RESUMO
Background: Maternal overweight, infant feeding and early growth velocity are risk factors for obesity later in life. The first one thousand days are a window of opportunity to program health and disease. Exclusive breastfeeding may protect against obesity; however, it is not consistently practiced. Obesity rates have been increasing worldwide. Overweight or obese women have lower rates of breastfeeding and face mechanical, psychological and biological difficulties. Breastfeeding counselling is a successful strategy to support breastfeeding in normal weight women; but there is a lack of evidence on its effectiveness in overweight women. Our purpose is to evaluate a new approach to exclusive breastfeeding counselling based on Carl Rogers' Centred-Client Theory in overweight women, and to examine effects on breastfeeding prevalence, infant growth velocity and maternal postpartum weight loss. Methods: A two-arm simple randomized controlled trial will be conducted in overweight and obese women recruited in a Baby Friendly Hospital in Bogotá, Colombia. The intervention is exclusive breastfeeding counselling based on Rogers' theory but adapted for overweight women; it will be performed during the last month of pregnancy, 24 h after delivery and during early infancy (1 and 3 months postpartum). The primary outcomes will be exclusive breastfeeding prevalence, infant growth velocity and maternal weight loss from birth up to 4 months after delivery; and the secondary outcomes will be prolactin and macronutrient levels in breast milk and serum prolactin levels. Intention to treat analysis will be performed to estimate the effect of the new counselling approach compared to standard management on the prevalence of exclusive breastfeeding, infant growth velocity and maternal weight loss. Discussion: We hypothesize that the intervention will result in an increase in the initiation and maintenance of exclusive breastfeeding, allowing adequate infant growth velocity and maternal weight loss after delivery. It is hoped that the results of this trial will provide evidence to support public health policy on supporting breastfeeding in this vulnerable group of women. Trial registration: (UTN) U1111-1228-9913 February 20th 2019; ISRCTN15922904February 27th 2019, retrospectively registered.
Assuntos
Aleitamento Materno/estatística & dados numéricos , Mães/psicologia , Obesidade/psicologia , Sobrepeso/psicologia , Complicações na Gravidez/psicologia , Adulto , Aleitamento Materno/psicologia , Desenvolvimento Infantil , Colômbia/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Período Pós-Parto/psicologia , Gravidez , Prevalência , Ensaios Clínicos Controlados Aleatórios como Assunto , Redução de Peso , Adulto JovemRESUMO
OBJECTIVE: The aim of the study was to use linear programming (LP) analyses to adapt New Complementary Feeding Guidelines (NCFg) designed for infants aged 6 to 12 months living in poor socioeconomic circumstances in Bogota to ensure dietary adequacy for young children aged 12 to 23 months. DESIGN: A secondary data analysis was performed using dietary and anthropometric data collected from 12-month-old infants (nâ=â72) participating in a randomized controlled trial. LP analyses were performed to identify nutrients whose requirements were difficult to achieve using local foods as consumed; and to test and compare the NCFg and alternative food-based recommendations (FBRs) on the basis of dietary adequacy, for 11 micronutrients, at the population level. RESULTS: Thiamine recommended nutrient intakes for these young children could not be achieved given local foods as consumed. NCFg focusing only on meat, fruits, vegetables, and breast milk ensured dietary adequacy at the population level for only 4 micronutrients, increasing to 8 of 11 modelled micronutrients when the FBRs promoted legumes, dairy, vitamin A-rich vegetables, and chicken giblets. None of the FBRs tested ensured population-level dietary adequacy for thiamine, niacin, and iron unless a fortified infant food was recommended. CONCLUSIONS: The present study demonstrated the value of using LP to adapt NCFg for a different age group than the one for which they were designed. Our analyses suggest that to ensure dietary adequacy for 12- to 23-month olds these adaptations should include legumes, dairy products, vitamin A-rich vegetables, organ meat, and a fortified food.
Assuntos
Alimentos Fortificados/estatística & dados numéricos , Fenômenos Fisiológicos da Nutrição do Lactente , Micronutrientes/deficiência , Recomendações Nutricionais , Fatores Etários , Estudos de Casos e Controles , Colômbia , Feminino , Alimentos Fortificados/análise , Humanos , Lactente , Fórmulas Infantis/análise , Transtornos da Nutrição do Lactente/prevenção & controle , Ferro da Dieta , Modelos Lineares , Masculino , Micronutrientes/administração & dosagem , Leite Humano , Niacina/deficiência , Pobreza , Tiamina/administração & dosagem , Deficiência de Tiamina/prevenção & controleRESUMO
OBJECTIVES: The optimal age for introducing complementary feeding to breast-fed infants may differ depending on the setting. Prolonged exclusive breast-feeding (EBF) protects against infection but may increase the risk of iron deficiency (ID)/anaemia (IDA) in vulnerable infants. The aim of the present study was to compare haemoglobin (Hb), serum ferritin (SF), anaemia (Hbâ<â11 g/L), ID (SFâ<â12âµg/L) and IDA (Hbâ<â10.5âg/dL + Hctâ<â33% + ID) using observational analyses in 6-month old infants from Bogota, Colombia who were EBF for 4 to 5 versus 6 months or older, and examine predictors. METHODS: Infant feeding was recorded, anthropometry performed, and blood obtained for Hb and SF at 6 months in healthy term infants (birth weightâ>â2500 g), all EBF for ≥4 months. RESULTS: One hundred eight infants (54% boys) were recruited; 46% EBF for 4 to 5 months, 54% EBF at 6 months. Prevalence of anaemia, ID, and IDA was 20%, 10%, and 5%, with no significant difference between EBF4-5 and EBF6 groups. In multivariate models, anaemia/ID were predicted by greater weight gain from 0 to 6 months, and anaemia also by caesarean delivery; Hb was lower in infants with higher intake of cows' milk; SF was lower in boys and those with greater weight gain. EBF4-5 versus EBF6 was not a significant predictor of any outcome. CONCLUSIONS: Anaemia and ID were common at 6 months but were not affected by EBF for 4 to 5 versus 6 months, suggesting 6 months EBF is safe in this population. Further research is, however, required to examine effects on later iron status. The findings highlight the need to emphasise avoidance of cow's milk before 12 months.
Assuntos
Anemia Ferropriva/etiologia , Aleitamento Materno/métodos , Fenômenos Fisiológicos da Nutrição do Lactente , Fatores Etários , Anemia Ferropriva/sangue , Anemia Ferropriva/diagnóstico , Anemia Ferropriva/epidemiologia , Biomarcadores/sangue , Aleitamento Materno/efeitos adversos , Aleitamento Materno/estatística & dados numéricos , Colômbia/epidemiologia , Feminino , Ferritinas/sangue , Hemoglobinas/metabolismo , Humanos , Lactente , Recém-Nascido , Masculino , Prevalência , Fatores de Risco , Fatores de TempoRESUMO
BACKGROUND: Iron deficiency and poor linear growth are common in infants from deprived socioeconomic backgrounds and may be associated with inadequate complementary feeding (CF) practices. OBJECTIVE: We tested the hypothesis that new CF guidelines emphasizing meat as a source of iron and zinc would improve linear growth, iron, and zinc status in infants living in poor socioeconomic circumstances in Bogota, Colombia. DESIGN: A total of 85 term infants who were exclusively breastfed for ≥4 mo were randomly assigned at 6 mo of age to a control group [CG (n = 43); current advice] or intervention group (new guidelines group [NGG (n = 42); with counseling to 1) continue breastfeeding, 2) offer red meat ≥3 d/wk, and 3) offer fruit and vegetables daily]). Main outcomes were 1) linear growth from 6 to 12 mo of age; 2) hemoglobin, hematocrit, iron [serum ferritin (SF)], and zinc status at 12 mo of age; and 3) meat intake at 12 mo of age (by using a food-frequency questionnaire). RESULTS: A total of 38 infants/group provided data at 12 mo of age. NGG infants had significantly higher red meat intake [mean ± SD: 5.4 ± 1.8 compared with 3.5 ± 1.7 d/wk at 12 mo of age; P < 0.001), higher hemoglobin and hematocrit at 12 mo of age, and a significantly greater increase in hemoglobin (mean ± SD change: 0.41 ± 0.8 compared with -0.13 ± 1.0; P = 0.01) and hematocrit (1.04 ± 2.2 compared with -0.15 ± 2.4; P = 0.03) from 6 to 12 mo of age than those in CG infants. There were no significant differences in linear growth from 6 to 12 mo of age or in SF or zinc. CONCLUSIONS: The new guidelines showed efficacy with higher red meat intake and positive effects on hemoglobin and hematocrit. The intervention was acceptable and affordable for most mothers. These preliminary results suggest that the intervention merits investigation in a larger cohort with longer-term follow-up. This trial was registered at http://isrctn.org as ISRCTN57733004.
Assuntos
Fenômenos Fisiológicos da Nutrição do Lactente , Carne , Animais , Estatura , Aleitamento Materno , Colômbia , Dieta , Seguimentos , Frutas , Hematócrito , Hemoglobinas/análise , Humanos , Lactente , Alimentos Infantis , Fenômenos Fisiológicos da Nutrição do Lactente/fisiologia , Ferro da Dieta/administração & dosagem , Política Nutricional , Estado Nutricional , Segurança , Verduras , Zinco/administração & dosagemRESUMO
La obesidad se ha considerado como una pandemia a nivel mundial, siendo más prevalente en los países desarrollados, pero con un incremento acelerado en los países en desarrollo como consecuencia de la transición epidemiológica dada por el desarrollo y las mejores condiciones económicas que favorecen el acceso a alimentos de alta densidad energética. América Latina y Colombia en ésta se encuentra en medio de la llamada transición epidemiológica, donde los problemas de salud tales como la desnutrición y las enfermedades infecciosas, coexisten con las enfermedades no transmisibles como la obesidad, la diabetes, las enfermedades cardiovasculares y el cáncer, patologías características de países desarrollados. En Colombia no se cuenta con estadísticas recientes que den un panorama del problema a nivel nacional, sin embargo, se observa que la desnutrición aguda ha dado un descenso marcado y la obesidad en algunas regiones comienza a emerger como un problema de salud pública, por ejemplo en Bogotá donde no se reportaba y para el año 2001 ya alcanza aproximadamente el 1 por ciento, porcentaje similar al de la desnutrición aguda con un 1,3 por ciento