Dietary intake quality and associated factors in one year-old children seen by primary healthcare services

Freitas, Laura Garcia de; Cortés, Margarita Alexandra Pena; Stein, Caroline; Cousin, Ewerton; Faustino-Silva, Daniel Demétrio; Hilgert, Juliana Balbinot

doi:10.1590/1413-81232020257.14592018

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ARTICLE • Ciênc. saúde coletiva 25 (7) • July 2020 • https://doi.org/10.1590/1413-81232020257.14592018 copy

Dietary intake quality and associated factors in one year-old children seen by primary healthcare services

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The purpose of this paper was to analyze the food intake quality in one year-old children seen by a primary healthcare (PHC) service. This is a cross-sectional studied nested within a child oral health cohort study which collected data regarding children born in 2013 and monitored in Porto Alegre for two years. We applied a questionnaire on maternal variables and frequency of pediatric appointments, weight and height measurements, and children’s food intake. To that end, a score was generated based on the points assigned according to SISVAN (meaning ‘food and nutrition monitoring system,’ run by the Brazilian Ministry of Health). A multivariate model was calculated using Poisson regression with robust variance. The sample comprised 249 children. We found 30.5% (76) of poor/regular dietary quality, which in the multivariate model was associated to the guardian’s educational background, considering up to incomplete high school (PR = 2.14, CI95% = 1.03-4.44) and complete high school (PR = 1.70, CI95% = 0.81-3.54), as well as their failure to see a dentist (PR = 2.54, CI95% = 1.33-4.84) or having seen one before the age of four months (PR = 1.94, CI95% = 1.01-3.72). It is our conclusion that failing to see a dentist within the first year of life and lower maternal schooling negatively impact on children’s dietary quality.

Key words
Child health; Dietary intake; Child care; Nutritional epidemiology

Variables	N	%
Child's age (months)
12 or younger	57	22.9
Over 12 months	192	77.1
Child's gender
Male	129	51.8
Female	120	48.2
Guardian's age (years)
Under 25	71	28.5
25 - 29	64	25.7
30 - 34	62	24.9
35 or older	52	20.9
Guardian's schooling
Incomplete High school	119	47.7
Complete High school	92	37.0
College education or beyond	38	15.3
Guardian's number of children
1	133	53.4
2 or more	116	46.6
Marital status
Single/Divorced/Widowed	64	25.7
Married/Living together	185	74.3
Secondary child care provider
Father	178	71.5
Grandmother	71	28.5
Child enrolled in day care
No	181	72.7
Yes	68	27.3
Child's age (months) at first dental appointment
No appointment	47	18.9
1 - 4	57	22.9
5 - 8	87	34.9
9 - 12	58	23.3
Child care monitoring in place
No	177	71.1
Yes	72	28.9
Income (BRL1,000) - mdn (P25 - P75)	1.6 (1-2.5)
Dietary quality
Poor/regular (≤ 20% to 60%)	76	30.5
Good/excellent (61% a > 80%)	173	69.5

Variables	Points^b b Points tallied according to answers, totaling 0 to 17, for the SISVAN tool's total score.	N(%)
Was your child breastfed yesterday?^* * questions which depend on interviewees' answers are assigned points to only one of the two first questions.
No	0	123 (49.4)
Yes	1	126 (50.6)
If not, how old was your child when he/she stopped breastfeeding?^* * questions which depend on interviewees' answers are assigned points to only one of the two first questions.
Never	0	14 (11.4)
< 120 days	1	40 (32.5)
≥ 120 days	2	69 (56.1)
How long was your child fed exclusively breast milk?
< 1 month or never	0	39 (16.2)
Up to 1 month	0	11 (4.4)
Up to 2 months	1	14 (56)
Up to 3 months	1	20 (8.0)
Up to 4 months	2	40(16.1)
Up to 5 months	2	26 (10.4)
Up to 6 months	3	99 (39.8)
Yesterday your child ate - n(%)
Vegetables	1	206 (82.7)
Fruit	1	222 (89.2)
Meat	1	205 (82.3)
Black beans	1	208 (83.5)
Watching TV	0	69 (27.7)
Stove-cooked food	1	218 (87.6)
Porridge and milk or milk thickened with flour	0	82 (32.9)
Ferrous sulfate	1	75 (30.1)
Was your child given honey/molasses/sugar/sugarcane hard candy before the age of 6 months?
No	1	200 (80.3)
Yes	0	49 (19.7)
Was your child fed soft baby food/stove-cooked food before the proper age?^* * questions which depend on interviewees' answers are assigned points to only one of the two first questions.
No	1	139 (55.8)
Yes	0	110 (44.2)
Has your child drunk processed or powdered juice in the past month?
No	1	97 (37.3)
Yes	0	163 (62.7)
Has your child drunk carbonated soft drinks in the past month?
No	1	120 (48.2)
Yes	0	129 (51.8)

Variables	Poor/regular dietary quality	Crude Analysis		Adjusted Analysis
Variables		PR (IC95%)	p	PR (IC95%)	p
Level 1
Child's age (months)			0.65		0.61
12 or younger	28.1	1		1
Over 12 months	31.3	1.11(0.70-1.77)		1.13(0.71 - 1.79)
Child's gender			0.13		0.14
Male	34.9	1.35(0.92-1.98)		1.33(0.91 - 1.94)
Female	25.8	1		1
Guardian's age (years)			0.09		0.10
Under 25	36.6	1.59(0.88-2.85)		1.57(0.88 - 2.80)
25 - 29	21.9	0.95(0.48-1.87)		0.94(0.48 - 1.86)
30 - 34	38.7	1.68(0.93-3.02)		1.66(0.92 - 2.99)
35 or older	23.1	1		1
Level 2
Guardian's schooling			0.05^* * Linear trend for p-value. aGrupo Hospitalar Conceição's Community Healthcare Service.		0.03^* * Linear trend for p-value. aGrupo Hospitalar Conceição's Community Healthcare Service.
Incomplete High school	35.3	1.92(0.94-3.91)		2.14(1.03-4.44)
Complete High school	29.4	1.59(0.76-3.35)		1.70(0.81-3.54)
College education or beyond	18.4	1		1
Guardian's number of children			0.08		0.09
1	35.3	1.41(0.96-2.09)		1.45(0.95-2.20)
2 or more	25.0	1		1
Marital status			0.08		0.09
Single/Divorced/Widowed	39.1	1.42(0.96-2.08)		1.39(0.95-2.05)
Married/Living together	27.6	1		1
Secondary child care provider			0.09		0.09
Father	33.7	1.50(0.93-2.41)		1.50(0.93-2.41)
Grandmother	22.5	1		1
Child enrolled in day care			0.41		0.49
No	32.0	1.22(0.77-0.90)		1.17(0.75-1.81)
Yes	26.5	1		1
Level 3
Child's age (months) at first dental appointment			0.03		0.04
No appointment	44.7	2.59(1.35-4.96)		2.54 (1.33-4.84)
1 - 4	33.3	1.93(0.99-3.79)		1.94(1.01-3.72)
5 - 8	29.9	1.73(0.90-3.32)		1.65(0.87-3.10)
9 - 12	17.2	1		1
Child care monitoring in place			0.56		0.47
No	31.6	1.14(0.74-1.75)		1.17(0.76-1.81)
Yes	27.8	1		1
Income (BRL1,000) - mdn (P25 - P75)		0.88(0.76-1.02)	0.09	0.92(0.78-1.08)	0.31

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[1] Collaborations

LG Freitas and DDF Silva participated in the project design, collection, analysis, interpretation of data and writing of the manuscript. C Stein, E Cousin, MAP Cortés and JB Hilgert participated in the analysis, interpretation of data, writing and relevant critical review of the intellectual content of the manuscript.