Abstract：
OBJECTIVE: To analyze trends in breastfeeding and complementary feeding indicators for infants and young children receiving primary health care (PHC) services in Brazil, considering the contextual aspects of local nurturing care (NC) environments.
METHODS: Ecological time-series study.
METHODS: Ten feeding indicators were extracted from 1,055,907 food intake records of children aged <2 years reported by PHC facilities from 2015 to 2019. Local NC environments were assessed with the Brazilian Early Childhood Friendly Municipal Index, calculating overall and stratified scores for the NC domains of adequate nutrition, good health, opportunities for early learning, and security and safety. Prais-Winsten regression was used to calculate annual percent changes (APC) by sex and the contrast in APC between the lower and upper quintiles of NC scores. Positive or negative APC with P-values <0.05 represented increasing or decreasing trends.
RESULTS: No significant trends of exclusive and continued breastfeeding, food introduction, or minimum dietary diversity were observed, with 2019 prevalences of 54.5%, 45.2%, 92.5%, and 78.2%, respectively. Increasing trends were observed for mixed milk feeding (2019: 19.2%; APC, +2.42%) and minimum meal frequency (2019: 61.1%; APC, +2.56%), while decreasing trends were observed for sweet beverage consumption (2019: 31.9%; APC, -5.92%) and unhealthy foods (2019: 16.1%; APC, -4.69%). Indicator improvements were significantly stronger in environments more favorable for NC.
CONCLUSIONS: Although the indicators did not meet global targets for infant feeding practices, the results suggest that the local NC environment encompasses facilitators that may be strategic in the design of early childhood programs and policies to improve nutrition.
METHODS: Ecological time-series study.
METHODS: Ten feeding indicators were extracted from 1,055,907 food intake records of children aged <2 years reported by PHC facilities from 2015 to 2019. Local NC environments were assessed with the Brazilian Early Childhood Friendly Municipal Index, calculating overall and stratified scores for the NC domains of adequate nutrition, good health, opportunities for early learning, and security and safety. Prais-Winsten regression was used to calculate annual percent changes (APC) by sex and the contrast in APC between the lower and upper quintiles of NC scores. Positive or negative APC with P-values <0.05 represented increasing or decreasing trends.
RESULTS: No significant trends of exclusive and continued breastfeeding, food introduction, or minimum dietary diversity were observed, with 2019 prevalences of 54.5%, 45.2%, 92.5%, and 78.2%, respectively. Increasing trends were observed for mixed milk feeding (2019: 19.2%; APC, +2.42%) and minimum meal frequency (2019: 61.1%; APC, +2.56%), while decreasing trends were observed for sweet beverage consumption (2019: 31.9%; APC, -5.92%) and unhealthy foods (2019: 16.1%; APC, -4.69%). Indicator improvements were significantly stronger in environments more favorable for NC.
CONCLUSIONS: Although the indicators did not meet global targets for infant feeding practices, the results suggest that the local NC environment encompasses facilitators that may be strategic in the design of early childhood programs and policies to improve nutrition.
摘要：
目的：分析巴西接受初级卫生保健（PHC）服务的婴幼儿母乳喂养和补充喂养指标的趋势，考虑到当地养育护理(NC)环境的上下文方面。
方法：生态时间序列研究。
方法：从2015年至2019年PHC机构报告的1,055,907岁以下儿童的食物摄入记录中提取了10项喂养指标。通过巴西幼儿友好市政指数评估了当地的NC环境，计算充足营养的NC领域的总体和分层分数，身体健康,早期学习的机会，和安全和安全。Prais-Winsten回归用于计算按性别划分的年度百分比变化（APC）以及NC得分的上下五分位数之间的APC对比。P值<0.05的阳性或阴性APC表示增加或减少的趋势。
结果：纯母乳喂养和持续母乳喂养没有显著趋势，食物介绍,或观察到最小的饮食多样性，2019年的患病率为54.5%，45.2%,92.5%,78.2%,分别。混合奶喂养呈增长趋势（2019年：19.2%；APC，+2.42%)和最低用餐频率(2019年：61.1%；APC，+2.56%），而甜味饮料消费量呈下降趋势(2019年：31.9%；APC，-5.92%)和不健康食品(2019年：16.1%；APC，-4.69%）。在对NC更有利的环境中，指标改善明显更强。
结论：尽管这些指标没有达到婴儿喂养实践的全球目标，结果表明，当地的NC环境包括在设计幼儿计划和改善营养政策方面可能具有战略意义的促进者。
方法：生态时间序列研究。
方法：从2015年至2019年PHC机构报告的1,055,907岁以下儿童的食物摄入记录中提取了10项喂养指标。通过巴西幼儿友好市政指数评估了当地的NC环境，计算充足营养的NC领域的总体和分层分数，身体健康,早期学习的机会，和安全和安全。Prais-Winsten回归用于计算按性别划分的年度百分比变化（APC）以及NC得分的上下五分位数之间的APC对比。P值<0.05的阳性或阴性APC表示增加或减少的趋势。
结果：纯母乳喂养和持续母乳喂养没有显著趋势，食物介绍,或观察到最小的饮食多样性，2019年的患病率为54.5%，45.2%,92.5%,78.2%,分别。混合奶喂养呈增长趋势（2019年：19.2%；APC，+2.42%)和最低用餐频率(2019年：61.1%；APC，+2.56%），而甜味饮料消费量呈下降趋势(2019年：31.9%；APC，-5.92%)和不健康食品(2019年：16.1%；APC，-4.69%）。在对NC更有利的环境中，指标改善明显更强。
结论：尽管这些指标没有达到婴儿喂养实践的全球目标，结果表明，当地的NC环境包括在设计幼儿计划和改善营养政策方面可能具有战略意义的促进者。
