Exclusive breastfeeding, complementary feeding and association with body fat excess among schoolchildren in Florianópolis, Santa Catarina, Brazil

Gonsalez, Priscila Schramm; Retondario, Anabelle; Bricarello, Liliana Paula; González-Chica, David Alejandro; Silva, Diego Augusto Santos; Vasconcelos, Francisco de Assis Guedes de

doi:10.1590/1806-93042017000100007

ORIGINAL ARTICLES • Rev. Bras. Saude Mater. Infant. 17 (1) • Jan-Mar 2017 • https://doi.org/10.1590/1806-93042017000100007 linkcopy

Exclusive breastfeeding, complementary feeding and association with body fat excess among schoolchildren in Florianópolis, Santa Catarina, Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objectives: to analyze the association between exclusive breastfeeding duration (EBF) and the age at which complementary feeding was introduced (CF) with the excess of body fat (BF) in schoolchildren from Florianópolis/SC, southern of Brazil.

Methods: cross sectional study, with probability sample of 1,531 schoolchildren aged 7-10 years from Florianópolis/SC. The percentage of BF was defined based on triceps and subscapular skinfolds. Information about EBF, CF and confounders variables were obtained through a questionnaire sent to parents or guardians. Multivariate analyzes were performed using Poisson.

Results: the prevalence of BF excess was 37.9% (CI95%: 32.4; 43.6), and 30.6% of children received EBF for 4-6 months (CI95%: 17, 3; 48, 2). The duration of EBF less than 4 or more than 6 months was associated with higher prevalence of BF excess, even after adjustment (p=0.015). Introduction of food groups had no association with BF excess.

Conclusions: the association between EBF and the excess of body fat for less than 4 months and higher prevalence of BF excess is probably a consequence of early introduction of others milk types, whilst association between EBF for more than 6 months and higher prevalence of BF excess is because of a catch-up growth situation.

Key words
Child nutrition; Pediatric obesity; Cross-sectional studies

	Evaluated(n=1531)		Non-evaluated(n=703)		p *
	n**	%	n**	%	p *
Gender
Male	687	44.9	383	54.5	<0.001
Female	844	55.1	320	45.5
Age range (in years)
7and 8	866	56.6	374	53.2	0.113
9 and 10	665	43.4	329	46.8
Type of school
Public	932	60.9	357	50.7	<0.001
Municipal	516	33.7	154	21.9
State	370	24.2	187	26.7
Federal	46	3.1	16	2.1
Private	599	39.1	346	49.3
Grade
1^st and 2^nd	536	35.0	291	41.4	0.004
3^rd and 4^th	773	50.5	304	43.3
5^th and 6^th	222	14.5	108	15.3

Charateristics	N*	%	Body fat excess % (CI95%)	p #
Maternal**
BMI (kg/m²), X̅ ± SD	1,424	100.0	25.0±4.5***	-
BMI				<0.001
Low weight (<18.5 kg/m²)	23	1.6	18.5 (2.9;34.2)
Normal weight (18.5 to 24.9 kg/m²)	788	55.8	30.8 (27.5;34.1)
Overweight (25.0 to 29.9 kg/m²)	403	28.5	48.0 (43.2;52.8)
Obesity (>30.0 kg/m²)	199	14.1	48.0 (41.1;55.0)
Age (years), X̅ ± SD	1,443	100.0	36.2±6.9***	-
Age (years)				0.010
< 15	8	0.6	75.0 (36.3;113.7)
15 to 19	0	0.0	0.0 (0.0;0.0)
20 to 39	1,000	69.3	36.1 (33.1;39.1)
40 or more	435	30.1	42.2 (37.5;46.8)
Schooling	1,477	100.0		0.222
Never studied	12	0.8	56.3 (29.9;83.6)
Elementary school	316	21.4	34.7 (29.7;39.6)
High School	525	35.5	39.4 (35.2;43.5)
Higher Education	624	42.3	38.3 (34.3;42.3)
Total monthly Family income (R$)	1,324	100.0	2000 [1500;4000] ****	-
Monthly Family income				0.146
1st tercile	474	35.8	34.8 (30.5;39.1)
2nd tercile	435	32.9	41.1 (36.4;45.7)
3rd tercile	415	31.3	38.8 (34.1;43.6)
Students**
Gender	1,531
Female	844	55.1	36.1 (32.8;39.4)	0.127
Male	687	44.9	39.9 (36.3;43.5)
Age (years), X̅± SD	1,429	100.0	8.99±1.16***	-
Age (years)				<0.001
7 and 8	727	50.9	33.5 (30.0;36.9)
9 and 10	702	49.1	43.0 (39.3;46.7)
Birth weight (g), X̅ ± SD	1,447	100.0	3,220.0±540***	-
Birth weight				0.020
Extremelow weight (< 1kg)	2	0.1	100.0 (100.0;100.0)
Very low weight (1 to 1.499kg)	10	0.7	30.0 (-4.6;64.6)
Low weight (1.5 to 2.499kg)	129	8.9	38.8 (30.2;47.3)
Normal weight (2.5 to 3.99kg)	1,228	84.9	37.0 (34.3;39.7)
Macrosomia (≥ 4.0kg)	78	5.4	53.3 (41.8;64.6)
Prematurity (<37 weeks)	1,520	100.0
No	1,260	82.9	38.2 (35.4;41.0)	0.637
Yes	260	17.1	36.8 (31.6;42.0)
Duration of exclusive breastfeeding	1,475	100.0		0.072
Never breastfed	314	21.3	31.4 (25.6;37.3)
<1 month	92	6.2	38.1 (28.7;47.5)
1 to 3 months	540	36.6	39.6 (35.7;43.6)
4 to 6 months	451	30.6	36.5 (32.2;40.7)
7 months	78	5.3	64.7 (39.4;90.0)

Variables		Prevalence of body fat excess	Crude analysis	p **	Adjusted analysis*	p **
	n	% (CI95%)	PR (CI95%)		PR (CI95%)
Time of EBF
Never breastfed	77	31.43 (25.57;37.28)	1.00	0.004	1.00	0.015
<1 month	40	38.10 (28.65;47.54)	1.58 (1.07;2.32)		1.61 (1.07;2.42)
1 to 3 months	237	39.63 (35.70;43.56)	1.65 (1.19;2.29)		1.66 (1.16;2.37)
4 to 6 months	182	36.47 (32.24;40.71)	1.35 (0.97;1.88)		1.31 (0.92;1.88)
7 months	11	64.71 (39.38;90.03)	2.53 (1.59;4.02)		2.34 (1.44;3.81)

Type of food	N*	%	Body fat excess	p #
Type of food	N*	%	% (CI95%)	p #
Water and teas
<6 months	938	63.6	37.4 (34.3;40.6)	0.849
6 to 11 months	497	33.7	36.9 (32.7;41.2)
≥12 months	40	2.7	42.7 (24.7;58.6)
Other milks
<6 months	642	43.5	37.7 (33.7; 41.7)	0.544
6 to 11 months	438	29.7	38.8 (34.4; 43.2)
≥12 months	395	26.8	35.3 (30.6; 39.9)
Fruit juices
<6 months	751	50.9	40.4 (36.8; 44.0)	0.058
6 to 11 months	680	46.1	34.3 (30.8; 37.8)
≥12 months	44	3.0	39.0 (23.4; 54.6)
Fruit
<6 months	702	47.6	40.5 (36.7; 44.3)	0.085
6 to 11 months	720	48.8	34.8 (31.5; 38.2)
≥12 months	53	3.6	35.6 (21.0; 50.1)
Vegetables
<6 months	534	36.2	40.7 (36.2; 45.1)	0.185
6 to 11 months	879	59.6	35.7 (32.6; 38.8)
≥12 months	62	4.2	37.3 (24.6; 50.0)
Cereals
<6 months	302	20.5	44.9 (38.5; 51.3)	0.033
6 to 11 months	1,008	68.3	36.1 (33.2; 39.0)
≥12 months	165	11.2	34.8 (27.8; 41.9)
Legumes
<6 months	150	1.0	39.3 (31.7; 46.8)	0.698
6 to 11 months	1,111	75.3	36.7 (33.8; 39.6)
≥12 months	214	14.5	39.1 (32.6; 45.6)
Meats
<6 months	142	9.6	40.4 (32.7; 48.0)	0.689
6 to 11 months	976	66.2	37.3 (34.2; 40.3)
≥12 months	357	24.2	36.5 (31.5; 41.5)
Non-healthy food
<6 months	41	2.8	34.6 (21.6; 47.5)	0.755
6 to 11 months	319	21.6	36.2 (31.2; 41.3)
≥12 months	1,115	75.6	38.0 (35.1; 40.9)

Variables		Body fat excess	Crude analysis	p **	Adjusted analysis*	p **
	N	% (CI95%)	PR (CI95%)		PR (CI95%)	p **
Age of introduction of cereals
<6 months	105	44.87 (38.45;51.29)	1.00	0.220	1.00	0.076
6 to 11 months	380	36.12 (33.21;39.03)	0.85 (0.66;1.08)		0.79 (0.61;1.01)
≥12 months	62	34.83 (27.76;41.89)	0.83 (0.59-1.17)		0.75 (0.51;1.10)

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Instituto de Medicina Integral Prof. Fernando Figueira Rua dos Coelhos, 300. Boa Vista, 50070-550 Recife PE Brasil, Tel./Fax: +55 81 2122-4141 - Recife - PR - Brazil
E-mail: revista@imip.org.br

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[TFN1] ^*
p-value for chi-square test;

[TFN2] ^**
n calculated based on complex sample, considering the layer and weight sample.