Factors associated with breastfeeding continuation for 12 months or more among working mothers in a general hospital. / Fatores associados à continuidade do aleitamento materno por 12 meses ou mais em mulheres trabalhadoras de um hospital geral.

This article aims to identify factors associated with breastfeeding continuation for at least 12 months among working mothers in a hospital in the south of Brazil. We conducted a cross-sectional study, interviewing 251 women who breastfed after returning to work. Eligibility criteria included non-twin biological children aged between 12 and 36 months and the absence of an illness (mother and/or child) that could affect breastfeeding. The association between breastfeeding continuation and the exposure variables was tested using Poisson multivariate regression. Only one work-related variable showed a significant association with the outcome. Working only during the day increased the prevalence of BF continuation for at least 12 months by 37%. The following non-work-related factors showed a positive association with the outcome: mothers without a college degree; mothers with at least 12 months' prior breastfeeding experience; child not given milks other than breast milk when the mother returned to work, and not using a pacifier. The following variables showed a negative association with the outcome: older maternal age; older gestational age; mother receiving support from the child's caregiver; and mother receiving professional breastfeeding support. Non-work-related factors had a greater influence on breastfeeding continuation for at least 12 months among working mothers.

O objetivo deste estudo é identificar fatores associados à continuidade da amamentação por 12 meses ou mais em mulheres trabalhadoras. Estudo transversal realizado por meio de entrevista com 251 trabalhadoras de um hospital, com filhos biológicos entre 12 e 36 meses de idade, não gemelares e sem doença que afetasse a amamentação, e amamentando quando do seu retorno ao trabalho. Para a associação entre a continuidade da amamentação e as variáveis de exposição utilizou-se a regressão multivariável de Poisson. Apenas uma variável relacionada ao local de trabalho da mulher mostrou associação significativa com o desfecho. Trabalhar durante o dia aumentou em 37% a prevalência da amamentação por 12 meses ou mais. Os fatores não relacionados ao trabalho da mulher que mostraram associação positiva com o desfecho: mãe sem curso superior, experiência de amamentação superior a 12 meses; criança não receber outro leite quando a mãe retornou ao trabalho e não ter usado chupeta. Por outro lado, maior idade da mãe, maior idade gestacional, apoio do cuidador da criança e apoio profissional na amamentação associaram-se negativamente ao desfecho. Fatores não relacionados diretamente ao trabalho materno tiveram maior participação na continuidade da amamentação por 12 meses ou mais.

A segurança dos alimentos nos Centros de Tradições Gaúchas do Rio Grande do Sul / Food safety in the Centros de Tradições Gaúchas of Rio Grande do Sul

Os Centros de Tradições Gaúchas (CTG) são entidades de divulgação e perpetuação da cultura do Rio Grande do Sul. A produção de refeições nessas entidades ocorre nos ensaios dos grupos de danças tradicionais e nos eventos oferecidos à comunidade, como jantares. Sabendo do impacto das doenças transmitidas por alimentos (DTA) na saúde humana, o objetivo deste trabalho é identificar a adequação dos CTG às boas práticas para manipulação de alimentos (BPM), explorar quem são os responsáveis pelas atividades de manipulação de alimentos e identificar a frequência e o número da produção de refeições servidas nessas instituições. A Portaria SES-RS nº 78/2009 e um questionário de coleta de dados dos grupos de dança e da produção de refeições foram aplicados em 5 CTG do Rio Grande do Sul. Outros 17 CTG do estado responderam a um segundo questionário, semelhante ao primeiro, com adição de perguntas sobre controle sanitário. Obteve-se uma média de adequação às BPM de 38% entre os CTG. Verificou-se que são servidas, em média, 4 refeições por semana entre os ensaios das invernadas artísticas próximos a competições. Em 36% dos CTG, ocorrem de 2 a 3 eventos por trimestre com produção de refeições. Em 45% dos CTG, são servidas de 100 a 200 pessoas nos eventos. Em relação aos trabalhos na cozinha, apenas 23,5% dos CTG têm como responsáveis dessas atividades pessoas devidamente capacitadas. Sendo os CTG instituições sem fins lucrativos, a criação de programas para a garantia do alimento seguro nesses espaços se faz necessária.

Centros de Tradições Gaúchas (CTG) are entities for the dissemination and perpetuation of Rio Grande do Sul culture. The production of meals in these entities takes place in the rehearsals of traditional dance groups and in events offered to the community, such as dinners. Knowing the impact of the foodborne diseases in human health, the objective of this work is to identify the adequacy of CTG to good food handling practices, to explore who are responsibles for food handling activities and identify the frequency and number of meals served in these institutions. The Portaria SES-RS No. 78/2009 and a questionnaire for data collection from dance groups and meals production were applied in 5 CTG in Rio Grande do Sul. Another 17 CTG in the state answered a second questionnaire, similar to the first, with the addition of questions about sanitary control. The average compliance with good practices was 38% among the CTG. It was found that, on average, 4 meals are served per week between rehearsals of the dance groups close to competitions. In 36% of the CTG, 2 to 3 events are held per quarter with production of meals. In 45% of the CTG, the number of people served at the events varies from 100 to 200. Regarding the work in the kitchen, only 23.5% of the CTG have duly trained people for these activities. Given that CTG are non-profit institutions, the creation of programs to ensure food safety in these spaces is necessary.

Involvement of maternal grandmother and teenage mother in intervention to reduce pacifier use: a randomized clinical trial.

OBJECTIVE: To assess the impact of an intervention for teenage mothers with the involvement of maternal grandmothers on the prevalence of pacifier use in the first six months of life. METHODS: This randomized clinical trial involved 323 teenage mothers, allocated to four groups: intervention with teenagers only, intervention with teenagers and their mothers, and respective controls. Six breastfeeding counseling sessions, including the recommendation to avoid the use of a pacifier, were delivered at the maternity ward and subsequently at the teenagers' homes, at seven, 15, 30, 60, and 120 days postpartum. Data on infant feeding and pacifier use were collected monthly by interviewers blinded to group allocation. The impact of the intervention was measured by comparing survival curves for pacifier use in the first six months of life and mean time to pacifier introduction. RESULTS: The intervention had a significant impact on reducing pacifier use only in the group in which grandmothers were involved. In this group, the intervention delayed by 64 days the introduction of a pacifier (21-85 days), compared to 25 days in the group without the participation of grandmothers (65-90 days). CONCLUSIONS: The intervention reduced pacifier use in the first six months of life and delayed its introduction until beyond the first month when grandmothers were involved. The intervention did not have a significant impact when only teenage mothers were involved.

Intake of water, herbal teas and non-breast milks during the first month of life: associated factors and impact on breastfeeding duration.

BACKGROUND: The use of non-breast milks seems to cause more harm to the child's health than the isolated introduction of water/herbal teas. AIMS: Study the factors associated with introduction of water/herbal teas or non-breast milks during the first month of life and determine the impact of this supplementation on breastfeeding duration. STUDY DESIGN: Nested cross-sectional study. SUBJECTS: 220 mother-infant pairs contacted in the maternity ward, at 7 days and at the end of 1, 2, 4, and 6 months. OUTCOME MEASURES: Introduction of water/herbal teas or non-breast milks in the first month of life based on data collected during a home visit 30 days after delivery. RESULTS: Introduction of water/herbal teas was associated with maternal age <20 years (prevalence ratio=1.55; 95%CI 1.14-2.09), <6 prenatal consultations (1.48; 1.09-2.01), cohabitation with maternal grandmother (1.51; 1.10-2.10), and poor latch-on at 30 days (1.87; 1.35-2.58). Introduction of non-breast milks was associated with breastfeeding of previous children for <6 months (3.18; 1.18-8.58), cesarean (1.92; 1.07-3.44), poor latch-on at 30 days (2.82; 1.55-5.11), use of pacifier at 7 days (2.75; 1.38-5.48), introduction of herbal teas in the first 7 days (2.75; 1.15-4.15) and breast engorgement at 7 days (2.19; 1.01-3.16). Introduction of non-breast milks negatively influenced breastfeeding duration (p<0.001); this was not observed with water/herbal teas (p=0.277). CONCLUSION: Priority should be given to preventing the early introduction on non-breast milks, especially in mother-infant pairs with associated risk factors.

[Bottle feeding during the first month of life: determinants and effect on breastfeeding technique]. / Uso de mamadeira no primeiro mês de vida: determinantes e influência na técnica de amamentação.

OBJECTIVE: To assess incidence rate and determinants of bottle feeding during the first month of life, and its potential effects on breastfeeding technique. METHODS: A nested cross-sectional study was conducted in a contemporary cohort in the city of Porto Alegre, Southern Brazil, between June and November 2003. A total of 211 pairs of healthy mothers and infants were followed up for a month. The effect of bottle feeding on breastfeeding technique was assessed by comparing five items unfavorable to mother-infant positioning and three items unfavorable to infant latch-on; and the average number of unfavorable items between the pairs who started bottle feeding in the first month of life and those who did not. A logistic regression analysis was carried out according to a hierarchical model. RESULTS: By Day 7, 21.3% of infants were bottle-fed and 46.9% were bottle-fed by Day 30. Living with maternal grandmother was associated with bottle feeding at Days 7 and 30. Maternal age <20 years, and nipple trauma at the maternity hospital were also associated with bottle feeding at Day 7. Other factors associated with bottle feeding at Day 3 were pacifier use at Day 7 and nipple trauma at Day 7. There was no association between the breastfeeding technique taught at the maternity hospital and subsequent bottle feeding. However, at Day 30, the breastfeeding technique was found to be more adequate among exclusively breast-fed infants than those who were also bottle fed. CONCLUSIONS: The study results showed that bottle feeding was quite widespread in the first month of life, mainly in infants born to teenage mothers, with nipple trauma, whose maternal grandmothers were living in the same household, and who were using pacifiers. Besides the already recognized negative effects, bottle feeding may negatively affect breastfeeding technique.

Sociobiodiversidade na Alimentação Escolar: os desafios e as potencialidades de um campo em construção no município de Mostardas-RS / Sociobiodiversity in School Meals: the challenges and potentialities of a field in construction in the municipality of Mostardas-RS

Resumo Este trabalho busca apreender os desafios que perpassam o processo, em curso, de inserção de alimentos da sociobiodiversidade na alimentação escolar, no município de Mostardas, no Rio Grande do Sul, bem como analisar os possíveis resultados desse movimento in loco. A respeito do percurso metodológico, em decorrência do contexto pandêmico de covid-19, foram realizadas entrevistas por telefone e/ou pelo aplicativo WhatsApp© com atores que tivessem, de algum modo, envolvimento no processo de inclusão de alimentos da sociobiodiversidade no Programa Nacional de Alimentação Escolar, como nutricionistas, comunidade escolar, entidades locais, agricultores(as) familiares e pesquisadores(as). Assim, recorreu-se à abordagem qualitativa, tanto para a geração do material empírico quanto para a análise dos dados. Acerca dos resultados, foram identificados desafios relacionados ao plano da produção, do consumo e do abastecimento. E, ainda, no âmbito das políticas públicas, foram constatados entraves relacionados ao acesso a determinados programas federais, burocracia dos processos e falta de iniciativas por parte do poder público local. Com relação aos possíveis desdobramentos do movimento em questão, os participantes manifestaram repercussões sobre a saúde, a qualidade da alimentação, o meio ambiente e a economia local, o que impactaria positivamente sobre a Soberania e a Segurança Alimentar e Nutricional.

Abstract This work seeks to understand the challenges that permeate the ongoing process of inserting sociobiodiversity foods into school meals, in the municipality of Mostardas, Rio Grande do Sul, and to analyze the possible results of this movement in loco. Regarding the methodological course, due to the covid-19 pandemic context, interviews were carried out by phone call and/or by the WhatsApp© application with actors who were somehow involved with the process of inclusion of sociobiodiversity foods in the National School Feeding Program, such as nutritionists, the school community, local entities, family farmers, and researchers. Thus, a qualitative approach was used, both for the generation of empirical material and for data analysis. Regarding the results, challenges related to the production, consumption, and supply plan were identified. And yet, in the scope of public policies, obstacles related to access to certain federal programs, bureaucracy of processes, and lack of initiatives on the part of the local government were found. Regarding the possible developments of the movement in question, the participants expressed repercussions on health, food quality, the environment, and the local economy, which would positively impact Food and Nutrition Sovereignty and Security.

Aceptabilidad de alimentos según sociodiversidad en comedores escolares de Brasil / Food acceptability according to sociodiversity in school canteens in Brazil

Una alimentación saludable en la escuela es fundamental para el crecimiento y desarrollo de los estudiantes, para su bienestar y su buen rendimiento escolar. El Programa Nacional de Alimentación Escolar (PNAE) de Brasil, en este sentido, pretende ofrecer una alimentación variada, segura y que respete la cultura, las tradiciones y los hábitos alimentarios saludables. Ante el escenario actual de malnutrición y de cambio climático, caracterizado por la Sindemia Global, desde diversos niveles gubernamentales se señala la importancia de incluir en los comedores escolares alimentos de la sociobiodiversidad, concepto definido en el Plan Nacional de Promoción de las Cadenas de Productos de la Sociobiodiversidad en Brasil en 2009. Objetivo. El estudio que se presenta tiene como objetivo evaluar la aceptabilidad de las preparaciones a base de productos de la sociobiodiversidad con estudiantes de escuelas públicas de Rio Grande do Sul (RS) y Rio Grande do Norte (RN), Brasil. Materiales y métodos. El trabajo forma parte de un estudio transversal y multicéntrico, con pruebas de adherencia y aceptabilidad de preparaciones a base de alimentos de la sociobiodiversidad realizado con estudiantes de escuelas públicas de RS y RN. Resultado. Se observó que las preparaciones obtuvieron excelentes porcentajes de adhesión, 100% en ambos estados, y de aceptabilidad, oscilando entre el 82 y el 97% de aceptación de las preparaciones. Conclusión. La alimentación puede ser utilizada en el ámbito escolar a partir de su potencial dialógico y socioeducativo para la transformación social y la promoción de la cohesión social en torno a dietas más sostenibles(AU)

Healthy nutrition at school is fundamental for the growth and development of students, for their well-being and good school performance. Brazil's National School Feeding Programme (PNAE) aims to offer a varied and safe diet that respects culture, traditions and healthy eating habits. Faced with the current scenario of malnutrition and climate change, characterised by the Global Syndemic, various levels of government have highlighted the importance of including sociobiodiverse foods in school feeding, a concept defined in the National Plan for the Promotion of Socio-biodiverse Product Chains in Brazil in 2009. Objective. The aim of this study is to evaluate the acceptability of preparations based on sociobiodiversity products with students from public schools in Rio Grande do Sul (RS) and Rio Grande do Norte (RN), Brazil. Materials and methods. The study is part of a cross-sectional, multicentre study, with adherence and acceptability tests of preparations based on sociobiodiversity foods carried out with students from public schools in RS and RN. Results. It was observed that the preparations obtained excellent percentages of adherence, 100% in both states, and acceptability, ranging from 82 to 97% of acceptance of the preparations. Conclusion. School feeding can be used in the school environment from its dialogical and socio-educational potential for social transformation and the promotion of social cohesion around more sustainable diets(AU)

[Effect of a healthy eating intervention on compliance with dietary recommendations in the first year of life: a randomized clinical trial with adolescent mothers and maternal grandmothers]. / Efeito de intervenção no cumprimento das recomendações alimentares no primeiro ano de vida: ensaio clínico randomizado com mães adolescentes e avós maternas.

The objective was to evaluate the effect of a healthy eating intervention targeting adolescent mothers and maternal grandmothers on compliance with dietary recommendations in the first year of life. This was a randomized clinical trial involving 320 adolescent mothers, their infants, and 169 maternal grandmothers (when the three generations were living together), randomly assigned to the intervention versus control group. The intervention consisted of six counseling sessions on healthy feeding during the child's first year of life, the first of which held at the maternity ward and the others at 7, 15, 30, 60, and 120 days, at the homes. Information on the infant's diet was obtained monthly during the first 6 months and then every 2 months until the child reached 12 months of age, using a Food Frequency Questionnaire, in addition to questions on mealtimes, consistency of the foods, hygiene, preparation of meals, conservation of foods, and the mother's or grandmother's approach to the child's diet in the presence of illness. The outcome was defined as meeting the Ten Steps to a Healthy Diet: A Food Guide for Children Under Two Years Old, assessed by a score. The mean sum of the scores for each step obtained in the intervention group was higher than in the control group; the intervention doubled the odds of the total score being greater than or equal to the median. Living with grandmother did not influence the score either in the intervention group or the control group. The proposed intervention had a positive effect on meeting the Ten Steps, independently of participation by the maternal grandmother, showing that educational interventions can improve quality of diet for children in the first year of life.

Effect of intervention to improve breastfeeding technique on the frequency of exclusive breastfeeding and lactation-related problems.

This randomized clinical trial compared frequencies of exclusive breastfeeding and lactation-related problems during the first 30 days among 74 mothers who received a 30-minute counseling session on breastfeeding technique in the maternity ward, and 137 controls. The frequency of exclusive breastfeeding among mothers who had received intervention was similar to controls by 7 days (79.7% vs 82.5%, respectively) and 30 days (60.8% vs 53.3%). There was no difference between groups in the frequency of sore nipples at 7 and 30 days, in breast engorgement and mastitis, and in the quality of breastfeeding technique at 30 days. Therefore, a single intervention at maternity was not sufficient to improve breastfeeding technique, increase exclusive breastfeeding rates, and reduce the incidence of breastfeeding problems during the first month.

Fatores associados à continuidade do aleitamento materno por 12 meses ou mais em mulheres trabalhadoras de um hospital geral / Factors associated with breastfeeding continuation for 12 months or more among working mothers in a general hospital

Resumo O objetivo deste estudo é identificar fatores associados à continuidade da amamentação por 12 meses ou mais em mulheres trabalhadoras. Estudo transversal realizado por meio de entrevista com 251 trabalhadoras de um hospital, com filhos biológicos entre 12 e 36 meses de idade, não gemelares e sem doença que afetasse a amamentação, e amamentando quando do seu retorno ao trabalho. Para a associação entre a continuidade da amamentação e as variáveis de exposição utilizou-se a regressão multivariável de Poisson. Apenas uma variável relacionada ao local de trabalho da mulher mostrou associação significativa com o desfecho. Trabalhar durante o dia aumentou em 37% a prevalência da amamentação por 12 meses ou mais. Os fatores não relacionados ao trabalho da mulher que mostraram associação positiva com o desfecho: mãe sem curso superior, experiência de amamentação superior a 12 meses; criança não receber outro leite quando a mãe retornou ao trabalho e não ter usado chupeta. Por outro lado, maior idade da mãe, maior idade gestacional, apoio do cuidador da criança e apoio profissional na amamentação associaram-se negativamente ao desfecho. Fatores não relacionados diretamente ao trabalho materno tiveram maior participação na continuidade da amamentação por 12 meses ou mais.

Abstract This article aims to identify factors associated with breastfeeding continuation for at least 12 months among working mothers in a hospital in the south of Brazil. We conducted a cross-sectional study, interviewing 251 women who breastfed after returning to work. Eligibility criteria included non-twin biological children aged between 12 and 36 months and the absence of an illness (mother and/or child) that could affect breastfeeding. The association between breastfeeding continuation and the exposure variables was tested using Poisson multivariate regression. Only one work-related variable showed a significant association with the outcome. Working only during the day increased the prevalence of BF continuation for at least 12 months by 37%. The following non-work-related factors showed a positive association with the outcome: mothers without a college degree; mothers with at least 12 months' prior breastfeeding experience; child not given milks other than breast milk when the mother returned to work, and not using a pacifier. The following variables showed a negative association with the outcome: older maternal age; older gestational age; mother receiving support from the child's caregiver; and mother receiving professional breastfeeding support. Non-work-related factors had a greater influence on breastfeeding continuation for at least 12 months among working mothers.

The Effect of a Pro-Breastfeeding and Healthy Complementary Feeding Intervention Targeting Adolescent Mothers and Grandmothers on Growth and Prevalence of Overweight of Preschool Children.

INTRODUCTION: The pattern and duration of breastfeeding (BF) and the age at onset of complementary feeding, as well as its quality, have been associated with the prevalence of overweight in childhood. OBJECTIVE: To assess the effect of a pro-BF and healthy complementary feeding intervention, targeted to adolescent mothers and maternal grandmothers, on growth and prevalence of overweight and obesity in children at preschool age. This intervention had a positive impact on duration of BF and timing of onset of complementary feeding. METHODS: This randomized clinical trial involved 323 adolescent mothers, their infants, and the infants' maternal grandmothers, when they cohabited. Mothers and grandmothers in the intervention group received counseling sessions on BF and healthy complementary feeding at the maternity ward and at home (7, 15, 30, 60, and 120 days after delivery). When children were aged 4 to 7 years, they underwent anthropometric assessment and collection of data on dietary habits. Multivariable Poisson regression with robust estimation was used for analysis. RESULTS: BMI-for-age and height-for-age were similar in the intervention and control groups, as was the prevalence of overweight (39% vs. 31% respectively; p=0.318). There were no significant between-group differences in dietary habits. CONCLUSION: Although the intervention prolonged the duration of exclusive BF and delayed the onset of complementary feeding, it had no impact on growth or prevalence of overweight at age 4 to 7 years. TRIAL REGISTRATION: ClinicalTrials.gov NCT00910377.

Involvement of maternal grandmother and teenage mother in intervention to reduce pacifier use: a randomized clinical trial / Participação da avó materna e mãe adolescente na intervenção para redução do uso de chupeta: um ensaio clínico randomizado

Abstract Objective: To assess the impact of an intervention for teenage mothers with the involvement of maternal grandmothers on the prevalence of pacifier use in the first six months of life. Methods: This randomized clinical trial involved 323 teenage mothers, allocated to four groups: intervention with teenagers only, intervention with teenagers and their mothers, and respective controls. Six breastfeeding counseling sessions, including the recommendation to avoid the use of a pacifier, were delivered at the maternity ward and subsequently at the teenagers' homes, at seven, 15, 30, 60, and 120 days postpartum. Data on infant feeding and pacifier use were collected monthly by interviewers blinded to group allocation. The impact of the intervention was measured by comparing survival curves for pacifier use in the first six months of life and mean time to pacifier introduction. Results: The intervention had a significant impact on reducing pacifier use only in the group in which grandmothers were involved. In this group, the intervention delayed by 64 days the introduction of a pacifier (21-85 days), compared to 25 days in the group without the participation of grandmothers (65-90 days). Conclusions: The intervention reduced pacifier use in the first six months of life and delayed its introduction until beyond the first month when grandmothers were involved. The intervention did not have a significant impact when only teenage mothers were involved.

Resumo Objetivo: Avaliar o impacto de uma intervenção para mães adolescentes com a participação de avós maternas na prevalência de uso de chupeta nos primeiros seis meses de vida. Métodos: Este ensaio clínico randomizado envolveu 323 mães adolescentes, alocadas para quatro grupos: intervenção com somente adolescentes, intervenção com adolescentes e suas mães e respectivos controles. Seis sessões de aconselhamento para amamentação, incluindo a recomendação de evitar o uso de chupeta, foram realizadas na maternidade e posteriormente nas casas das adolescentes ao 7°, 15°, 30°, 60° e 120° dias. Os dados sobre alimentação infantil e uso de chupeta foram coletados mensalmente por entrevistadores cegos a respeito da alocação dos grupos. O impacto da intervenção foi medido comparando as curvas de sobrevida para uso de chupeta nos primeiros 6 meses de vida e o tempo médio de introdução de chupetas. Resultados: A intervenção apresentou um impacto significativo sobre a redução do uso de chupeta somente no grupo em que as mães estiveram envolvidas. Nesse grupo, a intervenção mostrou atraso de 64 dias na introdução de chupeta (21 a 85 dias), em comparação a 25 dias no grupo sem a participação das avós (65 a 90 dias). Conclusões: A intervenção reduziu o uso de chupeta nos primeiros 6 meses de vida e atrasou sua introdução além do primeiro mês com a participação das avós. A intervenção não teve impacto significativo somente com o envolvimento das mães adolescentes.

Efeito de intervenção no cumprimento das recomendações alimentares no primeiro ano de vida: ensaio clínico randomizado com mães adolescentes e avós maternas / Effect of a healthy eating intervention on compliance with dietary recommendations in the first year of life: a randomized clinical trial with adolescent mothers and maternal grandmothers / Efecto de intervención en el cumplimiento de las recomendaciones alimentarias durante el primer año de vida: ensayo clínico randomizado con madres adolescentes y abuelas maternas

Avaliar o efeito de intervenção pró-alimentação saudável direcionada a mães adolescentes e avós maternas no cumprimento das recomendações alimentares no 1º ano de vida. Ensaio clínico randomizado envolvendo 320 adolescentes, seus filhos e 169 avós maternas, quando em coabitação, randomicamente alocados para o grupo intervenção ou controle. A intervenção consistiu de seis sessões de aconselhamento em alimentação saudável durante o 1º ano de vida da criança, a primeira na maternidade e as demais aos 7, 15, 30, 60 e 120 dias, nos domicílios. As informações relativas à alimentação da criança foram obtidas mensalmente nos primeiros 6 meses e, depois, a cada 2 meses até a criança completar 12 meses, por meio de Questionário de Frequência Alimentar, além de perguntas sobre horários de refeições, consistência dos alimentos, cuidado com a higiene, preparo e conservação dos alimentos e conduta do cuidador com a alimentação da criança na vigência de doenças. Como desfecho, considerou-se o cumprimento dos Dez Passos para uma Alimentação Saudável: Guia Alimentar para Crianças Menores de Dois Anos, avaliado por meio de um escore. A média do somatório dos escores de cada passo obtidos no grupo intervenção foi maior que a do grupo controle; a intervenção dobrou a chance de o escore total ser maior ou igual à mediana. A coabitação com as avós não influenciou os escores, nem no grupo intervenção nem no grupo controle. A intervenção proposta teve efeito positivo no cumprimento dos Dez Passos, independentemente da participação da avó materna, mostrando que intervenções educativas podem melhorar a qualidade da alimentação das crianças no 1º ano de vida.

The objective was to evaluate the effect of a healthy eating intervention targeting adolescent mothers and maternal grandmothers on compliance with dietary recommendations in the first year of life. This was a randomized clinical trial involving 320 adolescent mothers, their infants, and 169 maternal grandmothers (when the three generations were living together), randomly assigned to the intervention versus control group. The intervention consisted of six counseling sessions on healthy feeding during the child's first year of life, the first of which held at the maternity ward and the others at 7, 15, 30, 60, and 120 days, at the homes. Information on the infant's diet was obtained monthly during the first 6 months and then every 2 months until the child reached 12 months of age, using a Food Frequency Questionnaire, in addition to questions on mealtimes, consistency of the foods, hygiene, preparation of meals, conservation of foods, and the mother's or grandmother's approach to the child's diet in the presence of illness. The outcome was defined as meeting the Ten Steps to a Healthy Diet: A Food Guide for Children Under Two Years Old, assessed by a score. The mean sum of the scores for each step obtained in the intervention group was higher than in the control group; the intervention doubled the odds of the total score being greater than or equal to the median. Living with grandmother did not influence the score either in the intervention group or the control group. The proposed intervention had a positive effect on meeting the Ten Steps, independently of participation by the maternal grandmother, showing that educational interventions can improve quality of diet for children in the first year of life.

Evaluar el efecto de intervención pro-alimentación saludable, dirigida a madres adolescentes y abuelas maternas, en el cumplimiento de las recomendaciones alimentarias durante el 1º año de vida. Ensayo clínico randomizado involucrando a 320 adolescentes, sus hijos y 169 abuelas maternas, cuando en cohabitación, randómicamente se asignan al grupo de intervención o control. La intervención consistió en seis sesiones de asesoramiento en alimentación saludable durante el primer año de vida del niño, la primera en la maternidad y las demás a los 7, 15, 30, 60 y 120 días, en los domicilios. La información relativa a la alimentación del niño fueron obtenidas mensualmente durante los primeros 6 meses y, después, cada 2 meses hasta que el niño completara los 12 meses, mediante un Cuestionario de Frecuencia Alimentaria, además de preguntas sobre horarios de comidas, consistencia de los alimentos, cuidado con la higiene, preparación y conservación de los alimentos y conducta del cuidador con la alimentación del niño en la vigencia de enfermedades. Como desenlace, se consideró el cumplimiento de los Diez Pasos para una Alimentación Saludable: Guía Alimentaria para Niños Menores de Dos Años, evaluado mediante un marcador. La media de la suma de los marcadores de cada paso, obtenidos en el grupo de intervención, fue mayor que la del grupo control; la intervención dobló la oportunidad de que un marcador total fuera mayor o igual a la media. La cohabitación con las abuelas no influenció los marcadores, ni en el grupo de intervención, ni en el grupo de control. La intervención propuesta tuvo un efecto positivo en el cumplimiento de los Diez Pasos, independientemente de la participación de la abuela materna, mostrando que las intervenciones educativas pueden mejorar la calidad de la alimentación de los niños durante el 1º año de vida.

Impact of a strategy to prevent the introduction of non-breast milk and complementary foods during the first 6 months of life: a randomized clinical trial with adolescent mothers and grandmothers.

INTRODUCTION: Although the disadvantages of introducing non-breast milk and the early introduction of complementary foods are known, such practices are common worldwide. OBJECTIVE: To evaluate the efficacy of counseling about breastfeeding and complementary feeding in preventing the introduction of non-breast milk and complementary foods in the first 6 months. METHODS: This randomized clinical trial enrolled 323 adolescent mothers and their newborns and 169 maternal grandmothers; 163 mothers and 88 grandmothers received five counseling sessions on breastfeeding while in the hospital and at 7, 15, 30, and 60 days, and one session on complementary feeding at 120 days. Data about infant feeding were collected monthly. The impact was evaluated by comparing the Kaplan-Meier survival curves for the time of introduction of non-breast milk and complementary foods of the control and intervention groups. Median time of introduction of milk was calculated in the two groups. RESULTS: The survival curves showed that the intervention postponed the introduction of non-breast milk and complementary foods. At 4 months, 41% (95% CI, 32.8-49.2) of the infants in the control group received complementary foods in comparison to 22.8% (95% CI, 15.9-29.7) of the intervention group. Counseling postponed the introduction of non-breast milk, which occurred at 95 days (95% CI, 8.7-111.3) in the control group and at 153 days (95% CI, 114.6-191.4) in the intervention group. CONCLUSIONS: Counseling sessions on infant's first 4 months were an efficacious strategy to prevent the introduction of non-breast milk and complementary foods in the 6 months of life.

Reduction of unnecessary intake of water and herbal teas on breast-fed infants: a randomized clinical trial with adolescent mothers and grandmothers.

PURPOSE: To evaluate the efficacy of counseling sessions on breast-feeding for adolescent mothers and maternal grandmothers on the reduction of unnecessary water and herbal teas intake on breast-fed infants. METHODS: A randomized clinical trial was conducted involving adolescent mothers, newborn infants, and maternal grandmothers allocated into four groups: mother and grandmother not cohabitating, without intervention; mother and grandmother not cohabitating, with intervention directed only toward mother; mother and grandmother cohabitating, without intervention; and mother and grandmother cohabitating, with intervention directed toward both. The intervention consisted of six counseling sessions on breastfeeding: in the maternity ward, and after birth on days 7, 15, 30, 60, and 120 at home. The data about feeding practices were collected by telephone every month until the end of the sixth month of the baby's life. The effect of the intervention was measured by comparing the medians and the survival curves for initiation of water and/or tea intake in the first 6 months of life, and Cox regression was used to estimate its magnitude. RESULTS: The intervention had a positive effect for the group in which the adolescent mothers cohabitated with the baby's grandmother (hazard ratio = .53; 95% confidence interval = .35-.80), and also for the group in which they did not cohabitate with the baby's grandmother (hazard ratio = .48; 95% confidence interval = .31-.76). By comparing the medians of the time of initiation of water and/or tea intake between control and intervention groups, it was observed that the intervention postponed the use of these liquids in 67 days in the group in which mothers and grandmothers cohabitated and in 44 days in the group in which they did not live together. CONCLUSION: Multiple counseling sessions on infant feeding in the first 4 months postpartum for adolescent mothers and maternal grandmothers, when they cohabitate, proved to be an effective strategy to postpone the unnecessary water and/or tea intake of breast-fed infants.

Estado nutricional e hábitos alimentares de usuários em centro de atenção psicossocial de Porto Alegre, Brasil / Nutritional status and food habits of users in a psychosocial care center in Porto Alegre, Brazil

Introdução: O Centro de Atenção Psicossocial (CAPS) trabalha com o desenvolvimento de autonomia e responsabilização do usuário no seu tratamento. Levantamentos epidemiológicos mostraram que há relação entre Índice de Massa Corporal (IMC) e transtornos psiquiátricos, sendo a obesidade um desafio para usuários e trabalhadores da saúde mental. Sendo assim, o objetivo deste estudo é avaliar o estado nutricional e os hábitos alimentares de usuários de um CAPS em Porto Alegre, Brasil. Métodos: Estudo transversal desenvolvido com 40 usuários. O estado nutricional foi avaliado pela classificação do IMC e circunferência da cintura, e os hábitos alimentares foram avaliados com um questionário publicado no Guia Alimentar da População Brasileira e um questionário com perguntas referentes ao tipo de transtorno mental, comorbidades e estilo de vida. A análise foi descritiva em frequência e percentuais. Resultados: A patologia mais frequente foi a esquizofrenia (65,9%). A obesidade apresentou maior prevalência (45%) e a circunferência da cintura apresentou valores acima do recomendado. Foi verificada grande alteração nos hábitos alimentares dos usuários. De acordo com o questionário proposto, 85,4% dos usuários precisam melhorar a alimentação, pois foi observado baixo consumo de frutas, verduras e legumes e grande consumo de açúcares, gorduras e produtos industrializados. Conclusão: Grande parte dos pacientes psiquiátricos apresentou excesso de peso e valor de circunferência da cintura elevada, além de hábitos alimentares pouco saudáveis, importantes fatores de risco para doenças crônicas.

Introduction: The Psychosocial Care Center (PSCC) works towards developing the user’s autonomy and accountability in the treatment. Epidemiological surveys have shown that there is a correlation between Body Mass Index (BMI) and psychiatric disorders, and obesity in particular poses a challenge for users and mental health workers. Thus, the objective of the study is to assess the nutritional status and dietary habits of the users of a PSCC from Porto Alegre, Brazil. Methods: Cross-sectional study carried out with 40 users. Nutritional assessment was performed according to the classification of BMI and waist circumference. For the evaluation of eating habits, we used a questionnaire published on the Food. Guide of the Brazilian Population as well as questions regarding the type of mental disorder, comorbidity, and lifestyle. The analysis was descriptive of frequency and percentages. Results: The most frequent pathology was schizophrenia (65.9%). Obesity was more prevalent (45%) and waist circumference showed values above the recommended. A major change was seen in the dietary habits of users. According to the proposed questionnaire, 85.4% of users need to improve their eating habits since we observed low consumption of fruits and vegetables, and high intake of sugars, fats, and processed products. Conclusion: The majority of psychiatric patients presented with excess weight and high values of waist circumference, as well as poor dietary habits, which are all major risk factors for chronic diseases.

Factors associated with low incidence of exclusive breastfeeding for the first 6 months.

BACKGROUND: The identification of factors that are associated with early cessation of exclusive breastfeeding is important for defining strategies for the promotion of exclusive breastfeeding. The objective of this study was to identify the determinants of exclusive breastfeeding cessation before 6 months, including variables that generally receive little attention, such as the influence of grandmothers, breastfeeding technique, and sore nipples. METHODS: This prospective study follows a cohort of 220 healthy mother-baby pairs from birth to 6 months, living in Porto Alegre, Brazil. Data were collected at the maternity unit, during a home visit at 30 days, and by telephone interview at 60, 120, and 180 days. Breastfeeding technique was assessed and breasts examined at the maternity unit and during home visits. Cox regression was employed to estimate the degree of association between the variables and the outcome. RESULTS: The following factors were associated with cessation of exclusive breastfeeding before 6 months: adolescent mother (hazard ratio [HR] = 1.48, 95% CI 1.01-2.17), fewer than six prenatal visits (HR = 1.60, 95% CI 1.10-2.33), use of a pacifier within the first month (HR = 1.53, 95% CI 1.12-2.11), and poor latch-on (HR = 1.29, 95% CI 1.06-1.58 for each unfavorable parameter). CONCLUSIONS: Activities to promote exclusive breastfeeding should be intensified for adolescent mothers and for those whose prenatal care was less than ideal. These activities should reinforce the ill effects of pacifiers and should also include appropriate instruction for these mothers in correct breastfeeding technique.

A influência das avós no aleitamento materno exclusivo / The influence of grandmothers on exclusive breastfeeding

O aleitamento materno envolve mudanças corporais, alterações de humor e interferências ambientais, principalmente o contato com a mãe ou sogra, que interferem na duração e exclusividade do aleitar. O presente estudo tem como objetivo verificar a influência das avós no padrão de aleitamento materno nos primeiros seis meses de vida. As avós, na maioria das sociedades, são referências familiares e não consideram a exclusividade do aleitamento suficiente para manter o estado nutricional adequado, oferecendo precocemente diversos alimentos aos seus netos. O estudo apresenta delineamento de revisão bibliográfica e os seguintes critérios de refinamento: publicações nos últimos 20 anos; em português, inglês, ou espanhol; exclusão de textos coincidentes e seleção de textos de interesse. Os artigos foram analisados segundo autor, ano, local, número de sujeitos envolvidos, metodologia e tipo de influência exercida. No total foram 53 artigos, e destes, 23 atendiam ao critério de refinamento, a fim de servir aos objetivos do trabalho. Assim, se vê que a avó influencia negativamente na alimentação exclusiva, embora alguns estudos apontem que a intervenção em parentes próximos, em especial a avó, revelou uma adesão às práticas corretas de aleitamento exclusivo, provando assim a importância da realização de intervenções com essas cuidadoras.

Maternal breastfeeding involves factors such as body changes, emotional turmoil, and environmental interferences, especially the contact with the child's grandmothers, who interfere in the duration and exclusiveness of breastfeeding. The objective of this study is to examine the influence of grandmothers in the maternal breastfeeding pattern in the first six months of life. Grandmothers, in most societies, are regarded as models in the family and do not consider the exclusiveness of breastfeeding sufficient to provide their grandchildren with good nutritional status; therefore, there is early introduction of many types of foods to children. This study is a literature review with the following inclusion criteria: articles published in the last 20 years; in Portuguese, English, or Spanish; exclusion of coincident texts, and selection of texts related to the subject. The articles were analyzed based on authorship, year, place, number of subjects involved, methodology, and type of influence. A total of 53 articles were analyzed. Of these, 23 met the inclusion criteria. We found that grandmothers have a negative influence on exclusive feeding, although some studies have shown that intervention involving close relatives, grandmothers in particular, revealed adhesion to correct exclusive breastfeeding practices, thus confirming the importance of implementing such interventions in these caregivers.

Uso de mamadeira no primeiro mês de vida: determinantes e influência na técnica de amamentação / Bottle feeding during the first month of life: determinants and effect on breastfeeding technique

OBJETIVO: Analisar a incidência e os determinantes do uso de mamadeira no primeiro mês de vida e possíveis efeitos dessa prática na técnica de amamentação. MÉTODOS: Estudo transversal aninhado em uma coorte contemporânea de Porto Alegre, RS, de junho a novembro de 2003. Durante um mês foram acompanhados 211 pares de mãe e criança. A influência do uso de mamadeira sobre a técnica de amamentação foi avaliada comparando-se as freqüências de cinco itens desfavoráveis ao posicionamento mãe/criança e três itens desfavoráveis à pega da criança; e as médias do número de itens desfavoráveis entre as duplas que iniciaram o uso mamadeira no primeiro mês e as que não o fizeram. A regressão logística estimou o grau de associação das variáveis com os desfechos, utilizando modelo hierarquizado. RESULTADOS: Aos sete dias, 21,3 por cento das crianças usavam mamadeira e, aos 30 dias, 46,9 por cento. Coabitação com a avó materna esteve associada com uso de mamadeira tanto aos sete quanto aos 30 dias. Também estiveram associados ao uso de mamadeira aos sete dias: a mãe ser adolescente e trauma mamilar na maternidade. Os outros dois fatores associados ao uso de mamadeira aos 30 dias foram trauma mamilar aos sete dias e uso de chupeta aos sete dias. Não houve associação entre técnica de amamentação ensinada na maternidade e uso de mamadeira, mas aos 30 dias, crianças que usavam mamadeira apresentaram técnica menos adequada às que sugavam só no peito. CONCLUSÕES: Os resultados mostram que a mamadeira foi bastante utilizada no primeiro mês de vida, principalmente: em crianças com mães adolescentes e com trauma mamilar, cujas avós maternas estavam presentes no domicílio e que faziam uso de chupeta. Além dos efeitos negativos já conhecidos, a mamadeira pode influenciar negativamente a técnica de amamentação.

OBJECTIVE: To assess incidence rate and determinants of bottle feeding during the first month of life, and its potential effects on breastfeeding technique. METHODS: A nested cross-sectional study was conducted in a contemporary cohort in the city of Porto Alegre, Southern Brazil, between June and November 2003. A total of 211 pairs of healthy mothers and infants were followed up for a month. The effect of bottle feeding on breastfeeding technique was assessed by comparing five items unfavorable to mother-infant positioning and three items unfavorable to infant latch-on; and the average number of unfavorable items between the pairs who started bottle feeding in the first month of life and those who did not. A logistic regression analysis was carried out according to a hierarchical model. RESULTS: By Day 7, 21.3 percent of infants were bottle-fed and 46.9 percent were bottle-fed by Day 30. Living with maternal grandmother was associated with bottle feeding at Days 7 and 30. Maternal age <20 years, and nipple trauma at the maternity hospital were also associated with bottle feeding at Day 7. Other factors associated with bottle feeding at Day 3 were pacifier use at Day 7 and nipple trauma at Day 7. There was no association between the breastfeeding technique taught at the maternity hospital and subsequent bottle feeding. However, at Day 30, the breastfeeding technique was found to be more adequate among exclusively breast-fed infants than those who were also bottle fed. CONCLUSIONS: The study results showed that bottle feeding was quite widespread in the first month of life, mainly in infants born to teenage mothers, with nipple trauma, whose maternal grandmothers were living in the same household, and who were using pacifiers. Besides the already recognized negative effects, bottle feeding may negatively affect breastfeeding technique.