The results of this study showed that unhealthy foods are present in high frequency in the diets of children under one year old and that this behavior is associated with low maternal education. These results are consistent with the findings of other studies on infant feeding conducted in Brazil as well as those of studies in other countries [20, 21].
The presence of unhealthy foods in the diets of children was analyzed in three studies in the state of São Paulo. A survey conducted in 136 counties detected that 63% of children between 6 and 12 months consumed porridge, which, in most cases, has sugar added during the preparation . In the city of São Paulo, a study revealed that the introduction of food occurs before 6 months of age especially sweets, and that 69% of children consumed soft drinks at 12 months of age . Additionally, in the city of São Paulo, a study on a random sample of children from birth to 59 months showed that family income influenced the consumption of processed foods, and the children from families with lower incomes were more likely to consume sugar .
The consumption of unhealthy foods has also been demonstrated in children under five that are beneficiaries of Bolsa Família (Brazilian program of cash transfers for families in poverty and extreme poverty) in the Brazilian semiarid region. These children were three times more likely to consume sweets than children not receiving this benefit, which suggests that income and maternal education may have an important influence on food choice .
Weaning represents an opportunity to promote lasting dietary habits. An optimal transition from milk to healthy table and family foods will help to establish healthy eating habits that may affect food preferences into adulthood . Therefore, this period may be considered one of the determinants of healthy eating habits, which, ultimately, may prevent diet-related diseases .
In countries such as The United States, infants and young children obtain most of their nutrients from infant formulas and/or fortified cereals and other fortified foods. While these foods provide a substantial proportion of a child’s micronutrient requirement, there are some indications that excessive intake of these types of foods should be avoided . Overweight and obese children are a public health problem, and diets that exceed dietary guidelines for fat, cholesterol, added sugar, saturated fatty acids and sodium and are low in fiber must be avoided to prevent diseases . The consumption of sugar is associated with dental caries  and a higher risk of developing childhood obesity [31, 32]. In addition, low quality diets may cause micronutrient deficiencies due to their lower nutrient content when compared to products lower in sugar [33, 34]. Excessive salt intake during childhood increases the risk for cardiovascular disease in adulthood. High sodium intake during the first 6 months of life has been associated with higher blood pressure [35–37]. Therefore, excessive exposure to early obesogenic diets may also influence appetite regulation and the ability of the hypothalamic neural circuit to regulate appetite by inducing permanent changes in the complex pathways that link the hypothalamus, gastrointestinal tract and adipose tissue . These findings reinforce the importance of promoting healthy nutritional habits during childhood.
In Brazil, the prevalence of breastfeeding and exclusive breastfeeding, though still below the levels recommended by the WHO, has been gradually increasing in recent decades, as a result of major advances by the National Program to Encourage Breastfeeding (PNIAM) to promote breastfeeding since it was founded in 1981 [39, 40]. However, public strategies to promote healthy complementary feeding were adopted much more recently . Examples of these strategies are in the publication of “Dietary Guidelines for Children Under Two Years - Ten Steps to Healthy Eating” in 2002 (revised in 2010)  and the formulation of the National Strategy for Healthy Complementary Feeding (ENPACS) , which aim to support and promote healthy infant feeding at the primary health care level.
This study confirmed that children under one year consume high amounts of ultra-processed foods such as biscuits and soft drinks. It is important to know the deleterious effects of these foods. Because they are formulated to be durable, affordable and easy to eat, they contain excessive amounts of oils, fats, flour, starch, sugar and salt, as well as preservatives, stabilizers, flavorings and colorings. They feature high energy density, low nutritional value and scarcity of fiber, which are all characteristics that increase the risk for obesity, diabetes and cardiovascular disease [44, 45].
An association between unhealthy food consumption in children and socioeconomic status of their families was also found in developed countries. In Bristol, UK, an inverse relationship between maternal education and the consumption of unhealthy foods, such as sausage and burgers, by 10-year-old children was found; and, in contrast, there was a positive relationship between the consumption of fruits and vegetables and maternal education . In California, United States of America, a study conducted among parents of children who attended a school for low-income families showed that the most common barriers to healthy food consumption were their high cost and the ease of access to fast food. Furthermore, it was shown that many parent’s basic knowledge about nutrition came primarily from television, radio, magazines and newspapers, demonstrated that they were easily influenced by the media .
In a population-based cohort study with Brazilian children, it was found that maternal education has an effect on a child’s health, which is partly independent from that of other socioeconomic factors; it was also suggested that maternal care is more important than the biological characteristics of the mothers, because stronger effects were observed for a child’s health outcome later (post neonatal mortality, hospital admissions and nutritional status) rather than earlier (birth weight, perinatal mortality) .
The high consumption of unhealthy foods in children less than one year old is most likely a reflection of changes in food expenditures in the Brazilian population, which was identified by the Household Budget Surveys (HBS). For example, among the products that showed an increase in the average per capita amount purchased, cola soft drinks occupied a prominent place, which grew by 39.3% between 2002–2003 and 2008–2009 . Another important finding of this survey was that out of the 1,792 kcal available for each person on average, approximately 20% of the kcal come from products considered to be ultra-processed, while 38% of the kcal comes from processed foods .
We agree with Victora et al.  when they say that the main challenge is how to educate parents to provide healthy nutrition habits for their children, especially in a situation where the parents are undereducated or have deep-seated cultural values. The parent’s attitude towards eating is a determinant of their children’s future diets, and it influences their feeding habits and, consequently, their risk for diet-associated diseases.
One of the major limitations of this study is related to the use of the 24-hour recall with closed questions, which cannot investigate the amount consumed, the frequency of consumption or the introduction of foods into the diet of infants.
This study gave an important contribution to quantify, at a national level, some feeding practices in young children. The results serve as a warning to health professionals, managers and society about the need for developing effective strategies to tackle unhealthy food consumption among Brazilian children as a way to prevent obesity and other health problems in the future. It is hoped that the newly launched strategy “Breastfeeding and Feeding Brazil”, aimed at promoting healthy eating habits early in life at the primary health care level, can help address this important public health problem. Other measures, such as regulating food advertisements, which already occurs with products designed to substitute breast milk , has been widely debated by researchers, scientific societies, professional associations, consumer organizations and civil societies in general.