In 2007, WHO carried out a systematic review and meta-analysis on the long-term consequences of breastfeeding. The Department of Maternal, Newborn, Child and Adolescent Health of the WHO has now commissioned an update of this review. The following long-term outcomes were reviewed: blood pressure, type-2 diabetes, serum cholesterol, overweight and obesity, and intellectual performance. This report describes the methods, results and conclusions of this updated review.

Long-term effects of breastfeeding: a systematic review

The World Health Organisation recommends exclusive breastfeeding until 6 months of age and continued breastfeeding until 2 years of age or beyond. Appropriate complementary foods should be introduced in a timely fashion, beginning when the infant is 6 months old. In developing countries, early or inappropriate complementary feeding may lead to malnutrition and poor growth, but in countries such as the United Kingdom and United States of America, where obesity is a greater public health concern than malnutrition, the relationship to growth is unclear. We conducted a systematic review of the literature that investigated the relationship between the timing of the introduction of complementary feeding and overweight or obesity during childhood. Electronic databases were searched from inception until 30 September 2012 using specified keywords. Following the application of strict inclusion/exclusion criteria, 23 studies were identified and reviewed by two independent reviewers. Data were extracted and aspects of quality were assessed using an adapted Newcastle-Ottawa scale. Twenty-one of the studies considered the relationship between the time at which complementary foods were introduced and childhood body mass index (BMI), of which five found that introducing complementary foods at 6 months, may increase the risk of childhood overweight.

Timing of the introduction of complementary feeding and risk of childhood obesity: a systematic review

International health organizations have recommended exclusive breast-feeding (EBF) (i.e., breast milk as the only source of food) as the optimal infant feeding method during the first 4-6 mo of life. Therefore, it is important to document the determinants of EBF in different populations. Low-income urban women from Brazil (n = 446, 2 maternity wards), Honduras (n = 1582, 3 maternity wards) and Mexico (n = 765, 3 maternity wards) were interviewed at birth and in their homes at 1 mo and 2-4 mo after delivery. Multivariate survival analyses (Cox model) indicated that planned duration of EBF (all 3 countries), having a female infant, and not being employed (Brazil and Honduras), lower socioeconomic status (Honduras and Mexico) and higher birth weight (control hospital in Brazil and Honduras) were positively associated (P < or = 0.10) with EBF. Women who delivered in the maternity wards that had more developed breast-feeding promotion programs were more successful with EBF. The association between maternal education and EBF was modified by the maternity ward in Mexico and Honduras. Being > or = 18 y and having a partner living (Brazil) or not (Mexico) living at home were positively associated with EBF. These findings can contribute toward the design of EBF promotion efforts in Latin America.

Exclusive breast-feeding duration is associated with attitudinal, socioeconomic and biocultural determinants in 3 latin-american countries

The determinants of childhood overweight and obesity are complex, but infant feeding and the early diet are important contributing factors. The complementary feeding period in particular, is a time during which children are nutritionally vulnerable, and a time where life-long eating habits may be established. We conducted a systematic review of the literature that investigated the relationship between the types of food consumed by infants during the complementary feeding period and overweight or obesity during childhood. Electronic databases were searched from inception until June 2012 using specified keywords. Following the application of strict inclusion/exclusion criteria, 10 studies were identified and reviewed by two independent reviewers. Data were extracted and aspects of quality were assessed using an adapted Newcastle-Ottawa scale. Studies were categorised into three groups: macronutrient intake, food type/group and adherence to dietary guidelines. Some association was found between high protein intakes at 2-12 months of age and higher body mass index (BMI) or body fatness in childhood, but was not the case in all studies. Higher energy intake during complementary feeding was associated with higher BMI in childhood. Adherence to dietary guidelines during weaning was associated with a higher lean mass, but consuming specific foods or food groups made no difference to children's BMI. We concluded that high intakes of energy and protein, particularly dairy protein, in infancy could be associated with an increase in BMI and body fatness, but further research is needed to establish the nature of the relationship. Adherence to dietary guidelines during weaning is recommended.

The types of food introduced during complementary feeding and risk of childhood obesity: a systematic review

Phylogenetic analysis of a large dataset (72 taxa, 212 characters) focuses on the in-group relationships of temnospondyls, the largest lower tetrapod clade. Representatives of all clades and grades were considered, spanning the entire stratigraphical range of temnospondyls from the Early Carboniferous through to the Early Cretaceous. Several major groups are defined phylogenetically (node or branch-based) rather than by apomorphies. The following groups were unequivocally found to be monophyletic: Edopoidea (node), Dvinosauria (stem, excl. Brachyopidae), Dissorophoidea (node), Eryopidae (stem), and Stereospondyli (node). The latter encompass three well-defined, branch-based taxa: Rhinesuchidae, Trematosauria and Capitosauria. Trematosauria (stem) contain Trematosauroidea (node), which includes the classic trematosaurids, metoposaurids, and possibly part of the rhytidosteids (Peltostega) but their in-group relationships remain unsettled; most other short-snouted stereospondyls (chigutisaurids, brachyopids,...

The evolution of major temnospondyl clades: an inclusive phylogenetic analysis

OBJETIVO: Analizar la asociacion del sobrepeso y de la obesidad con el amamantamiento materno y la alimentacion complementaria en preescolares. METODOS: Estudio transversal envolviendo 566 ninos matriculados en escuelas privadas en el municipio de Sao Paulo (Sureste de Brasil), 2004-2005. La variable dependiente fue sobrepeso y obesidad. Para la clasificacion del estado nutricional de los ninos fueron utilizadas las curvas de percentiles del indice de masa corporal para edad, clasificando como sobrepeso valores ?P85 y <P95, y como obesidad valores ?P95. Las variables explicativas analizadas fueron: caracteristicas sociodemograficas del nino y su familia; peso al nacer; estado nutricional de los padres; amamantamiento materno; alimentacion complementaria y alimentacion actual. El analisis de asociacion de las variables explicativas con el hecho, fue realizado por medio de regresion logistica simple y regresion logistica multiple con modelo jerarquizado. RESULTADOS: La prevalencia de sobrepeso y obesidad de la poblacion estudiada fue de 34,4%. Fueron factores de proteccion contra sobrepeso y obesidad, el amamantamiento materno exclusivo por seis meses o mas (IC 95% [0,38;0,86]; OR=0,57; p=0,02) y el amamantamiento materno por mas de 24 meses (IC 95% [0,05;0,37]; OR=0,13; p=0,00). CONCLUSIONES: Los resultados sugieren que el amamantamiento materno puede proteger los ninos contra sobrepeso y la obesidad, agregando otra ventaja a la leche materna.

/pdf/amamantamiento-materno-alimentacion-complementaria-sobrepeso-1twwv7y0bk.pdf

Amamantamiento materno, alimentación complementaria, sobrepeso y obesidad en preescolares

OBJETIVO: Analisar a associacao do sobrepeso e da obesidade com o aleitamento materno e a alimentacao complementar em pre-escolares. METODOS: Estudo transversal envolvendo 566 criancas matriculadas em escolas particulares no municipio de Sao Paulo, SP, 2004-2005. A variavel dependente foi sobrepeso e obesidade. Para a classificacao do estado nutricional das criancas foram utilizadas as curvas de percentis do Indice de Massa Corporal para idade, classificando como sobrepeso valores e"P85 e <P95, e como obesidade valores e"P95. As variaveis explanatorias analisadas foram: caracteristicas sociodemograficas da crianca e sua familia peso ao nascer; estado nutricional dos pais; aleitamento materno; alimentacao complementar e alimentacao atual. A analise de associacao das variaveis explanatorias com o desfecho foi feita por meio de regressao logistica simples e regressao logistica multipla com modelo hierarquizado. RESULTADOS: A prevalencia de sobrepeso e obesidade da populacao estudada foi de 34,4%. Foram fatores de protecao contra sobrepeso e obesidade o aleitamento materno exclusivo por seis meses ou mais (IC 95% [0,38;0,86]; OR=0,57; p=0,02) e o aleitamento materno por mais de 24 meses (IC 95% [0,05;0,37]; OR=0,13; p=0,00). CONCLUSOES: Os resultados sugerem que o aleitamento materno pode proteger as criancas contra o sobrepeso e a obesidade, agregando mais uma vantagem ao leite materno.

/pdf/aleitamento-materno-alimentacao-complementar-sobrepeso-e-3yrnjf3cb8.pdf

Aleitamento materno, alimentação complementar, sobrepeso e obesidade em pré-escolares

INTRODUCAO: A alimentacao da crianca no 1o ano de vida e muito importante para seu crescimento e desenvolvimento. A alimentacao complementar e influenciada por complexos fatores sociais, economicos e culturais. OBJETIVO: Verificar a idade de introducao de alimentos complementares no primeiro ano de vida, e sua relacao com variaveis demograficas e socioeconomicas. METODOS: Estudou-se uma coorte de criancas nascidas em Hospital Universitario do Municipio de Sao Paulo. A verificacao da idade de introducao de alimentos foi feita a partir de fichas preenchidas pela mae, diariamente, onde constavam os alimentos oferecidos a crianca a cada dia, ate o final do seguimento. A introducao dos alimentos foi descrita utilizando-se a tecnica de analise de sobrevida de Kaplan & Meier, e a analise de associacao entre idade de introducao dos alimentos e as variaveis independentes foi feita pelo modelo de analise multivariavel de Cox. RESULTADOS: As idades medianas de introducao de agua ou cha, leite nao materno, frutas, verduras e legumes, cereais e tuberculos foram menores de 6 meses. Foram verificadas associacoes estatisticamente significativas entre escolaridade materna, renda familiar, trabalho materno e introducao de alguns alimentos. CONCLUSAO: Houve introducao precoce de agua ou cha e de leite nao materno. Alem da renda e do trabalho materno, a escolaridade materna parece ser a variavel que mais influencia a introducao de alimentos complementares.

/pdf/introducao-de-alimentos-complementares-e-sua-relacao-com-3qkpolkyom.pdf

Introdução de alimentos complementares e sua relação com variáveis demográficas e socioeconômicas, em crianças no primeiro ano de vida, nascidas em Hospital Universitário no município de São Paulo

/pdf/breastfeeding-complementary-feeding-overweight-and-obesity-gei3lq7408.pdf

Breastfeeding, complementary feeding, overweight and obesity in pre-school children

OBJETIVO: verificar a prevalencia de sobrepeso e obesidade segundo sexo e idade em criancas de 2 a 6 anos de idade, alunos de escolas particulares no municipio de Sao Paulo. METODO: foram realizadas medidas de peso e de altura para verificacao do estado nutricional de oitocentos e seis criancas de ambos os sexos. Para a classificacao do estado nutricional das criancas foram utilizadas as curvas de percentis do Indice de Massa Corporal (IMC = Peso (kg) / Altura² (cm)) para idade, conforme padrao de referencia do Multicentre Growth Study, recomendado pela Organizacao Mundial de Saude que classifica como sobrepeso valores de percentis >; 85 e < 97 e para a obesidade valores < 97. Para analise da relacao entre sexo, idade da crianca e estado nutricional utilizou-se modelo linear generalizado de regressao multipla (glm) com ligacao logaritmica e familia binomial, que permite, diretamente, a estimacao das razoes de prevalencias. A prevalencia de sobrepeso+obesidade foi 37,2% para o sexo masculino e 33,4% para o sexo feminino. A razao de prevalencia (RP) mostrou que nao existe diferenca significativa entre obesidade e sobrepeso+obesidade para sexo e idade. CONCLUSAO: observaram-se prevalencias de sobrepeso e de obesidade superiores as prevalencias medias da populacao brasileira. Os resultados encontrados neste estudo reforcam a preocupacao com a obesidade infantil que aparentemente vem crescendo, em idades mais precoces como dos pre-escolares.

/pdf/prevalencia-de-sobrepeso-e-obesidade-em-criancas-de-dois-a-6hwcb7mtx1.pdf

Viviane Gabriela Nascimento Simon

Papers

Amamantamiento materno, alimentación complementaria, sobrepeso y obesidad en preescolares

Aleitamento materno, alimentação complementar, sobrepeso e obesidade em pré-escolares

Introdução de alimentos complementares e sua relação com variáveis demográficas e socioeconômicas, em crianças no primeiro ano de vida, nascidas em Hospital Universitário no município de São Paulo

Breastfeeding, complementary feeding, overweight and obesity in pre-school children

Prevalência de sobrepeso e obesidade em crianças de dois a seis anos matriculadas em escolas particulares no município de São Paulo