Early feeding patterns, nutritional status and growth in Portuguese children 12-36 months

: a national representative study

Abstract

Metabolic programming results from the influence of early environmental experiences, particularly nutritional, on the future expression of the health-disease binomial, notably of non-communicable diseases. The period before conception, pregnancy and the first years of life constitutes a window of high sensitivity in respect of the environmental effect on genetic plasticity, with repercussions on general health and especially future nutritional status. Knowledge about each modifiable factor is essential for the establishment of recommendations for paediatric age, as well as for adults of reproductive age. EPACI Portugal 2012, Estudo do Padrão Alimentar e de Crescimento na Infância (Study of the Childhood Feeding Patterns and Growth)'s purpose was to study Portuguese children's dietary patterns and nutritional status. It was a nationally representative study that included 2230 children between 12-36 months and took place in 2012-2013, in 128 randomly selected Health Units of mainland Portugal. Through a team of trained interviewers, a questionnaire was applied, which included the collection of data on the parents, health history, dietary practices and anthropometric data of the children at different time milestones based on the consultation of the Child and Youth Health Bulletin, as well as the measurement of the weight, length/height and head circumference at the assessment moment. The body mass index (BMI) was afterwards calculated, and the nutritional status was characterised based on the World Health Organization (WHO) criteria. Information regarding the current diet was obtained through a 3-day food diary. A sub-sample of 2009 full-term children was analysed to describe early feeding practices. Most started breastfeeding (BF), but the prevalence decreased over time. Only about 20% met the WHO recommendation regarding exclusive BF for six months. Most infants complied with the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) recommendations regarding the timing of introduction of complementary feeding (CF). The foods introduced and the age of introduction of each respected the recommendations, with the exception of foods rich in sugar, which were early and excessively consumed. No association was found between the BF or timing of CF and the expression of overweight (OW)/obesity (OB). To determine the prevalence of nutritional inadequacy, and in the absence of national recommendations or the official adoption of a reference, the existing nutritional recommendations were analysed. After the review of the most commonly used recommendations and its systematisation, the comparison of the three main international recommendations - Food and Nutrition Board/Institute of Medicine (FNB/IOM), Food and Agriculture Organization of the United Nations/World Health Organization (FAO/WHO) and European Food Safety Authority/European Commission (EFSA/EC) - was made. EFSA's recommendations, established for the European reality, are the most recent, and present a great methodological robustness, were chosen to assess the nutritional adequacy of Portuguese children. For such purpose, nutritional intake and inadequacy and main suppliers of energy, macronutrients and some micronutrients were assessed in a sub-sample of 853 children, corresponding to those who filled in the food diaries. It was observed that most of the children exceeded the recommendations for energy but consumed a low proportion of energy provided by fat. The average daily protein intake was about five times higher than recommended, milk being the main supplier of energy and protein. Most children exceeded their sodium intake and none reached the recommended intake for vitamin D. At the time of the interview, 32.0% of children were at risk of OW, BMI z-score (zBMI) >1, and more than half of the parents were OW/OB. Higher maternal age and gestational weight gain (GWG) below recommendations were associated with lower zBMI in the offspring. In contrast, maternal OB at the time of assessment and high BMI before pregnancy were associated with higher zBMI in the offspring. About half of the mothers with OW or OB had a GWG above the recommendations. It becomes crucial to develop tools to identify and make early interventions in the life cycle aiming at preventing non-communicable diseases in adulthood, particularly the transgenerational transmission of OB.

Date of Award	23 Feb 2024
Original language	English
Awarding Institution	Universidade Católica Portuguesa
Supervisor	Carla Maria Barreto da Silva de Sousa Rêgo (Supervisor) & Elisabete Pinto (Co-Supervisor)