Feeding infants and toddlers study: improvements needed in meeting infant feeding recommendations

Complementary feeding challenges: Insights from Swiss parents' perspectives

Parents play a crucial role in deciding what foods to introduce to their infants during the transition from milk to solids. This study examined the challenges they face, including adherence to official complementary feeding recommendations and the struggles and concerns across different stages of feeding. Specifically, this study focused on the initial stage (transition from breastmilk/formula to mashed foods), middle stage (consumption of mashed foods and some fingerfoods, transitioning towards family foods) and late stage (complete transition to family diet). Findings from 22 semi-structured interviews with Swiss parents reveal that, despite being well-informed, practical obstacles such as returning to work, limited time for preparing homemade foods, managing multiple children, and food preferences often hinder adherence. Safety concerns like allergies and choking were prominent early on but decreased as infants grew older and parents gained confidence. In the middle phase, concerns shifted towards pesticides, indicating a growing awareness of food quality. Maintaining a healthy diet was a constant concern, with early reassurance from breastfeeding or formula feeding giving way to worries about balanced nutrition as solids became more prominent. Time constraints were particularly significant in the first two stages, due to the effort of preparing small amounts of mash and later cooking separate meals. Tailored support and clear communication can help parents navigate these challenges and promote healthier feeding practices.

Current Evidence on Nutrient Intakes and Infant Growth: A Narrative Review of Baby-Led Weaning vs. Conventional Weaning

Throughout infancy, changes in growth and development are observed, including changes in nutritional requirements; at approximately 6 months of age, when complementary feeding begins, breastmilk and/or formula are no longer the sole source of energy and nutrients. Little is known about the impact of complementary feeding (CF) approaches used during this time on infant nutrition and growth. Baby-led weaning (BLW) has continued to gain popularity over the last two decades, emphasizing the importance of examining the adequacy of different CF methods. This narrative review of 19 studies from January 2010 to April 2024 aims to discuss the differences between BLW and conventional weaning (CW). The definition of BLW varied across studies, and no standard definition has been established. Though no differences in energy were reported, macronutrient and micronutrient intakes were variable between approaches, including for micronutrients such as iron and zinc. Of the few studies with growth data, results comparing BLW and CW were conflicting. Differences were seen in the demographics of parents who chose to follow BLW and breastfeeding prevalence and duration prior to complementary feeding. Additional research is needed to understand the impacts of BLW and CW on nutrient intakes and growth to inform recommendations for infant complementary feeding approaches.

The Investigation of Mycotoxins and Enterobacteriaceae of Cereal-Based Baby Foods Marketed in Turkey

In this study, a total of 85 cereal-based baby foods with or without milk (four different brands; A, B, C, and D) collected from Ankara local markets, Turkey were analyzed for mycotoxins, total aerobic mesophilic bacteria (TAMB), and Enterobacteriaceae contamination. Baby foods were analyzed for 12 toxicological important mycotoxins such as aflatoxin B1, B2, G1, and G2; fumonisin B1 and B2; ochratoxin A; sterigmatocystin (STE); deoxynivalenol (DON); zearalenone (ZON); and T-2 toxin and HT-2 toxin by LC-MS/MS multi-mycotoxin method. In addition to these mycotoxins, the presence of aflatoxin M1 (AFM1) was investigated in baby foods containing milk. The classical culture method was used for microbiological analysis. Consequently, at least one mycotoxin was detected in 69.41% of the total samples. The most frequently detected mycotoxins were STE (34.12%) and HT-2 (34.12%). However, AFM1 was not detected in any of the baby foods containing milk. Also, TAMB and Enterobacteriaceae were isolated from 30.59% and 10.59% of samples, respectively. As a result, it was determined that the mycotoxin levels in the analyzed samples were in accordance with the mycotoxin levels specified in the Turkish Food Codex.

Examining patterns of postnatal feeding in relation to infant's weight during the first year

BACKGROUND

There is mixed evidence regarding specific infant feeding behaviors and later risk for overweight and obesity. We sought to detect underlying patterns in duration of breastfeeding, introduction of solid foods and sweetened beverages, in order to understand the relation to later weight.

METHODS

Patterns of postnatal feeding were examined among infants enrolled in the Infant Feeding Practices Study II (N = 3033). At monthly intervals, mothers reported on the duration of any and exclusive breastfeeding, age of solid food and sweetened beverage introduction, and reported infant weight at ages 9- and 12-months. Latent profile analysis was used to empirically derive patterns of postnatal feeding and examine associations with weight z-scores at 9 and 12 months.

RESULTS

Two profiles emerged: (1) Short breastfeeding duration and early introduction to solid foods and sweetened beverages (Short BF/Early Introduction; 53%) and (2) longer breastfeeding duration and later introduction to solid foods and sweetened beverages (Longer BF/Later Introduction; 43%). Infants in the Shorter BF/Early Introduction profile had significantly greater weight z-scores at 9 (M = 0.18) and 12 months (M = 0.26), compared to those in the Longer BF/Later Introduction profile (M = -0.21; M = -0.17, respectively).

CONCLUSIONS

Overall, shorter BF duration and earlier food and sweetened beverage introduction is associated with higher weight z-scores at 9 and 12 months. Early intervention should aim to promote breastfeeding and later introduction of solids and discourage consumption of sweetened beverages. These postnatal patterns of feeding behaviors provides important context to inform targeted interventions aimed at reducing risk for later obesity.

Exploring Physicians' Perspectives on the Introduction of Complementary Foods to Infants and Toddlers

Complementary feeding is the subject of many recommendations regarding the benefits of its use, illustrating its crucial impact on further health. However, it still poses a significant problem for caregivers, and thus for doctors. This survey focused on nutritional problems faced by the parents of infants and toddlers, as well as how physicians deal with these problems. Based on the responses from 303 doctors, it was determined that the time and sequence of introducing complementary foods raise the greatest doubts in parents. This study also found that at least one-third of pediatricians experience difficulties in providing effective nutritional counseling. Increasing the nutritional awareness of physicians can allow them to provide more appropriate support to parents.

β-1,3/1,6-Glucans and Immunity: State of the Art and Future Directions

The innate immune system responds in a rapid and non-specific manner against immunologic threats; inflammation is part of this response. This is followed by a slower but targeted and specific response termed the adaptive or acquired immune response. There is emerging evidence that dietary components, including yeast-derived β-glucans, can aid host defense against pathogens by modulating inflammatory and antimicrobial activity of neutrophils and macrophages. Innate immune training refers to a newly recognized phenomenon wherein compounds may "train" innate immune cells, such that monocyte and macrophage precursor biology is altered to mount a more effective immunological response. Although various human studies have been carried out, much uncertainty still exists and further studies are required to fully elucidate the relationship between β-glucan supplementation and human immune function. This review offers an up-to-date report on yeast-derived β-glucans as immunomodulators, including a brief overview of the current paradigm regarding the interaction of β-glucans with the immune system. The recent pre-clinical work that has partly decrypted mode of action and the newest evidence from human trials are also reviewed. According to pre-clinical studies, β-1,3/1,6-glucan derived from baker's yeast may offer increased immuno-surveillance, although the human evidence is weaker than that gained from pre-clinical studies.

Validation and calibration of the Eating Assessment in Toddlers FFQ (EAT FFQ) for children, used in the Growing Up Milk - Lite (GUMLi) randomised controlled trial

The Eating Assessment in Toddlers FFQ (EAT FFQ) has been shown to have good reliability and comparative validity for ranking nutrient intakes in young children. With the addition of food items (n 4), we aimed to re-assess the validity of the EAT FFQ and estimate calibration factors in a sub-sample of children (n 97) participating in the Growing Up Milk - Lite (GUMLi) randomised control trial (2015-2017). Participants completed the ninety-nine-item GUMLi EAT FFQ and record-assisted 24-h recalls (24HR) on two occasions. Energy and nutrient intakes were assessed at months 9 and 12 post-randomisation and calibration factors calculated to determine predicted estimates from the GUMLi EAT FFQ. Validity was assessed using Pearson correlation coefficients, weighted kappa (κ) and exact quartile categorisation. Calibration was calculated using linear regression models on 24HR, adjusted for sex and treatment group. Nutrient intakes were significantly correlated between the GUMLi EAT FFQ and 24HR at both time points. Energy-adjusted, de-attenuated Pearson correlations ranged from 0·3 (fibre) to 0·8 (Fe) at 9 months and from 0·3 (Ca) to 0·7 (Fe) at 12 months. Weighted κ for the quartiles ranged from 0·2 (Zn) to 0·6 (Fe) at 9 months and from 0·1 (total fat) to 0·5 (Fe) at 12 months. Exact agreement ranged from 30 to 74 %. Calibration factors predicted up to 56 % of the variation in the 24HR at 9 months and 44 % at 12 months. The GUMLi EAT FFQ remained a useful tool for ranking nutrient intakes with similar estimated validity compared with other FFQ used in children under 2 years.

Health Impacts of Early Complementary Food Introduction Between Formula-fed and Breastfed Infants

BACKGROUND

Global health agencies agree that infants should not be fed complementary foods before 4 to 6 months of age. However, given the World Health Organization (WHO) definition of complementary food as "anything other than breast milk," little is known about the relative risks of formula compared with other complementary foods on infant health. This article aims to fill this gap in the literature, by assessing how differences in the timing of the introduction of nonformula complementary food between breastfed and formula-fed infants impacts infant health.

METHODS

Eight health outcomes by complementary food introduction, breast-feeding, formula feeding, and mixed feeding (breastfed and formula-fed) were predicted using logistic regression with generalized estimating equations on the newborn through 6-month waves of the Infant Feeding Practices Study II (IFPS-II).

RESULTS

Complementary foods increased the likelihood for all health risks measured. Given greater prevalence of early complementary food introduction among formula-fed infants, most health differences between breast-feeding groups shift to nonsignificance in full models, with the exception of higher rates of hard stool and cough/wheeze among formula-fed and mixed-fed infants but lower rates of diarrhea (LO = -0.577; 95% confidence interval [CI] = -1.074 to 0.080) and runny nose or cold (LO = -3.19; 95% CI = -0.552 to -0.086) for mixed-fed than breastfed infants.

CONCLUSIONS

Our results confirm health benefits of exclusive breast-feeding and that the introduction of complementary foods before 4 to 6 months poses a greater risk to infant health than does formula. Greater attention to the early introduction of complementary foods is needed in research and clinical practice.

Trends in Mean Nutrient Intakes of US Infants, Toddlers, and Young Children from 3 Feeding Infants and Toddlers Studies (FITS)

BACKGROUND

Many updates to young child feeding recommendations have been published over the past decade, but concurrent intake trends have not been assessed.

OBJECTIVE

The aim of this study was to evaluate adequacy and trends in energy and nutrient intakes of US infants and children aged 0-47.9 mo through use of Feeding Infants and Toddlers Study (FITS) data from 2002, 2008, and 2016.

METHODS

FITS are cross-sectional surveys of parents/caregivers of infants and young children (FITS 2002, n = 2962; FITS 2008, n = 3276; FITS 2016, n = 3235). Dietary intakes were assessed by telephone with trained interviewers using the Nutrition Data System for Research. Mean ± SE nutrient intakes were calculated. Diet adequacy was assessed with the nutrient adequacy ratio (NAR) for 17 nutrients and the corresponding mean adequacy ratio.

RESULTS

Energy and macronutrient intakes were generally stable across surveys, but significant decreases for saturated fat and total sugars and an increase in fiber were observed among 6-11.9-mo-olds and 12-23.9-mo-olds (P-trend < 0.0001). Mean sodium intakes exceeded Adequate Intakes (AI) for all ages, whereas fiber intakes were universally below the AI. Nutrients with the lowest NAR values were vitamin D (range 0.41-0.67/1.00) and vitamin E (range 0.60-0.79/1.00 for 2008 and 2016). For iron, infants aged 6-11.9 mo had the lowest NAR values at 0.77-0.88/1.00, compared to 0.85-0.89/1.00 for 12-47.9-mo-olds. Potassium was low from 12 to 47.9 mo (NAR range 0.55-0.63/1.00 across survey years). The nutrients with the greatest decline in mean intakes were iron and vitamins D and E among 6-11.9-mo-olds, and vitamin D and potassium among 12-23.9-mo-olds in 2016 compared to 2002.

CONCLUSIONS

The diets of US infants and young children were generally adequate for most micronutrients and stable over time, but sodium intakes were too high, and nutrient gaps still existed, especially for vitamins D, E, and fiber across ages and for iron among infants.

Effectiveness of hermetic maize grain storage technology in limiting aflatoxin exposure in women and children from smallholder farming areas

The longitudinal study assessed the effectiveness of hermetic storage technology in limiting aflatoxin exposure among women aged 15-45 years and children under five years of age from households in selected smallholder farming areas of Zimbabwe. Exposure levels were determined by measuring aflatoxin M1 (AFM1) in urine samples from women and children every three months during the 2015/2016 storage season for nine months. After extraction and immunoaffinity column clean up, AFM1 was determined by high performance liquid chromatography. Generally, the proportion of AFM1 positive urine samples from women increased throughout the grain storage season from 5.4% (n=23) (geometric mean (GM) 1.62 μg/l) at harvest to 75% (n=315) (GM 48.35 μg/l) nine months later (range <limit of quantification (LOQ)-217.29 μg/l). In urine samples from children, AFM1 positive samples increased from 2.2% (n=4) (GM 0.78 μg/l) at harvest to 72.5% (n=98) (GM 22.81 μg/l) nine months later (range <LOQ- 135.00 μg/l). Urinary AFM1 was significantly higher in samples from participants using conventional storage (GM 62.28 μg/l; range <LOQ-217.29 μg/l) compared with samples from participants using hermetic technology (GM 31.95 μg/l; range <LOQ-157.71 μg/l. There was no significant difference in AFM1 concentrations in urine samples from participants consuming grain from metal silos and hermetic bags (P>0.05) hence the two technologies are equally effective in limiting exposure to aflatoxins in humans. The study concluded that aflatoxin exposure levels among women and children from small-holder farming areas increase throughout the postharvest season and the use of hermetic storage technology resulted in up to 33.2% decrease in frequency of detection and 48.7% decrease in levels of AFM1 compared to conventional storage technologies. Thus hermetic grain storage can be an effective technology recommended for limiting aflatoxin exposure in smallholder farming populations.

Could the high consumption of high glycaemic index carbohydrates and sugars, associated with the nutritional transition to the Western type of diet, be the common cause of the obesity epidemic and the worldwide increasing incidences of Type 1 and Type 2 diabetes?

The globally increasing incidences of Type 1 diabetes (T1DM) and Type 2 diabetes (T2DM) can have a common background. If challenged by the contemporary high level of nutritional glucose stimulation, the β-cells in genetically predisposed individuals are at risk for damage which can lead to the diseases. The fat to carbohydrate dietary shift can also contribute to the associated obesity epidemic.

Evaluation of the Effect of a Growing up Milk Lite vs. Cow's Milk on Diet Quality and Dietary Intakes in Early Childhood: The Growing up Milk Lite (GUMLi) Randomised Controlled Trial

scores provide an alternative approach to measuring dietary quality. The Growing Up Milk-Lite (GUMLi) Trial was a multi-centre, double-blinded, randomised controlled trial of children randomised to receive a reduced protein GUM (GUMLi) or unfortified cow's milk (CM). In a secondary analysis of the GUMLi Trial, we used the Probability of Adequate Nutrient Intake (PANDiet) to determine the nutritional adequacy of the diets of participating children living in Auckland. The PANDiet was adapted to the New Zealand Nutrient Reference Values and data from four 24 h Recalls (24HR) collected at months 7, 8, 10, and 11 post-randomisation were used. Differences between randomised groups (GUMLi vs. CM) of the PANDiet and its components were made. Eighty-three Auckland participants were included in the study (GUMLi n = 41 vs. CM n = 42). Total PANDiet scores were significantly higher in the GUMLi group (p < 0.001), indicating better overall nutrient adequacy and diet quality. Dietary intakes of children in both groups met the recommendations for fat, total carbohydrates and most micronutrients; however, protein intakes exceeded recommendations. Consumption of GUMLi was associated with higher nutritional adequacy, with an increased likelihood of meeting nutrient requirements; however, the impact of the family diet and GUMLi on dietary diversity requires further evaluation.

The association between antibiotics in the first year of life and child growth trajectory

BACKGROUND

Antibiotics are frequently prescribed to children, and may be an environmental influence that contributes to the increasing prevalence of childhood obesity. The aim of this study was to examine the effect of antibiotic use in the first year of life on child growth trajectories from birth to age 6 years including significant covariates.

METHODS

Data from 586 children in the Infant Feeding Practices II (IFPS II) and 6 year follow-up study (6YFU) were included. Antibiotic exposures, weight and height measurements were collected from birth through the first 12 months, and then again at 6 years. Linear mixed effects growth modeling, controlling for exclusive breastfeeding, socio-demographic factors, smoking during pregnancy, gestational diabetes, and maternal pre-pregnancy weight status, was used to examine the association between antibiotic exposure and child growth trajectories through age 6 years.

RESULTS

The majority of infants (60.58%) did not receive any antibiotics; 33.79% received 1-2 courses and 5.63% received 3 or more antibiotic courses during the first year. In the unadjusted model, children with 1-2 antibiotic exposures had a 0.17 (SE 0.08) higher rate of change in BMI z-score (BMIz) than children without any antibiotics, and children with ≥3 exposures had a 0.42 (SE 0.16) higher rate of change in BMIz (p = 0.009). Growth trajectory over time for those who had ≥3 antibiotics was greater than those without any antibiotics (p = 0.002).

CONCLUSIONS

Efforts to guide the judicious use of antibiotics should continue, particularly in the first year of life.

Consumption of sugars, saturated fat, and sodium among US children from infancy through preschool age, NHANES 2009-2014

Background

Expert guidelines advise that intake of added sugars (ASs), free sugars, and saturated fats be limited to <10% total energy (TE), and that children's sodium not exceed 1500-1900 mg, yet intake among many older children and adolecents exceeds these limits. Although research suggests young children's diets influence future eating patterns, little is known about the intake of these nutrients throughout early childhood.

Objective

The objective of this study was to describe intake and leading sources of sugars, saturated fats, and sodium among US children from infancy through preschool age.

Design

Cross-sectional data from the NHANES 2009-2014 were used to estimate 1) mean intake of sugars [%TE from ASs, naturally occurring sugars (NOSs), and free sugars], saturated fats (%TE), and sodium (milligrams), 2) the proportion exceeding recommended limits, and 3) the leading sources of these nutrients in the diets of US (nonbreastfeeding) children <5 y old (n = 3345). Sampling weights and procedures to account for the complex sampling design were used to estimate intake by age and to compare across race/ethnicity, sex, and income subgroups.

Results

Nonbreastfeeding children <5 y old consumed a mean ± SE %TE of 10.1% ± 0.2% from ASs, 13.9% ± 0.2% from free sugars, 12.8% ± 0.1% from saturated fats, and 1804 ± 26 mg Na . Sugary beverages (sugar-sweetened beverages + 100% juices) contributed 6.7% ± 0.2% TE, with consumption lowest among higher-income children. AS and sodium consumption rose rapidly from infancy to age 1-<2 y and gradually thereafter. Saturated fat intake was highest in infancy and decreased to a mean ± SE of 11.3% ± 0.3% TE among 4-<5-y-olds. Intake exceeded recommended limits for ASs, free sugars, saturated fats, and sodium for 45%, 63%, 72%, and 67% of all children, respectively.

Conclusion

The consumption of sugars, fats, and sodium exceeds recommended guidelines before many US children reach school age.

Starch Malabsorption in Infants

Based on the developmental physiology of pancreatic amylase production, starch digestion in young infants was anticipated to be compromised whenever compared with that in older infants and toddlers. This appears to be the case, but with great variability among infants to digest starch. Evidence points to the importance of maltase-glucoamylase in young infants and its effect on starch digestion. These observations have critical importance for recommendations regarding the feeding of starch-containing foods to young infants.

Timing of Introduction of Complementary Foods to US Infants, National Health and Nutrition Examination Survey 2009-2014

BACKGROUND

Although there has been inconsistency in recommendations regarding the optimal time for introducing complementary foods, most experts agree that introduction should not occur before 4 months. Despite recommendations, studies suggest that 20% to 40% of US infants are introduced to foods at younger than 4 months. Previous studies focused on the introduction of solid foods and are not nationally representative.

OBJECTIVE

Our aims were to provide a nationally representative estimate of the timing of introduction of complementary foods and to describe predictors of early (<4 months) introduction.

DESIGN

We conducted a cross-sectional analysis of 2009-2014 National Health and Nutrition Examination Survey data.

PARTICIPANTS

The study included 1,482 children aged 6 to 36 months.

MAIN OUTCOME MEASURES

Timing of first introduction to complementary foods (anything other than breast milk or formula) was analyzed.

STATISTICAL ANALYSES PERFORMED

Prevalence estimates of first introduction to complementary foods are presented by month. Logistic regression was used to assess characteristics associated with early (<4 months) introduction.

RESULTS

In this sample, 16.3% of US infants were introduced to complementary foods at <4 months, 38.3% between 4 and <6 months, 32.5% between 6 and <7 months, and 12.9% at ≥7 months of age. In unadjusted analyses, early introduction varied by breastfeeding status; race/Hispanic origin; Special Supplemental Nutrition Program for Women, Infants, and Children participation; and maternal age. In adjusted analyses, only breastfeeding status remained significant; infants who never breastfed or stopped at <4 months were more likely (odds ratio 2.27; 95% CI 1.62 to 3.18) to be introduced to complementary foods early than infants who breastfed ≥4 months.

CONCLUSIONS

Despite using a broader definition of complementary foods, this analysis found a lower prevalence of early introduction in this nationally representative sample than previous studies that included only solids. However, many young children were still introduced to complementary foods earlier than recommended. Strategies to support caregivers to adhere to infant feeding guidelines may be needed.

Early feeding and risk of Juvenile idiopathic arthritis: a case control study in a prospective birth cohort

BACKGROUND

Juvenile idiopathic arthritis (JIA) is considered to be an autoimmune disease, but the etiology is unknown. We decided to study the influence of early nutrition on later development of JIA.

METHODS

All parents with children born between October 1, 1997 and October 1, 1999 in Southeast Sweden were asked to participate in the ABIS prospective cohort study (All Babies in Southeast Sweden), At 1 year, questionnaires with information on breastfeeding and introduction of foods were completed by 10,565 families. We identified 32 children with JIA and 111 children with non-chronic arthritis with completed questionnaires after delivery and after 1 year. A multivariable logistic regression model, adjusted for relevant factors, was performed to calculate the association between JIA and feeding during the first year of life.

RESULTS

An increased risk for JIA was found in children who had breast fed for less than 4 months, as opposed to those who were continued on breast milk beyond 4 months of age (aOR 3.5, 95% CI 1.4-8,5; p = 0.006). A short duration of exclusive as well as total breastfeeding was associated with an increased risk of JIA (aOR 1.3, 95% CI 1.1-1.6; p = 0.008 and aOR 1.2, 95% CI 1.1-1.3; p < 0.001). All associations between breastfeeding and JIA persisted after adjustment. There was no relationship between early nutrition and non-chronic arthritis.

CONCLUSIONS

Our results indicate that there are different disease mechanisms for different types of arthritis in childhood. Longer duration of breastfeeding (both total and exclusive) may protect against development of JIA. Mothers should be encouraged to breast-feed their babies exclusively, if at all possible, for 4 months and continue partial breastfeeding for an extended time when foreign proteins are introduced.

Nutritional aspects of commercially prepared infant foods in developed countries: a narrative review

Nutritional intake during infancy is a critical aspect of child development and health that is of significant public health concern. Although there is extensive research on breast-feeding and timing of solid food introduction, there is less evidence on types of solid foods fed to infants, specifically commercially prepared infant foods. The consumption of commercially prepared infant foods is very prevalent in many developed countries, exceeding the consumption of homemade foods in some situations. Although these food products may have practical advantages, there are concerns about their nutritional composition, sweet taste, bioavailability of micronutrients, diversity of ingredients and long-term health effects. The extent that the manufacturing, fortification and promotion of these products are regulated by legislation varies between countries and regions. The aim of the present narrative review is to investigate, appraise and summarise these aspects. Overall there are very few studies directly comparing homemade and commercial infant foods and a lack of longitudinal studies to draw firm conclusions on whether commercial infant foods are mostly beneficial or unfavourable to infant health.

Effect of Exclusive Breastfeeding Among Overweight and Obese Mothers on Infant Weight-for-Length Percentile at 1 Year

BACKGROUND

Breastfeeding is associated with decreased risk of childhood obesity. However, there is a strong correlation between maternal weight status and childhood obesity, and it is unclear whether or not breastfeeding among overweight mothers could mitigate this risk. Our goal was to examine whether or not exclusive breastfeeding (compared to formula feeding) among overweight and obese mothers is associated with lower weight-for-length (W/L) percentile at 1 year.

MATERIALS AND METHODS

Data from the Infant Feeding Practices II study were used. Infants who were preterm or underweight at 1 year, and mothers who were underweight before pregnancy, were excluded from analysis. There was a significant interaction between exclusive breastfeeding for 4 months and maternal prepregnancy weight status (normal weight, overweight, obese) on infant W/L percentile at 1 year. Stratified linear mixed-effects growth modeling controlling for covariates was created to test the relationship between exclusive breastfeeding and infant W/L percentile within each maternal weight category.

RESULTS

A total of 915 subjects met inclusion criteria. Normal weight and obese mothers who exclusively breastfed for 4 months had infants with a smaller rate of increase in W/L percentile during the first year compared with those who used formula. Infants of overweight and obese mothers who exclusively breastfed for 4 months had lower W/L percentile at 1 year than those who used formula.

CONCLUSIONS

Exclusive breastfeeding for 4 months among normal weight and obese mothers resulted in less increase in W/L percentiles in the first year. Obese mothers often have a difficult time initiating and maintaining breastfeeding. Concerted efforts are needed to support this population with breastfeeding.

Infant Dietary Exposures to Sweetness and Fattiness Increase during the First Year of Life and Are Associated with Feeding Practices

BACKGROUND

Taste is a strong determinant of food intake. Previous research has suggested that early taste exposures could influence preferences and later eating behavior, but little is known about the factors related to this.

OBJECTIVES

The aims of this study were to describe infants' exposure to sweetness and fattiness and to examine whether maternal and infant characteristics and feeding practices are related to these exposures in participants from the OPALINE [Observatoire des Préférences Alimentaires du Nourrisson et de l'Enfant (Observatory of Infant and Child Food Preferences)] cohort study.

METHODS

Food consumption frequency was assessed with a 7-d food record completed monthly over the first year. Dietary taste exposure was defined by the consumption frequency of each food multiplied by the intensity of its taste, summed over all foods. The daily sweetness exposure (SweetExp) and fattiness exposure (FatExp) were calculated at 3-6, 7-9, and 10-12 mo of age for 268 infants from complementary feeding initiation (CFI) to 12 mo. Associations between taste exposure and potential factors were tested by multiple linear regressions.

RESULTS

Both FatExp and SweetExp increased from 3-6 mo to 10-12 mo (mean ± SD: 7.5 ± 2.3 to 12.2 ± 2.5 and 6.8 ± 2.8 to 14.7 ± 4.1, respectively). Breastfeeding duration ≥6 mo was associated with higher SweetExp at all ages, with a decreasing β [β (95% CI): 2.6 (1.8; 3.4) at 3-6 mo and 1.3 (0.1; 2.4) at 10-12 mo]. CFI at <6 mo was associated with higher SweetExp at all ages but with higher FatExp only at 3-6 mo. Higher SweetExp and FatExp were associated with a higher use of all complementary food types. Boys were more likely to be exposed to SweetExp at 10-12 mo and to FatExp at 3-6 mo and 10-12 mo than were girls. Maternal higher education attainment and return to work after 6 mo were linked with higher FatExp and higher FatExp and SweetExp, respectively.

CONCLUSION

SweetExp and FatExp increased from CFI until 12 mo and were associated with feeding practices in OPALINE infants. Studying early taste exposure longitudinally should provide new insights regarding the development of food preferences.

Regional differences in milk and complementary feeding patterns in infants participating in an international nutritional type 1 diabetes prevention trial

Differences in breastfeeding, other milk feeding and complementary feeding patterns were evaluated in infants at increased genetic risk with and without maternal type 1 diabetes (T1D). The Trial to Reduce IDDM in the Genetically at Risk is an international nutritional primary prevention double-blinded randomized trial to test whether weaning to extensively hydrolyzed vs. intact cow's milk protein formula will decrease the development of T1D-associated autoantibodies and T1D. Infant diet was prospectively assessed at two visits and seven telephone interviews between birth and 8 months. Countries were grouped into seven regions: Australia, Canada, Northern Europe, Southern Europe, Central Europe I, Central Europe II and the United States. Newborn infants with a first-degree relative with T1D and increased human leukocyte antigen-conferred susceptibility to T1D were recruited. A lower proportion of infants born to mothers with than without T1D were breastfed until 6 months of age in all regions (range, 51% to 60% vs. 70% to 80%). Complementary feeding patterns differed more by region than by maternal T1D. In Northern Europe, a higher proportion of infants consumed vegetables and fruits daily compared with other regions. Consumption of meat was more frequent in all European regions, whereas cereal consumption was most frequent in Southern Europe, Canada and the United States. Maternal T1D status was associated with breastfeeding and other milk feeding patterns similarly across regions but was unrelated to the introduction of complementary foods. Infant feeding patterns differed significantly among regions and were largely inconsistent with current recommended guidelines.

Mid-childhood fruit and vegetable consumption: The roles of early liking, early consumption, and maternal consumption

Previous studies have shown that early liking, early consumption, and maternal consumption of fruits and vegetables (F&V) each predict children's F&V consumption, but no one has examined the independent contributions of these three correlated factors. We aim to examine the extent to which each of these 3 factors is associated with F&V consumption in mid-childhood after accounting for the other 2 in the analysis. We analyzed data from 901 mother-child dyads from Project Viva, a prospective pre-birth cohort study. Mothers reported their child's early liking and consumption of F&V at age 2 years and later consumption at mid-childhood (median age 7.7 years). They also reported their own consumption of F&V at 6 months postpartum. We used multivariable linear regression models to examine the independent associations of these 3 factors with mid-childhood consumption, adjusting for socio-demographic, pregnancy, and child confounders. At 2 years, 53% of the mothers strongly agreed that their child liked fruit and 25% strongly agreed that their child liked vegetables. F&V consumption was 2.5 (1.3) and 1.8 (1.1) times/d at age 2 y and 1.5 (1.1) and 1.3 (0.8) times/d in mid-childhood. Maternal F&V consumption was 1.4 (1.1) and 1.5 (1.0) times/d, respectively. Children's early consumption played the most predominant role. For every 1 time/d increment in children's early consumption of F&V, mid-childhood consumption was higher by 0.25 (95% confidence interval [CI]: 0.19, 0.30) times/d for fruits and 0.21 (95% CI: 0.16, 0.26) times/d for vegetables, adjusted for confounders plus the other 2 exposures. In conclusion, children's early F&V consumption has the most significant influence on children's later consumption.

An Overview of Iron in Term Breast-Fed Infants

BACKGROUND

Iron is an essential nutrient for normal growth and neurodevelopment of infants. Iron deficiency (ID) remains the most common micronutrient deficiency worldwide. There are convincing data that ID is associated with negative effects on neurological and psychomotor development.

OBJECTIVES

In this review, we provide an overview of current knowledge of the importance of iron in normal term breast-fed infants with a focus on recommendations, metabolism, and iron requirements.

CONCLUSIONS

Health organizations around the world recommend the introduction of iron-rich foods or iron supplements for growing infants to prevent ID. However, there is no routine screening for ID in infancy. Multicenter trials with long-term follow-up are needed to investigate the association between iron fortification/supplementation and various health outcomes.

Comparison of Feeding Practices in Infants in the WIC Supplemental Nutrition Program Who Were Enrolled in Child Care as Opposed to Those with Parent Care Only

BACKGROUND

The environment or setting to which an infant is exposed is crucial to establishing healthy eating habits and to preventing obesity. This study aimed to compare infant feeding practices and complementary food type between parent care (PC) and childcare (CC) settings among infants receiving the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

MATERIALS AND METHODS

This study sampled 105 dyads of mothers and infants between 2 to 8 months of age from a WIC office in Central Illinois. Mothers completed a cross-sectional survey to assess their infant feeding practices and demographic characteristics. CC was defined as infants receiving 10 hours or more per week of care from a nonparental caregiver.

RESULTS

Almost half of the infants (44%) were enrolled in CC. Infants in CC had an average of 29 hours of care per week compared with 0.64 hours in the PC group (p<0.01). There were no differences between the two groups in age, sex, race/ethnicity, preterm birth, and birth weight. Overall, there were no significant differences in breastfeeding initiation and duration. The average age at formula introduction was earlier for PC infants (0.90 ± 1.16 months) than for CC infants (1.66 ± 1.64 months) (p = 0.03). PC infants stopped breastfeeding at 1.96 ± 1.15 months compared with 2.31 ± 1.64 months for CC infants (p = 0.080). Among complementary foods introduced to infants, the primary food type was infant cereal, followed by baby food of fruits and vegetables, 100% fruit juice, and meat-based baby food. The timing of introduction and the types of complementary foods were similar between study groups.

CONCLUSIONS

CC use is not a significant influence on breastfeeding rates, introduction of complementary foods, and types of complementary foods; however, it does influence when formula is introduced. The findings support the need for infant nutrition education and breastfeeding promotion targeting WIC mothers, regardless of their pattern of CC.

Lactation Consultant Support from Late Pregnancy with an Educational Intervention at 4 Months of Age Delays the Introduction of Complementary Foods in a Randomized Controlled Trial

BACKGROUND

Although the WHO recommends that complementary feeding in infants should begin at 6 mo of age, it often begins before this in developed countries.

OBJECTIVE

Our objective was to determine whether lactation consultant (LC) support, with educational resources given at 4-mo postpartum, can delay the introduction of complementary foods until around 6 mo of age.

METHODS

A total of 802 mother-infant pairs were recruited from the single maternity hospital serving Dunedin, New Zealand (59% response rate) and randomly assigned to the following: 1) usual care (control group); 2) infant sleep education intervention (Sleep); 3) food, activity, and breastfeeding intervention (FAB); or 4) combination (both) intervention (Combo). Certified LCs delivered 3 intervention sessions (late pregnancy and 1-wk and 4-mo postpartum). The 4-mo contact used educational resources focused on developmental readiness for complementary foods. Age when complementary foods were introduced was obtained from repeated interviews (monthly from 3- to 27-wk postpartum).

RESULTS

A total of 49.5% and 87.2% of infants received complementary foods before 5 and 6 mo of age, respectively. There was evidence of group differences in the number of infants introduced to complementary foods before 5 mo (P = 0.006), with those receiving support and resources (FAB and Combo groups combined; 55.6%) more likely to wait until at least 5 mo compared with controls (control and Sleep groups combined; 43.3%) (OR: 1.52; 95% CI: 1.08, 2.16). However, there was no evidence they were more likely to wait until 6 mo of age (P = 0.52). Higher maternal age, higher parity, and a less positive attitude toward breastfeeding were positively associated, and drinking alcohol during pregnancy was negatively associated, with later age of introduction of complementary foods.

CONCLUSIONS

Providing an LC and educational resources at 4-mo postpartum to predominantly well-educated, mainly European, women can delay the introduction of complementary foods until 5 mo of age, but not until the WHO recommendation of 6 mo. This trial was registered at clinicaltrials.gov as NCT00892983.

Nutrient Adequacy and Associated Factors in a Nationwide Sample of German Toddlers

OBJECTIVES

Nutrition in toddlerhood may have short- and long-term impacts on health and nutrition behavior. The objectives of the present article are to describe intake of energy and nutrients from the end of infancy to toddlerhood, and to examine dietary and socioeconomic factors (socioeconomic status [SES]) associated with total nutrient adequacy measured by a nutrient-based index (Nutrient Quality Index [NQI]).

METHODS

In the German Representative Study of Toddler Alimentation from 2008, 7-day estimated dietary records were collected cross-sectionally from toddlers ages 10 to 36 months (n = 525). The study population was recruited in the TNS access panel. The intakes of energy and 18 nutrients were evaluated and the NQI was determined. Age trends in nutrient intake were tested with analysis of variance. Analysis of the association between SES and the NQI was performed by multiple linear regression analysis.

RESULTS

In all of the age groups, energy intake was close to the reference value representing moderate physical activity. The mean intake of most vitamins and minerals reached the respective reference values, but nutrient density decreased with age. Dietary intakes of iron, iodine, and vitamin D are low in our study. The NQI reached approximately 80 points and was lower in older children than in younger children. NQI was not affected by SES but by formula use.

CONCLUSIONS

Nutritional quality measured by total nutrient intake is altogether high in German toddlers, although NQI decreased with increasing age. The NQI is independent of social class. The positive association with formula intake can be explained by the general enrichment of vitamins and minerals of these products.

Adherence to complementary feeding recommendations for infants and implications for public health

Objective

The current study investigates (i) the extent to which breast-feeding and non-breast-feeding mothers follow the Canadian Nutrition for Healthy Term Infants (NHTI) recommendations; (ii) the first complementary foods given and the differences by breast-feeding status; (iii) whether any breast-feeding is associated with earlier introduction to complementary foods relative to non-breast-feeding, after controlling for potentially confounding factors; and (iv) the need for improvements in timing and resources of interventions by examining breast-feeding rates over time and information sources used by mothers.

Design

Longitudinal data from the Kingston, Frontenac, and Lennox & Addington (KFL&A) Infant Feeding Survey were used. Mothers completed a survey at the end of their hospital stay and were interviewed by telephone at 2, 4, 6 and 12 months thereafter.

Setting

The study took place in the KFL&A region of Ontario, Canada.

Subjects

The sample consisted of 325 mothers who gave birth to a live infant of at least 36 weeks’ gestation and a birth weight of at least 1500 g at Kingston General Hospital between January and July of 2008.

Results

Four in five mothers introduced complementary foods prior to 6 months. Mothers not breast-feeding at 6 months introduced water, juice, infant cereals, fruit and vegetables, and foods not recommended by Canada’s Food Guide sooner than breast-feeding mothers. Breast-feeding mothers were more likely to introduce milks appropriately, but had low adherence to giving their infants vitamin D supplements.

Conclusions

To support adherence to NHTI recommendations, interventions should be conducted during early infancy and deliver consistent, evidence-based recommendations.

Tools for teen moms to reduce infant obesity: a randomized clinical trial

BACKGROUND

Unhealthy infant feeding practices, such as a combination of formula feeding and early introduction of solids may lead to rapid or excessive weight gain in early infancy. Adolescent mothers' feeding behaviors are most directly related to infant weight gain in the first year of life. Compared to adult mothers, adolescent mothers are less knowledgeable, less responsive, more controlling, and less skilled in infant feeding, which interferes with infants' healthy growth. The Tools for Teen Moms trial aims to compare the effect of a social media intervention for low-income adolescent, first-time mothers of infants 2 months of age or younger, versus standard care on infant weight, maternal responsiveness, and feeding style and practices. The intervention is conducted during the infant's first four months of life to promote healthy transition to solids during their first year. Tools for Teen Moms is an intervention delivered via a social media platform that actively engages and coaches low-income adolescent mothers in infant-centered feeding to reduce rapid/excessive infant weight gain in the first six months of life.

METHODS/DESIGN

We describe our study protocol for a randomized control trial with an anticipated sample of 100 low-income African- American and Caucasian adolescent, first-time mothers of infants. Participants are recruited through Maternal-Infant Health Programs in four counties in Michigan, USA. Participants are randomly assigned to the intervention or the control group. The intervention provides infant feeding information to mothers via a web-based application, and includes daily behavioral challenges, text message reminders, discussion forums, and website information as a comprehensive social media strategy over 6 weeks. Participants continue to receive usual care during the intervention. Main maternal outcomes include: (a) maternal responsiveness, (b) feeding style, and (c) feeding practices. The primary infant outcome is infant weight. Data collection occurs at baseline, and when the baby is 3 and 6 months old.

DISCUSSION

Expected outcomes will address the effectiveness of the social media intervention in helping teen mothers develop healthy infant feeding practices that contribute to reducing the risk of early onset childhood obesity.

TRIAL REGISTRATION

Clinical Trials.Gov NCT02244424, June 24, 2014.

Preventing obesity in infants and toddlers in child care: results from a pilot randomized controlled trial

Few interventions have focused on very young children for obesity prevention. This study evaluated a pilot intervention to improve the nutrition and physical activity environments of child care centers serving infants and toddlers. This randomized controlled trial took place in 32 centers in Boston, Massachusetts. The intervention aimed to improve policies and practices related to nutrition and physical activity within the center. For the outcome, observers assessed center environments using the Environment and Policy Assessment and Observation (EPAO) instrument (range 0-320 points) at baseline and the 6-month follow-up. We fit linear regression models with change in EPAO score from baseline to follow-up, controlling for potential confounders for total score, nutrition sub-score, and physical activity sub-score. Intervention centers had a mean (SD) of 98.2 (144.8) children enrolled, while control centers had 59.2 (34.5). In intervention centers, 47.5% of children were white, compared to 46.2% in controls. Fewer intervention centers had outdoor play areas on site (75 vs. 100%) but more had indoor play space (67 vs. 25%). At baseline, intervention centers had a mean (SD) EPAO score of 134.5 (7.0) points and controls had 146.8 (4.8) points. Compared with controls, intervention centers improved their EPAO scores at follow-up by 18.5 points (95% CI 0.1, 37.0; p = 0.049), chiefly through greater improvement in physical activity (12.2; 95% CI -1.6, 26.0; p = 0.075) and not nutrition (6.4; 95% CI -7.1, 19.8; p = 0.385). The pilot showed promise as an intervention to improve center environments, but future studies should include child-level outcomes.

Follow-up formula consumption in 3- to 4-year-olds and respiratory infections: an RCT

OBJECTIVE

Children are vulnerable to diet inadequacies, which may affect immune function. Our objective was to determine if a follow-up formula (FUF) containing DHA, the prebiotics PDX and GOS, and yeast β-glucan affects incidence of respiratory infections and diarrheal disease in healthy children.

METHODS

In a double-blind, randomized, controlled, prospective trial, 3-4 year old children were fed 3 servings per day of either a FUF with 25 mg DHA, 1.2 g PDX/GOS, and 8.7 mg yeast β-glucan per serving or an unfortified, cow's milk-based beverage (control) for 28 weeks. Fecal and blood samples were collected to assess immune markers and iron/zinc status. Incidence of acute respiratory infections (ARI), diarrheal disease, and antibiotic treatment were obtained from medical records.

RESULTS

The FUF group had fewer episodes and shorter duration of ARI (mean days [SE]; control = 4.3 [0.2]; FUF = 3.5 [0.2]; P = .007), less antibiotic use (n [%]; control = 21 [14%]; FUF = 8 [5%]; P = .01), and fewer missed days of day care due to illness. No diarrheal disease was diagnosed in either group. The FUF group had higher interleukin-10 and white blood cell count at the end of the study. There were no differences in hemoglobin, serum ferritin and zinc, or fecal secretory immunoglobulin A.

CONCLUSIONS

Daily consumption of a FUF was associated with fewer episodes and shorter duration of ARI, as well as less antibiotic use. The children who consumed the FUF had increased interleukin-10 and white blood cells, suggesting an antiinflammatory mechanism and/or an increase of effector immune cells.

Farmers' markets: costs compared with supermarkets, use among WIC clients, and relationship to fruit and vegetable intake and related psychosocial variables

OBJECTIVE

To determine fruit and vegetable (FV) costs at farmers' markets (FMs) and grocery stores, determine Special Supplemental Nutrition Program for Women, Infants, and Children participants' FV intake and psychosocial predictors, and compare FM users and nonusers.

METHODS

Prices were collected biweekly from grocery stores and FM vendors. Participants were recruited from Special Supplemental Nutrition Program for Women, Infants, and Children clinic to complete a survey of FV intake, psychosocial variables, and FM usage.

RESULTS

The FM cost was greater. A total of 377 participants (51%) used FMs. The FM users more often ate vegetables as snacks and > 1 vegetable per day (P < .05).

CONCLUSIONS AND IMPLICATIONS

Despite higher costs, FMs were often used. The FM users had a better vegetable intake pattern.

Mothers prefer fresh fruits and vegetables over jarred baby fruits and vegetables in the new Special Supplemental Nutrition Program for Women, Infants, and Children food package

OBJECTIVE

This study examined Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participant use and satisfaction with jarred baby foods, assessed preference for cash value vouchers (CVVs) for fruits and vegetables vs jarred baby foods, and examined whether preferences varied among selected ethnic groups.

METHODS

A survey of California WIC participants and statewide redemption data were used.

RESULTS

Participants reported high satisfaction with the CVV for fruits and vegetables and jarred baby foods, with statistically significant variation across ethnic groups. About two thirds of all participants reported a preference for CVVs for fruits and vegetables over jarred baby foods. Redemption data indicated declining redemption rates for jarred fruits and vegetables with increasing age of the infant across all ethnic groups.

CONCLUSIONS AND IMPLICATIONS

Although the addition of jarred fruits and vegetables to the food package for infants ages 6-11 months was well received, many caregivers want the option to choose between jarred foods and fresh fruits and vegetables.

Prevalence and reasons for introducing infants early to solid foods: variations by milk feeding type

OBJECTIVE

To examine the prevalence of, and mothers' self-reported reasons for, introducing solid foods to infants earlier than recommended (aged <4 months) and the variation in reasons for early introduction by milk feeding type.

METHODS

The study included 1334 mothers who participated in the national longitudinal Infant Feeding Practices Study II (2005-2007). Monthly 7-day food-frequency questions throughout infancy were used to determine infant age at solid food introduction and to classify infant's milk feeding at introduction as breast milk only, formula only, or mixed. Reasons for introducing solid foods at age <4 months were assessed through maternal responses to a list of 12 potential reasons. Analyses included descriptive statistics and multivariable logistic regression.

RESULTS

Overall, 40.4% of mothers introduced solid foods before age 4 months. Prevalence varied by milk feeding type (24.3%, 52.7%, and 50.2% for breastfed, formula-fed, and mixed-fed infants, respectively). The most commonly cited reasons for early introduction of solid food were as follows: "My baby was old enough," "My baby seemed hungry," "I wanted to feed my baby something in addition to breast milk or formula," "My baby wanted the food I ate," "A doctor or other health care professional said my baby should begin eating solid food," and "It would help my baby sleep longer at night." Four of these reasons varied by milk feeding type.

CONCLUSIONS

Our findings highlight the high prevalence of early introduction of solids and provide details on why mothers introduced solid foods early.

How feasible is Baby-led Weaning as an approach to infant feeding? A review of the evidence

Baby-Led Weaning (BLW) is an alternative method for introducing complementary foods to infants in which the infant feeds themselves hand-held foods instead of being spoon-fed by an adult. The BLW infant also shares family food and mealtimes and is offered milk (ideally breast milk) on demand until they self-wean. Anecdotal evidence suggests that many parents are choosing this method instead of conventional spoon-feeding of purées. Observational studies suggest that BLW may encourage improved eating patterns and lead to a healthier body weight, although it is not yet clear whether these associations are causal. This review evaluates the literature with respect to the prerequisites for BLW, which we have defined as beginning complementary foods at six months (for safety reasons), and exclusive breastfeeding to six months (to align with WHO infant feeding guidelines); the gross and oral motor skills required for successful and safe self-feeding of whole foods from six months; and the practicalities of family meals and continued breastfeeding on demand. Baby-Led Weaning will not suit all infants and families, but it is probably achievable for most. However, ultimately, the feasibility of BLW as an approach to infant feeding can only be determined in a randomized controlled trial. Given the popularity of BLW amongst parents, such a study is urgently needed.

Commercial 'ready-to-feed' infant foods in the UK: macro-nutrient content and composition

Quantitative analyses of the macronutrient content of eight popular commercial 'ready-to-feed' baby meals for 6-9-month old infants in the UK market have been undertaken in order to ascertain their nutritional suitability in relation to the total daily dietary intake as well as nutritional profiling of the products. The chemical analyses conducted included Kjeldhal for protein, acid hydrolysis and extraction for fat, phenol sulphuric acid for carbohydrate and Association of Official Analytical Chemists 985.29 for fibre. The only difference found between different varieties (meat- and vegetable-based) was with respect to the protein content (P=0.04) per 100 g of food. The experimentally determined concentrations of macronutrients (g/100 kcal) were compared with the declared values provided by the manufacturers on the product labels and, despite some variations, the values obtained comply with regulatory requirements (Commission Directive 2006/125/EC). The total daily intake of fat (27.0 g per day) - based on the menu composed from commercial complementary food - is suggested to exceed the daily recommended values for fat (31%), if the intake of snacks and desserts are incorporated. These findings imply that the formulation of recipes, based on a standard commercial menu, is an important consideration in relation to the nutritional quality of the diet of infants.

Elemental content of commercial 'ready to-feed' poultry and fish based infant foods in the UK

The study reported herein was conducted in order to establish the concentration of 20 essential and non-essential elements in a representative range of commercial infant foods in the UK targeted for infants aged between 6-12 months. The primary objective of this study was to examine the nutritive values and safety of such complementary infant foods on the UK market in relation to dietary and safety guidelines. Quantitative analyses were conducted on eight different products representing four popular brands (poultry and fish based) of ready to-feed infant foods currently on sale in the UK. Six essential elements, namely: calcium, iron, magnesium, potassium, sodium and zinc were determined by ICP-OES. The concentrations of six essential trace elements (selenium, molybdenum, cobalt, copper, chromium, manganese) and eight non-essential, potentially toxic, elements (arsenic, barium, nickel, cadmium, antimony, lead, mercury, aluminium) were determined by ICP-MS due to the higher sensitivity required. The total daily intakes of essential and trace elements from the consumption of such products were then estimated, based on the results of this study, and were referenced to the Recommended Nutrient Intake (RNI) values and safety guidelines for 6-9 months old children. Based on these comparisons the concentration of essential, except for potassium, and trace elements were found to be inadequate in meeting the RNI. In terms of the risk of exposure to toxicity, the concentration of toxic elements in ready to feed products analysed in this study, were not considered to be of concern. These results suggest that commercial complementary infant foods on the UK market may not contain minimum levels of minerals required for labelling declaration of micronutrient content (Commission Directive 2006/125/EC). This provides opportunities and scope for product optimisation to improve their nutritive value.

Need for early interventions in the prevention of pediatric overweight: a review and upcoming directions

Childhood obesity is currently one of the most prevailing and challenging public health issues among industrialized countries and of international priority. The global prevalence of obesity poses such a serious concern that the World Health Organization (WHO) has described it as a "global epidemic." Recent literature suggests that the genesis of the problem occurs in the first years of life as feeding patterns, dietary habits, and parental feeding practices are established. Obesity prevention evidence points to specific dietary factors, such as the promotion of breastfeeding and appropriate introduction of nutritious complementary foods, but also calls for attention to parental feeding practices, awareness of appropriate responses to infant hunger and satiety cues, physical activity/inactivity behaviors, infant sleep duration, and family meals. Interventions that begin at birth, targeting multiple factors related to healthy growth, have not been adequately studied. Due to the overwhelming importance and global significance of excess weight within pediatric populations, this narrative review was undertaken to summarize factors associated with overweight and obesity among infants and toddlers, with focus on potentially modifiable risk factors beginning at birth, and to address the need for early intervention prevention.

Inorganic arsenic contents in rice-based infant foods from Spain, UK, China and USA

Spanish gluten-free rice, cereals with gluten, and pureed baby foods were analysed for total (t-As) and inorganic As (i-As) using ICP-MS and HPLC-ICP-MS, respectively. Besides, pure infant rice from China, USA, UK and Spain were also analysed. The i-As contents were significantly higher in gluten-free rice than in cereals mixtures with gluten, placing infants with celiac disease at high risk. All rice-based products displayed a high i-As content, with values being above 60% of the t-As content and the remainder being dimethylarsinic acid (DMA). Approximately 77% of the pure infant rice samples showed contents below 150 μg kg(-1) (Chinese limit). When daily intake of i-As by infants (4-12 months) was estimated and expressed on a bodyweight basis (μg d(-1) kg(-1)), it was higher in all infants aged 8-12 months than drinking water maximum exposures predicted for adults (assuming 1 L consumption per day for a 10 μg L(-1) standard).

Breastfeeding duration in relation to child care arrangement and participation in the special supplemental nutrition program for women, infants, and children

This study was conducted to examine associations among breastfeeding duration, child care arrangement, and participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). The authors analyzed the nationally representative sample of infants born in 2001 who were enrolled in the Early Childhood Longitudinal Study-Birth Cohort (9 months). They estimated the risks of short breastfeeding duration (< 6 months of age) among infants according to the child care arrangement and WIC participation (n = 7515). Approximately 50% of US infants were enrolled in WIC, and 47% received child care on a regular basis. Both WIC participation and child care use were independently associated with short breastfeeding duration. Compared to those under parental care, WIC participants under relative care were more likely to discontinue breastfeeding before the age of 6 months. A breastfeeding support program targeted toward relative care users may be useful for WIC participants.

Mothers' perceptions of introducing solids to their infant at six months of age: identifying critical belief-based targets to promote adherence to current infant feeding guidelines

We investigated critical belief-based targets for promoting the introduction of solid foods to infants at six months. First-time mothers (N = 375) completed a Theory of Planned Behaviour belief-based questionnaire and follow-up questionnaire assessing the age the infant was first introduced to solids. Normative beliefs about partner/spouse (β = 0.16) and doctor (β = 0.22), and control beliefs about commercial baby foods available for infants before six months (β = -0.20), predicted introduction of solids at six months. Intervention programs should target these critical beliefs to promote mothers' adherence to current infant feeding guidelines to introduce solids at around six months.

Erros alimentares na dieta de crianças frequentadoras de berçários em creches públicas no município de São Paulo, Brasil

OBJETIVO: Descrever os erros alimentares presentes na introdução da alimentação complementar e na oferta de leite não materno em crianças frequentadoras de creches públicas do município de São Paulo (SP). MÉTODOS: Estudo descritivo transversal, composto por 255 crianças, com faixa etária entre cinco e 29 meses. Os questionários estruturados e pré-codificados, com perguntas abertas e fechadas, foram elaborados para a coleta de dados, que ocorreu entre abril e novembro de 2007. Estes foram transcritos e analisados no programa estatístico Epi-Info 2000. As variáveis avaliadas foram a introdução de leite não materno, a introdução de alimentos e a consistência inicial da alimentação complementar. RESULTADOS: A introdução do leite não materno ocorreu em 40% das crianças até três meses e em 78% até seis meses. Aos três meses, aproximadamente 50% recebiam líquidos não lácteos e 15%, papas de frutas, legumes, verduras e carnes. Na introdução do leite não materno, 68% dos bebês receberam leite de vaca e 31%, fórmulas infantis. Fígado e peixe foram os alimentos mais tardiamente oferecidos. Quanto à consistência das refeições oferecidas, 49% foram inadequadas. CONCLUSÕES: O fato de as crianças serem frequentadoras de creches públicas aponta para a importância da capacitação dos profissionais que nelas atuam e que, eventualmente, são os responsáveis pela introdução da alimentação complementar.

Introdução de alimentos industrializados e de alimentos de uso tradicional na dieta de crianças de creches públicas no município de São Paulo

OBJETIVO: Descrever e discutir a introdução de alimentos industrializados na dieta de crianças frequentadoras de berçários em creches, considerando a recomendação do Ministério da Saúde para uma alimentação saudável. MÉTODOS: Estudo transversal com 270 crianças frequentadoras de berçários de 8 creches públicas e filantrópicas do município de São Paulo. Por meio de questionário estruturado e pré-codificado, foi avaliada a introdução de alimentos a partir de 11 perguntas. Para cada alimento analisado foi registrada a idade em meses de introdução e avaliada a concordância com o oitavo passo do Guia Alimentar. No estudo das associações, utilizou-se o teste Qui-quadrado, a partir das variáveis idade e escolaridade maternas, renda familiar e trabalho da mãe fora do lar. RESULTADOS: Os resultados mostram que para aproximadamente 2/3 das crianças foram oferecidos, antes dos 12 meses, alimentos com potencial obesogênico, como macarrão instantâneo, salgadinhos, bolacha recheada, suco artificial, refrigerante e bala/pirulito/chocolate. São os filhos de mães com baixa escolaridade, mais jovens e com menor renda, os mais susceptíveis ao erro alimentar de introdução precoce de alimentos industrializados. CONCLUSÃO: Diante desses resultados, medidas educativas e preventivas devem ser propostas para a formação de hábitos alimentares saudáveis desde a infância, além da criação de campanhas abrangentes e efetivas que estimulem o consumo de frutas e hortaliças, considerando-se os fatores culturais, comportamentais e afetivos envolvidos com a alimentação.