Abstract
Objective
To investigate the effectiveness of a training program for health workers regarding
infant feeding practices to reduce sugar consumption in children.
Design
A cluster randomized trial was conducted at 20 health centers in southern Brazil randomly
assigned to an intervention (n = 9) or control (n = 11) group.
Participants
The 715 pregnant women enrolled were assessed when their children were aged 6 months,
3 years, and 6 years.
Intervention
A training session for primary care workers based on the Brazilian National Guidelines
for Children.
Main Outcome Measure
Mothers were asked when sugar was first offered to children. Added sugars intake was
obtained from dietary recalls.
Analysis
The effectiveness of the intervention was modeled using generalized estimation equations
and Poisson regression with robust variance.
Results
Children attending intervention health centers had a 27% reduced risk of sugar introduction
before 4 months of age (relative risk, 0.73; 95% confidence interval [CI], 0.61-0.87)
as well as lower added sugars consumption (difference, −6.36 g/d; 95% CI, −11.49 to
−1.23) and total daily energy intake (difference, −116.90 kcal/d; 95% CI, −222.41
to −11.40) at 3 years of age.
Conclusions and Implications
Health care worker training in infant feeding guidelines may be an effective intervention
to delay the introduction of added sugars and lower the subsequent intake of added
sugars in infants and toddlers.
Key Words
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REFERENCES
- Prenatal and postnatal flavor learning by human infants.Pediatrics. 2001; 107 (e88)
- Ontogeny of taste preferences: basic biology and implications for health.Am J Clin Nutr. 2014; 99: 704S-711S
- Acceptance of sweet and salty tastes in 2-year-old children.Appetite. 1984; 5: 291-305
- The development of sweet taste: from biology to hedonics.Rev Endocr Metab Disord. 2016; 17: 171-178
- Frequent consumption of sugar-sweetened beverages and sweets starts at early age.Acta Odontol Scand. 2018; 76: 105-110
- Total and added sugar intake: assessment in eight Latin American countries.Nutrients. 2018; 10: 389
- Added sugars and cardiovascular disease risk in children: a scientific statement from the American Heart Association.Circulation. 2017; 135: e1017-e1034
- Dietary sugars and body weight: systematic review and meta-analyses of randomised controlled trials and cohort studies.BMJ. 2013; 346: e7492
- Dietary sugars and cardiometabolic risk: systematic review and meta-analyses of randomized controlled trials of the effects on blood pressure and lipids.Am J Clin Nutr. 2014; 100: 65-79
- Effect on caries of restricting sugars intake: systematic review to inform WHO guidelines.J Dent Res. 2014; 93: 8-18
- Free sugars consumption around bedtime and dental caries in children: a systematic review.JDR Clin Transl Res. 2018; 3: 118-129
- WHO global consultation on public health intervention against early childhood caries.Commun Dent Oral Epidemiol. 2018; 46: 280-287
- Sugars Intake for Adults and Children.World Health Organization, 2015
- Dietary Guidelines for Americans 2015–2020.US Department of Agriculture, 2017
- Impacts of the 10 Steps to Healthy Feeding in Infants: a randomized field trial.Cad Saúde Publ. 2005; 21: 1448-1457
- Positive impact of child feeding training program for primary care health professionals: a cluster randomized field trial.Rev Bras Epidemiol. [Braz J Epidemiol]. 2014; 17: 873-886
- The impact of a primary health care intervention on infant feeding practices: a cluster randomised controlled trial in Brazil.J Hum Nutr Diet. 2019; 32: 21-30
- Infant feeding practices and the effect in reducing functional constipation 6 years later: a randomized field trial.J Pediatr Gastroenterol Nutr. 2018; 67: 660-665
- Guia Alimentar Para Crianças Menores de Dois Anos.Ministry of Health/Pan American Health Organization, 2002
- Caderno de Atenção Básica n. Atenção Ao Prénatal de Baixo Risco.Ministério da Saúde, 2013
- Tabela Para Avaliação de Consumo Alimentar Em Medidas Caseiras.5th ed. Atheneu, 2008
- USDA National Nutrient Database for Standard Reference, Release 12.US Department of Agriculture, 1998
- Pesquisa de Orçamentos Familiares 2008–2009: Tabelas de Composição Nutricional Dos Alimentos Consumidos No Brasil.Instituto Brasileiro de Geografia e Estatística, 2011
- USDA National Nutrient Database for Standard Reference, Release 26.US Department of Agriculture, 2013
- The MSM program: web-based statistics package for estimating usual dietary intake using the Multiple Source Method.Eur J Clin Nutr. 2011; 65: S87-S91
- Longitudinal data analysis for discrete and continuous outcomes.Biometrics. 1986; 42: 121-130
- Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect.Lancet. 2016; 387: 475-490
- Influência regional no consumo precoce de alimentos diferentes do leite materno em menores de seis meses residentes nas capitais brasileiras e Distrito Federal [Regional influence on early consumption of foods other than breast milk in infants less than 6 months of age in Brazilian State capitals and the Federal District].Cad Saúde Publ. 2011; 27: 2253-2262
- Maternal infant feeding behaviors and disparities in early child obesity.Child Obes. 2014; 10: 145-152
- Effect of breastfeeding promotion interventions on breastfeeding rates, with special focus on developing countries.BMC Public Health. 2011; 11: 1-8
- Quality of care provided by mid-level health workers: systematic review and meta-analysis.Bull World Health Organ. 2013; 91: 824-833I
- Added sugar and dental caries in children: a scientific update and future steps.Dent Clin North Am. 2019; 63: 17-33
- Obesity prevention and the role of hospital and community-based health services: A scoping review.BMC Health Serv Res. 2019; 19: 1-16
- Effects of healthcare professional delivered early feeding interventions on feeding practices and dietary intake: a systematic review.Appetite. 2018; 123: 56-71
- Influences on the development of children's eating behaviours: from infancy to adolescence.Can J Diet Pract Res. 2007; 68: s1-s56
- Intergenerational comparison of food parenting of home eating behaviors of schoolchildren.J Nutr Educ Behav. 2021; 53: 130-141
- Parenting advice school-age kids offer to parents to promote healthier child weight-related behaviors.J Nutr Educ Behav. 2020; 52: 290-298
- Consumption of ultra-processed foods and its association with added sugar content in the diets of US children, NHANES 2009-2014.Pediatr Obes. 2019; 14: e12563
Article info
Publication history
Published online: August 14, 2021
Accepted:
July 22,
2021
Footnotes
Conflict of Interest Disclosure: The authors have not stated any conflicts of interest.
Identification
Copyright
© 2021 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.
