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R
ibas
DF
et
al
.
712
R
ev
A
ssoc
M
ed
B
ras
2016; 62(8):711-717
The program Ten Steps for Healthy Feeding from
Birth to 2 Years of Age aims to support healthcare profes-
sionals and promote healthy eating habits for children
under 2 years of age, prioritizing exclusive breastfeeding
for the first 6 months of life and a supplementary diet of
sufficient quantity and quality in order to provide for the
growth and development of children. A group of profes-
sionals received educational materials to deliver to the
mothers of children under 6 months of age, with informa-
tion on the importance of not offering other liquids and
foods, as well as breastfeeding, introducing meat in order
to prevent anemia, suitable consistency of food for the
baby, the importance of not replacing baby food with
sandwiches or snacks, and example food compositions for
meals. Another group of mothers formed the control group,
where the professionals did not receive retraining on the
subject or the educational materials. The breastfeeding
rate was 66.1% (n=409) at 6 months of age. After the in-
tervention, the group significantly increased the exclusive
breastfeeding time (2.34±1.63 months) compared to the
control group (1.92±1.60 months). The prevalence of chil-
dren with exclusive breastfeeding for less than one month
decreased significantly in the intervention group (27.7%)
compared to the control group (40.5%). The impact of the
intervention was also positive among children aged 6 to
9 months due to increased consumption of fruits, beans,
meat (≥ 4 times/week), and liver (once per week).
3
(
B
)
The aim of the intervention study is to encourage the
practice of breastfeeding, dietary adequacy, and the growth
of infants and children (6 to 15 months). The mothers were
encouraged to have questions and concerns about the child
nutrition elucidated, to undergo cognitive skills training
with the practice aimed at influencing self-efficacy, to take
a course to increase practical knowledge about selection
and preparation of new recipes and the mobilization of
social support. The nutritional intervention package in-
cluded: 1) education and counseling of mothers, 2) training
about nutritional counseling and monthly home visits, 3)
meetings to raise awareness, and 4) supervision by com-
munity-based nutrition advisors. Thus, the intervention
group received this nutritional counseling package, which
was planned and well prepared with closed questions, details
of the process and plausible guidance, while the control
group received routine general health visits.
4
(
B
)
Recommendation
Conveying the information in a personalized manner is
indicated for nutritional education in the child care set-
ting, involving educational materials with information
about the scheme for introducing supplementary foods,
positively influencing linear growth, changes in length in
relation to age, feeding practices, nutrient intake, and
level of knowledge about the recommended practices.
C
hildren
and
adolescents
We studied healthy infants and children (6 to 24 months
old) consuming foods combined with breastfeeding for a
period of 6 months, and divided them into three groups: 1)
those who received fortified supplementary food and nu-
tritional education, 2) those who received granules in a
fortified sachet (20 g for children under 1 year or 40 g for
children over 1 year) and nutritional education, and 3) those
who received isolated nutritional education as a control. The
supplements were delivered to the mothers monthly and
comprised 7.9 mg of iron and 6.5 mg of zinc in the 20 g
sachets, and 15.9 mg of iron and 13.0 mg of zinc in the
40 g sachets; protein-to-energy ratio of 3.73 g/100 calories
and fat-to-energy ratio of 1.87 g/100 calories. The sachet
was added once a day to the child’s meal after being cooked.
Nutritional education included the importance of micro-
nutrients, and various ways of including foods high in iron
and zinc as well as other sources of foods rich in different
micronutrients that are easily added to a child’s diet. This
was given to the mothers once a month. A food frequency
questionnaire was appliedmonthly, showing that there was
no change in the common food intake of the patients in
each group. The hematological markers showed improve-
ments in hematocrit (mean HT group 1: 3.20±4.4%, group
2: 0.65±2.7%), mean corpuscular volume (meanMCV group
1: 4.30±8.3 ff, group 2: -0.008±8.8 ff), and hemoglobin (mean
Hb group 1: 1.29±1.6 g/dL and group 2: 0.37±1.1 g/dL),
thus the rate of anemia decreased by 67% (Hb < 10 g/dL) in
group 2, 27% in group 1, and 22% in the control group.
There was no information regarding speed of weight/height
gain with the intervention.
5
(
B
)
A systematic review gathered data related to the change
in diet, physical activity and the effect on the prevention
of obesity in children and adolescents (2 to 18 years). In
one study, the nutritional intervention meant encouraging
the consumption of fruits and vegetables and reducing the
intake of foods high in fat and sugar, as well as stimulating
physical activity. Another study assessed the effect of the
intervention on the acts of watching television, consuming
snacks and sweets, eating out and engaging in physical
activity. The third study assessed the effect of dietary in-
tervention on the intake of fat, fruits and vegetables, the
act of watching television and physical activity. None of
these presented significantly beneficial results on the body
mass index (BMI), weight or prevalence of excess weight,
the time spent in front of the television, or the minutes of