Exclusive breastfeeding and introduction of ultra-processed foods in the first year of life: a cohort study in southwest Bahia, Brazil, 2018

Porto, Jessica Prates; Bezerra, Vanessa Moraes; Pereira Netto, Michele; Rocha, Daniela da Silva

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Epidemiologia e Serviços de Saúde

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ORIGINAL ARTICLE • Epidemiol. Serv. Saúde 30 (2) • 2021 • https://doi.org/10.1590/S1679-49742021000200007 copy

Exclusive breastfeeding and introduction of ultra-processed foods in the first year of life: a cohort study in southwest Bahia, Brazil, 2018^* * Manuscript originated from the Master’s Degree dissertation in Public Health, by Jessica Prates Porto, entitled 'Introduction of ultra-processed foods and associated factors in children living in the municipality of Vitória da Conquista - Bahia' and submitted to the Multidisciplinary Institute of Health of the Universidade Federal da Bahia (IMS/UFBA) in August 2020. The study received financial support in the form of a Master's scholarship, granted to the student Jessica Prates Porto by the Bahia State Foundation for Research Support (Fapesb): Scholarship Grant Term No. BOL07587/2018.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To analyze association between exclusive breastfeeding (EBF) and the introduction of ultra-processed foods in children under 12 months old.

Methods:

This was a Cohort study, conducted with children in Vitória da Conquista, Bahia, Brazil. The main exposure was EBF (days: <120; 120-179; ≥180). The outcome variable was the introduction of four or more types of ultra-processed foods in the first year of life. Poisson regression analysis was used.

Results:

286 children were evaluated, of whom 40.2% received four or more ultra-processed foods and 48.9% EBF for less than 120 days. EBF for less than 120 days (RR=2.94 - 95%CI 1.51;5.71) and for 120-179 days (RR=2.17 - 95%CI 1.09;4.30) was associated with the outcome after adjustment by socioeconomic, maternal, paternal and child variables.

Conclusion:

EBF for less than 180 days increased the risk of introducing four or more ultra-processed foods in the first year of life.

Keywords:
Breastfeeding; Infant Nutrition; Industrialized Foods; Longitudinal Studies

Characteristics	n	%	95%CI^a
Socioeconomic
Family income^b (in minimum wages)
≤1	70	26.0	21.1;31.6
>1	199	74.0	68.4;78.9
Maternal education (in years of study)
≤8	65	22.7	18.2;28.0
>8	221	77.3	72.0;81.8
Paternal schooling^b (in years of study)
≤8	76	28.3	23.2;34.0
>8	193	71.7	66.0;76.8
Maternal and gestational, and paternal
Maternal age (in years)
<20	34	11.9	8.6;16.2
20-34	201	70.3	64.7;75.3
≥35	51	17.8	13.8;22.7
Paternal age^b (in years)
<20	5	1.8	0.7;4.2
20-34	184	64.8	59.0;70.2
≥35	95	33.4	28.2;39.2
Maternal skin race/color
White/yellow	69	24.1	19.5;29.5
Black/brown	217	75.9	70.5;80.5
Maternal work
No	126	44.1	38.4;49.9
Yes	160	55.9	50.1;61.6
Maternal marital status
With partner	37	13.0	9.5;17.4
Without partner	248	87.0	82.6;90.5
Parity
Primiparous	141	49.3	43.5;55.1
Multiparous	145	50.7	44.9;56.5
Number of prenatal consultations
<6	50	17.5	13.5;22.4
≥6	236	82.5	77.6;86.5
Child-related
Guidance of a healthcare professional on complementary feeding
No	94	32.9	27.6;38.6
Yes	192	67.1	61.4;72.4
Attends or has attended day care or school
No	273	95.5	92.3;97.3
Yes	13	4.5	2.6;7.7
Person responsible for feeding the child
Mother or father	216	75.5	70.2;80.2
Other	70	24.5	19.8;29.8
Amount of ultra-processed foods
<4	171	59.8	54.0;65.3
≥4	115	40.2	34.6;46.0
Breastfeeding in the first hour of life
No	148	51.7	45.9;57.5
Yes	138	48.3	42.5;54.1
Exclusive breastfeeding (in days)
<120	140	48.9	43.2;54.8
120-179	99	34.6	29.3;40.3
≥180	47	16.4	12.5;21.2

Ultraprocessed foods	Percentage introduction of ultra-processed foods
Ultraprocessed foods	Exclusive breastfeeding <120 days n (%)	Exclusive breastfeeding 120-179 days n (%)	Exclusive breastfeeding ≥180 days n (%)	p-value^a
Cookie/Biscuit	128 (91.4)	89 (89.9)	42 (89.4)	0.627
Petit suisse cheese	106 (75.7)	66 (66.7)	22 (46.8)	<0.001
Sweet food	67 (47.9)	38 (38.4)	18 (38.3)	0.147
Stuffed cookie	46 (32.9)	24 (24.2)	7 (14.9)	0.012
Snack	36 (25.7)	14 (14.1)	4 (8.5)	0.003
Instant noodles	36 (25.7)	12 (12.1)	4 (8.5)	0.002
Chocolate	32 (22.9)	11 (11.1)	4 (8.5)	0.006
Yogurt/dairy drink	32 (22.9)	22 (22.2)	9 (19.1)	0.629
Soft drink	25 (17.9)	11 (11.1)	1 (2.1)	0.004
Artificial fruit juice	25 (17.9)	9 (9.1)	2 (4.3)	0.007
Sausages	22 (15.7)	10 (10.1)	2 (4.3)	0.028

Exclusive breastfeeding (in days)	Introduction of four or more ultra-processed foods
	Crude analysis		Model 1		Model 2		Model 3
	RR^a (95%CI^b)	p-value^c	RR^a (95%CI^b)	p-value^c	RR^a (95%CI^b)	p-value^c	RR^a (95%CI^b)	p-value^c
	RR^a (95%CI^b)	<0.001	RR^a (95%CI^b)	<0.001	RR^a (95%CI^b)	<0.001	RR^a (95%CI^b)	<0.001
<120	2.76 (1.50;5.07)		3.05 (1.51; 6.14)		2.86 (1.44;5.67)		2.94 (1.51;5.71)
120-179	1.69 (0.88;3.25)		2.01 (0.97;4.17)		2.07 (1.02;4.22)		2.17 (1.09;4.30)
≥180	Ref		Ref		Ref		Ref
Akaike criterion	432.39		356.93		351.70		349.58

Secretaria de Vigilância em Saúde e Ambiente - Ministério da Saúde do Brasil SRTVN Quadra 701, Via W5 Norte, Lote D, Edifício P0700, CEP: 70719-040, +55 61 3315-3464, Fax: +55 61 3315-3464 - Brasília - DF - Brazil
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[1] Correspondence: Daniela da Silva Rocha - Universidade Federal da Bahia, Instituto Multidisciplinar em Saúde, Campus Anísio Teixeira, Rua Rio de Contas, No. 58, Quadra 17, Lote 58, Candeias, Vitória da Conquista, BA, Brazil E-mail: drochaufba@gmail.com