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BACKGROUND: The exploitative marketing of commercial milk formula (CMF) reduces breastfeeding, and harms child and maternal health globally. Yet forty years after the International Code of Marketing of Breast-Milk Substitutes (The Code) was adopted by WHO member states, many countries are still to fully implement its provisions into national law. Furthermore, despite The Code, worldwide CMF markets have markedly expanded. In this paper, we adopt Brazil as a case study to understand the power of the baby food industry's marketing and corporate political activity, and how this influences the country's 'first-food system' in ways that promote and sustain CMF consumption. METHODS: We used a case study design, drawing data from from documents and key informant interviews (N = 10). RESULTS: Breastfeeding rates plummeted in Brazil to a historic low in the 1970s. A resurgence in breastfeeding from the mid-1980s onwards reflected strengthening political commitment for a national policy framework and breastfeeding protection law, resulting in-turn, from collective actions by breastfeeding coalitions, advocates, and mothers. Yet more recently, improvements in breastfeeding have plateaued in Brazil, while the industry grew CMF sales in Brazil by 750% between 2006 and 20. As regulations tightened, the industry has more aggressively promoted CMF for older infants and young children, as well as specialised formulas. The baby food industry is empowered through association with powerful industry groups, and employs lobbyists with good access to policymakers. The industry has captured the pediatric profession in Brazil through its long-standing association with the Brazilian Society of Pediatrics. CONCLUSION: Brazil illustrates how the baby food industry uses marketing and political activity to promote and sustain CMF markets, to the detriment of breastfeeding. Our results demonstrate that this industry requires much greater scrutiny by regulators.

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OBJECTIVES: Consumption of sugar sweetened beverages (SSB) is associated with childhood obesity and other negative health conditions. Feeding SSB to infants and young children (IYC) under 2 years may displace consumption of breastmilk and nutrient rich foods critical for optimal growth and development. The World Health Organization (WHO) recommends avoiding added sugar (e.g. SSB) for IYC under 2 years. We sought to describe the variety of homemade and commercial SSB as well as breastmilk and beverages without added sugar fed to IYC aged 4-23 months living in a low-income, populous peri-urban area of Lima, Peru. METHODS: A cross-sectional survey was conducted with 181 households with IYC aged 4-23 months. A list of common local homemade and commercial beverages was used to investigate what caregivers had fed to the child in the past 24 h. RESULTS: A total of 93.9% of caregivers reported feeding at least one beverage to their child other than breastmilk in the past 24 h. This included a variety of homemade SSB (73.5%), commercial SSB (18.2%) and homemade beverages without added sugar (70.2%). A high percentage (83.4%) of children were also breastfed. CONCLUSIONS FOR PRACTICE: Our findings suggest that interventions to address feeding homemade SSB to IYC within households are needed to support WHO recommendations and complement current commercial SSB policy regulations in Peru.

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BACKGROUND: The prenatal, perinatal, postnatal and nutritional (A3PN) support study was a 4-year initiative aimed to reduce maternal mortality in Haiti. A cross-sectional study was developed to collect the baseline data for evaluation purposes of the A3PN. This study aimed to determine the factors contributing to dietary diversity (DD) in Haitian children aged 6-23 months. METHODS: A cross-sectional study during two seasons (the lean season and the harvest season) was carried out in Haiti to assess the DD of children and their mothers using non-quantitative 24-h recalls. Indicators of DD were minimum dietary diversity for children (MDD-C) and minimum dietary diversity for women (MDD-W). Mid-upper arm circumference was measured in women and children, and food security was assessed using the Household Hunger Scale. Focus groups were also conducted to gain a better understanding of the quantitative findings. RESULTS: Only 7.3% of the children included in this study met the MDD-C. Factors associated with MDD-C were the season (odds ratio [OR]: 0.141 [0.039-0.513]), land ownership or rental (OR: 4.603 [1.233-17.188]), maternal education (OR: 0.092 [0.011-0.749]), the mother's responsibility for the main or secondary source of income for the household (OR: 2.883 [1.030-8.069]) and her DD (OR: 5.690 [1.916-16.892]). Focus groups revealed the existence of various food restrictions. CONCLUSIONS: The results indicated that the low prevalence of MDD-C in three regions of study in Haiti is indicative of a serious public health concern that might be further aggravated by local food taboos. They also suggest that to fight against hunger, it is necessary to focus on women's well-being.

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Objetivo: Avaliar os marcadores de consumo alimentar e a diversidade alimentar mínima em lactentes de 12 meses de vida expostos a diferentes métodos de introdução alimentar. Métodos: Ensaio clínico randomizado com pares mãe-lactente submetidos à intervenção sobre introdução alimentar em três métodos: Método tradicional (MT), Baby-led Introduction to SolidS (BLISS) e misto (combinação das duas técnicas). Os marcadores de consumo alimentar foram avaliados por questionário online aos 12 meses com base nos alimentos consumidos no dia anterior, utilizando os marcadores de consumo alimentar para menores de 2 anos do Sistema de Vigilância Alimentar e Nutricional. O estudo foi aprovado no comitê de ética. Resultados: Aos 12 meses foram avaliadas 136 crianças: 45 alocadas no MT, 48 no BLISS e 43 no misto. Os alimentos com maior prevalência de consumo foram: leite materno103 (75,7%), frutas, legumes e verduras 122 (89,7%), carnes ou ovos 135 (99,3%), feijão 115 (84,6%), cereais ou tubérculos 135 (99,3%). Alimentos ultraprocessados que estiveram presentes na dieta dos lactentes foram hambúrguer ou salsichas 3 (2,2%), bebidas açucaradas 2 (1,5%), macarrão instantâneo 4 (2,9%) e biscoito recheado 2 (1,5%).Não foram encontradas diferenças entre os métodos de introdução da alimentação complementar. A diversidade alimentar mínima esteve presente na alimentação de 22 lactentes (16,2%), sendo: 6 (13,3%) no MT, 8 (16,7%) no BLISS e 8 (18,6%) no misto (p=0,793). Conclusão: Leite materno,frutas, legumes e verduras, carne, feijão e arroz estiveram presentes na alimentação da maioria dos lactentes; no entanto, a prevalência de diversidade alimentar mínima foi baixa.O consumo de alimentos ultraprocessados também esteve presente na alimentação dos lactentes. Registro Brasileiro de Ensaios Clínicos (ReBEC) identificação RBR-229scm.

Objective: To evaluate food consumption markers and minimum dietary diversity in 12-month-old infants exposed to different methods of food introduction. Methods: A randomized clinical trial with mother-infant pairs undergoing intervention on food introduction in three methods: Parent-Led Weaning (PLW), Baby-Led Introduction to SolidS (BLISS), and mixed (combination of the two techniques). Food consumption markers were evaluated by an online questionnaire at 12 months based on food consumed the previous day, using food consumption markers for children under 2 years of the Food and Nutrition Surveillance System. The study was approved by the ethics committee. Results: At 12 months, 136 children were evaluated: 45 allocated to PLW, 48 to BLISS, and 43 to mixed. The foods with the highest prevalence of consumption were breast milk 103 (75.7%), vegetables 122 (89.7%), meat 135 (99.3%), beans 115 (84.6%), rice, potatoes, or yam 135 (99.3%). Ultra-processed foods were present in the diet of infants, including hamburgers or sausages 3 (2.2%), sweetened beverages 2 (1.5%), instant noodles 4 (2.9%), and sandwich cookies 2 (1.5 %). No differences were found between the methods of introducing complementary feeding. The minimum dietary diversity was present in the diet of 22 infants (16.2%), being: 6 (13.3%) in the PLW, 8 (16.7%) in the BLISS, and 8 (18.6%) in the mixed (p=0.793). Conclusion: Breast milk, vegetables, meat, beans, and rice were present in the diet of most infants; however, the prevalence of minimal dietary diversity was low. The consumption of ultra-processed foods was also present in the diet of infants. Brazilian Registry of Clinical Trials (ReBEC) identification RBR-229scm.

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Objetivo: avaliar a experiência de mães residentes em município paraibano sobre aleitamento materno. Método: nota prévia de um projeto guarda-chuva, de corte transversal, realizado com 252 mães, através de questionário virtual, por meio do Google Forms. Resultados: a principal motivação para continuidade do aleitamento materno exclusivo foi vínculo entre mãe e filho (23,4%) e a principal barreira foi o retorno ao trabalho (16,8%). Os três principais recursos de ingestão que provocaram a percepção do aumento do aleitamento materno foram sucos cítricos (21,2%), água (19,5%) e frutas diversas (7%). A maioria ingeriu até dois litros de água (46,4%), a substância mais eliciada para favorecer o volume de leite foi a tintura de algodoeiro (12,3%) e o método mais referido para aumento da produção foi a ordenha manual (63,6%), sendo problemas emocionais (40,5%) o maior motivo para a redução do leite. Sobre a ingestão de alimentos que porventura poderiam provocar gases, foram chocolate (27,6%), refrigerante (17,6%) e café (15%) os mais eliciados. Conclusão: acredita-se que este estudo traz contribuições a área materno-neonatal, bem como aos profissionais de saúde, pois incita o debate acerca dessa temática, de maneira que possibilita a ampliação do conhecimento e permita uma reflexão sobre as ações de promoção e apoio a amamentação, em busca da intersetorialidade e interdisciplinaridade, visando a redução nas taxas de desmame precoce.

Objective: to evaluate the experience of mothers living in a municipality in Paraíba regarding breastfeeding. Method: previous note of an umbrella project, cross- sectional, carried out with 252 mothers, through a virtual questionnaire, using Google Forms. Results: the main motivation for continuing exclusive breastfeeding was the bond between mother and child (23.4%) and the main barrier was returning to work (16.8%). The three main intake resources that caused the perception of increased breastfeeding were citrus juices (21.2%), water (19.5%) and various fruits (7%). The majority ingested up to two liters of water (46.4%), the most elicited substance to favor milk volume was cotton dye (12.3%) and the most mentioned method for increasing production was manual milking ( 63.6%), with emotional problems (40.5%) being the main reason for reducing milk. Regarding the intake of foods that could possibly cause gas, chocolate (27.6%), soda (17.6%) and coffee (15%) were the most elicited. Conclusion: it is believed that this study brings contributions to the maternal-neonatal area, as well as to health professionals, as it encourages the debate on this theme, in a way that allows the expansion of knowledge and allows a reflection on the promotion and support actions breastfeeding, in search of intersectoriality and interdisciplinarity, aiming at reducing early weaning rates.

Objetivo: evaluar la experiencia de las madres residentes en un municipio de Paraíba sobre la lactancia materna. Método: nota previa de un proyecto paraguas, transversal, realizado con 252 madres, a través de un cuestionario virtual, utilizando Google Forms. Resultados: la principal motivación para continuar con la lactancia materna exclusiva fue el vínculo madre-hijo (23,4%) y la principal barrera fue la reincorporación al trabajo (16,8%). Los tres principales recursos de ingesta que provocaron la percepción de aumento de la lactancia materna fueron los jugos de cítricos (21,2%), el agua (19,5%) y las frutas diversas (7%). La mayoría ingirió hasta dos litros de agua (46,4%), la sustancia más elicitada para favorecer el volumen de leche fue el tinte de algodón (12,3%) y el método más mencionado para aumentar la producción fue el ordeño manual (63,6%), con problemas emocionales (40,5%). %) siendo la principal razón para reducir la leche. En cuanto a la ingesta de alimentos que posiblemente puedan causar gases, el chocolate (27,6%), las gaseosas (17,6%) y el café (15%) fueron los más elicitados. Conclusión: se cree que este estudio trae contribuciones para el área materno- neonatal, así como para los profesionales de la salud, una vez que incentiva el debate sobre este tema, de manera que permite la ampliación del conocimiento y posibilita una reflexión sobre la promoción y acciones de apoyo a la lactancia materna, en busca de la intersectorialidad y la interdisciplinariedad, con el objetivo de reducir las tasas de destete precoz.

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BACKGROUND: The indigenous child population in Ecuador has a high prevalence of stunting. There is limited evidence of the association between breastfeeding, feeding practices, and stunting in indigenous children. This study aimed to analyze the prevalence of breastfeeding and complementary feeding practices and explore their association with stunting in Ecuadorian indigenous children under two years of age. METHODS: Cross-sectional study of secondary data analysis using the 2012 Ecuador National Health and Nutrition Study, in 625 children aged 0-23 months (48,069 expanded sample), representative for the indigenous population. Breastfeeding and complementary feeding indicators were analyzed by age groups. Timely initiation of breastfeeding (within one hour after birth), exclusive breastfeeding (infants under six months who received only breast milk for the previous day), and other indicators were measured. Chi-square test or Fisher's exact test and logistic regression for complex samples were used to explore association with demographic and socioeconomic factors and stunting. RESULTS: Twenty-six-point eight percent of the children were stunted. Stunting occurred mainly in children with rural residence, on poor households, and where there were four or more children. Most of the children had a timely initiation of breastfeeding (69.5% for 0-12 months and 75.5% for 13-23 months) and exclusive breastfeeding up to six months (78.2%). Among children between 6-12 months of age, 99.3% continued to be breastfed. In children from ages 6 to 12 months, 32.5% received food with adequate dietary diversity. Lower percentages of complementary feeding occurred in the poorest, adolescent mothers or those with less education. Children who did not receive the minimum frequency of meals for their age had higher odds of stunting (OR 3.28; 95% CI 1.3, 8.27). Children from age 19 to 23 months who consumed foods rich in iron showed lower probabilities of stunting (OR 0.04; 95% CI 0.00, 0.51). CONCLUSIONS: Breastfeeding practices reached a prevalence of 70% or more, without being associated with stunting. Complementary feeding practices showed differences by socioeconomic condition. Not reaching the minimum meal frequency between 6 and 12 months of age was associated with stunting. Plans and strategies are necessary to promote adequate feeding and breastfeeding practices in the indigenous population.

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Food choice for children has important implications in establishing early-life dietary habits and preferences. Food choice for children has been studied as parent-child dyad dynamics, but little is known about the extended system of relationships in maternal food choice for children. The objective of this study was to understand the functions of mothers' social networks in the food choices that mothers make for their children ages 1 to 5 years old in rural Mexico. In-depth interviews were conducted with 46 participants in three rural communities. The interviews inquired about participants' child-feeding practices, personal and local beliefs about child feeding and the individuals with whom they had conversations about food and child feeding. All interviews were conducted in Spanish, audio-recorded, transcribed verbatim, verified for quality and analysed using the constant comparative method. Five interconnected networks emerged, consisting of household family, non-household family, community, children's initial school and health and nutritional programme personnel. Each network had functions in food choice that ranged from shared food decision-making in the household family network to imparting formal dietary guidance in the health and nutritional programme personnel network. Across the networks, professionals, participants' mothers and mothers-in-law, community senior women and other women with children emerged as prominent figures whom participants would turn to for child-feeding advice. These findings provide empirical evidence that social networks, as an organized system of interconnected relationships, have vital functions in establishing social norms for food choices made for children that can be leveraged to promote healthy food choices.

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Poor feeding practices in infants and young children may lead to malnutrition, which, in turn, is associated with an increased risk of infectious diseases, such as respiratory tract infections (RTIs), a leading cause of under-five mortality. We explored the association between RTIs and the WHO infant and young child feeding (IYCF) indicators: minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD), among infants and preschool children in Suriname. A validated pediatric food frequency questionnaire was used and data on RTIs, defined as clinical care for fever with respiratory symptoms, bronchitis, or pneumonia were obtained. Associations between feeding indicators and RTIs were explored using hierarchical logistic regression. Of 763 children aged 10-33 months, 51.7% achieved the MDD, 88.5% the MMF, and 46.5% the MAD. Furthermore, 73% of all children experienced at least one upper and/or lower RTI. Children meeting the MDD and MAD had significantly lower odds on RTIs (OR 0.53; 95%CI: 0.37-0.74, p < 0.001; OR 0.55; 95%CI: 0.39-0.78, p < 0.001, respectively). The covariates parity and household income were independently associated with RTIs. In conclusion, MDD and MAD were associated with (upper) RTIs. Whether these indicators can be used as predictors for increased risk for RTIs should be assessed in future prospective studies.

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Abstract Objectives: to identify dietary patterns of children under two years of age in primary care, associating them with maternal variables. Methods: cross-sectional study carried out in basic health units. Sample selected for convenience with 321 children under two years old and their mothers. Food consumption was obtained through a 24-hour food record. The method of factor analysis by main components was used to determine dietary patterns. Associations between maternal variables and dietary patterns were tested. Results: "mixed", "porridge" and "snacks" patterns were identified. Receiving guidance on infant feeding was related to greater adherence to the "mixed" (p = 0.02; PR = 2.98; 95% CI95% = 1.49-5.96) and "porridge" (p = 0.026; PR = 2.10; CI95% = 1.09-4.02) patterns. Experience with breastfeeding showed greater adherence to the "porridge" standards (p=0.038; PR = 1.78; CI95%= 1.03-3.08) and "snacks" (p = 0.026; PR = 1.09; CI95% = 1.01-1.18) and children of overweight mothers showed less adherence to the "snacks" pattern (p = 0.042; PR = 0.51; CI95%= 0.26-0.98). Conclusions: patterns found were associated with guidance on infant feeding and breastfeeding, previous experience with breastfeeding, as well as with maternal excess weight, emphasizing the importance of professional guidance for greater adherence to more varied and healthy consumption patterns and that include the different food groups.

Resumo Objetivos: identificar padrões alimentares de crianças menores de dois anos na atenção primária associando-os com variáveis maternas. Métodos: estudo transversal desenvolvido em unidades básicas de saúde. Amostra selecionada por conveniência com 321 menores de dois anos e suas mães. O consumo alimentar foi obtido através de recordatório alimentar de 24 horas. O método de análise fatorial por componentes principais foi utilizado para determinação dos padrões alimentares. Associações entre variáveis maternas e padrões alimentares foram testadas. Resultados: padrões "misto", "mingaus" e "lanches" foram identificados. Receber orientações sobre alimentação infantil relacionou-se a maior aderência aos padrões "misto" (p= 0,02; RP= 2,98; IC95%= 1,49-5,96) e "mingaus" (p= 0,026; RP= 2,10; IC95%= 1,09-4,02). Experiência com aleitamento materno mostrou maior adesão aos padrões "mingaus" (p= 0,038; RP= 1,78; IC95%= 1,03-3,08) e "lanches" (p= 0,026; RP= 1,09; IC95%= 1,01-1,18) e filhos de mães com excesso de peso apresentaram menor aderência ao padrão "lanches" (p= 0,042; RP= 0,51; IC95%= 0,26-0,98). Conclusões: os padrões encontrados associaram-se com orientação sobre alimentação infantil e amamentação, experiência prévia com amamentação, bem como com excesso de peso materno, ressaltando a importância da orientação profissional para maior adesão a padrões de consumo mais variados e saudáveis e que contemplem os diversos grupos de alimentos.

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BACKGROUND: Adequate complementary feeding practices in early childhood contribute to better food preferences and health outcomes throughout the life course. OBJECTIVES: The aim of this study was to describe patterns and socioeconomic inequalities in complementary feeding practices among children aged 6-23 mo in 80 low- and middle-income countries. METHODS: We analyzed national surveys carried out since 2010. Complementary feeding indicators for children aged 6-23 mo included minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD). Between- and within-country inequalities were documented using relative (wealth deciles), gross domestic product (GDP) per capita, and absolute (estimated household income) socioeconomic indicators. Statistical analyses included calculation of the slope index of inequality, Pearson correlation and linear regression, and scatter diagrams. RESULTS: Only 21.3%, 56.2%, and 10.1% of the 80 countries showed prevalence levels >50% for MDD, MMF, and MAD, respectively. Western & Central Africa showed the lowest prevalence for all indicators, whereas the highest for MDD and MAD was Latin America & Caribbean, and for MMF it was East Asia & the Pacific. Log GDP per capita was positively associated with MDD (R2 = 48.5%), MMF (28.2%), and MAD (41.4%). Pro-rich within-country inequalities were observed in most countries for the 3 indicators; pro-poor inequalities were observed in 2 countries for MMF, and in none for the other 2 indicators. Breast milk was the only type of food with a pro-poor distribution, whereas animal-source foods (dairy products, flesh foods, and eggs) showed the most pronounced pro-rich inequality. Dietary diversity improved sharply when absolute annual household incomes exceeded ∼US$20,000. All 3 dietary indicators improved by age and no consistent differences were observed between boys and girls. CONCLUSIONS: Monitoring complementary feeding indicators across the world and implementing policies and programs to reduce wealth-related inequalities are essential to achieve optimal child nutrition.

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OBJECTIVE: To study the barriers and enablers of breast-feeding protection and support after the 2017 earthquakes in Mexico. DESIGN: A qualitative study using a phenomenological approach to analyse data collected from in-depth interviews, virtual ethnography and documentary analysis of newspapers. SETTING: Data were collected after the September 2017 earthquakes in Mexico (from 8 September 2017 to 15 May 2018). PARTICIPANTS: The participants included key informants (n 13) from different sectors. Postings retrieved from forty-two Facebook and forty-seven Twitter accounts and a WhatsApp group informed the virtual ethnography analysis. Newspaper material covering the 2017 earthquakes in Mexico (seven newspapers) was retrieved for the documentary analysis. RESULTS: Interviews with key informants revealed a lack of knowledge, unclear institutional protocols during emergencies and lack of enforcement of existing international frameworks. The virtual ethnography uncovered a strong call for donations in the immediate aftermath of the earthquakes, and generalized donations of formula revealed a tense relationship between actions taken by breast-feeding experts and the negative reactions from the government and citizens. This analysis highlights the relevance of pre-existing networks of experts in protecting and supporting breast-feeding. From the newspaper documentary analysis, similar themes emerged. CONCLUSIONS: This study identified key barriers and enablers in the protection and support of breast-feeding during the 2017 earthquakes in Mexico. Relevant actors should embrace the lessons highlighted in this study because countries such as Mexico are likely to experience other emergencies in the near future.

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Resumen Este estudio tuvo como objetivo conocer la relación entre estado nutricional, prácticas de alimentación del cuidador y conducta alimentaria en preescolares de una comuna del centro sur de Chile. La muestra estuvo compuesta por 249 preescolares y sus cuidadores principales. Se encontró una relación positiva entre índice de masa corporal (IMC) del niño y preocupación por el peso del niño (r = .51, p < .01), así como entre IMC del niño y alimentación restrictiva del cuidador (r = .20, p < .01). Se encontraron relaciones débiles aunque significativas entre estado nutricional (IMC y porcentaje de grasa corporal) y conducta alimentaria en niños. Análisis de correlaciones canónicas indicaron que las variables agrupadas de prácticas de alimentación infantil se relacionaron positivamente con el estado nutricional del niño (ρ3 = .54, < .001). Adicionalmente, se encontró que la preocupación por el peso del niño mediaba parcialmente la relación entre restricción alimentaria e IMC (IC 95% efecto indirecto "ab" [.02; .13]) y entre restricción y porcentaje de grasa corporal (IC 95% efecto indirecto "ab" [.06; .50]). Las actitudes y prácticas de alimentación infantil de los cuidadores principales, particularmente la preocupación por el peso del niño y la restricción en la alimentación juegan un rol crítico en la mantención y manejo de la obesidad en preescolares. Se exploran las implicancias prácticas de estos hallazgos.

Abstract The objective of this research was to determine the relationship between child nutritional status, feeding practices of the primary caregiver and the child eating behavior of preschoolers in a community in south-central Chile. The sample comprised 249 preschool children from three public and semi-public schools and their primary caregivers. A positive relationship was found between body mass index (BMI) and weight concern (r = .51, p < .01) and restrictive feeding practice (r = .20, p < .01). Significant but weak relationship existed between BMI, body fat percentage and child eating behavior. Canonical correlation analysis indicated that child feeding practices as a group were related to nutritional status of children. Additionally, weight concerns partially mediate the relationship between restrictive feeding and BMI (CI 95% indirect effect "ab" [.02; .13]) and body fat percentage (IC 95% efecto indirecto "ab" [.06; .50]). Child feeding practices of the primary caregivers, particularly weight concern and restrictive feeding play an important role in the management of the preschool children obesity.

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OBJECTIVES: Brazilians comprise a rapidly growing immigrant Latino group in the USA, yet little research has focused on health issues affecting Brazilian children in immigrant families. As increasing evidence is documenting fathers' influential role in their children's eating behaviours and ultimately weight status, the current study sought to explore the Brazilian immigrant fathers' perspectives and practices related to child's feeding practices and their preschool-aged children's eating. DESIGN: Qualitative study using in-depth, semi-structured interviews. Interviews were conducted in Portuguese by native Brazilian research staff using a semi-structured interview guide. Interviews were audio-recorded and transcribed verbatim. Transcripts were analysed thematically using a hybrid approach that incorporated deductive and inductive analytical approaches. SETTING: Massachusetts. PARTICIPANTS: Twenty-one Brazilian immigrant fathers who had at least one child aged 2-5 years. RESULTS: Results revealed fathers' awareness of the importance of healthy eating for their children, their influence as role models and their involvement in feeding routines of their preschool-aged children. Moreover, fathers were receptive to participating in family interventions to promote their children's healthy eating. Nearly all fathers reported wanting to learn more and to do 'what's right' for their children. CONCLUSIONS: The current study provides new information about Brazilian immigrant fathers' views about factors influencing their children's healthy eating behaviours and paternal feeding practices. Future research should quantify fathers' feeding styles and practices and solicit fathers' input in the design of culturally appropriate family interventions targeting the home environment of preschool-aged children of Brazilian immigrant families.

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Optimising child feeding behaviours could improve child health in Guatemala, Honduras and El Salvador, where undernutrition rates remain high. However, the design of interventions to improve child feeding behaviours is limited by piecemeal, theoretically underdeveloped evidence on factors that may influence these behaviours. Between July 2018 and January 2020, we systematically searched Cochrane, Medline, EMBASE, Global Health and LILACS databases, grey literature websites and reference lists, for evidence of region-specific causes of child feeding behaviours and the effectiveness of related interventions and policies. The Behaviour Change Wheel was used as a framework to synthesise and map the resulting literature. We identified 2,905 records and included 68 relevant studies of mixed quality, published between 1964 and 2019. Most (n = 50) were quantitative, 15 were qualitative and three used mixed methods. A total of 39 studies described causes of child feeding behaviour; 29 evaluated interventions or policies. Frequently cited barriers to breastfeeding included mothers' beliefs and perceptions of colostrum and breast milk sufficiency; fears around child illness; and familial and societal pressures, particularly from paternal grandmothers. Child diets were influenced by similar beliefs and mothers' lack of money, time and control over household finances and decisions. Interventions (n = 22) primarily provided foods or supplements with education, resulting in mixed effects on breastfeeding and child diets. Policy evaluations (n = 7) showed positive and null effects on child feeding practices. We conclude that interventions should address context-specific barriers to optimal feeding behaviours, use behaviour change theory to apply appropriate techniques and evaluate impact using robust research methods.

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Este estudio tuvo como objetivo asociar actitudes y prácticas de alimentación infantil de cuidadores con el estado nutricional de niños de origen mapuche y no mapuche. Participaron 200 escolares de primero a cuarto básico y sus cuidadores. Se realizó medición de peso y talla en los niños, y cuidadores respondieron el Child Feeding Questionnaire y un instrumento de caracterización sociodemográfica. Los resultados indicaron presencia de sobrepeso y obesidad en 56% del total de niños evaluados, cifra superior al promedio nacional, con un porcentaje significativamente superior (p≤0.001) en el grupo de origen mapuche (71,9%). Las asociaciones más fuertes del puntaje z de IMC del niño se encontraron con peso percibido d (r= 0,56, p= <0,001) y preocupación por el peso (r= 0,34, p= <0,001). Lo mismo ocurrió al segmentar la muestra por etnia. La única actitud que demostró diferencias entre grupos fue la responsabilidad percibida (p=0,018), resultando inferior en el grupo mapuche. No obstante, las diferencias según etnia, ésta no resultó predictora del estado nutricional del niño, pero sí el peso percibido (β= 3,778, p< 0,001) y la preocupación por el peso (β= 0,944, p= 0,018). Lo anterior refuerza el rol de actitudes y prácticas de padres y cuidadores en el estado nutricional del niño con independencia de los factores culturales implicados.

This study aims to associate child feeding attitudes and practices of caregivers with the nutritional status of Mapuche and non-Mapuche children. Two hundred schoolchildren from first to fourth grade and their caregivers participated. Measurement of weight and height was performed in children; caregivers completed the Child Feeding Questionnaire and a sociodemographic characterization instrument. Fifty six percent of the children assessed were overweight or obese, with a significantly higher percentage (p≤0,001) in the Mapuche group (71.9%). Child's BMI z-score was strongly related with perceived weight (r= 0,56 p= <0.001) and weight concern (r= 0,34, p= <0,001). The same results were found when segmenting the sample by ethnicity. The only attitude that showed differences between groups was perceived responsibility (p= 0,018), being lower in the Mapuche group. Despite the differences according to ethnicity, this variable was not predictive of the nutritional status of the child, unlike perceived weight (β= 3,778, p<0,001) and weight concern (β= 0,944, p= 0,018). These findings reinforce the role of attitudes and practices of parents and caregivers in the nutritional status of the child, regardless of the cultural factors involved.

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OBJECTIVE: To identify modifiable risk factors associated with early initiation of breastfeeding (EIBF) and exclusive breastfeeding (EBF) in Colombia. DESIGN: Cross-sectional study from the 2010 Colombia nationally representative Demographic Health Survey (DHS). Studied exposures were categorized into five hierarchical blocks of increasing proximity to the outcomes: household, maternal, health systems, child, and early feeding characteristics. The two outcomes examined were delayed breastfeeding initiation among infants <24 months and interruption of EBF among infants <6 months. Prevalence ratios were computed using Poisson regression analysis with robust error variance, adjusted for sampling weights, following a hierarchical modelling approach. SETTING: Nationally representative cross-sectional survey from Colombia. PARTICIPANTS: The EIBF analytical sample included 6592 and the EBF sample 1512 women with young children. RESULTS: EIBF prevalence was 65·6 % in children under 24 months and EBF was 43 % in infants under 6 months. Modifiable risk factors associated with delayed breastfeeding initiation were: C-section (PR = 2·08, CI 95 % = 1·92, 2·25), maternal overweight/obesity (PR = 1·09, CI 95 % = 1·01, 1·17), lack of skilled attendant at birth (PR = 1·09, CI 95 % = 1·01, 1·18). Modifiable risk factors for EBF interruption were C-section (PR = 1·12, CI 95 % = 1·02, 1·23) and prelacteal feeding (PR = 1·51, CI 95 % = 1·37, 1·68). Non-pregnancy intention was a protective factor for EBF interruption (PR = 0·82, CI 95 % = 0·72, 0·93). CONCLUSIONS: C-section, lack of skilled attendant at birth, prelacteal feeding, maternal nutritional status, and pregnancy intention were modifiable factors associated with suboptimal breastfeeding practices in Colombia.

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BACKGROUND: In contrast with the ample literature on within- and between-country inequalities in breastfeeding practices, there are no multi-country analyses of socioeconomic disparities in breastmilk substitute (BMS) consumption in low- and middle-income countries (LMICs). OBJECTIVE: This study aimed to investigate between- and within-country socioeconomic inequalities in breastfeeding and BMS consumption in LMICs. METHODS: We examined data from the Demographic Health Surveys and Multiple Indicator Cluster Surveys conducted in 90 LMICs since 2010 to calculate Pearson correlation coefficients between infant feeding indicators and per capita gross domestic product (GDP). Within-country inequalities in exclusive breastfeeding, intake of formula or other types of nonhuman milk (cow/goat) were studied for infants aged 0-5 mo, and for continued breastfeeding at ages 12-15 mo through graphical presentation of coverage wealth quintiles. RESULTS: Between-country analyses showed that log GDP was inversely correlated with exclusive (r = -0.37, P < 0.001) and continued breastfeeding (r = -0.74, P < 0.0001), and was positively correlated with formula intake (r = 0.70, P < 0.0001). Continued breastfeeding was inversely correlated with formula (r = -0.79, P < 0.0001), and was less strongly correlated with the intake of other types of nonhuman milk (r = -0.40, P < 0.001). Within-country analyses showed that 69 out of 89 did not have significant disparities in exclusive breastfeeding. Continued breastfeeding was significantly higher in children belonging to the poorest 20% of households compared with the wealthiest 20% in 40 countries (by ∼30 percentage points on average), whereas formula feeding was more common in the wealthiest group in 59 countries. CONCLUSIONS: BMS intake is positively associated with GDP and negatively associated with continued breastfeeding in LMICs. In most countries, BMS intake is positively associated with family wealth, and will likely become more widespread as countries develop. Urgent action is needed to protect, promote, and support breastfeeding in all income groups and to reduce the intake of BMS, in light of the hazards associated with their use.

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BACKGROUND: The impact of the Conditional Cash Transfer Program in Mexico was significant but smaller than expected. Several bottlenecks related to program design and implementation have been identified that may have limited its impact; population and other contextual factors may be equally important to analyze. OBJECTIVES: We aimed to explore how sociocultural context contributes to poor nutrition in Mexico and how it shaped the acceptability, fidelity, and penetration of the fortified food and of education sessions provided by the program. METHODS: We carried out qualitative research studies in the central and southern states in urban, rural, and indigenous settings between 2001 and 2014 with different informants and by using interviews, focus group discussions, and nonparticipatory observation. We explored 4 dimensions of the sociocultural context: objective dimension (e.g., food availability and family organization), social norms and symbolic meaning related to child feeding, literacy and communication with the biomedical culture, and knowledge related to child care generally and child feeding. We generated information about the experience of the beneficiaries with fortified food and education sessions. RESULTS: Several sociocultural factors, including patriarchal family organization, high availability of nonnutritious food, social norms promoting the consumption of food in liquid form for young children, sharing of food among family members, traditional knowledge, and communication barriers with the biomedical culture, participated in shaping the poor nutrition situation, the inadequate utilization of fortified foods, and the inappropriateness of the education sessions. CONCLUSIONS: Our studies revealed the importance of local context and culture to understand the acceptance, utilization, and impact of a nutrition program and shed light on infant and child feeding practices. This knowledge is critical to strengthen program designs and ensure adequacy with the diversity of cultural and social contexts in which programs are implemented.

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Introdução: A anemia ferropriva é considerada uma das carências nutricionais mais frequentes e um grande problema para a Saúde Pública mundial, sendo as mulheres e as crianças menores de dois anos de vida os grupos mais suscetíveis. O Ministério da Saúde preconiza o aleitamento materno exclusivo até os seis meses de vida e como complemento, até no mínimo os 24 meses. Aos seis meses, deve-se iniciar a introdução alimentar como complemento ao aleitamento materno, para suprir as necessidades de energia e de nutrientes essenciais para um crescimento adequado. Objetivo: Avaliar se há uma associação entre o desmame precoce e a prevalência de anemia ferropriva em lactentes. Casuística e métodos:Estudo quantitativo, com delineamento transversal, realizado entre outubro de 2016 e fevereiro de 2017, com 31 crianças de zero a 23 meses de idade, acompanhadas na Unidade Básica de Saúde Centro, do município de Gravataí, localizado ao sul do Brasil. Foi realizada a aplicação de um questionário com perguntas relacionadas à amamentação e foram coletados dados de níveis de hemoglobina dos prontuários dos participantes da pesquisa. Foram realizadas análises descritivas e calculada a razão de prevalência, sendo considerados estatisticamente significativos valores de p<0,05. Resultados: Foi observada uma tendência linear entre anemia ferropriva e idade das crianças (p= 0,004), porém a relação entre o desmame precoce e a anemia ferropriva não apresentou associação estatisticamente significativa. No entanto pode haver uma tendência futura de maior prevalência de anemia ferropriva nas crianças que desmamaram precocemente tanto aos quatro, quanto aos seis meses. Conclusão: Na amostra estudada de lactentes, com até 23 meses de idade, o desmame precoce não foi associado com a prevalência de anemia ferropriva. A introdução alimentar precoce e a não realização do aleitamento materno exclusivo podem contribuir para a maior ocorrência de anemia ferropriva em lactentes na faixa etária de zero a seis meses de vida.

Introduction:The iron-deficiency anemia due to iron-deficiency is considered one of the most frequent nutritional deficiencies and a major problem for world public health, where women and children under two years of age are the main group susceptible to its occurrence. The Brazilian Ministry of Health recommends exclusive breastfeeding up to six months of life and after, as a complement, until at least 24 months of age. Feeding should be initiated as a complement to breastfeeding at six months' age, in order to provision energy and other nutrient essential needs for adequate growth. Objective: to evaluate if early weaning is associated with iron-deficiency anemia in infants. Material and methods: A quantitative study with a cross-sectional design was carried out with 31 children from zero to 23 months of age, duly followed up at the Basic Health Center of the city of Gravataí. A questionnaire was applied with questions related to breastfeeding, and hemoglobin levels data were collected from the study participants' charts. Descriptive analyses were performed and the prevalence ratio was calculated, considering p ≤ 0.05 as significant. Results: A linear trend was observed between iron deficiency anemia and age (p = 0.004), but the relationship between early weaning and iron deficiency anemia did not present a statistically significant association. However, there may be a future trend towards a higher prevalence of iron deficiency anemia in children who weaned early at both four and six months. Conclusion: In the studied sample of infants, up to 23 months of age, early weaning was not associated with the prevalence of iron-deficiency anemia. Early feeding and failure to deliver exclusive breastfeeding may contribute to the increased occurrence of iron-deficiency anemia in infants between 0-6 months of age.

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