Evolução das práticas alimentares em crianças menores de dois anos: uma análise da coorte brasileira do estudo MAL-ED

Abstract

Eating habits in the first two years of life impact children's nutritional and health status, influencing growth and development. Few studies have prospectively evaluated these practices, also considering the characteristics of the foods used, such as their level of processing. This study aimed to evaluate the evolution of eating habits in children under two years of age, considering indicators from the World Health Organization (WHO) and the level of processing of the food consumed. This study is part of a multicentric birth cohort (MAL-ED). For this work, children from the Brazilian cohort at 9 (n=193), 15 (n=182) and 24 months (n=164) were evaluated. Dietary practices were analyzed using 24-hour recalls, using the indicators proposed by the WHO. Foods consumed were evaluated according to the level of processing. Logistic regression models were built to determine socioeconomic variables and dietary practices associated with the consumption of ultra-processed foods at 9, 15 and 24 months of age. The number of breastfed children decreased over time, from 77.6% at 9 months to 55.0% at 15 months and 45.1% at 24 months. The minimum meal frequency was reached by 88.6% of the children at 9 months, 99.5% at 15 months and 97% at 24 months. Although dietary diversity did not increase significantly during the study period, the minimum acceptable diet increased significantly to 76.1% at 24 months (p <0.0005). There were also high percentages of children consuming sweetened beverages - 100% at 15 and 24 months. A significant increase in the number of children consuming sentinel foods was also seen, 5.7% at 9 months, 9.9% at 15 months and 18.9% at 24 months (Chisquare, p < 0.0005). The indicator of zero consumption of vegetables and fruits also significantly increased, with 14% at 9 months, 17.6% at 15 months and 30.5% at 24 months (Chi-square, p < 0.0005). The number and frequency of unprocessed food consumption decreased from 9 to 24 months of age (p < 0.0005); while the number and frequency of consumption of ultra-processed foods increased (p < 0.0005) during the study period. Logistic regressions showed that, at 9 months, children who were breastfed presented a lower chance of high consumption of ultra-processed foods (OR = 0.42; 95% CI = 0.19 - 0.95) and children who reached the minimum acceptable diet were more likely to have this high consumption (OR = 4.74; 95% CI = 1.50 – 14.94). Thus, reduced breastfeeding, high consumption of sweetened beverages, increased consumption of sentinel foods and increased percentage of children who did not consume vegetables and fruits, added to the reduction in the consumption of unprocessed foods and increased consumption of ultra-processed foods, demonstrated a reduction in the quality of dietary practices over the first two years of life. Breastfeeding an important protective factor against a greater consumption of ultra-processed foods.