Timing of Introduction to Solid Food, Growth, and Nutrition Risk in Later Childhood

Effects of an Online Theory-Based Educational Programme for Primiparous Women on Improving Breastfeeding-Related Outcomes: A Randomised Controlled Trial

OBJECTIVE

To evaluate the effectiveness of a theory-based, Real-time-online Education and Support with Telephone follow-ups (REST) programme for primiparous women on their breastfeeding outcomes over 6 months postpartum.

STUDY DESIGN

Randomised controlled trial.

METHODS

Convenience sampling was used to recruit 150 low-risk primiparous mothers, and then they were randomly assigned into intervention and control groups by computerised block randomisation. Participants received a 3-month real-time online educational and support programme across antepartum and postpartum period or usual care only (75 mothers per group). Primary outcomes were exclusive breastfeeding (EBF) rate and breastfeeding self-efficacy (BSE); and secondary outcomes were predominant and partial breastfeeding rate, formula feeding rate, mothers' postnatal depression score, infant's morbidity, and EBF duration at 2 and 6 months postpartum, as well as breastfeeding initiation rate.

RESULTS

Then, 72 of 75 mothers (96%) successfully completed the REST programme. They had a significantly higher EBF rate, longer EBF duration, and greater increase in BSE, when compared to the control group at the two posttests (except the EBF rate at 6 months postpartum). Overall, the REST was highly valued by all participants on providing detailed useful information and regular postnatal follow-ups with prompt and practical advice.

CONCLUSIONS

The REST effectively improved BSE and EBF duration of the primiparous participants over 6 months postpartum and EBF rate at 2 months postpartum. With strong commendations from primiparous mothers, the REST with prenatal and postnatal online breastfeeding support to these mothers can be offered to address breastfeeding and infant-care needs.

IMPLICATIONS FOR PATIENT CARE

The findings indicate that the REST conducted from prenatal to 2 months postpartum can be feasible and useful to provide adequate breastfeeding education and support in current maternal care setting under limited staff and resources. Online platforms can be used for future antenatal breastfeeding talks.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT04741425.

Complementary Food and Obesity

BACKGROUND

Early infant feeding is essential for children's development and future health, particularly in preventing obesity, which is the most common nutrition-related disorder in children worldwide.

SUMMARY

Obesity, characterized by excess body fat and numerous complications, arises from a combination of genetic susceptibility and an obesogenic environment, including lifestyle behaviors related to energy balance. Eating habits start to be shaped early in life, making the introduction of solid foods a critical period. Given the high prevalence of obesity, its long-term health consequences, and social implications, prevention is crucial. This narrative review aimed to identify factors related to the introduction of solid foods that influence obesity and suggest feeding strategies to prevent it. Tracking studies indicate that overweight and obesity during childhood often persist into adulthood, with associated complications such as hyperglycemia, dyslipidemia, hypertension, and nonalcoholic fatty liver disease. Complementary feeding involves introducing solid foods besides breast milk or formula. The timing and content of complementary feeding are crucial in influencing obesity risk. Introduction of solid foods before 4 months is associated with higher BMI in childhood. The method of introducing complementary feeding, such as baby-led weaning, has been proposed to predict later obesity risk, though findings are currently inconclusive. Parental feeding practices and socioeconomic factors significantly influence complementary feeding and obesity risk. Early prevention programs, especially those involving parental education on responsive feeding and diet, are promising for reducing obesity risk. Future programs should incorporate parents' perceptions and motivations to improve intervention effectiveness.

Early life factors that affect obesity and the need for complex solutions

The prevalence of obesity increases with age but is apparent even in early life. Early childhood is a critical period for development that is known to influence future health. Even so, the focus on obesity in this phase, and the factors that affect the development of obesity, has only emerged over the past two decades. Furthermore, there is a paucity of iterative work in this area that would move the field forward. Obesity is a complex condition involving the interplay of multiple influences at different levels: the individual and biological level, the sociocultural level, and the environmental and system levels. This Review provides a brief overview of the evidence for these factors with a focus on aspects specific to early life. By spotlighting the complex web of interactions between the broad range of influences, both causal and risk markers, we highlight the complex nature of the condition. Much work in the early life field remains observational and many of the intervention studies are limited by a focus on single influences and a disjointed approach to solutions. Yet the complexity of obesity necessitates coordinated multi-focused solutions and joined-up action across the first 2,000 days from conception, and beyond.

Adherence to Introduction of Iron-Rich Solid Foods Recommendations for Infants: An Analysis of Canadian Community Health Survey Data Using Cycles 2015-2018

BACKGROUND

Globally, guidelines on the introduction of solid foods to a breastfed infant's diet emphasize the importance of iron-rich foods.

OBJECTIVES

The objective of this study was to report on adherence to Nutrition for Healthy Term Infants (NHTI) guidance on introduction of iron-rich solid foods first in infants living in Canada and to explore factors associated with adherence using disaggregated data.

METHODS

Nationally representative cross-sectional data from the Canadian Community Health Survey annual cycles 2015-2018 from biological mothers delivering an infant in the past 5 y were used (N = 7253). Age at introduction of solid food and the type of first food were weighted and then categorized by breastfeeding history. Foods were categorized as typically iron-rich or not. Correlates of adherence were explored using logistic regression.

RESULTS

Most (65.8%; 95% CI: 63.7, 67.8) mothers introduced iron-rich solids first to their infant's diet between 5 and 6.99 mo of age. The most common first iron-rich solid was infant cereal (66.1%; 95% CI: 64.3, 67.9). Mothers from rural areas had a higher odds of introducing an iron-rich food first. Lower odds were observed among those from the Western provinces and immigrants. Among those who exclusively breastfed for ≥5 mo (n = 3390), 62.3% (95% CI: 59.5, 65.1) introduced an iron-rich solid food first, of these 19.7% (95% CI: 16.9, 22.6) did so late (≥7 mo). Higher odds of late introduction of iron-rich foods in this subgroup were associated with mothers who were single, never married, were of lower education, immigrated >5 y ago, and were of Black or South Asian race.

CONCLUSIONS

Most infants in Canada are introduced to an iron-rich solid food first at about 6 mo of age, indicating partial adherence to the NHTI guidelines. More efforts are needed to reinforce the importance of introducing iron-rich solid foods first in the diet of the breastfed infant at about 6 mo of age.

Relationship between Infant Feeding and the Microbiome: Implications for Allergies and Food Intolerances

Childhood is a critical period for immune system development, which is greatly influenced by the gut microbiome. Likewise, a number of factors affect the gut microbiome composition and diversity, including breastfeeding, formula feeding, and solid foods introduction. In this regard, several studies have previously demonstrated that breastfeeding promotes a favorable microbiome. In contrast, formula feeding and the early incorporation of certain solid foods may adversely affect microbiome development. Additionally, there is increasing evidence that disruptions in the early microbiome can lead to allergic conditions and food intolerances. Thus, developing strategies to promote optimal infant nutrition requires an understanding of the relationship between infant nutrition and long-term health. The present review aims to examine the relationship between infant feeding practices and the microbiome, as well as its implications on allergies and food intolerances in infants. Moreover, this study synthesizes existing evidence on how different eating habits influence the microbiome. It highlights their implications for the prevention of allergies and food intolerances. In conclusion, introducing allergenic solid foods before six months, alongside breastfeeding, may significantly reduce allergies and food intolerances risks, being also associated with variations in gut microbiome and related complications.

Optimal timing of introduction of complementary feeding: a systematic review and meta-analysis

CONTEXT

The timing of introducing complementary feeding (CF) is crucial because premature or delayed CF can be associated with adverse health outcomes in childhood and adulthood.

OBJECTIVE

This systematic review aims to evaluate the impact of the timing of CF introduction on health, nutrition, and developmental outcomes among normal-term infants.

DATA SOURCES

Electronic databases and trial registries were searched, along with the reference lists of the included studies and relevant systematic reviews.

DATA EXTRACTION

Two investigators independently extracted data from the included studies on a standardized data-extraction form.

DATA ANALYSIS

Data were meta-analyzed separately for randomized controlled trials (RCTs) and observational studies on the basis of early introduction of CF (< 3 months, < 4 months, < 6 months of age) or late introduction of CF (> 6 months, > 8 months of age). Evidence was summarized according to GRADE criteria. In total, 268 documents were included in the review, of which 7 were RCTs (from 24 articles) and 217 were observational studies (from 244 articles). Evidence from RCTs did not suggest an impact of early introduction, while low-certainty evidence from observational studies suggested that early introduction of CF (< 6 months) might increase body mass index (BMI) z score and overweight/obesity. Early introduction at < 3 months might increase BMI and odds of lower respiratory tract infection (LRTI), and early introduction at < 4 months might increase height, LRTI, and systolic and diastolic blood pressure (BP). For late introduction of CF, there was a lack of evidence from RCTs, but low-certainty evidence from observational studies suggests that late introduction of CF (> 6 months) might decrease height, BMI, and systolic and diastolic BP and might increase odds of intestinal helminth infection, while late introduction of CF (> 8 months) might increase height-for-age z score.

CONCLUSION

Insufficient evidence does suggest increased adiposity with early introduction of CF. Hence, the current recommendation of introduction of CF should stand, though more robust studies, especially from low- and middle-income settings, are needed.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration number CRD42020218517.

Maternal Preconception Body Mass Index and Early Childhood Nutritional Risk

BACKGROUND

Risk factors for problematic child eating behaviors and food preferences are thought to begin during the preconception period. It is unknown if maternal preconception body mass index (BMI) is associated with child nutritional risk factors (eg, poor dietary intake and eating behaviors).

OBJECTIVES

We aimed to determine whether maternal preconception BMI was associated with child nutritional risk.

METHODS

In this longitudinal cohort study, a secondary data analysis of children ages 18 mo to 5 y were recruited from The Applied Research Group for Kids (TARGet Kids!), a primary care practice-based research network in Canada. The primary exposure was maternal preconception BMI. The primary outcome was parent-reported child nutritional risk score, measured using the Nutrition Screening for Every Preschooler/Toddler (NutriSTEP), an age-appropriate validated questionnaire. Fitted linear mixed effects models analyzed associations between maternal preconception BMI and child nutritional risk after adjusting for covariates.

RESULTS

This study included 4733 children with 8611 repeated NutriSTEP observations obtained between ages 18 mo to 5 y. The mean (standard deviation [SD]) maternal preconception BMI was 23.6 (4.4), where 73.1% of mothers had a BMI ≤24.9 kg/m2, and 26.9% had a BMI ≥25 kg/m2. The mean (SD) NutriSTEP total score was 13.5 (6.2), with 86.6% at low risk (score <21) and 13.4% at high risk (score ≥21). Each 1 unit increase in maternal preconception BMI was associated with a 0.09 increase in NutriSTEP total score (95% confidence interval [CI]: 0.05, 0.12; P ≤ 0.001). After stratification, each 1 unit increase in maternal BMI was associated with a 0.06 increase in mean NutriSTEP total score (95% CI: 0.007, 0.11; P = 0.025) in toddlers and 0.11 increase in mean NutriSTEP total score (95% CI: 0.07, 0.15; P < 0.001) in preschoolers.

CONCLUSION

Higher maternal preconception BMI is associated with slightly higher NutriSTEP total scores. This provides evidence that the preconception period may be an important time to focus on for improving childhood nutrition. This study was registered at clinicaltrials.gov as NCT01869530.

Timing of introduction of complementary foods, breastfeeding, and child cardiometabolic risk: a prospective multiethnic Asian cohort study

BACKGROUND

The timing of introduction of complementary foods and the duration of breastfeeding (BF) have been independently associated with child overweight and obesity; however, their combined influence on body fat partitioning and cardiometabolic risk is unclear.

OBJECTIVE

We investigated the associations of the timing of introduction of complementary foods, the duration of BF, and their interaction with child adiposity and cardiometabolic risk markers.

METHODS

We analyzed data from 839 children in the prospective Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort. Mothers reported the age at which infants were first fed complementary foods and BF duration, classified as early (≤4 mo) versus typical (>4 mo) complementary feeding (CF) and short (≤4 mo) versus long (>4 mo) duration of any BF, respectively. We measured adiposity and cardiometabolic risk markers at the age of 6 y and examined their associations with infant feeding patterns using multiple regression, adjusting for sociodemographics, parents' body mass index (BMI), maternal factors, birth weight for gestational age, and infant weight gain.

RESULTS

Of 839 children, 18% experienced early CF, whereas 54% experienced short BF. Short (vs. long) BF and early (vs. typical) CF were independently associated with higher z-scores of BMI [β (95% confidence interval), short BF, 0.18 standard deviation score (SDS) (-0.01, 0.38); early CF, 0.34 SDS (0.11, 0.57)] and sum of skinfolds [short BF, 1.83 mm (0.05, 3.61); early CF, 2.73 mm (0.55, 4.91)]. Children who experienced both early CF and short BF (vs. typical CF-long BF) had synergistically higher diastolic blood pressure [1.41 mmHg (-0.15, 2.97), P-interaction = 0.023] and metabolic syndrome score [0.81 (0.16, 1.47), P-interaction = 0.081]. Early CF-long BF (vs. early CF-short BF) was associated with a lower systolic blood pressure [-3.74 mmHg (-7.01, -0.48)], diastolic blood pressure [-2.29 mmHg (-4.47, -0.11)], and metabolic syndrome score [-0.90 (-1.80, 0.00)].

CONCLUSIONS

A combination of early CF and short BF was associated with elevated child adiposity and cardiometabolic markers. Longer BF duration may protect against cardiometabolic risk associated with early CF. This trial was registered at clinicaltrials.gov as NCT01174875.

Patterns in Mothers' Recollection of Health Care Providers' Young Child Feeding Recommendations

OBJECTIVE

Characterize feeding guidance mothers recall receiving from their child's health care provider (HCP).

DESIGN

Cross-sectional study of mothers participating in the 2017-2019 National Survey of Family Growth.

PARTICIPANTS

US mothers reporting (n = 1,302) information about their youngest child (aged 6 months to 5 years).

VARIABLES MEASURED

Weighted percentage of mothers who recalled their child's HCP discussing 6 different feeding topics by demographic characteristics.

ANALYSIS

Logistic regression assessing the relationship between recall of feeding guidance and demographics.

RESULTS

In this sample, 36.9% of mothers (95% confidence interval, 32.3-41.4) recalled HCPs recommending solid food before 6 months old (34.6% at 4-5 months, and 2.3% before 4 months). Mothers who were older or had a higher education level were more likely than their counterparts to recall their HCP discussing several of the feeding topics examined.

CONCLUSION AND IMPLICATIONS

Mothers reported high recollection of early childhood nutrition guidance from their HCP; however, certain topics (eg, appropriate timing of solid food introduction) could be prioritized, and some subpopulations may need additional focus to improve receipt of messages. A better understanding of variability in recall of feeding guidance could provide information for interventions to address barriers to receiving and retaining guidance.