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Background: Cow's milk protein allergy (CMPA) is a common allergy in infants and can affect proper growth and development. This study verified factors associated with the evolution of the nutritional status (NS) among infants with CMPA fed with hypoallergenic formulas (HF). Methods: This is a longitudinal study of infants (n = 1036) participating on a governmental program in Brazil. Researchers assessed Nutritional status before HF treatment (T1) and after HF treatment (T2). The causality of exposure variables on the evolution of NS was verified by Multinomial Logistic Regression (MLR). Results: We observed an increase in anthropometric indexes analyzed with statistically significant results (p < 0.01). The weight/age and height/age scores showed a significant reduction in infants with nutritional deficit. The Body Mass Index (BMI) showed a decrease in the number of infants with nutritional deficit (< -2 z-score). On the other hand, there was an increase in those classified as at risk of overweight, overweight and obese. MLR showed that those who remained < 12 months in the program had a lower odds ratio (95% CI = 0.355–0.906; p = 0.018) to have inadequate NS with increasing BMI. Preterm infants were 4 times more likely (CI 95% = 1.520–10.694; p = 0.005) to have their BMI decreased and those who received nutritional counseling had a lower odds ratio (CI 95% = 0.411–0.953; p = 0.029) to maintain adequate NS. Conclusion: The program has a significant impact on the NS of infants with CMPA. The constant management and implementation of differentiated criteria according to the evolution of NS for the supply of HF is fundamental in the continuity of this public policy. [ABSTRACT FROM AUTHOR]

Objective: to describe the process of creating and validating an instrument for detecting the risk of early weaning. Methods: methodological study developed after approval by the Research Ethics Committee for the development of a checklist-type instrument composed of 8 blocks, based on literature review and situational diagnosis of a maternity hospital in Maranhão. The validation occurred according to the Delphi technique, through the evaluation of 9 judges in the first stage and 8 in the second stage. The Content Validity Index for each item and the overall Content Validity Coefficient were considered with minimum values ≥ 0.80, as well as a minimum agreement of 80% for validation. Results: the blocks "Breast milk substitutes" and "Professional guidelines" achieved maximum validation in the first stage. After the adjustments suggested by the judges, validation of the checklist was obtained with a Coefficient of Content Validity value = 0.96 in the overall assessment of the second stage. Conclusion: the instrument was considered valid and will contribute to the improvement of the approach to breastfeeding, directing attention and identifying care needs to detect the risk of early weaning. [ABSTRACT FROM AUTHOR]

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Infant milk is a manufactured food designed for feeding babies and infants under 12 months of age. This product is indicated when, for some reason, the baby can not be fed by breast milk. It is used in case of intolerance to milk from farmed animals and is widely used for the nutrition of newborns in artificial lactation, in place of breastfeeding. It can be used as a complete or partial substitute for human milk. In the current study, the committed effective dose and lifetime cancer risk due to ingestion of 4 K, 226Ra, and 228Ra were estimated using activity concentration obtained from high-resolution gamma spectrometry. Consumption data and dose coefficients were obtained from Brazilian Institute of Geography and Statistics and data published by ICRP 119. Infant milk and water samples were collected in the Rio de Janeiro trade, placed in a polystyrene container, and then sealed to reach the secular radioactive equilibrium condition (at least 45 days). The samples were analyzed by gamma spectrometry using a High Purity Germanium (HPGE). Detection efficiency for each sample was obtained with LabSOCS software. For infant milk samples, the highest values of activity concentrations were (242 ± 9) Bq.kg−1 for 4 K, (5 ± 1) Bq.kg−1 for 228Ra and presented values below the detection limit for 226Ra. The higher values obtained for water samples were (10 ± 1) Bq.l−1, (5 ± 1) Bq.l−1, (5.3 ± 0.1) Bq.l−1 for 4 K, 226Ra and 228Ra, respectively. These values of committed effective dose are below the values stipulated by UNSCEAR (290 μSv.y−1) and by the ICRP (1 mSv.y−1). The values obtained for lifetime cancer risk are considered negligible, once they are below the limit considered for taking action (10−4). It can be concluded that the values calculated do not present a significant risk regarding the intake of infant milk in the first two years of the child's life. • 1° estimate in Brazil of the cancer risk from the ingestion of infant formulas consumed by children using gamma spectrometry. • Activity concentrations were determined using high resolution gamma spectrometry. • Committed effective dose and the cancer risk was estimated due to the ingestion of infant milk. • Milk ingestion does not represent any significant radiological health effect. [ABSTRACT FROM AUTHOR]

Background: The International Code of Marketing of Breast-Milk Substitutes is a global public health policy aiming to protect breastfeeding from the influence of human-milk substitutes marketing. Brazil is one of the few countries substantially implementing it. Most countries adopted selected provisions, including Portugal., Research Aim: To explore whether Brazilians' perspectives about breastfeeding intention and practice are influenced by human-milk substitutes marketing upon migration to Portugal., Methods: A qualitative, prospective, cross-sectional survey design was conducted in Brazil and Portugal (2018-2019). Qualitative semi-structured interviews were performed with native ( n = 16) and immigrant ( n = 15) Brazilians. Women aged 18 or above, mothers of 0-12 month infants, and without contraindications to breastfeed, were eligible for the study. Heterogeneity sampling was employed based on socioeconomic status and infants' age. Content analysis was conducted using NVivo., Results: Brazilian immigrants were more aware of the potential negative influence of human-milk substitutes marketing than natives. Sociocultural factors contributed to Brazilian immigrants being less permeable to the influence of human-milk substitutes marketing in the host country, where a less protective breastfeeding environment was perceived., Conclusions: Sociocultural factors including breastfeeding promotion strategies and a strong breastfeeding culture in the home country appear to play a protective role on breastfeeding intention and practice among Brazilians migrating to Portugal.

Objective: To analyze the receipt of sponsorships from breast-milk substitute companies by health professionals in scientific events., Methods: Multicenter study (Multi-NBCAL) performed from November 2018 to November 2019 in six cities in different Brazilian regions. In 26 public and private hospitals, pediatricians, nutritionists, speech therapists, and a hospital manager were interviewed using a structured questionnaire. Descriptive analyses were carried out regarding the health professionals' knowledge about the Norma Brasileira de Comercialização de Alimentos para Lactentes e Crianças de Primeira Infância, Bicos, Chupetas e Mamadeiras (NBCAL - Brazilian Code of Marketing of Infant and Toddlers Food and Childcare-related Products), companies sponsoring scientific events, and material or financial sponsorships received, according to profession., Results: We interviewed 217 health professionals, mainly pediatricians (48.8%). Slightly more than half of the professionals (54.4%) knew NBCAL, most from Baby-friendly Hospitals. Most health professionals (85.7%) attended scientific events in the last two years, more than half of them (54.3%) sponsored by breast-milk substitute companies, especially Nestlé (85.1%) and Danone (65.3%). These professionals received sponsorships in the events, such as office supplies (49.5%), meals or invitations to parties (29.9%), promotional gifts (21.6%), payment of the conference registration fee (6.2%) or ticket to the conference (2.1%)., Conclusion: The infant food industries violate NBCAL by harassing health professionals in scientific conferences, offering diverse material and financial sponsorships.

Objective: To evaluate the impact of exclusive breastfeeding and introduction of cow's milk in the first year of life on the diagnosis of asthma, wheezing, and atopy in children aged 3 to 4 years., Methods: This is a cohort study nested in a randomized field trial investigating the effectiveness of dietary guidelines during the first year of life of children in the city of São Leopoldo, southern Brazil. Children who had their diet monitored during the first year of life, in a primary study, were revisited three years later, when their parents answered a questionnaire related to respiratory problems, applied during home visits by trained interviewers. Children were also skin-prick tested to assess responses to common environmental allergens., Results: Of the 397 children followed during the first year of life, 354 were reassessed between 3 and 4 years of age. Prevalence of wheezing, evaluated for the 12 months prior to questionnaires, was 21.3%, while prevalence of asthma and atopy was 5.5 and 28.7%, respectively. Children fed cow's milk previous to being four months of life were significantly more likely to have asthma between three and four years of age (OR 3.22; 95%CI 1.05-9.80). In the same line, exclusive breastfeeding for a period shorter than six months was marginally associated with atopy., Conclusions: The early introduction of cow's milk was an important risk factor for triggering asthma/wheeze symptoms at the age of 4 years. Exclusive breastfeeding for longer than six months was also potentially associated with protection against the development of atopy. The results of this study suggest that dietary interventions during the first year of life have the potential to reduce the impact of asthma, and possibly, atopy.

An increase in exclusive breastfeeding prevalence can substantially reduce mortality and morbidity among infants. In this paper, estimates of the costs and impacts of three breastfeeding promotion programmes, implemented through maternity services in Brazil, Honduras and Mexico, are used to develop cost-effectiveness measures and these are compared with other health interventions. The results show that breastfeeding promotion can be one of the most cost-effective health interventions for preventing cases of diarrhoea, preventing deaths from diarrhoea, and gaining disability-adjusted life years (DALYs). The benefits are substantial over a broad range of programme types. Programmes starting with the removal of formula and medications during delivery are likely to derive a high level of impact per unit of net incremental cost. Cost-effectiveness is lower (but still attractive relative to other interventions) if hospitals already have rooming-in and no bottle-feeds; and the cost-effectiveness improves as programmes become well-established. At an annual cost of about 30 to 40 US cents per birth, programmes starting with formula feeding in nurseries and maternity wards can reduce diarrhoea cases for approximately $0.65 to $1.10 per case prevented, diarrhoea deaths for $100 to $200 per death averted, and reduce the burden of disease for approximately $2 to $4 per DALY. Maternity services that have already eliminated formula can, by investing from $2 to $3 per birth, prevent diarrhoea cases and deaths for $3.50 to $6.75 per case, and $550 to $800 per death respectively, with DALYs gained at $12 to $19 each.