Prevalência e duração do aleitamento materno em crianças dos dois aos cinco anos de idade: associação com o índice de massa corporal
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2015
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INTRODUÇÃO: A obesidade tem um peso marcante no surgimento da maioria das patologias que ditam maior custo vital na nossa sociedade, como diabetes, doenças cardiovasculares e neoplasias. Das diversas medidas preventivas propostas pela literatura científica a nível mundial, o aleitamento materno parece ter um papel determinante para a prevenção da obesidade.
OBJETIVOS: Como objetivos gerais, pretende-se caraterizar a prevalência do aleitamento materno na população portuguesa e caraterizar a associação entre a duração do aleitamento materno e o excesso de peso em crianças portuguesas entre os 2 e os 5 anos de idade.
MÉTODOS: Este estudo consiste numa uma análise secundária do Estudo de Prevalência da Obesidade na Infância e dos Adolescentes em Portugal Continental, o primeiro estudo de prevalência realizado em Portugal com representatividade nacional para estimar a prevalência do excesso de peso (pré-obesidade e obesidade) em crianças e adolescentes. O EPObIA é um estudo transversal, com representatividade ao nível de NUTS II do Continente, seguindo uma amostragem polietápica, por aglomerados. A população estudada foi constituída por crianças e adolescentes de ambos os sexos, com idades compreendidas entre os 2 e os 5 anos e entre os 11 e os 15 anos. A recolha de dados foi feita através de entrevista estruturada, com recurso a um questionário sobre: consumo alimentar, atividades físicas e sedentárias, caraterização dos pais da criança/adolescente quanto ao peso e altura, indicadores relacionados com o período gestacional e perinatal e hábitos de saúde dos pais e criança. Foram também recolhidos dados antropométricos (nomeadamente, peso e altura) das crianças, com medição objetiva realizada por entrevistadores credenciados (nutricionistas/dietistas) e devidamente treinados para o efeito. A amostra utilizada para esta análise secundária é uma subamostra do EPObIA, constituída pelas crianças (e respetivas mães) com idades entre os 2 e os 5 anos.
RESULTADOS: Nesta análise secundária foram incluídos os dados relativos a 1977 crianças (e respetivas mães). Foi encontrada uma prevalência de 36.2% de excesso de peso e 12.1% de obesidade na amostra estudada. Foram observadas prevalências de excesso de peso e pré-obesidade mais elevadas nos rapazes (36.9% e 26.4%) e, por outro lado, maior prevalência de obesidade nas raparigas (13.8%). Verificaram-se ainda prevalências de pré-obesidade (31.8%) e obesidade (14.4%) maiores nas crianças com 2 anos e menores (20.1% e 8.7%) nas crianças de 4 anos. As prevalências do aleitamento materno aos 3 e 6 meses são 86.6% e 83.4%, respetivamente. No cômputo geral, há uma grande adesão ao aleitamento materno até aos 6
meses (acima dos 80%), sendo que as prevalências decrescem mais rapidamente a partir desta idade. As mães de 15 aos 19 anos têm maiores taxas de adesão ao aleitamento materno (84.0%). As crianças amamentadas até aos 3 meses detêm a menor taxa de excesso de peso, sendo transversal às crianças das idades estudadas, mas com maior expressão nas crianças com idades superiores a 3 anos, desde que amamentadas pelo menos de 3 a 6 meses. A prevalência de excesso de peso é menor nos rapazes amamentados no primeiro mês de idade e ainda com menos obesidade até ao 3º mês de amamentação. Nas raparigas, este efeito é mais notório entre os 3 e os 6 meses de idade, perdurando após os 6 meses de amamentação.
DISCUSSÃO E CONCLUSÕES: O efeito protetor do aleitamento materno é mais evidente em estados de pré-obesidade e de excesso de peso nas faixas etárias dos 2 anos e 4 anos, com uma duração de aleitamento materno mínima de 3 meses. Assim sendo, o aleitamento materno confirma-se como uma medida eficaz para a prevenção do excesso de peso na infância.
INTRODUCTION: obesity has a significant weight in the emergence of most pathologies that dictate greater vital cost in our society, such as diabetes, cardiovascular diseases and cancer. Of several preventive measures proposed by the scientific literature worldwide, breastfeeding seems to have a key role on the prevention of obesity. OBJECTIVES: As general objectives, we want to characterize the prevalence of breastfeeding in Portuguese population and characterize the association between duration of breastfeeding and overweight in Portuguese children between 2 and 5 years of age. METHODS: This study is a secondary analysis of the Study of the Prevalence of Obesity in Childhood and Adolescents in Continental Portugal (EPObIA), the first prevalence study conducted in Portugal with national representativeness to estimate the prevalence of overweight (pre-obesity and obesity) in children and adolescents. The EPObIA is a cross-sectional study, with representativeness at the level of NUTS II of the Continent, polistage sampling, by clusters. The study population consisted of children and adolescents of both genders, aged between 2 and 5 years and between 11 and 15 years. The data collection was done through a structured interview, with the use of a questionnaire on: food consumption, physical activity and sedentary, characterization of the parents of the child/adolescent in terms of weight and height, indicators related to the gestational period and perinatal and health habits of parents and child. Were also collected anthropometric data (in particular, weight, and height) of the children, with objective measurement performed by accredited interviewers (nutritionists/dieticians) and trained for the purpose. The sample used for this secondary analysis is a subsample of EPObIA, composed by children (and respective mothers) with ages between 2 and 5 years. RESULTS: In this secondary analysis were included data of 1977 children (and respective mothers). It was found a prevalence of 36.2% of overweight and 12.1% of obesity in the studied sample. Were observed prevalence of overweight and pre-obesity higher among boys (36.9% and 26.4%) and, on the other hand, a higher prevalence of obesity in girls (13.8%). The prevalence of pre-obesity (31.8 %) and obesity (14.4 %) are higher in children aged 2 years and lower (20.1 % and 8.7 %) in children of 4 years. The prevalence of breastfeeding at 3 and 6 months is 86.6% and 83.4%, respectively. Overall, there is a large accession to breastfeeding up to 6 months (over 80%), being that the prevalence decrease quicker from this age on. The mothers of 15 to 19 years of age have higher rates of accession to breastfeeding (84.0%).Children who are breastfed up to 3 months have the lowest rate of over weight, being transversal to children of ages studied, but with greater expression in children aged over 3 years, that are breastfed at least 3 to 6 months. The prevalence of overweight is lower in boys who were breastfed in the first month of age and also with less obesity until the third month of breastfeeding. In girls, this effect is most noticeable between 3 and 6 months of age, lasting after 6 months of breastfeeding. DISCUSSION AND CONCLUSIONS: The protective effect of breastfeeding is more evident in states of pre-obesity and overweight in the age of 2 years and 4 years, with a duration of breastfeeding minimum of 3 months. Thus, breastfeeding is confirmed as an effective measure for the prevention of overweight in childhood.
INTRODUCTION: obesity has a significant weight in the emergence of most pathologies that dictate greater vital cost in our society, such as diabetes, cardiovascular diseases and cancer. Of several preventive measures proposed by the scientific literature worldwide, breastfeeding seems to have a key role on the prevention of obesity. OBJECTIVES: As general objectives, we want to characterize the prevalence of breastfeeding in Portuguese population and characterize the association between duration of breastfeeding and overweight in Portuguese children between 2 and 5 years of age. METHODS: This study is a secondary analysis of the Study of the Prevalence of Obesity in Childhood and Adolescents in Continental Portugal (EPObIA), the first prevalence study conducted in Portugal with national representativeness to estimate the prevalence of overweight (pre-obesity and obesity) in children and adolescents. The EPObIA is a cross-sectional study, with representativeness at the level of NUTS II of the Continent, polistage sampling, by clusters. The study population consisted of children and adolescents of both genders, aged between 2 and 5 years and between 11 and 15 years. The data collection was done through a structured interview, with the use of a questionnaire on: food consumption, physical activity and sedentary, characterization of the parents of the child/adolescent in terms of weight and height, indicators related to the gestational period and perinatal and health habits of parents and child. Were also collected anthropometric data (in particular, weight, and height) of the children, with objective measurement performed by accredited interviewers (nutritionists/dieticians) and trained for the purpose. The sample used for this secondary analysis is a subsample of EPObIA, composed by children (and respective mothers) with ages between 2 and 5 years. RESULTS: In this secondary analysis were included data of 1977 children (and respective mothers). It was found a prevalence of 36.2% of overweight and 12.1% of obesity in the studied sample. Were observed prevalence of overweight and pre-obesity higher among boys (36.9% and 26.4%) and, on the other hand, a higher prevalence of obesity in girls (13.8%). The prevalence of pre-obesity (31.8 %) and obesity (14.4 %) are higher in children aged 2 years and lower (20.1 % and 8.7 %) in children of 4 years. The prevalence of breastfeeding at 3 and 6 months is 86.6% and 83.4%, respectively. Overall, there is a large accession to breastfeeding up to 6 months (over 80%), being that the prevalence decrease quicker from this age on. The mothers of 15 to 19 years of age have higher rates of accession to breastfeeding (84.0%).Children who are breastfed up to 3 months have the lowest rate of over weight, being transversal to children of ages studied, but with greater expression in children aged over 3 years, that are breastfed at least 3 to 6 months. The prevalence of overweight is lower in boys who were breastfed in the first month of age and also with less obesity until the third month of breastfeeding. In girls, this effect is most noticeable between 3 and 6 months of age, lasting after 6 months of breastfeeding. DISCUSSION AND CONCLUSIONS: The protective effect of breastfeeding is more evident in states of pre-obesity and overweight in the age of 2 years and 4 years, with a duration of breastfeeding minimum of 3 months. Thus, breastfeeding is confirmed as an effective measure for the prevention of overweight in childhood.
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Orientação: Vasco Reis; co-orientação: Osvaldo Santos
Palavras-chave
GESTÃO DE UNIDADES DE SAÚDE, AMAMENTAÇÃO, OBESIDADE INFANTIL, ÍNDICE DE MASSA CORPORAL, CRIANÇAS, HEALTH CARE FACILITIES MANAGEMENT, BREASTFEEDING, CHILD OBESITY, BODY MASS INDEX, CHILDREN, MESTRADO EM GESTÃO DE UNIDADES DE SAÚDE