Characteristics associated with dietary patterns in Brazilian children under two years of age

Carvalho, Rumão Batista Nunes de; Louzada, Maria Laura da Costa; Rauber, Fernanda; Levy, Renata Bertazzi

doi:10.11606/s1518-8787.2022056003757

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Brasil

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Original Article • Rev. Saúde Pública 56 • 2022 • https://doi.org/10.11606/s1518-8787.2022056003757 copy

Characteristics associated with dietary patterns in Brazilian children under two years of age

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To analyze the dietary patterns of Brazilian children under two years of age and assess their association with sociodemographic characteristics and health service use.

METHODS

This is a cross-sectional study with data from the 2013 National Health Survey (PNS). Patterns were found for two age groups by principal component analysis and their correlation with characteristics of interest was tested by linear regression models.

RESULTS

We found two dietary patterns for our groups. The first consisted of the consumption of fresh or minimally processed foods and the second, of ultra-processed foods. The greater adherence of children between six and 11 months to the first pattern was associated with higher per capita family income and urban residences in the most developed regions of Brazil. At 12 months or more, adherence related to white race/color, higher per capita family incomes, residence in more developed regions, and visits to private childcare. Adherence to the second pattern among children under one year of age was inversely associated with Yellow or Indigenous race/color, residence in the Brazilian Northeast, and childcare in specialized public or private services. At 12 months or more, greater adherence was directly associated with Black or Brown children who resided in more developed regions, and inversely associated with those living in the Brazilian Northeast.

CONCLUSION

We found two opposite dietary patterns in Brazilian children under two years of age and that several social determinants modify their chance of adhering to these patterns.

Infant Nutrition; Diet, Food, and Nutrition; Socioeconomic Factors; Child Health Services

Characteristics	Percentage (%)	95%CI
Sociodemographic
Gender
Male	53.3	50.7–55.8
Women	46.7	44.2–49.3
Age
6–11 months and 29 days	31.7	29.3–34.1
12–23 months and 29 days	68.3	65.9–70.7
Race/color
White	47.1	44.6–49.6
Black or Brown	51.9	49.3–54.4
Other^a	1.0	0.5–1.9
Per capita family income
1st quintile (lowest income)	26.9	25.0–29.0
2nd quintile	25.7	23.5–28.0
3rd quintile	21.5	19.5–23.6
4th quintile	13.5	11.8–15.5
5th quintile (highest income)	12.4	10.5–14.4
Area of residence
Rural	16.2	14.8–17.6
Urban	83.8	82.4–85.2
Region of the Country
North	11.0	10.3–11.8
Northeast	29.4	27.9–31.0
Southeast	37.2	35.5–38.9
Sul	15.6	14.4–16.9
Midwest	6.8	6.2–7.3
Health service use
Health insurance coverage
Yes	26.4	24.0–29.0
No	73.6	71.0–76.0
Childcare
No follow up	7.3	6.1–8.8
Basic health unit	55.4	52.6–58.0
Specialized public service^b	6.7	5.5–8.1
Private office or clinic	27.9	25.4–30.5
Other	2.7	2.0–3.7

Consumed food	Percentage (%)	95%CI
Cereals and derivatives (rice, bread, cereal, pasta, flour, etc.)	83.1	81.1–84.9
Fruit or fruit juice	81.5	79.5–83.3
Non-breast milk or derivatives	80.5	78.3–82.5
Beans or other legumes (lentils, peas, etc.)	79.3	77.2–81.2
Biscuits or cake	76.6	74.3–78.7
Meat or eggs	76.1	73.9–78.2
Leaf vegetables	74.8	72.6–76.9
Potato and other tubers and roots (sweet potato, cassava)	61.1	58.6–63.5
Sweets, candies or other sugary foods	39.5	36.9–42.1
Artificial juices	31.7	29.4–34.1
Soft drinks	20.7	18.7–22.9

	6–11 months and 29 days (n = 1,249)			12–23 months and 29 days (n = 2,397)			Total sample (n = 3,646)

	Minimally processed pattern	Ultra-processed pattern	Common percentage^a	Minimally processed pattern	Ultra-processed pattern	Common percentage	Minimally processed pattern	Ultra-processed pattern	Common percentage
Consumed food
Non-breast milk or derivatives	0.35	-0.07	0.87	0.38	-0.02	0.86	0.36	0.04	0.87
Fruit or fruit juice	0.64	-0.05	0.59	0.57	-0.09	0.67	0.60	-0.06	0.63
Leaf vegetables	0.75	-0.07	0.44	0.71	-0.06	0.49	0.73	-0.08	0.46
Beans or other legumes	0.61	0.23	0.58	0.60	0.16	0.61	0.60	0.23	0.59
Meat or eggs	0.69	0.21	0.47	0.65	0.22	0.53	0.65	0.28	0.50
Potato and other tubers and roots	0.75	0.00	0.44	0.63	0.11	0.60	0.67	0.02	0.55
Cereals and derivatives	0.61	0.25	0.56	0.60	0.26	0.57	0.60	0.29	0.56
Artificial juices	0.03	0.69	0.53	0.06	0.64	0.59	0.04	0.67	0.56
Sweets, candies or other sugary foods	0.18	0.70	0.48	0.13	0.73	0.45	0.14	0.74	0.44
Soft drinks	-0.02	0.75	0.44	0.02	0.73	0.46	0.00	0.73	0.46
Proportional variance (%)	29.00	17.00	-	25.00	16.00	-	26.00	18.00	-
Accumulated variance (%)	29.00	46.00	-	25.00	41.00	-	26.00	44.00	-

Características	Minimally processed pattern				Ultra-processed pattern

	Crude β^c (95%CI)	p	Adjusted β^d (95%CI)	p	Crude β^c (95%CI)	p	Adjusted β^d (95%CI)	p
Sociodemographic
Gender
Male	Ref.		Ref.		Ref.		Ref.
Women	-0.08 (-0.25 to 0.09)	0.361	-		-0.03 (-0.19 to 0.13)	0.718	-	-
Race/color
White	Ref.		Ref.		Ref.		Ref.
Black or Brown	-0.28 (-0.42 to -0.13)	< 0.001	-0.00 (-0.16 to 0.15)	0.971	0.12 (-0.05 to 0.29)	0.152	0.11 (-0.06 to 0.29)	0.190
Other^a	-0.07 (-0.68 to 0.54)	0.821	-0.15 (-0.81 to 0.52)	0.666	-0.52 (-0.89 to -0.14)	0.007	-0.40 (-0.77 to -0.02)	0.039
Per capita household income
1st quintile (lowest income)	Ref.		Ref.		Ref.		Ref.
2nd quintile	0.51 (0.29 to 0.74)	0.000^e	0.31 (0.10 to 0.53)	< 0.001^e	0.06 (-0.15 to 0.28)	< 0.001^e	0.07 (-0.15 to 0.29)	0.060^e
3rd quintile	0.76 (0.56 to 0.96)		0.44 (0.21 to 0.68)		-0.02 (-0.30 to 0.26)		0.01 (-0.30 to 0.32)
4th quintile	0.83 (0.63 to 1.03)		0.43 (0.18 to 0.68)		-0.17 (-0.37 to 0.03)		-0.13 (-0.38 to 0.11)
5th quintile (highest income)	1.03 (0.83 to 1.23)		0.53 (0.27 to 0.78)		-0.49 (-0.66 to -0.33)		-0.31 (-0.59 to -0.03)
Area of residence
Rural	Ref.		Ref.		Ref.		Ref.
Urban	0.51 (0.29 to 0.74)	< 0.001	0.40 (0.21 to 0.60)	< 0.001	-0.11 (-0.34 to 0.11)	0.322	-	-
Region of the Country
North	Ref.		Ref.		Ref.		Ref.
Northeast	0.33 (0.12 to 0.55)	0.003	0.35 (0.14 to 0.55)	0.001	-0.26 (-0.46 to -0.05)	0.013	-0.25 (-0.43 to -0.06)	0.010
Southeast	0.80 (0.58 to 1.03)	< 0.001	0.54 (0.31 to 0.78)	< 0.001	-0.08 (-0.34 to 0.18)	0.528	0.11 (-0.16 to 0.38)	0.421
South	0.81 (0.60 to 1.01)	< 0.001	0.54 (0.33 to 0.74)	< 0.001	0.02 (-0.25 to 0.29)	0.895	0.22 (-0.04 to 0.47)	0.096
Midwest	0.83 (0.61 to 1.05)	< 0.001	0.60 (0.38 to 0.81)	< 0.001	0.06 (-0.22 to 0.35)	0.671	0.20 (-0.07 to 0.78)	0.146
Health service use
Health insurance coverage
Yes	Ref.		Ref.		Ref.		Ref.
No	-0.54 (-0.69 to -0.39)	< 0.001	-0.11 (-0.28 to 0.06)	0.211	0.23 (0.07 to 0.40)	0.006	-0.02 (-0.22 to 0.18)	0.842
Childcare
No follow up	Ref.		Ref.		Ref.		Ref.
Basic health unit	0.45 (0.13 to 0.76)	0.005	0.15 (-0.16 to 0.46)	0.345	-0.17 (-0.47 to 0.12)	0.252	-0.17 (-0.47 to 0.13)	0.272
Specialized public service^b	0.29 (-0.12 to 0.71)	0.167	0.04 (-0.33 to 0.42)	0.820	-0.41 (-0.78 to -0.03)	0.032	-0.40 (-0.78 to -0.01)	0.043
Private office or clinic	0.96 (0.65 to 1.30)	< 0.001	0.30 (-0.04 to 0.65)	0.086	-0.65 (-0.94 to -0.36)	< 0.001	-0.57 (-0.93 to -0.21)	0.002
Other	0.09 (-0.39 to 0.57)	0.710	-0.04 (-0.44 to 0.37)	0.864	-0.33 (-0.80 to 0.14)	0.167	-0.32 (-0.77 to 0.13)	0.159

Characteristics	Minimally processed pattern				Ultra-processed pattern

	Crude β^c (95%CI)	p	Adjusted β^d (95%CI)	p	Crude β^c (95%CI)	p	Adjusted β^d (95%CI)	p
Sociodemographic
Gender
Male	Ref.		Ref.		Ref.		Ref.
Women	0.07 (-0.04 to 0.18)	0.231	-	-	0.06 (-0.06 to 0.19)	0.312	-	-
Race/color
White	Ref.		Ref.		Ref.		Ref.
Black or Brown	-0.37 (-0.48 to -0.26)	< 0.001	-0.13 (-0.24 to -0.01)	0.030	0.14 (0.03 to 0.26)	0.015	0.17 (0.05 to 0.29)	0.005
Other^a	-0.30 (-0.78 to 0.17)	0.213	-0.09 (-0.52 to 0.33)	0.670	0.35 (-0.09 to 0.79)	0.120	0.26 (-0.14 to 0.66)	0.204
Per capita household income
1st quintile (lowest income)	Ref.		Ref.		Ref.		Ref.
2nd quintile	0.33 (0.18 to 0.48)	< 0.001^e	0.23 (0.07 to 0.39)	< 0.001^e	0.04 (-0.12 to 0.20)	0.012^e	-0.04 (-0.20 to 0.13)	0.068^e
3rd quintile	0.60 (0.44 to 0.76)		0.38 (0.21 to 0.55)		0.05 (-0.14 to 0.24)		-0.01 (-0.20 to 0.18)
4th quintile	0.72 (0.56 to 0.89)		0.45 (0.27 to 0.63)		0.07 (-0.12 to 0.27)		0.03 (-0.19 to 0.25)
5th quintile (highest income)	0.90 (0.74 to 1.06)		0.54 (0.34 to 0.74)		-0.37 (-0.57 to -0.18)		-0.38 (-0.64 to -0.13)
Area of residence
Rural	Ref.		Ref.		Ref.		Ref.
Urban	0.39 (0.25 to 0.53)	< 0.001	0.13 (-0.02 to 0.27)	0.082	0.03 (-0.10 to 0.16)	0.648	-	-
Region of the Country
North	Ref.		Ref.		Ref.		Ref.
Northeast	0.30 (0.11 to 0.49)	0.002	0.30 (0.12 to 0.48)	0.001	-0.17 (-0.32 to -0.02)	0.022	-0.16 (-0.31 to -0.02)	0.027
Southeast	0.70 (0.50 to 0.89)	< 0.001	0.43 (0.24 to 0.63)	< 0.001	0.08 (-0.09 to 0.26)	0.339	0.25 (0.07 to 0.43)	0.006
South	0.77 (0.58 to 0.96)	< 0.001	0.54 (0.35 to 0.73)	< 0.001	0.24 (0.05 to 0.44)	0.016	0.41 (0.20 to 0.62)	< 0.001
Midwest	0.72 (0.52 to 0.93)	< 0.001	0.53 (0.33 to 0.73)	< 0.001	0.12 (-0.08 to 0.32)	0.254	0.23 (0.03 to 0.43)	0.026
Health service use
Health insurance coverage
Yes	Ref.		Ref.		Ref.		Ref.
No	-0.47 (-0.58 to -0.36)	< 0.001	-0.06 (-0.20 to 0.08)	0.395	0.14 (-0.00 to 0.29)	0.053	0.03 (-0.15 to 0.21)	0.734
Childcare
No follow up	Ref.		Ref.		Ref.		Ref.
Basic health unit	0.27 (0.06 to 0.48)	0.011	0.16 (-0.03 to 0.35)	0.093	-0.03 (-0.23 to 0.16)	0.738	-0.05 (-0.25 to 0.15)	0.614
Specialized public service^b	0.29 (0.00 to 0.58)	0.047	0.16 (-0.12 to 0.43)	0.261	0.00 (-0.26 to 0.26)	0.985	-0.01 (-0.27 to 0.24)	0.922
Private office or clinic	0.76 (0.55 to 0.97)	< 0.001	0.27 (0.05 to 0.49)	0.015	-0.23 (-0.44 to -0.01)	0.043	-0.19 (-0.42 to 0.05)	0.119
Other	0.31 (-0.03 to 0.64)	0.071	0.21 (0.10 to 0.52)	0.176	0.22 (-0.17 to 0.62)	0.294	0.25 (-0.10 to 0.61)	0.157

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[1] Correspondence: Rumão Batista Nunes de Carvalho Universidade Federal do Piauí Rua Cícero Duarte, 905 64607-670 Picos, PI, Brasil E-mail: rumaobatista@ufpi.edu.br