Age at introduction of ultra-processed food among preschool children attending day-care centers<sup>,</sup>

Longo-Silva, Giovana; Silveira, Jonas Augusto C.; Menezes, Rísia Cristina Egito de; Toloni, Maysa Helena de Aguiar

doi:10.1016/j.jped.2016.11.015

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Original articles • J. Pediatr. (Rio J.) 93 (5) • Sep-Oct 2017 • https://doi.org/10.1016/j.jped.2016.11.015 copy

Age at introduction of ultra-processed food among preschool children attending day-care centers^☆ ☆ Please cite this article as: Longo-Silva G, Silveira JA, Menezes RC, Toloni MH. Age at introduction of ultra-processed food among preschool children attending day-care centers. J Pediatr (Rio J). 2017;93:508–16. ^,^☆☆ ☆☆ Study developed at Universidade Federal de Alagoas (UFAL), Faculdade de Nutrição (FANUT), Programa de Pós-Graduação em Nutrição, Maceió, AL, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To identify the age of introduction of ultra-processed food and its associated factors among preschool children.

Methods:

Cross-sectional study carried out from March to June 2014 with 359 preschool children aged 17 to 63 months attending day-care centers. Time until ultra-processed food introduction (outcome variable) was described by the Kaplan–Meier analysis, and the log-rank test was used to compare the survival functions of independent variables. Factors associated with ultra-processed food introduction were investigated using the multivariate Cox proportional hazards model. The results were shown as hazard ratios with their respective 95% confidence intervals.

Results:

The median time until ultra-processed food introduction was six months. Between the 3rd and 6th months, there is a significant increase in the probability of introducing ultra-processed food in the children's diet; and while the probability in the 3rd month varies from 0.15 to 0.25, at six months the variation ranges from 0.6 to 1.0. The final Cox proportional hazards model showed that unplanned pregnancy (1.32 [1.05–1.65]), absence of prenatal care (2.50 [1.02–6.16]), and income >2 minimum wages (1, 50 [1.09–2.06]) were independent risk factors for the introduction of ultra-processed food.

Conclusion:

Up to the 6th month of life, approximately 75% of preschool children had received one or more ultra-processed food in their diet. In addition, it was observed that the poorest families, as well as unfavorable prenatal factors, were associated with early introduction of ultra-processed food.

KEYWORDS
Preschool child; Overweight; Obesity; Supplementary feeding; Industrialized foods; Child nutrition

Characteristics	n ^a a Number of individuals in the database.	x(SD) or %^b b Median (interquartile range).	Characteristics	n ^a a Model adjusted for age and gender (n = 348).	x(SD) or %^b b Median (interquartile range).
Age (months)	358	45.4 (9.9)	Was on maternity leave (%)	359

Gender (%)	359		Yes	25	7.0
Male	193	53.8	No	75	20.9
Female	166	46.2	Unemployed	259	72.1
Birth weight (kg)	329	3.21 (0.52)	Mother lives with the child's father (%)	282
WAZ at birth (SD)	329	-0.24 (1.14)	Yes	229	63.8
HAZ at birth (SD)	277	-0.14 (1.52)	No (partner)	30	8.4
WAZ at survey (SD)	353	-0.02 (1.15)	No (no partner)	100	27.9

HAZ at survey (SD)	355	-0.14 (1.10)	Maternal level of schooling (%)	358
Short stature (HAZ < -2 SD) (%)	356	3.9	<8 years	178	49.7
BAZ at survey (SD)	355	0.15 (1.24)	≥8 years	180	50.3
Thinness (BAZ < -2 SD)	7	2.0	Family income (%)	353
Normal weight (BAZ ± 2 SD)	321	90.4	<2 minimum wages	304	86.1
Excess weight (BAZ > +2 SD)	27	7.6	≥2 minimum wages	49	13.9

Hemoglobin (mg/dL)	355	11.0 (1.38)	No. of individuals in household	359	4 (3-5)^b b Median (interquartile range).
Hb < 11 mg/dL	157	44.2	Receives government aid (%)	357
Hb ≥ 11 mg/dL	198	55.8	Yes	270	75.6

Maternal age (years)	357	28.3 (6.75)	No	87	24.4

Prenatal consultations (%)	358		Place of residence (%)	359
No	7	2.0	Owns residence	163	45.4
Yes	351	98.0	Rented	157	43.7
No. of prenatal consultations	345	7 (6-8)^b b Median (interquartile range).	Lives free of charge	39	10.9

Planned pregnancy (%)	357		Trash collection services (%)	357
Yes	189	52.9	≤2×/week	50	14.0
No	168	47.1	>2×/week	307	86.0
First child (%)	359		Sewage treatment services	359
Yes	115	32.0	Sim	173	48.2
No	244	68.0	No	186	51.8

Variable	Category	n ^a a Number of individuals in the database with information on UPF consumption.	Median (months)	Probability of UPF introduction					p ^b b Log-rank test.
				1 month	3 months	6 months	9 months	12 months
Introduction of UPF (global)	-	338	6	0.047	0.240	0.752	0.885	0.991	-

Sociodemographic
Maternal age	<24 years	89	6	0.090	0.315	0.832	0.910	1.0	0.034
Maternal age	≥24 years	244	6	0.032	0.215	0.729	0.879	0.988
Maternal schooling	<8 years	166	6	0.048	0.265	0.747	0.874	0.988	0.706
Maternal schooling	≥8 years	172	6	0.047	0.215	0.756	0.895	0.994
Mother lives with the child's father^c c Biological.	Yes	243	6	0.045	0.255	0.757	0.893	0.996	0.479
Mother lives with the child's father^c c Biological.	No	95	6	0.053	0.200	0.737	0.863	0.979
Income	<2 MW	283	6	0.049	0.217	0.734	0.871	0.990	<0.001
Income	≥2 MW	47	4	0.043	0.362	0.872	1.0	1.0
Receives government aid	Yes	254	6	0.032	0.232	0.756	0.878	0.992	0.533
Receives government aid	No	82	6	0.085	0.256	0.744	0.915	1.0
Sewage treatment services	Yes	163	6	0.049	0.307	0.785	0.902	0.994	0.016
Sewage treatment services	No	175	6	0.046	0.177	0.720	0.869	0.989
Trash collection services	Yes	290	6	0.048	0.252	0.769	0.890	0.99	0.140
Trash collection services	No	47	6	0.043	0.149	0.638	0.851	1.0

Gestational
Planned pregnancy	Yes	179	6	0.028	0.189	0.678	0.839	0.994	<0.001
Planned pregnancy	No	155	6	0.071	0.295	0.840	0.942	0.994
Prenatal consultation	Yes	329	6	0.048	0.233	0.749	0.885	0.994	0.004
Prenatal consultation	No	6	3	0.000	0.667	1.0	1.0	1.0
First child	Yes	108	6	0.046	0.241	0.750	0.889	1.0	0.784
First child	No	230	6	0.048	0.239	0.752	0.883	0.987
Was on maternity leave	Yes^d d Was on maternity leave or unemployed at the time.	269	6	0.045	0.231	0.747	0.877	0.993	0.903
Was on maternity leave	No	69	6	0.058	0.275	0.768	0.913	0.986

Behavioral
Child was ever breastfed	Yes	316	6	0.041	0.218	0.753	0.896	0.994	0.743
Child was ever breastfed	No	22	3	0.136	0.546	0.727	0.727	0.955
Time of EBF	≤6 months	80	5	0.025	0.300	0.825	0.888	1.0	0.066
Time of EBF	>6 months	235	6	0.047	0.192	0.732	0.902	0.996
Was bottle-fed	Yes	174	6	0.063	0.282	0.793	0.891	0.994	0.023
Was bottle-fed	No	163	6	0.031	0.196	0.712	0.883	0.994
Used pacifier	Yes	65	5	0.077	0.385	0.754	0.846	0.985	0.308
Used pacifier	No	272	6	0.040	0.206	0.734	0.897	0.996
Considers diet outside of the day-care healthy	Yes	287	6	0.045	0.230	0.742	0.878	0.993	0.025
Considers diet outside of the day-care healthy	No	50	5	0.060	0.300	0.820	0.940	1.0
Food consistency^e e Inadequate, pureed or strained; adequate, mashed with a fork or the same as the rest of the family (with or without preparation modifications).	Inadequate	117	6	0.051	0.222	0.829	0.923	1.0	0.187
	Adequate	218	6	0.046	0.252	0.720	0.876	1.0
Received information on infant feeding	Yes	143	6	0.028	0.231	0.748	0.930	0.993	0.588
Received information on infant feeding	No	194	6	0.062	0.247	0.758	0.856	0.995

Biological
Anemia^f f Hemoglobin < 11 mg/dL.	Yes	150	6	0.047	0.240	0.713	0.860	0.980	0.191
Anemia^f f Hemoglobin < 11 mg/dL.	No	184	6	0.044	0.239	0.783	0.902	1.0
Excess weight^g g BMI-for-age Z-score ≥+2SD.	Yes	26	6	0.115	0.231	0.615	0.846	1.0	0.310
Excess weight^g g BMI-for-age Z-score ≥+2SD.	No	308	6	0.039	0.240	0.766	0.890	0.990

Variable	Category	Simple			Multiple
		HR	95% CI	p	HR^a a Model adjusted for age and gender (n = 348).	95% CI	p
Maternal age	<24 years	1.24	0.97-1.57	0.091
Maternal age	≥24 years	1
Planned pregnancy	No	1.41	1.13-1.75	0.002	1.32	1.05-1.65	0.016
Planned pregnancy	Yes	1			1
Prenatal consultation	No	2.76	1.22-6.22	0.014	2.50	1.02-6.16	0.045
Prenatal consultation	Yes	1			1
Income	≥2 MW	1.58	1.16-2.17	0.004	1.50	1.09-2.06	0.014
Income	<2 MW	1			1
Sewage treatment services	Yes	1.23	0.99-1.53	0.057
Sewage treatment services	No	1
Trash collection	Yes	1.20	0.88-1.63	0.247
Trash collection	No	1
Time of EBF	≤6 months	1.21	0.93-1.56	0.150
Time of EBF	>6 months	1
Bottle-fed	Yes	1.22	0.98-1.51	0.073
Bottle-fed	No	1
Considers diet outside of the day-care healthy	No	1.32	0.98-1.79	0.071
Considers diet outside of the day-care healthy	Yes	1
Food consistency	Inadequate	1.13	0.90-1.41	0.298
Food consistency	Adequate	1
Anemia	No	1.12	0.90-1.39	0.300
Anemia	Yes	1

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[1] * Corresponding author. E-mail:giovana_longo@yahoo.com.br (G. Longo-Silva).