RESUMO
BACKGROUND: Although childhood obesity is increasing in low-income regions, theoretical models cannot be adequately applied due to the lack of prospective studies with under 2-year-old children from impoverished populations. OBJECTIVE: To analyse direct and indirect effects of environmental, maternal, and individual factors on excess weight gain among low-income children during the first year of life. METHODS: We analysed data from a prospective birth cohort conducted in Brazil, which followed infants at birth, 3rd, 6th, and 12th month of life (n = 205). The weight-for-age z-score was used to calculate the conditional weight gain (CWG). Direct and indirect effects on CWG were estimated using structural equation modelling. RESULTS: Children's consumption of ultra-processed food (UPF) ≥1 time/day, breastfeeding duration >90 days, and maternal obesity showed a statistically significant direct effect on children's CWG. We observed a positive indirect pathway linking the maternal intake of UPF ≥4 times/day to the CWG, given its direct effect on the infant's UPF consumption. CONCLUSIONS: In this low-income population, women who were frequent users of UPF tended to introduce these products more frequently into their children's diets. The early trade-off trend in children's diet between breastfeeding and UPF was the leading cause of excessive weight gain.
Assuntos
Obesidade Infantil , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Análise de Classes Latentes , Obesidade Infantil/epidemiologia , Obesidade Infantil/etiologia , Obesidade Infantil/prevenção & controle , Pobreza , Gravidez , Estudos Prospectivos , Aumento de PesoRESUMO
CONTEXT: There is an increasing prevalence of overweight during early childhood in the most impoverished areas in Brazil, although there is a lack of evidence regarding its onset. OBJECTIVES: To investigate the incidence and risk factors associated with overweight among low-income children during their first year of life. METHODS: We analysed data from a prospective birth cohort study conducted in Brazil, which followed-up children at birth, 3rd, 6th and 12th months (n = 196). The overweight incidence (zBMI/A > 2SD) was analysed using the Kaplan-Meier survival estimator and its associated factors by the Coxs regression model. Missing data were addressed with multiple imputations and results on the final adjusted model were calculated by pooling the estimates generated for each imputed dataset. RESULTS: The overweight incidence was 17 events/100 children-year, and most cases occurred before the 6th month. The final model showed that children exclusively breastfed up to 30 days (vs. >30 days; HR 2.68; 95%CI 1.11-6.49) and whose mothers consumed ultra-processed foods more than 4 times/day (vs. ≤4 times/day; HR 3.02; 95%CI 1.28-7.13) presented a higher risk of developing overweight. CONCLUSION: The overweight incidence was high in this impoverished population. Shorter exclusive breastfeeding duration and an unhealthy household food environment provided a short-term risk increase.
Assuntos
Aleitamento Materno , Sobrepeso , Coorte de Nascimento , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Mães , Sobrepeso/epidemiologia , Estudos ProspectivosRESUMO
OBJECTIVE: To organize the main findings and list the most frequent recommendations from systematic reviews of interventions developed at the school environment aimed at reducing overweight in children and adolescents. DATA SOURCE: Searches for systematic reviews available until December 31, 2014 were conducted in five electronic databases: Cochrane, PubMed, SciELO, SPORTDiscus, and Web of Science. Manual search for cross-references were also performed. SUMMARY OF THE FINDINGS: Of the initial 2139 references, 33 systematic reviews adequately met the inclusion criteria and were included in the descriptive summary. In this set, interventions with periods of time greater than six months in duration (nine reviews), and parental involvement in the content and/or planned actions (six reviews) were identified as the most frequent and effective recommendations. Additionally, it was observed that boys respond more effectively to structural interventions, whereas girls respond to behavioral interventions. None of the included reviews was able to make inferences about the theoretical basis used in interventions as, apparently, those in charge of the interventions disregarded this component in their preparation. CONCLUSIONS: Although the summary identified evidence with important applications in terms of public health, there are still gaps to be filled in this field of knowledge, such as the effectiveness of different theoretical models, the identification of the best strategies in relation to gender and age of participants and, finally, the identification of moderating variables to maximize the benefits provided by the interventions.