SciELO - Scientific Electronic Library Online

 
vol.17 issue51Detection, surveillance, and monitoring of multiresistant germs, in the sanitary areas III-IV of Cantabria (2013-2016)A situational study of electronic records in an internal medicine unit: barriers and opportunities author indexsubject indexarticles search
Home Pagealphabetic serial listing  

My SciELO

Services on Demand

Journal

Article

Indicators

Related links

  • On index processCited by Google
  • Have no similar articlesSimilars in SciELO
  • On index processSimilars in Google

Share


Enfermería Global

On-line version ISSN 1695-6141

Enferm. glob. vol.17 n.51 Murcia Jul. 2018  Epub July 01, 2018

http://dx.doi.org/10.6018/eglobal.17.3.285011 

Originals

Diet quality of nursing mothers using the Healthy Eating Index

Ronilson Ferreira Freitas1  11  , Diego Silva Caetano2  , Angelina do Carmo Lessa3  31  , Mariana de Souza Macedo4  , Nísia Andrade Villela Dessimoni Pinto5  51  , Romero Alves Teixeira6  61 

1 Máster en Salud, Sociedad y Ambiente por la Universidad Federal de Vales del Jequitinhonha y Mucuri - UFVJM - Brasil. ronnypharmacia@gmail.com

11 Profesor de las Facultades Integradas del Norte de Minas - FUNORTE y de la Facultad Verde Norte - FAVENORTE, Montes Claros, Minas Gerais, Brasil. ronnypharmacia@gmail.com

2 Estudiante de Graduación en la Universidad Federal de los Vales del Jequitinhonha y Mucuri - UFVJM. Becario de Iniciación Científica por la Fundación de Amparo a la Investigación del Estado de Minas Gerais - FAPEMIG. Brasil

3 Doctora en Salud Comunitaria por la Universidad Federal de la Bahia - UFBA. Brasil.

31 Profesora Adjunta de la Universidad Federal de los Vales del Jequitinhonha y Mucuri - UFVJM Brasil.

4 Doctora en Ciencias de la Salud por la Universidad Federal de Minas Gerais - UFMG. Brasil

5 Doctora en Ciencias de los Alimentos por la Universidad Federal de Lavras - UFLA. Brasil.

51 Profesora Adjunta de la Universidad Federal de los Vales del Jequitinhonha y Mucuri - UFVJM. Brasil.

6 Doctor en Ciencias de la Salud por la Universidad Federal de Minas Gerais - UFMGBrasil.

61 Profesor Adjunto de la Universidad Federal de los Vales del Jequitinhonha y Mucuri - UFVJM. Brasil

ABSTRACT:

Goal:

To evaluate the overall diet quality of the nursing mothers using the Healthy Eating Index as an instrument.

Methods:

We carried out a cross-sectional-observational-epidemiological study using as data collection instrument a semi-structured questionnaire to characterize the sample and the habitual intake reminder. The diet quality was evaluated through the Healthy Eating Index (HEI) validated to the Brazilian population. For the analysis, we estimated the means and standard deviations, the medians and interquartile ranges of the HEI total and of each component. We used the Kolmogorov-Sminorv test to verify the normality of the data. HEI total score averages by groups according to socio-demographic, nutritional and obstetric variables were assessed using Student's t-tests, ANOVA and Tukey's “post hoc” test.

Results:

A total of 106 nursing mothers with a mean HEI score of 64.36 ± 10.68 were studied. Foods from the group of total fruit, whole fruit, total cereal, whole cereal and milk and dairy products were the components of HEI of the nursing mothers with lower scores, and with a higher frequency of minimum score. It was possible to observe a low intake of total fruits, whole fruits, total cereals, whole cereal and milk and dairy products. Comparing the means and medians of the total HEI score with the demographic, socioeconomic, nutritional and obstetric variables of the nursing mothers, we observed that women with 12 or more years of completed study had a significantly higher mean in relation to the less educated mothers.

Keywords: Food intake; Healthy Eating Index; Maternal Nutrition; Nursing mothers

INTRODUCTION

In recent years, Brazil has undergone a phase of demographic and epidemiological transformation, which challenges health authorities to create public policies that promote better quality of life and empower the citizen1, especially in relation to healthy eating, which is essential for the prevention and treatment of chronic no communicable diseases2. In this context, studies that evaluate the dietary habits and nutritional condition of the population have been decisive to guide programs and public policies for the promotion of health3. The pattern of food intake is the most important focus of a healthy eating4.

Thus, it was necessary to adapt the indices of global diet quality, based on specific proposals for the Brazilian population, evaluating in a qualitative and quantitative way the usual diet. These indices need to be constantly reviewed and adapted to the new nutritional recommendations5.

Faced with this situation, and considering the complexity of the diets, researchers have sought to develop and adapt instruments to evaluate the quality of the diet and incorporate in the analysis the correlation between food and nutrients, using parameters to identify deficiencies and nutritional excesses6)(7.

Brazil, however, undergoes a nutritional transition, where the occurrence of malnutrition has been reduced, and cases of overweight and obesity have increased significantly8. This change in the Brazilian epidemiological profile has favoured research with the intention of identifying factors associated with energy consumption and nutrient intake and the development of diseases9. However, standardized instruments such as adapted HEI in nursing mothers are scarce in the literature, and studies on food consumption in the postpartum period are rare. In Brazil, we found only one study by Tavares et al.10, in order to assess the quality of nursing mothers diet using adapted HEI.

In this perspective, studies that address dietary patterns in nursing mothers are scarce. Even so, work on food consumption in nursing mothers is fundamental to estimate the food intake in this population, besides allowing the identification of vulnerability groups, so that nutritional public policies are implemented in order to modify the food behaviour and the lifestyle of these women, taking into account the promotion of health, especially in this important phase of the life for them.

Thus, this study's goal was to evaluate the overall diet quality of the nursing mothers using as an instrument the Healthy Eating Index adapted according to Previdelli et al.6.

MATERIALS AND METHODS

A cross-sectional observational epidemiological study was carried out, with a sample of 106 nursing mothers, as well as with their new-borns. This is a sample of convenience chosen at random, whose recruitment was performed from prenatal care in the areas covered by the Family Health Strategy Units (FHS), located in the urban area of the town of Diamantina, Alto do Vale do Jequitinhonha, Minas Gerais, from August 2014 to December 2015.

The following exclusion criteria were adopted: prolonged hospitalizations that led to the suspension of breastfeeding; babies with congenital anomalies; mothers who stopped breastfeeding before the 15th day of the child's life; mothers with a diagnosis of diseases that indicated the need to stop breastfeeding. Participated in the study only those who signed the Term of Free and Informed Consent.

We collected the data from a questionnaire that addressed socio-demographic aspects (maternal age, self-reported skin colour and maternal education), economical aspects (total income and paid work), nutritional aspects (pre-gestational BMI and gestational BMI at the last prenatal visit) and obstetric history (gestational age and type of delivery). Pre-gestational BMI results were classified according to WHO11 criteria in adults: low weight (<18.5); eutrophic (≥18.5 and <25), overweight (≥ 25.0 and <30) and obesity (≥ 30.0). For the classification of nutritional status during pregnancy in low weight, eutrophic, overweight and obesity were considered critical levels of body mass index (BMI) for gestational age, proposed by Atalahet al.12) and adopted by the Ministry of Health13.

Information regarding dietary intake was obtained by applying an ordinary intake reminder, which was based on a 24-hour recall where the questions referred to the usual intake at each meal. The data obtained in home measures were transformed into grams or millilitres, thus enabling a detailed nutritional analysis of food consumption. The analysis of the nursing mothers' ordinary diet nutritional composition was done using the software AVANUTRI® version 3.

For evaluating the overall quality of the diet, we used the HEI proposed by Guenther; Reedy; Krebs-Smith14),(15, and adapted by Previdelli et al.6. This index is composed of 12 components: 9 food groups ("Total Cereals", "Whole Cereal", "Meat, Eggs and Legumes", "Total Fruits", "Whole Fruits", "Total Vegetable"); 2 components based on nutrients ("Saturated Fat" and "Sodium"); and 1 component that corresponds to the sum of the energetic value from the intake of solid fats (saturated and trans), alcohol and added sugar (“Gord_AA”)6. In the construction of the HEI, the ingested amounts of food obtained in the recall were evaluated, weighting them by the recommended portions for daily intake of the Food Guide for Brazilian Population16, adjusted to 1000 kcal.

Foods that were not included in the food groups' portions list of the Food Guide for the Brazilian Population16 were weighted in the food groups by the caloric value of the guide’s portion. Foods that were composed predominantly of simple carbohydrates (ex: soft drinks, candies, sweets, jellies, etc.) were considered as the group of sugars and sweets.

For the HEI analysis, preparations with ingredients from different food groups (cakes, pasta with sauce, meat preparations) were broken down into ingredients and these were computed in each corresponding group. Similarly, for industrialized foods with ingredients from different food groups (cookies and sweets) were also dismembered, and their components are standardized according to label information5),(17.

In order to construct the HEI, each component of the index received a score, which is calculated based on the number of servings consumed per 1000 Kcal for the food groups; in mg/1000 Kcal for sodium; and proportion of the total energy consumption by the nutrient for saturated fat and solid fats, sugar and alcohol ("Gord_AA"). For the total HEI, the maximum score is 100 points. For the individual components, the minimum score was zero; and the maximum scores ranged around 5, 10 or 20, depending on the component14),(6. The score for the intermediate values of intake, included in the interval between the criteria of minimum and maximum score, is assigned proportionally (Frame 1).

Frame 1 Scores and portions distribution of Healthy Eating Index components. Diamantina, MG, 2015 

includes fruits and natural fruit juices; excludes fruit juices from juices; includes legumes only after the maximum score of Meat, Eggs and Legumes is reached; includes milk and soy based beverage derivatives; e Includes monounsaturated and polyunsaturated fats from oilseeds and fish fat; HEI: Diet Quality Index; Gord_AA: Calories from solid fat, alcohol and added sugar; * the average score of the Gord_AA were obtained by weighting the values between 34 and 11, were considered the values of 0 to 19.9;

TEV: Total Energy Value.

Adapted from PREVIDELLI et al.6.

For the "Meat, Eggs and Legumes" component, the score was estimated from the sum of the energy value of the group "Meat and Eggs" and "Legumes". If there were surplus calories, the caloric value from the "Legumes" was computed in the groups "Dark green and Orange Vegetables and Legumes" and "Total Vegetables", simultaneously6.

In relation to the total score, the closer to the maximum score, the better the quality of the diet. As the index was developed to reflect different aspects of the diet, there is no adequate and inadequate classification considering the total score, so the score of each component should be evaluated alone14),(15.

The database was typed and stored in Microsoft Office Excel 2007® and validated in EPI-INFO, version 6.04. Data analysis was performed in the Statistical Package for Social Sciences (SPSS) software version 20.0. For the analysis of this study, the means and standard deviations, the medians and interquartile ranges of the HEI total and of each component were estimated, as well as the percentage of the minimum and maximum scores of the components. The normality of the HEI values distribution among the categories of the interest variables was evaluated from the Kolmogorov-Smirnov test. The means of total HEI score by groups according to socio-demographic, nutritional and obstetric variables were assessed using Student's t tests, ANOVA and Tukey's "post hoc" test.18.

Obeying the ethical precepts of resolution 466/2012, the study was submitted and approved by the Research Ethics Committee of the State University of Montes Claros with document nº 1,321,802.

RESULTS

The sample consisted of 106 nursing mothers, with a predominant age group between 20 and 29 years of age (48.1%), and black / brown skin colour (81.2%). Regarding education, 44.3% of the mothers studied from 9 to 11 years, 51% worked in paid work and 91.5% reported receiving up to 3 minimum wages.

Table 1 shows the means and medians, as well as their measures of dispersion of the values of the demographic, socioeconomic and nutritional characteristics of nursing mothers. The Kolmogorov-Smirnov test indicates that maternal age, BMI in gestation, energy, protein, carbohydrate and cholesterol intake, with p> 0.05 had normal distribution in the sample.

Table 1 Demographic, socioeconomic and nutritional characteristics of nursing mothers assisted in the public health system in Diamantina (MG), 2015 

*Komogorov-Sminorv test- indicating that p> 0.05 the distribution is normal and the appropriate central tendency measure is the mean.

** Reduction of n due to lack of information on the pregnant woman's cards and omission of the interviewee. # BMI in the third trimester of gestation. SD = Standard Deviation.

The HEI mean score was 64.36 (SD = 10.68). The components that obtained the lowest mean and median scores, as well as the highest frequency of minimum scores were total fruits, whole fruits, total cereal, whole cereal, milk and dairy products. On the other hand, higher mean and median scores were observed for total vegetable intake, dark green and orange vegetables, meat, eggs and legumes, oil, saturated fat and sodium (Table 2).

Table 2 Score of the Healthy Eating Index (HEI) components in nursing mothers (n = 106), Diamantina (MG), 2015 

* The legumes begin to compute in the total vegetable component and dark and orange vegetables component after reaching maximum score of the component meats, eggs and legumes. **Gord_AA: calories from solid fats, sugar and alcohol. ***Komogorov-Sminorv test (p > 0.05) indicating that the distribution is normal and the appropriate central tendency measure is the mean. SD = Standard Deviation.

Table 3 presents a comparison between the means and medians of the total score of the Healthy Eating Index with the demographic, socioeconomic, nutritional and obstetric variables in nursing mothers. It was possible to observe that in the variable maternal education, the means between the groups were different (p <0.05), where it was possible to observe that women with 12 or more years of completed study had a significantly higher mean in relation to the mothers with less education. This indicates that nursing mothers’ education may be a discriminatory variable for HEI scoring. Nursing mothers who worked and had higher income had higher scores, but did not present statistical significance.

Table 3 Total score of the Healthy Eating Index and the demographic, socioeconomic, nutritional and obstetric variables in nursing mothers of Diamantina (MG), 2015 

* Analysis of Variance - ANOVA; **Student’s t test; *** Tukey’s test.

DISCUSSION

Quality feeding is an important predictor of health, as it acts both in prevention and in the treatment of diseases. During lactation, nutritional and energy needs are increased. In this sense, although well established in the literature, special attention should be given to determining factors of the diet quality of nursing mothers, in order to prevent the occurrence of an unfavourable outcome and to provide adequate and good nutritional assistance in the postpartum period.

Regarding the results of this study, considering the reference scores for each HEI component, foods from the total fruit group, whole fruit, total cereal, whole cereal, milk and dairy products were the components of HEI of the nursing mothers with lower scores, and with a higher frequency of minimum grade. Similar results were reported in studies which showed that postpartum diets were limited in the variety of foods, with low fruit, cereal, milk and dairy products intake19),(20.

On the foods of the total vegetables group, dark green and orange vegetables, meat, eggs and legumes, oil and saturated fat, it was possible to observe a higher intake by the nursing mothers, thus increasing the consumption mean score of these foods. Regarding the consumption of proteins and saturated fat, the findings of the present study are in agreement with the study by Castro; Kac; Sichieri19 performed with nursing mothers, who observed that the diet was richer in proteins and saturated fats. However, a study by Durham et al.20, observed that in the postpartum period there was a low consumption of vegetables in the diet of the study population, results different from the findings of the present study. Fowles; Walke21 also reported in their studies that the intake of vegetables by puerperal women is insufficient.

Postpartum is a phase permeated by actions that involve taking care of and preventing complications, especially in the care of food, since studies consider that a healthy diet is necessary to improve milk production22. According to the Food Guide for the Brazilian Population23, healthy food must provide water, carbohydrates, proteins, lipids, vitamins, fibers and minerals, which are irreplaceable and indispensable to the proper functioning of the body.

Given this assumption, the diet should be varied, arranged in a colourful and harmonious way, since food ingested in a specific way, or isolated groups, are insufficient to provide all the nutrients necessary to maintain health2. During gestation and puerperium, women need to pay special attention to the quality of their diet, especially in relation to the choice of food, since maternal nutrition contributes to the development of the fetus during gestation, and after delivery during pregnancy lactation, as well as being a determinant of the quality of breast milk.24),(25.

The total score average of diet quality of the nursing mothers using as instrument of analysis the healthy eating index was low when compared to the reference score. In a study with women whose average age was 30 years, the education approximately 10 years and income per capita an average of a minimum wage, performed by Tavares et al.13, a total score average of 72.3 was found, higher than the findings of this study. When comparing the means and medians of the total score of the Healthy Eating Index with the demographic, socioeconomic, nutritional and obstetric variables in nursing mothers, it was possible to observe that higher maternal education presented a higher HEI score average.

The increase in education in this study was favourable for improvement of the HEI total score. In studies carried out by Figueiredo; Jaime; Monteiro26 and Levy et al.27, with the increase of maternal education, also increases the consumption of fruits and vegetables. Molina et al.28 affirms that mother's degree of education is a determinant factor for the selection and acquisition of healthier foods, and women with more years of schooling have greater access to adequate information, distinguishing which foods are nutritionally adequate to make up the diet.

The HEI, as an instrument capable of analyzing various components of the diet, allows a qualitative evaluation of the diet, allowing to evaluate which food groups, foods or nutrients are being consumed by the nursing mothers, as well as if the quantity is adequate or not. Thus allowing a monitoring if the diet is within the nutritional recommendations of the Food Guide.

Regarding the limitations of this study, it was possible to highlight the results interpretation in a cross-sectional study with a convenience sample. Thus suggesting a longitudinal study that evaluates the causes and consequences of diet quality through primary care, promoting a better quality of life for this population.

CONCLUSION

Regarding HEI scores, the findings of the present study were smaller when compared to a study performed with Brazilian nursing mothers. It was possible to observe a low intake of total fruits, whole fruits, total cereal, whole cereal, milk and dairy products and higher intake of total vegetables, dark green and orange vegetables, meat, eggs and legumes, oil, saturated fat and sodium. In the comparison between the means and medians of the total HEI score with the demographic, socioeconomic, nutritional and obstetric variables of the nursing mothers, it was observed that women with 12 or more years of completed study had a significantly higher mean in relation to the mothers with less education. This indicates that nursing mothers’ education may be a discriminatory variable for HEI scoring.

REFERENCIAS

1. Luz EP; Dallepiane LB; Kirchner RM; Silva LA; Silva FP; Kohler J. et al. Perfil sociodemográfico e de hábitos de vida da população idosa de um município da região norte do Rio Grande do Sul, Brasil. Rev. Bras. Geriatr. Gerontol. 2014; 17(2): 303-314. [ Links ]

2. Felippe F; Balestrin L; Silva FM; Schneider AP. Qualidade da dieta de indivíduos expostos e não expostos a um programa de reeducação alimentar. Rev. Nutr. 2011; 24(6): 833-844. [ Links ]

3. Elli E; Silva DO; Nazareno ER; Brandenburgi A. Conceptions of healthy eating among ecological farmers in Paraná, Southern Brazil. Rev. Saúde Pública. 2012; 46(2): 218-25. [ Links ]

4. Freeland-Graves JH; Nitzke S. Position of the Academy of Nutrition and Dietetics: Total Diet Approach to Healthy Eating. Journal of the Academy of Nutrition and Dietetics. 2013; 113(2): 307-317. [ Links ]

5. Mota JF; Rinaldi AEM; Pereira AF; Maesta N; Scarpin MM; Burini RC. Adaptação do índice de alimentação saudável ao guia alimentar da população brasileira. Rev Nutr. 2008; 21(5): 545-552. [ Links ]

6. Previdelli ÁN; Andrade SC; Pires MM; Ferreira SRG; Fisberg RM; Marchioni, DM. A revised version of the Healthy Eating Index for the Brazilian population. Rev Saúde Pública. 2011; 45(4): 794-8. [ Links ]

7. Nespeca M; Cyrillo DC. Diet quality assessment through the health yeating index of employees at a public university. Nutrire: Rev. Soc. Bras. Alim. Nutr. 2010; 35(2): 81-90. [ Links ]

8. Rombaldi AJ; Silva MC; Neutzling MB; Azevedo MR; Hallal PC. Factors associated with the consumption of high-fat foods among adults in a Southern Brazilian city. Ciência & Saúde Coletiva. 2014; 19(5): 1513-1521. [ Links ]

9. Lopes ACS; Caiaffa WT; Sichieri R; Mingoti SA; Lima-Costa MF. Consumo de nutrientes em adultos e idosos em estudo de base populacional: Projeto Bambuí. Cad. Saúde Pública. 2005; 21(4): 201-1209. [ Links ]

10. Tavares MP; Devincenzi MU; Sachs A; Abrão ACFV. Nutritional status and diet quality of nursing mothers on exclusive breastfeeding. Acta Paul Enferm. 2013; 26(3): 294-8. [ Links ]

11. World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO consultation on obesity. Geneva: World Wealth Organization; 2000. [ Links ]

12. Atalah E; Castillo CL; Castro RS; Amparo AP. Propuesta de un Nuevo estándar de evaluación nutritional de embarazadas. Rev Med Chile. 1997; 125: 1429-36. [ Links ]

13. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Orientações para a coleta e análise de dados antropométricos em serviços de saúde: Norma Técnica do Sistema de Vigilância Alimentar e Nutricional - SISVAN/Ministério da Saúde, Secretaria de Atenção à Saúde. Departamento de Atenção Básica - Brasília: Mistério da Saúde, 2011, 76 p. [ Links ]

14. Guenther PM; Reedy J; Krebs-Smith SM. Development of the Healthy Eating Index-2005. Journal of the American Dietetic Association. 2008a; 108(11): 1896-901. [ Links ]

15. Guenther PM; Reedy J; Krebs-Smith SM. Evaluation of the Healthy Eating Index-2005. Journal of the American Dietetic Association. 2008b; 108(11): 1854-1864. [ Links ]

16. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Coordenação-Geral da Política de Alimentação e Nutrição. Guia alimentar para a população brasileira: promovendo a alimentação saudável/Ministério da Saúde, Secretaria de Atenção à Saúde, Coordenação Geral da Política de Alimentação e Nutrição. Brasília: Ministério da Saúde. 2006; 210p. [ Links ]

17. Silva DA. Hábito e preferência alimentar de adolescentes residentes na zona rural e urbana de Viçosa-MG: análise dos fatores determinantes e da relação com estado nutricional e de saúde. 2012. 157 f. Dissertação (Mestrado em Ciência da Nutrição) - Universidade Federal de Viçosa, Viçosa, 2012. [ Links ]

18. Hosmer DW; Lemeshow S. Applied logistic regression. New York: John Wiley, 1989. [ Links ]

19. Castro MBT; Kac G; Sichieri R. Padrão de consumo alimentar em mulheres no pós-parto atendidas em um centro municipal de saúde do Rio de Janeiro, Brasil. Cad. Saúde Pública. 2006; 22(6): 1159-1170. [ Links ]

20. Durham HA; Lovelady CA; Brouwer RJN; Krause KM; Østbye T. Comparison of dietary in take of overweight post-partum mothers practicing breast feeding or formula feeding. J Am Diet Assoc. 2011; 111(1): 67-74. [ Links ]

21. Fowles ER; Walker LO. Correlates of dietary quality and weight retention in post partum women. J Community Health Nurs. 2006; 23: 183-97. [ Links ]

22. Stefanello J; Nakano AMS; Gomes AG. Beliefs and taboos related to the care after delivery: their meaning for a women group. Acta Paul Enferm. 2008; 21(2): 275-81. [ Links ]

23. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde, Coordenação-Geral da Política de Alimentação e Nutrição. Guia alimentar para a população brasileira: promovendo a alimentação saudável. Brasília, 2005. 236 p. (Série A. Normas e manuais técnicos). [ Links ]

24. Baião MR; Deslandes SF. Alimentação na gestação e puerpério. Rev. Nutr. 2006; 19(2): 245-253. [ Links ]

25. Marques ES; Cotta RMM; Botelho MIV; Franceschini SCC; Araújo RMA. Práticas e percepções acerca do aleitamento materno: consensos e dissensos no cotidiano de cuidado numa Unidade de Saúde da Família. Physis Revista de Saúde Coletiva. 2009; 19(2): 439-455. [ Links ]

26. Figueiredo IC; Jaime PC; Monteiro CA. Factors associated with fruit and vegetable in take among adults of the city of São Paulo, Southeastern Brazil. Rev Saúde Pública. 2008; 42(5): 777-85. [ Links ]

27. Levy RB; Castro IRR; Cardoso LO; Tavares LF; Sardinha LMV; Gomes FS. et al. Food consumption and eating behavior among Brazilian adolescents: National Adolescent School-based Health Survey (PeNSE), 2009. Ciência & Saúde Coletiva. 2010; 15(2): 3085-3097. [ Links ]

28. Molina MDCB; Lopéz PM; Faria CP; Cade NV; Zandonadeiv E. Socioeconomic predictors of child diet quality. Rev Saúde Pública.2010; 44(5): 785-92. [ Links ]

Received: March 01, 2017; Accepted: May 27, 2017

Creative Commons License Este es un artículo publicado en acceso abierto bajo una licencia Creative Commons