basis in the first six months, every two months in the second half-year, and at four to seven years, using a food frequency questionnaire. To assess the adequacy of food consumption to the recommendations from the Ministry of Health, we elaborated a score system that would reflect the compliance with the Ten Steps for Healthy Toddlers from 2 to 10 Years. The average scores of intervention and control groups were compared using the t-test. RESULTS: Low adherence to recommendations on child nutrition was found in the study population, with no difference in implementation the steps between the groups. The score on the compliance with the steps was similar in both groups (9.6 [SD = 1.63] and 9.3 [SD = 1.60] in the intervention and control groups, respectively) and no influence of the cohabitation with the grandmother was found. CONCLUSIONS: Educational dietary intervention in the first four months of the child's life for teenage mothers and grandmothers had no effect on the compliance with the recommendations at four to seven years of the child's life. OBJETIVO: Avaliar o efeito de intervenção alimentar educativa oferecida, no primeiro ano de vida da criança, a mães adolescentes e avós maternas, no cumprimento das recomendações alimentares aos quatro a sete anos. MÉTODOS: Ensaio clínico randomizado iniciado em 2006, em Porto Alegre, RS, envolvendo 323 mães adolescentes e avós maternas, quando em coabitação. A intervenção consistiu em seis sessões de aconselhamento sobre aleitamento materno e alimentação complementar saudável. A primeira sessão ocorreu na maternidade e as demais, nos domicílios das mães aos sete, 15, 30, 60 e 120 dias de vida da criança. As informações sobre alimentação da criança foram obtidas mensalmente nos primeiros seis meses de vida, a cada dois meses no segundo semestre, e aos quatro a sete anos, por meio de questionário de frequência alimentar. Para avaliar a adequação do consumo alimentar às recomendações do Ministério da Saúde, elaborou-se um sistema de escore que refletisse o cumprimento dos Dez Passos Para Uma Alimentação Saudável Para Crianças de 2 a 10 Anos. As médias dos escores dos grupos intervenção e controle foram comparadas por meio do teste t. RESULTADOS: Houve baixa adesão às recomendações sobre alimentação infantil na população estudada, sem diferença no cumprimento dos passos entre os grupos. O escore relativo ao cumprimento dos passos foi semelhante nos dois grupos (9,6 [DP = 1,63] e 9,3 [DP = 1,60] nos grupos intervenção e controle, respectivamente) e não houve influência da coabitação com a avó materna. CONCLUSÕES: Intervenção alimentar educativa nos primeiros quatro meses de vida da criança para mães adolescentes e avós maternas não teve efeito no cumprimento das recomendações alimentares aos quatro a sete anos de vida.

Adherence to dietary recommendations for preschoolers: clinical trial with teenage mothers / Adesão a recomendações alimentares em pré-escolares: ensaio clínico com mães adolescentes

ABSTRACT OBJECTIVE To assess the effect of educational dietary intervention offered in the child's first year of life, as well as teenage mothers and grandmothers in carrying out the dietary recommendations at four to seven years. METHODS Randomized clinical trial initiated in 2006, in Porto Alegre, RS, involving 323 teenage mothers and grandmothers who cohabited. The intervention consisted of six counseling sessions on breastfeeding and healthy complementary feeding. The first session occurred in the maternity ward and the other ones in the households of mothers at seven, 15, 30, 60, and 120 days of the child's life. The information about the child's diet were obtained on a monthly basis in the first six months, every two months in the second half-year, and at four to seven years, using a food frequency questionnaire. To assess the adequacy of food consumption to the recommendations from the Ministry of Health, we elaborated a score system that would reflect the compliance with the Ten Steps for Healthy Toddlers from 2 to 10 Years. The average scores of intervention and control groups were compared using the t-test. RESULTS Low adherence to recommendations on child nutrition was found in the study population, with no difference in implementation the steps between the groups. The score on the compliance with the steps was similar in both groups (9.6 [SD = 1.63] and 9.3 [SD = 1.60] in the intervention and control groups, respectively) and no influence of the cohabitation with the grandmother was found. CONCLUSIONS Educational dietary intervention in the first four months of the child's life for teenage mothers and grandmothers had no effect on the compliance with the recommendations at four to seven years of the child's life.

RESUMO OBJETIVO Avaliar o efeito de intervenção alimentar educativa oferecida, no primeiro ano de vida da criança, a mães adolescentes e avós maternas, no cumprimento das recomendações alimentares aos quatro a sete anos. MÉTODOS Ensaio clínico randomizado iniciado em 2006, em Porto Alegre, RS, envolvendo 323 mães adolescentes e avós maternas, quando em coabitação. A intervenção consistiu em seis sessões de aconselhamento sobre aleitamento materno e alimentação complementar saudável. A primeira sessão ocorreu na maternidade e as demais, nos domicílios das mães aos sete, 15, 30, 60 e 120 dias de vida da criança. As informações sobre alimentação da criança foram obtidas mensalmente nos primeiros seis meses de vida, a cada dois meses no segundo semestre, e aos quatro a sete anos, por meio de questionário de frequência alimentar. Para avaliar a adequação do consumo alimentar às recomendações do Ministério da Saúde, elaborou-se um sistema de escore que refletisse o cumprimento dos Dez Passos Para Uma Alimentação Saudável Para Crianças de 2 a 10 Anos. As médias dos escores dos grupos intervenção e controle foram comparadas por meio do teste t. RESULTADOS Houve baixa adesão às recomendações sobre alimentação infantil na população estudada, sem diferença no cumprimento dos passos entre os grupos. O escore relativo ao cumprimento dos passos foi semelhante nos dois grupos (9,6 [DP = 1,63] e 9,3 [DP = 1,60] nos grupos intervenção e controle, respectivamente) e não houve influência da coabitação com a avó materna. CONCLUSÕES Intervenção alimentar educativa nos primeiros quatro meses de vida da criança para mães adolescentes e avós maternas não teve efeito no cumprimento das recomendações alimentares aos quatro a sete anos de vida.

Acne e dieta: uma revisão / Acne and diet: a review

Objective: To evaluate the relationship between diet and acne in adolescents and adults through a review of observational studies and drandomized trials conducted between 2003 and 2013. Data source: The search was performed in the Medline, Lilacs, Scielo, Cochrane and Coordination of Improvement of Higher Education (CAPES) databases. Data synthesis: 13 studies were included in this review and had their quality evaluated by two independent reviewers. Evidence suggests involvement of diet in the pathology of acne in adolescents and adults, especially in relation to dairy products and high glycemic load foods. Conclusions: Most of the studies included in the review suggest that there is a relationship between diet and acne. The relationship between acne and fish intake and specific diets, such as the Mediterranean, need to be further investigated

Objetivo: Avaliar a relação entre acne e dieta em adolescentes e adultos por meio de revisão de estudos observacionais e ensaios randomizados realizados entre 2003 e 2013. Fonte de dados: A busca foi realizada nas bases de dados Medline, Lilacs, Scielo, Cochrane e banco de teses da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Capes). Síntese dos dados: Foram incluídos nesta revisão 13 estudos que tiveram suas qualidades avaliadas por dois revisores, independentemente. As evidências sugerem relação da dieta na patologia da acne, em adolescentes e adultos, principalmente em relação aos laticínios e alimentos com alta carga glicêmica. Conclusões: A maioria dos estudos incluídos na revisão sugere relação da dieta com a acne. As relações da acne com o consumo de peixe e com dietas específicas, como a mediterrânea, ainda precisam ser mais investigadas.