REPLY TO ARTICLE: CONSUMPTION OF ULTRA-PROCESSED FOODS BY CHILDREN UNDER 24 MONTHS OF AGE AND ASSOCIATED FACTORS

2. Souza JP, Ferreira CS, Lamounier DM, Pereira LA, Rinaldi AE. Caracterização da alimentação de crianças menores de 24 meses em unidades da estratégia saúde da família. Rev Paul Pediatr. 2020;38:e2019027. http://dx.doi.org/10.1590/19840462/2020/38/2019027 3. Boccolini CS, Boccolini PM, Monteiro FR, Venâncio SI, Giugliani ER. Breastfeeding indicators trends in Brazil for three decades. Rev Saúde Pública. 2017;51:108. http://dx.doi.org/10.11606/ s1518-8787.2017051000029

It is true that changes in dietary pattern have increased in the past decades, thus providing room for the growth of comorbidities related to weight gain, mainly among children. Therefore, the rise of ultra-processed foods, especially in the diet of children aged under 24 months of age, played an essential role for the changes in dietary pattern, and can be attributed to several factors, such as the return of the maternal figure to the work place, and the consequent early weaning. 1 This study, carried out in the State of Minas Gerais, identified that 74.3% of the analyzed infants, mainly those aged more than 6 months, already consumed ultra-processed foods. 1 On the other hand, another study in the same State showed that exclusive breast feeding until the age of 6 months occurred only among 24.9% of the participants, and that only 49% of the mothers participated in groups about breast feeding. 2 Such data, found in different studies, agree that weaning is, in fact, early among Brazilian families.
A study, carried out to update maternal breast feeding indicators in Brazil in the last three decades, showed there was an increasing tendency until 2006; after that decade, the numbers became stable, which led to national warning, since recent studies reinforce the protection breast feeding provides against infectious diseases, besides leading to lower risk of chronic conditions. 3 In this sense, the intake of human milk is associated to the reduced consumption of ultra-processed foods, thus showing the indispensability of actions to change the current breast feeding scenario, leading to benefits such as improved dietary habits and fewer child health problems. 4 Therefore, the question is: how would it be possible to increase the number of breast-feeding months, and, consequently, reduce the introduction of ultra-processed foods?
The conclusion is that the article in question does not present the strategic actions that can be used to fight this problem. It is necessary to reassess the established public policies, proposing new strategies of intervention in Primary Health care, in order to provide more social engagement and support to breast feeding. Besides, it is important to train health professionals to advise and support the mothers, thus increasing the responsibility of the Family Health Strategy (ESF) to provide information and care to all of its users, especially the most vulnerable populations. Therefore, it is necessary to search for efficient tools to increase the breast-feeding period, in order to promote better quality of life to the children.

Dear editors,
The article in question did not aim at assessing or proposing intervention strategies, but instead, the objective was that described in the last paragraph of the introduction: "… to assess the intake of ultra-processed foods by children in the city of Montes Claros, aged under 24 months, and to identify its associated factors…". It was based on a diagnostic and observational study. Therefore, the obtained results, the discussion and the final conclusions were based on a study of such a design. 1 However, since the discussion of the article is also a place where the authors can issue their opinion on the findings, 2 we point to an alternative described in the fifth paragraph of the discussion: "The association observed here, between the care taker and the early intake of ultra-processed foods, has to be considered from the perspective of programs addressed to the promotion of health diets for children…". Therefore, the study provides evidence that can assist health professionals and administrators in the definition of policies and programs destined to this group.
In the conclusion of the article, we mentioned that "Therefore, this study can contribute with the orientation of health professionals in the counselling of families regarding the diet of children in the early years of life, emphasizing the proper introduction of complementary feeding, thus discouraging the introduction of ultra-processed foods".
It is important to mention that diagnostic studies are carried out to scientifically support and contribute with intervention studies and research. And this study was relevant to point out the high intake of ultra-processed foods, which are introduced early in children's diet.
We invite academics, professors, researchers and health professionals to invest more in interventions and tools, and to publish analyses on the subject, so that it is possible to evaluate better strategies to increase the time of breast feeding, to improve the adequation of complementary feeding, and to discourage the use of ultra-processed foods in this age group.
Finally, we understand that the comment is, above all, a reflection that is added to the interest of the authors to raise awareness for the theme. Considering that most readers are health professionals, many of whom in decision-making positions in health policies and programs, we expect that our study can assist them in this sense.