Ultra-processed food consumption among infants in primary health care in a city of the metropolitan region of São Paulo, Brazil

Relvas, Gláubia Rocha Barbosa; Buccini, Gabriela dos Santos; Venancio, Sonia Isoyama

doi:10.1016/j.jped.2018.05.004

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Original articles • J. Pediatr. (Rio J.) 95 (5) • Sep-Oct 2019 • https://doi.org/10.1016/j.jped.2018.05.004 copy

Ultra-processed food consumption among infants in primary health care in a city of the metropolitan region of São Paulo, Brazil^☆ ☆ Please cite this article as: Relvas GR, Buccini GS, Venancio SI. Ultra-processed food consumption among infants in primary health care in a city of the metropolitan region of São Paulo, Brazil. J Pediatr (Rio J). 2019;95:584-92. , ^☆☆ ☆☆ Study conducted at Universidade de São Paulo, Faculdade de Saúde Pública, Programa de Pós-Graduação Nutrição em Saúde Pública, São Paulo, SP, Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To analyze the prevalence of ultra-processed food intake among children under one year of age and to identify associated factors.

Methods:

A cross-sectional design was employed. We interviewed 198 mothers of children aged between 6 and 12 months in primary healthcare units located in a city of the metropolitan region of São Paulo, Brazil. Specific foods consumed in the previous 24 h of the interview were considered to evaluate the consumption of ultra-processed foods. Variables related to mothers' and children's characteristics as well as primary healthcare units were grouped into three blocks of increasingly proximal influence on the outcome. A Poisson regression analysis was performed following a statistical hierarchical modeling to determine factors associated with ultra-processed food intake.

Results:

The prevalence of ultra-processed food intake was 43.1%. Infants that were not being breastfed had a higher prevalence of ultra-processed food intake but no statistical significance was found. Lower maternal education (prevalence ratio 1.55 [1.08-2.24]) and the child's first appointment at the primary healthcare unit having happened after the first week of life (prevalence ratio 1.51 [1.01-2.27]) were factors associated with the consumption of ultra-processed foods.

Conclusions:

High consumption of ultra-processed foods among children under 1 year of age was found. Both maternal socioeconomic status and time until the child's first appointment at the primary healthcare unit were associated with the prevalence of ultra-processed food intake.

KEYWORDS
Complementary feeding; Infant feeding practices; Primary health care; Ultra-processed food

	n ^a a The total was lower for some variables due to missing information.	%
Socioeconomic proxy: maternal education, years of study
≥11	81	45.8
<11	96	54.2
Characteristics of health unit during the follow-up
Primary healthcare model
Family health strategy	46	23.2
Traditional or mixed	152	76.8
First appointment at the primary healthcare unit (PHU)
First week of child's life	96	49.5
After first week of child's life	98	50.5
Home visits from health team
Yes	47	24.2
No	147	75.8
PHU schedules regular appointments
Yes	171	94.0
No	11	6.0
Health care attendance without appointment
Yes	109	57.7
No	80	42.3
Counseling on complementary feeding
Yes	137	73.3
No	50	26.7
Family and maternal characteristics
Maternal age, years
≥20 years	161	82.1
<20 years	35	17.9
Primiparity
No	91	46.4
Yes	105	53.6
Maternal work
Not working outside the home	145	74.7
Working outside the home	49	25.3
Cohabitation with the child's father
Yes	154	79.0
No	41	21.0
Cohabitation with child's grandmother
No	163	83.6
Yes	32	16.4
Maternal daily dedication to child care
All day	147	75.8
1 or 2 periods	47	24.2
Child characteristics and feeding practices
Infant gender
Female	90	45.4
Male	108	54.6
Low birth weight (<2.500 g)
No	160	86.0
Yes	26	14.0
Bottle feeding
No	50	27.2
Yes	134	72.8
Food adequacy
Yes	36	22.5
No	124	77.5
Minimum food diversity
Yes	62	37.1
No	105	62.9
Breastfeeding
Yes	132	70.2
No	56	29.8
Ultra-processed food
Yes	78	43.1
No	103	56.9

Variable (n total)	UPF consumption
	n	%	PR_unajusted	p
Socioeconomic proxy: maternal education, years of study (n = 169)
≥11	26	32.5	1
<11	45	50.6	1.55 [1.07-2.27]	0.02
Distal block (1) - characteristics of health unit during follow-up
Primary healthcare model (n = 181)
Family health strategy	21	48.8	1
Traditional or mixed	57	41.3	0.84 [0.59-1.22]	0.370
First appointment at the primary healthcare unit (PHU) (n = 178)
First week of child's life	30	35.7	1
After first week of child's life	48	51.1	1.43 [1.01-2.03]	0.04
Home visits from healthcare team (n = 178)
Yes	19	46.3	1
No	58	42.3	0.91 [0.62-1.34]	0.645
PHU schedules regular appointments (n = 166)
Yes	63	40.5	1
No	7	63.6	1.56 [0.96-2.55]	0.071
Health care attendance without appointment (n = 173)
Yes	47	48.0	1
No	27	36.0	0.75 [0.52-1.08]	0.125
Counseling on complementary feeding (n = 175)
Yes	54	43.2	1
No	22	44.0	1.02 [0.70-1.48]	0.923
Intermediate block (2) - family and maternal characteristics
Maternal age, years (n = 179)
≥20	65	43.9	1
<20	13	41.9	0.95 [0.61-1.50]	0.842
Primiparity (n = 179)
No	37	43.5	1
Yes	41	43.6	1.00 [0.72-1.40]	0.991
Maternal work (n = 181)
Not working outside the home	59	44.7	1
Working outside the home	19	41.3	0.92 [0.62-1.37]	0.695
Cohabitation with the child's father (n = 178)
Yes	62	43.7	1
No	15	41.7	0.95 [0.62-1.47]	0.831
Cohabitation with child's grandmother (n = 178)
No	63	42.3	1
Yes	14	48.3	1.14 [0.75-1.74]	0.538
Maternal daily dedication to child care (n = 178)
All day	55	41.7	1
1 or 2 periods	22	47.8	1.15 [0.80-1.65]	0.458
Proximal block (3) - Child characteristics and feeding practices
Infant gender (n = 181)
Female	37	46.2	1
Male	41	40.6	0.87 [0.63-1.23]	0.445
Low birth weight (<2.500 g) (n = 171)
No	64	43.0	1
Yes	9	40.9	0.95 [0.56-1.63]	0.859
Bottle feeding (n = 170)
No	18	37.5	1
Yes	56	45.9	1.22 [0.81-1.85]	0.339
Food adequacy (n = 160)
Yes	18	50.0	1
No	49	39.5	0.79 [0.53-1.17]	0.242
Minimum food diversity (n = 167)
Yes	29	46.7	1
No	40	38.1	0.81 [0.57-1.17]	0.266
Breastfeeding (n = 173)
Yes	47	38.8	1
No	28	53.8	1.39 [1.00-1.94]	0.058

	UPF consumption
	PR_ajusted	p
Model 1 ^a a Model 1, maternal socioeconomic proxy and infant age. - maternal socioeconomic proxy
Maternal education, years of study
11	1
<11	1.55 [1.08-2.24]	0.018
Model 2 ^b b Model 2, Model 1 + first appointment at PHU, PHU schedules regular appointments, health care attendance without appointment. - characteristics of health unit during follow-up
First appointment at the primary healthcare unit (PHU)
First week of child's life	1
After first week of child's life	1.51 [1.01-2.27]	0.046
PHU schedules regular appointments
Yes	1
No	1.50 [0.86-2.62]	0.150
Health care attendance without appointment
Yes	1
No	0.74 [0.50-1.08]	0.122
Model 3 ^c c Model 3, Model 2 + maternal age. - family and maternal characteristics
Maternal age, years
≥20 years	1
<20 years	0.77 [0.44-1.34]	0.352
Model 4 ^d d Model 4, Model 3 + breastfeeding. - child characteristics and feeding practices
Breastfeeding
Yes	1
No	1.18 [0.80-1.72]	0.401

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E-mail: jped@jped.com.br

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[1] * Corresponding author. E-mail:glaubia@usp.br (G.R. Relvas).