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[This corrects the article DOI: 10.1371/journal.pone.0151097.].

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Introduction Breastfeeding is an important determinant of child survival and normal growth and development, but breastfeeding prevalence is generally low in Brazil. Factors associated with infant feeding practices there are not well understood. This paper examines factors associated with breastfeeding cessation in a township in the western Brazilian Amazon. Methods A cross-sectional, population-based study was conducted among children younger than 25 months and collected information on maternal and child characteristics. Survival analysis based on a proximal-distal framework examined the association between breastfeeding duration and socioeconomic and maternal/child biological factors. Results The median breastfeeding duration among 101 children who were no longer breastfeeding was 120 days. Almost two-thirds (63 %) of these children stopped breastfeeding before 6 months of age. In the larger sample of 209 children, 74.6 % had previously been bottle-fed. Considering the full proximal-distal model, a child who had ever been bottle-fed was expected to cease breastfeeding about 88 % sooner than one who was never bottle-fed (p < 0.001). Children in the second-poorest wealth quartile stopped breastfeeding sooner than children in the poorest quartile (p < 0.05). Discussion Breastfeeding cessation in the study area occurred much earlier than the recommended 2 years of age. Factors associated with ending breastfeeding early included ever-use of a bottle, having a single mother, and belonging to the second-poorest wealth quartile. Further research is needed to better understand these factors and other barriers women face to continuing breastfeeding.

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BACKGROUND: Multiple micronutrients in powder (MNP) are recommended by WHO to prevent anemia in young children. However, evidences for its effectiveness in different populations and improvements in other outcomes (e.g. linear growth and vitamin A deficiency) are scarce. METHODS: A multicentre pragmatic controlled trial was carried out in primary health centres. At study baseline, a control group (CG) of children aged 10- to 14 months (n = 521) was recruited in the routine healthcare for assessing anemia, anthropometric and micronutrient status. At the same time, an intervention group (IG) of infants aged 6- to 8 months (n = 462) was recruited to receive MNP daily in complementary feeding over a period of 60 days. Both study groups were compared when the IG infants reached the age of the CG children at enrolment. RESULTS: In CG, the prevalence of anemia [hemoglobin (Hb) < 110 g/L], iron deficiency (ID, plasma ferritin < 12 µg/L or TfR > 8.3 mg/L), and vitamin A deficiency (VAD, serum retinol < 0.70µmol/L) were 23.1%, 37.4%, and 17.4%, respectively. Four to six months after enrolment, when the IG participants had the same age of the controls at the time of testing, the prevalence of anemia, ID and VAD in IG were 14.3%, 30.1% and 7.9%, respectively. Adjusting for city, health centre, maternal education, and age, IG children had a lower likelihood of anemia and VAD [Prevalence Ratio (95% CI) = 0.63 (0.45, 0.88) and 0.45 (0.29, 0.69), respectively] when compared with CG children. The adjusted mean distributions of Hb and length-for-age Z-scores improved by 2 SE in the IG compared to CG children. CONCLUSIONS: MNP effectively reduced anemia and improved growth and micronutrient status among young Brazilian children. TRIAL REGISTRATION: Registro Brasileiro de Ensaios Clinicos RBR-5ktv6b.

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Low- to middle-income countries may experience the occurrence of a dual burden of under and overnutrition. To better understand the overall progression of body mass index (BMI) during childhood, we estimated average BMI-for-age z-score (BAZ) growth curves in a population-based longitudinal study of 255 children living in the Brazilian Amazon. Children were aged 0.1-5.5 years at recruitment (2003). We collected data on socio-economic and maternal characteristics, children's birthweight and infant feeding practices. Child anthropometric measurements were taken in 2003, 2007 and 2009. BAZ differences among categories of exposure variables were calculated at 6 and 12 months, and 2, 7 and 10 years. At baseline, the mean (standard deviation) age was 2.6 (1.4) years; 12.9% were overweight and 3.9% thin. After adjustment, mean BAZ estimates were mostly negative. Boys were close to the median value for BAZ until 12 months, whereas girls were below the median (P=0.05). Children from households above the wealth median were 0.36 z- and 0.49 z-less underweight than poorer children at 7 and 10 years, respectively (P<0.01). Maternal BMI was positively associated with children's BAZ since 12 months old; BAZ in children from overweight mothers was higher by 0.69 compared with their counterparts at 10 years (P<0.01). Birthweight was positively related to BAZ up until 2 years (P=0.01). Socio-economic background and maternal nutritional status are important predictors of BAZ throughout childhood. Although excessive weight gain is a public health concern, it is critical to restrict inequities, while promoting healthier growth in developing countries.

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BACKGROUND: Although linear growth during childhood may be affected by early-life exposures, few studies have examined whether the effects of these exposures linger on during school age, particularly in low- and middle-income countries. METHODS: We conducted a population-based longitudinal study of 256 children living in the Brazilian Amazon, aged 0.1 y to 5.5 y in 2003. Data regarding socioeconomic and maternal characteristics, infant feeding practices, morbidities, and birth weight and length were collected at baseline of the study (2003). Child body length/height was measured at baseline and at follow-up visits (in 2007 and 2009). Restricted cubic splines were used to construct average height-for-age Z score (HAZ) growth curves, yielding estimated HAZ differences among exposure categories at ages 0.5 y, 1 y, 2 y, 5 y, 7 y, and 10 y. RESULTS: At baseline, median age was 2.6 y (interquartile range, 1.4 y-3.8 y), and mean HAZ was -0.53 (standard deviation, 1.15); 10.2% of children were stunted. In multivariable analysis, children in households above the household wealth index median were 0.30 Z taller at age 5 y (P = 0.017), and children whose families owned land were 0.34 Z taller by age 10 y (P = 0.023), when compared with poorer children. Mothers in the highest tertile for height had children whose HAZ were significantly higher compared with those of children from mothers in the lowest height tertile at all ages. Birth weight and length were positively related to linear growth throughout childhood; by age 10 y, children weighing >3500 g at birth were 0.31 Z taller than those weighing 2501 g to 3500 g (P = 0.022) at birth, and children measuring ≥51 cm at birth were 0.51 Z taller than those measuring ≤48 cm (P = 0.005). CONCLUSIONS: Results suggest socioeconomic background is a potentially modifiable predictor of linear growth during the school-aged years. Maternal height and child's anthropometric characteristics at birth are positively associated with HAZ up until child age 10 y.

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