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- CoFI - Consensus on infant formulas: the opinion of portuguese experts on their composition and indicationsPublication . Rego, Carla; Pereira-da-Silva, Luis; Ferreira, RicardoIntroduction: Breastfeeding has unique health benefits. Exclusive breastfeeding is recommended during the first six months of life and should be maintained during complementary feeding. Alternatively, infant formulas, which are designed to mimic human breastmilk to promote similar metabolic and growth profiles, can be used. This study aimed to assess the opinion of Portuguese paediatricians with expertise in nutrition on the composition, benefits and indications of commercialised infant formulas.Material and Methods: A survey based on the Delphi method with application of a questionnaire developed by a scientific committee was issued to a panel of paediatricians with expertise in nutrition. An initial questionnaire that included 65 items covering 11 areas was administered in two rounds.Results: Twenty-one experts participated, and the final response rate was 87.5%. The panel was in agreement in 68.3% of the enquired items, namely that infant formulas should be used only when breastfeeding is not possible. Notwithstanding, the opinion of the panel was heterogeneous on a number of issues, particularly those related to the advantages and indications of ‘special’ or modified infant formulas (partially hydrolysed formulas and anti-colic, anti-constipation and anti-regurgitation formulas) and of young child formulas (‘growing-up formulas’). Discussion: A wide consensus was recorded on the nutritional quality, food safety and indications attributed to commercialized infant formulas.Conclusion: The opinion of Portuguese experts was consensual in most of the enquired topics. The absence of consensus was mostly related to issues that remain under debate in the literature and lack robust scientific evidence.
- Suplementação vitamínica e mineral em Portugal durante o primeiro ano de vida. resultados do EPACI Portugal 2012Publication . Rego, Carla; Nazareth, Margarida; Lopes, Carla; Graça, Pedro; Pinto, ElisabeteIntroduction: Adequate nutritional status is essential for health, growth and development. Practices regarding vitamin and mineral supplementation in Portuguese infants are unknown. The objectives were to characterise vitamin and mineral supplementation practices and to quantify their association with social, demographic and health- -related factors, in a representative national sample. Methods: From the EPACI Portugal 2012 study protocol, a questionnaire that included, among others, retrospective information reporting supplementation during the first year of life was applied in the presence of the caregivers of 2232 children (aged 12-36 months). Results: A total of 68.3% of Portuguese infants receive vitamin D supplements; 16.6%, 24.0% and 4.5% receive supplements of iron, vitamin C and fluoride, respectively. Living in the North region (except for fluoride) and followed simultaneously by a paediatrician and a general practitioner is associated with a significantly higher frequency of supplementation. Being followed only by a general practitioner increases the risk of non-supplementation with vitamin D and iron in 23% and 45%, respectively. Prematurity is associated with iron and multivitamin supplementation. Children whose mothers have higher education level or are married or live in a de facto union are more often supplemented with vitamin D. Discussion: Only two-thirds of Portuguese infants receive vitamin D supplements, a sixth receive iron supplements and a quarter receive vitamin C supplements. Fluoride supplementation is uncommon, and multi-vitamin supplementation is strongly associated with prematurity. Socioeconomic factors, the usual health care provider and the geographical area of residence seem to be associated, in Portugal, with the prevalence of vitamin and mineral supplementation during the first year of life.
- Cardiovascular risk factors in Portuguese obese children and adolescents: impact of small reductions in body mass index imposed by lifestyle modificationsPublication . Nascimento, Henrique; Costa, Elísio; Rocha-Pereira, Petronila; Rego, Carla; Mansilha, Helena Ferreira; Quintanilha, Alexandre; Santos-Silva, Alice; Belo, LuísObjectives: Evaluate cardiovascular risk factors in Portuguese obese children and adolescents and the long-term effects of lifestyle modifications on such risk factors. Design: Transversal cohort study and longitudinal study. Setting: University Hospital S. João and Children's Hospital Maria Pia, Porto. Patients/Participants: 148 obese children and adolescents [81 females (54.7%); mean age of 11.0 years]and 33 controls (sex and age matched) participated in a cross-sectional study. Sixty obese patients agreed to participate in an one year longitudinal study after medical and nutritionist appointments to improve lifestyle modification; a substantial body mass index (BMI) reduction was defined by a decrease in BMI z-score (BMI z-sc) of 0.3 or more over the studied period. Main Outcome measures: Lipid profile (triglycerides, cholesterol, HDLc, LDLc, lipoprotein (a), apolipoproteins A and B) and circulating levels of C-reactive protein (CRP), adiponectin, glucose, and insulin. Results: Compared with the lean children, obese patients demonstrated statistically significantly higher insulin resistance index [Homeostasis model assessment (HOMA)], and triglycerides, LDLc, apolipoprotein (apo) B, insulin and CRP concentrations, whereas their HDLc and apo A levels were significantly lower (cross-sectional study). In the longitudinal study (n=60), a substantial BMI reduction occurred in 17 (28.3%) obese patients which led to a significant reduction in triglycerides, cholesterol, LDLc, apo B, glucose and insulin levels and in HOMA. The ΔBMI values over the studied period correlated inversely and significantly with BMI (P<0.001) and HOMA (P=0.026) values observed at baseline. In multiple linear regression analysis, BMI at baseline remained associated to changes in BMI over the studied period (standardised Beta: -0.271, P=0.05). Conclusion: Our data demonstrates that small reductions in BMI-zc, imposed by lifestyle modifications in obese children and adolescents, improve the cardiovascular risk profile of such patients. Furthermore, patients with higher BMI and/or insulin resistance seem to experience a greater relative reduction in their BMI after lifestyle improvements.
- Associação entre a composição corporal em crianças até aos 36 meses e a dos progenitores: EPACI Portugal 2012Publication . Nazareth, Margarida; Pinto, Elisabete; Lopes, Carla; Graça, Pedro; Rego, Carla
- Determinantes da selecção do alimento com o qual se inicia a diversificação alimentar: resultados do EPACI Portugal 2012Publication . Pinto, Elisabete; Nazareth, Margarida; Lopes, Carla; Graça, Pedro; Rego, Carla