Longitudinal study of nutrient and food intakes of infants aged 2 to 24 months

Impact of a modified version of baby-led weaning on iron intake and status: a randomised controlled trial

OBJECTIVE

To determine the iron intake and status of infants following a version of baby-led weaning (BLW) modified to prevent iron deficiency (Baby-Led Introduction to SolidS; BLISS) compared with those of infants following traditional spoon-feeding.

DESIGN, PARTICIPANTS AND INTERVENTION

This randomised controlled trial included 206 participants assigned to control (n=101) or BLISS (n=105) groups. Both groups received standard midwifery and 'Well Child' care. BLISS participants received eight additional visits (from before birth to 9 months) providing education and support on the BLISS approach to complementary feeding (ie, BLW modified to increase iron intake). The primary outcome of the BLISS study (growth) has been previously reported. This paper reports the key prespecified secondary outcomes, iron intake and iron status.

OUTCOME MEASURES

Intake of iron and key absorption modifiers were assessed using weighed 3-day diet records at 7 and 12 months. A venipuncture blood sample was collected at 12 months to determine plasma ferritin, haemoglobin, soluble transferrin receptor, C-reactive protein and α1-acid glycoprotein concentrations; and body iron was calculated.

RESULTS

Differences in median dietary iron intakes between the control and BLISS groups were not significant at 7 (difference 0.6 mg/day; 95% CI -1.0 to 2.3) or 12 (-0.1 mg/day; -1.6 to 1.4) months of age. Similarly, there were no significant differences in plasma ferritin concentration (difference -2.6 µg/L; 95% CI -10.9 to 5.8), body iron (0.04 mg/kg; -1.1 to 1.2) or the prevalence of depleted iron stores, early functional iron deficiency or iron deficiency anaemia (all p≥0.65) at 12 months of age.

CONCLUSIONS

A baby-led approach to complementary feeding does not appear to increase the risk of iron deficiency in infants when their parents are given advice to offer 'high-iron' foods with each meal.

TRIAL REGISTRATION NUMBER

ACTRN12612001133820; Pre-results.

Feeding frequency in infancy and dental caries in childhood: a prospective cohort study

OBJECTIVES

Feeding patterns in infancy are plausible contributors to dental caries later in childhood, yet relatively few cohort studies have examined potential dietary risk factors at this age. This study aimed to investigate the associations between feeding frequency at age 12 months and caries prevalence at age 3 years.

METHODS

In this prospective birth cohort of 345 Brazilian children, all foods and drinks consumed at age 12 months, including bottle-use and breastfeeding, were recorded using two 24-hour infant dietary recalls with mothers. The prevalence of early childhood caries (ECC) and severe ECC (S-ECC) at age 38 months were compared in groups defined according to 12-month feeding frequency, using regression models to adjust for sociodemographic characteristics and total carbohydrate intake.

RESULTS

Independent of other variables, compared with children with infrequent bottle-use and breastfeeding at 12 months, at 38 months the ECC prevalence was 1.8-times higher in children breastfed more than three times/day (P = 0.001), 1.4-times higher in children bottle-fed more than three times/day (P = 0.07) and 1.5-times higher with combined high frequency of bottle and breastfeeding together (P = 0.04), but the association with consumption of other foods or drinks more than five times/day [risk ratio (RR) = 1.2; P = 0.10] was not statistically significant. Prevalence of S-ECC was significantly associated with frequent breastfeeding (RR = 2.4; P < 0.001) and with greater frequency of consumption of other foods or drinks (RR = 1.7, P = 0.001).

CONCLUSIONS

High-frequency feeding in late infancy, including both bottle use and breastfeeding, were positively associated with dental caries in early childhood, suggesting possible early-life targets for caries prevention.

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.

Calcium to phosphorus ratio, essential elements and vitamin D content of infant foods in the UK: Possible implications for bone health

Adequate intake of calcium and phosphorus in the appropriate ratio of 1-2:1 (Ca:P), in addition to magnesium and vitamin D, is vital for bone health and development of infants. In this feasibility study, the ratio of Ca:P in conjunction with vitamin D and other essential elements (Cu, Fe, K, Mg, Na, and Zn) in a range of commercial infant food products in the UK was investigated. The elemental analysis was carried out using inductively coupled plasma optical emission spectrometry, and vitamin D levels were determined using an enzyme-linked immunosorbent assay. The quantitative data were further evaluated, based on a standardised menu, to measure the total daily intake of an infant aged 7-12 months against the Reference Nutrient Intake. The results from the study show that the Ca:P ratio of the infant's total dietary intake was within the recommended range at 1.49:1. However, the level of intake for each of the nutrients analyzed, with the exception of sodium, was found to be above the Reference Nutrient Intake, which warrants further investigation in relation to both micronutrient interactions and in situations where the intake of fortified infant formula milk is compromised. Finally, as the study is the first to include consumption of infant snack products, the level of total calorie intake was also calculated in order to assess the total daily estimated energy intake; the results indicate that energy intakes exceed recommendations by 42%, which may have implications for obesity.

How different are baby-led weaning and conventional complementary feeding? A cross-sectional study of infants aged 6-8 months

OBJECTIVES

To compare the food, nutrient and 'family meal' intakes of infants following baby-led weaning (BLW) with those of infants following a more traditional spoon-feeding (TSF) approach to complementary feeding.

STUDY DESIGN AND PARTICIPANTS

Cross-sectional study of dietary intake and feeding behaviours in 51 age-matched and sex-matched infants (n=25 BLW, 26 TSF) 6-8 months of age.

METHODS

Parents completed a questionnaire, and weighed diet records (WDRs) on 1-3 non-consecutive days, to investigate food and nutrient intakes, the extent to which infants were self-fed or parent-fed, and infant involvement in 'family meals'.

RESULTS

BLW infants were more likely than TSF infants to have fed themselves all or most of their food when starting complementary feeding (67% vs 8%, p<0.001). Although there was no statistically significant difference in the large number of infants consuming foods thought to pose a choking risk during the WDR (78% vs 58%, p=0.172), the CI was wide, so we cannot rule out increased odds with BLW (OR, 95% CI: 2.57, 0.63 to 10.44). No difference was observed in energy intake, but BLW infants appeared to consume more total (48% vs 42% energy, p<0.001) and saturated (22% vs 18% energy, p<0.001) fat, and less iron (1.6 vs 3.6 mg, p<0.001), zinc (3.0 vs 3.7 mg, p=0.001) and vitamin B12 (0.2 vs 0.5 μg, p<0.001) than TSF infants. BLW infants were more likely to eat with their family at lunch and at the evening meal (both p≤0.020).

CONCLUSIONS

Infants following BLW had similar energy intakes to those following TSF and were eating family meals more regularly, but appeared to have higher intakes of fat and saturated fat, and lower intakes of iron, zinc and vitamin B12. A high proportion of both groups were offered foods thought to pose a choking risk.

Early Eating Behaviours and Food Acceptance Revisited: Breastfeeding and Introduction of Complementary Foods as Predictive of Food Acceptance

Current dietary advice for children is that they should eat at least five portions of fruit and vegetables a day (Department of Health. National Diet and Nutrition Survey, 2014). However, many parents report that children are reluctant to eat vegetables and often fail to comply with the five-a-day rule. In fact, in surveys carried out in areas in the UK, the number of children eating according to the five-a-day rule has been found to be as low as 16 % (Cockroft et al. Public Health Nutr 8(7):861-69, 2005). This narrative review looks at those factors which contribute to food acceptance, especially fruit and vegetables, and how acceptance might be enhanced to contribute to a wider dietary range in infancy and later childhood. The questions we address are whether the range of foods accepted is determined by the following: innate predispositions interacting with early experience with taste and textures, sensitive periods in infancy for introduction, breastfeeding and the pattern of introduction of complementary foods. Our conclusions are that all of these factors affect dietary range, and that both breastfeeding and the timely introduction of complementary foods predict subsequent food acceptance.

Parental perception of child weight in the first two years-of-life: a potential link between infant feeding and preschoolers' diet

Approximately 23% of preschoolers are overweight or obese. Establishing a healthy dietary lifestyle at an early age can improve later child diet and body weight. This study examined the determinants of past infant feeding practices that do not follow standard feeding recommendations (breastfeeding for less than 6 months duration, cow's milk prior to the first year of age and solid foods at or before 4 months of age). It also examined the role of parental perception of child weight in the first 2 years-of-life on past infant feeding practices as well as current child diet and body weight. Families of 497 preschoolers aged 22-63 months (39.0 ± 8.2) were recruited from 30 child care centers in East-Central Illinois. Main findings indicate that past infant feeding practices were common and varied by socio-demographic factors including race/ethnicity, parental education and child gender. Children perceived as overweight in the first 2 years-of-life tended to breastfeed for lesser duration. Additionally, the majority (79.8%) of preschoolers who were classified as overweight using BMI percentile were perceived as non-overweight by the parent in the first 2 years-of-life. Mean daily total fatty/sugary food intake was higher among those perceived to be non-overweight in the first 2 years-of-life. These findings have identified parental perception of child weight in the first 2 years-of-life as a modifiable risk factor for unhealthy child diet and obesity among preschoolers.

Dietary intake in Australian children aged 4–24 months: consumption of meat and meat alternatives

Meat/meat alternatives (M/MA) are key sources of Fe, Zn and protein, but intake tends to be low in young children. Australian recommendations state that Fe-rich foods, including M/MA, should be the first complementary foods offered to infants. The present paper reports M/MA consumption of Australian infants and toddlers, compares intake with guidelines, and suggests strategies to enhance adherence to those guidelines. Mother–infant dyads recruited as part of the NOURISH and South Australian Infants Dietary Intake studies provided 3 d of intake data at three time points: Time 1 (T1) (n482, mean age 5·5 (sd1·1) months), Time 2 (T2) (n600, mean age 14·0 (sd1·2) months) and Time 3 (T3) (n533, mean age 24 (sd0·7) months). Of 170 infants consuming solids and aged greater than 6 months at T1, 50 (29 %) consumed beef, lamb, veal (BLV) or pork on at least one of 3 d. Commercial infant foods containing BLV or poultry were the most common form of M/MA consumed at T1, whilst by T2 BLV mixed dishes (including pasta bolognaise) became more popular and remained so at T3. The processed M/MA increased in popularity over time, led by pork (including ham). The present study shows that M/MA are not being eaten by Australian infants or toddlers regularly enough; or in adequate quantities to meet recommendations; and that the form in which these foods are eaten can lead to smaller M/MA serve sizes and greater Na intake. Parents should be encouraged to offer M/MA in a recognisable form, as one of the first complementary foods, in order to increase acceptance at a later age.

Methods for the year 6 follow-up study of children in the Infant Feeding Practices Study II

OBJECTIVE

We describe methods used in the Year 6 Follow-Up (Y6FU) of children who participated in the Infant Feeding Practices Study II (IFPSII). This study consists of a questionnaire administered 6 years after the IFPSII to characterize the health, development, and diet quality of the children.

METHODS

The Y6FU sample was a subset of those who participated in IFPSII. The IFPSII participants were drawn from a national consumer opinion panel; neither the IFPSII nor the Y6FU sample is nationally representative. The Y6FU sampling frame included all qualified participants who answered at least the first postnatal questionnaire. One questionnaire was administered by mail in 2012, and nonrespondents were contacted for a telephone interview. Survey topics included measures of health, development, diet, physical activity, screen time, and family medical history. We attempted to contact 2958 mothers and obtained completed questionnaires from 1542, a response rate of 52.1%. We conducted 2 sample evaluations, 1 comparing respondents and nonrespondents on data from IFPSII and the other comparing Y6FU respondents with 6-year-old participants in the National Survey of Children's Health.

RESULTS

Y6FU mothers are more likely to be white, married, older, and of higher education and income than both nonresponders and nationally representative mothers. Comparisons also revealed health-related differences and similarities.

CONCLUSIONS

Although not nationally representative, the Y6FU provides a valuable database because of its wide coverage of diet and health issues and its unique ability to link early feeding patterns with outcomes at age 6 years.

Is iron and zinc nutrition a concern for vegetarian infants and young children in industrialized countries?

Well-planned vegetarian diets are considered adequate for all stages of the life cycle, despite limited data on the zinc status of vegetarians during early childhood. The bioavailability of iron and zinc in vegetarian diets is poor because of their higher content of absorption inhibitors such as phytate and polyphenols and the absence of flesh foods. Consequently, children as well as adult vegetarians often have lower serum ferritin concentrations than omnivores, which is indicative of reduced iron stores, despite comparable intakes of total iron; hemoglobin differences are small and rarely associated with anemia. However, data on serum zinc concentrations, the recommended biomarker for identifying population groups at elevated risk of zinc deficiency, are sparse and difficult to interpret because recommended collection and analytic procedures have not always been followed. Existing data indicate no differences in serum zinc or growth between young vegetarian and omnivorous children, although there is some evidence of low serum zinc concentrations in vegetarian adolescents. Some vegetarian immigrants from underprivileged households may be predisposed to iron and zinc deficiency because of nondietary factors such as chronic inflammation, parasitic infections, overweight, and genetic hemoglobin disorders. To reduce the risk of deficiency, the content and bioavailability of iron and zinc should be enhanced in vegetarian diets by consumption of fortified cereals and milk, by consumption of leavened whole grains, by soaking dried legumes before cooking and discarding the soaking water, and by replacing tea and coffee at meals with vitamin C-rich drinks, fruit, or vegetables. Additional recommended practices include using fermented soy foods and sprouting at least some of the legumes consumed. Fortified foods can reduce iron deficiency, but whether they can also reduce zinc deficiency is less certain. Supplements may be necessary for vegetarian children following very restricted vegan diets.

Attitudes and practices of family paediatricians in Italy regarding infant feeding

AIM

  The aim of this study was to examine attitudes and practices of family paediatricians in Italy towards infant feeding.

METHODS

  A questionnaire was sent to 850 paediatricians across Italy, asking about attitudes and practices towards infant feeding with focus on the World Health Organization's criteria.

RESULTS

  The response rate was 91.2%. Breastfeeding is recommended for 6-11 months (70.6%) or longer (29.4%). A 95% of paediatricians recommend introducing complementary foods throughout 4-5.9 months. Among paediatricians who give indications about the minimum acceptable diet (61.7%), recommendations agree with WHO in 71.3% and 83.3% of cases for infants aged 6-8 or 9-11 months, respectively. A 95.6% of paediatricians recommend consumption of meat for infants aged 6 months or more, and 98.4% use of formula milk for infants having breastfeeding stopped in the first year of life. Paediatricians reported own experience (73.4%) and reading (54.2%) as main sources of information. A 70% of paediatricians know the WHO/Infant and Young Child Feeding Practices criteria regarding breastfeeding but <5% the complementary feeding indicators.

CONCLUSION

  Family paediatricians in Italy have positive disposition towards infant feeding but their knowledge and practices are suboptimal with respect to the WHO criteria, especially regarding complementary feeding.

Validation of energy requirement equations for estimation of breast milk consumption in infants

Objective

To test equations for calculating infants’ energy requirements as a simple and reliable instrument for estimating the amount of breast milk consumed in epidemiological studies where test-weighing is not possible.

Design

Infants’ energy requirements were calculated using three different equations based on reference data and compared with actual energy intakes assessed using the 3 d weighed dietary records of breast-fed infants from the DOrtmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study.

Setting

A sub-sample of 323 infants from the German DONALD Study who were predominantly breast-fed for at least the first four months of life, and who had 3 d weighed dietary records and repeated body weight measurements within the first year of life.

Subjects

Healthy, term infants breast-fed for at least 4 months, 0–12 months of age.

Results

The overall differences between measured energy intake and calculated energy requirements were quite small, never more than 10 % of total energy intake, and smaller than the mean variance of energy intake between the three days of recording. The equation of best fit incorporated body weight and recent growth, while the worst fit was found for the equation not considering body weight.

Conclusions

Breast milk consumption in fully and partially breast-fed infants can be reasonably quantified by calculating the infants’ individual energy requirements via simple equations. This provides a feasible approach for estimating infant energy intake in epidemiological studies where test-weighing of breast milk is not possible.

Development of food variety in children

Eating a variety of foods is essential to achieve adequate coverage of macro- and micronutrient needs. We expose here how eating habits for a variety of foods develop in childhood, from early infancy on. Preferences for specific flavours might develop early, through milk-related flavour exposures. Breastfeeding favours the acquisition of a taste for a variety of foods. At introduction of solid foods, food preferences develop thanks to repeated exposures to a variety of foods. The persistence of these early influences is still unknown. During the third year of life, most children enter a neophobic phase during which previously liked foods are no longer accepted and introduction of new foods becomes difficult. However, habits of eating a variety of foods acquired before the neophobic phase track further on into childhood, adolescence and early adulthood. This underlines the importance of promoting the access to a variety of foods in early childhood. However, beyond the nutritional advantage of eating a varied diet, could this present any drawbacks? Providing a variety of foods generally stimulates food intake and thereby might favour obesity. More research is needed to understand the link between variety and obesity, which might be food-group dependant.

Selected complementary feeding practices and their association with maternal education

OBJECTIVE

As infants transition from a milk-based diet to one that includes most food groups, the timing of the transition, how infants are fed, and the quality of their diet can have important health implications. Our objective is to describe these factors for US infants.

METHODS

We analyzed data from the Infant Feeding Practices Study II. Sample sizes varied for relevant questions from approximately 1600 to approximately 2400. We analyzed the prevalence of 14 feeding practices and their association with the mothers' education and also examined participants' use of commercial baby foods.

RESULTS

Approximately 21% of the mothers introduced solid foods before 4 months; 7% introduced solids after 6 months. Twenty-nine percent of the mothers introduced > 3 new foods per week to infants aged 5 to 10 months. Approximately 20% of the mothers fed juice before 6 months, fed cow's milk before 12 months, and fed infants < 5 times per day after 5 months. Fourteen percent of the mothers chewed food for their infant. Approximately 15% of the mothers fed < 1 serving daily of either a fruit or vegetable to infants aged > or = 9 months, half added salt to their infant's food, and more than one third who added salt used noniodized salt. Approximately 20% fed reduced-fat cow's milk at 1 year. Almost half of the 10-month-old infants had eaten restaurant food in a restaurant in the previous week, 22% had eaten carry-out food, and 28% had eaten either type of restaurant food > or = 2 times. The prevalence of 8 of the 14 unhealthful infant feeding practices we examined was inversely associated with maternal education.

CONCLUSIONS

Nutrition and feeding guidance should be especially targeted to mothers with a high school education or less.

Infant feeding and feeding transitions during the first year of life

OBJECTIVE

Infancy is a time of rapid transition from a diet of virtually nothing but milk (either breast milk or infant formula) to a varied diet from nearly all food groups being consumed on a daily basis by most infants. Despite various recommendations about infant feeding, little is known about actual patterns of feeding among US infants. This article documents transitions in infant feeding patterns across the first year of life and determinants of key aspects of infant feeding.

METHODS

Using data from the Infant Feeding Practices Study II, we analyzed responses to a 7-day food-recall chart that was administered every month. The sample size declined from 2907 at birth to 1782 at 12 months of age.

RESULTS

Although 83% of survey respondents initiated breastfeeding, the percentage who breastfed declined rapidly to 50% at 6 months and to 24% at 12 months. Many of the women who breastfed also fed their infants formula; 52% reported that their infants received formula while in the hospital. At 4 months, 40% of the infants had consumed infant cereal, 17% had consumed fruit or vegetable products, and <1% had consumed meat. Compared with infants who were not fed solid foods at 4 months, those who were fed solid foods were more likely to have discontinued breastfeeding at 6 months (70% vs 34%) and to have been fed fatty or sugary foods at 12 months (75% vs 62%).

CONCLUSIONS

Supplementing breast milk with infant formula while infants were still in the hospital was very common. Despite recommendations that complementary foods not be introduced to infants aged 4 months or younger, almost half of the infants in this study had consumed solid foods by the age of 4 months. This early introduction of complementary foods was associated with unhealthful subsequent feeding behaviors.

Indicators of zinc status at the population level: a review of the evidence

The role of zinc deficiency as an important cause of morbidity and impaired linear growth has prompted the need to identify indicators of population zinc status. Three indicators have been recommended - prevalence of zinc intakes below the estimated average requirement (EAR), percentage with low serum zinc concentrations, and percentage of children aged < 5 years who are stunted. This review outlines steps to estimate the prevalence of inadequate intakes, and confirm their validity based on the EARs set by International Zinc Nutrition Collaborative Group. Next, the appropriateness of serum zinc as a biochemical marker for population zinc status is confirmed by a summary of: (a) the response of serum zinc concentrations to zinc intakes; (b) usefulness of serum zinc concentrations to predict functional responses to zinc interventions; (c) relationship between initial serum zinc and change in serum zinc in response to interventions. Height- or length-for-age was chosen as the best functional outcome after considering the responses of growth, infectious diseases (diarrhoea, pneumonia), and developmental outcomes in zinc supplementation trials and correlation studies. The potential of other zinc biomarkers such as zinc concentrations in hair, cells, zinc-metalloenzymes, and zinc-binding proteins, such as metallothionein, is also discussed. Molecular techniques employing reverse transcriptase (RT)-polymerase chain reaction to measure mRNA in metallothionein and ZIP1 transporter hold promise, as do kinetic markers such as exchangeable zinc pools (EZP) and plasma zinc turnover rates. More research is needed to establish the validity, specificity, sensitivity, and feasibility of these new biomarkers, especially in community-settings.

[Nutrient intakes in 2005 by non-breast fed French children of less than 36 months]

BACKGROUND

Knowledge of the nutritional consumption of very young children is of main interest, but little is known about the dietary status of French infants and toddlers.

OBJECTIVE

To assess energy and nutrient intake and the adequacy of diet of French infants and toddlers.

DESIGN AND SETTING

A national cross-sectional survey was conducted in France from January to March 2005, using proportionate quota sampling based on the age of the children, the occupation of the mother, and the family socioeconomic category.

SUBJECTS

Seven-hundred and six children were allocated to 11 age subgroups ranging from one to three months to 31-36 months. Totally or partially breastfed infants were excluded. ANALYSES PERFORMED: Individual consecutive 3-day weight food records were converted into energy intake and intake of 24 nutrients according to food composition databases recently updated for 1260 standard foods and all the formulae and specific baby foods manufactured and marketed in France in 2005.

RESULTS

Mean daily energy intake in 2005 was above the estimated average requirement up to seven months of age, but was lower after one year. Protein, fat, and carbohydrate intakes were adequate, while calcium, magnesium, phosphorus and B group vitamins were above the recommended dietary allowances for all 11 subgroups. However, for toddlers over 12 months of age, some may have had an inadequate intake of alpha-linolenic acid, vitamin E, vitamin C, iron and zinc, whereas mean sodium intake was above the adequate intake for all age subgroups.

CONCLUSIONS

The diet of French infants was adequate for a large proportion of children and satisfied most of their nutritional requirements. However, the intake of iron and alpha-linolenic acid in particular needs to be improved for some French toddlers.

Egg allergy: are all childhood food allergies the same?

Egg allergy is one of the most common food allergies in childhood affecting about 1-2% of preschool children and differs in a number of ways from other common childhood food allergies such as cows milk and peanut. Common egg allergens are altered both by heat and gastric enzymes. Compared with peanuts/tree nuts and milk, egg allergy appears less likely to cause severe life-threatening reactions or fatal anaphylaxis. Children are much more likely to outgrow egg allergy by school age as compared with peanut allergy. While the MMR vaccine is no longer contraindicated in egg allergy, influenza vaccine is contraindicated in children with anaphylaxis to egg. An understanding of the similarities and differences in these common food allergies of childhood is helpful in the management of these common and increasing problems.

Complementary foods consumed by 6 – 12-month-old rural infants in South Africa are inadequate in micronutrients

Objective

To determine the nutrient composition of complementary foods consumed by 6–12-month-old South African infants.

Design

Nutrient intake was determined for infants who were recruited to participate in a randomised controlled trial using a single 24-hour dietary recall.

Setting/subjects

Infants aged 6–12 months (n = 475) residing in The Valley of a Thousand Hills, a rural area in KwaZulu-Natal, South Africa.

Results

Energy and protein intakes from complementary foods were adequate. Infants who consumed infant products (commercially available fortified infant cereals/ready-to-eat canned baby foods/formula milk powder) had significantly higher intakes of calcium, iron, zinc, vitamin A, thiamine, riboflavin, niacin, vitamin B6, vitamin B12 and vitamin C than infants who did not consume any infant products. For infants who consumed infant cereals (n = 142), these cereals provided 51% of total iron intake. Infant cereals provided more than 25% of total intake for magnesium, thiamine, niacin and vitamin B12. For infants consuming ready-to-eat canned baby foods (n = 77), these products contributed less than 15% of total intake for all the micronutrients. The nutrient density of the complementary diet was less than half the desired density for calcium, iron and zinc. Animal products were consumed by 17% of infants, 26% consumed dairy products and 18% consumed vitamin-A-rich fruit and vegetables during the 24-hour recall period.

Conclusion

The nutrient composition of complementary foods among rural South African infants was inadequate, especially for iron, zinc and calcium. Strategies should be developed to improve the nutritional quality of their diets.

On risks and benefits of iron supplementation recommendations for iron intake revisited

Iron is an essential trace element with a high prevalence of deficiency in infants and in women of reproductive age from developing countries. Iron deficiency is frequently associated with anaemia and, thus, with reduced working capacity and impaired intellectual development. Moreover, the risk for premature delivery, stillbirth and impaired host-defence is increased in iron deficiency. Iron-absorption and -distribution are homeostatically regulated to reduce the risk for deficiency and overload. These mechanisms interact, in part, with the mechanisms of oxidative stress and inflammation and with iron availability to pathogens. In the plasma, fractions of iron may not be bound to transferrin and are hypothesised to participate in atherogenesis. Repleted iron stores and preceding high iron intakes reduce intestinal iron absorption which, however, offers no reliable protection against oral iron overload. Recommendations for dietary iron intake at different life stages are given by the US Food and Nutrition Board (FNB), by FAO/WHO and by the EU Scientific Committee, among others. They are based, on estimates for iron-losses, iron-bioavailability from the diet, and iron-requirements for metabolism and growth. Differences in choice and interpretation of these estimates lead to different recommendations by the different panels which are discussed in detail. Assessment of iron-related risks is based on reports of adverse health effects which were used in the attempts to derive an upper safe level for dietary iron intake. Iron-related harm can be due to direct intestinal damage, to oxidative stress, or to stimulated growth of pathogens. Unfortunately, it is problematic to derive a reproducible cause-effect and dose-response relationship for adverse health effects that suggest a relationship to iron-intake, be they based on mechanistic or epidemiological observations. Corresponding data and interpretations are discussed for the intestinal lumen, the vascular system and for the intracellular and interstitial space, considering interference of the mechanisms of iron homoeostasis as a likely explanation for differences in epidemiological observations.

Consumption of ‘extra’ foods (energy-dense, nutrient-poor) among children aged 16–24 months from western Sydney, Australia

Objective

This study evaluates the contribution of energy-dense, nutrient-poor ‘extra’ foods to the diets of 16–24-month-old children from western Sydney, Australia.

Design

An analysis of cross-sectional data collected on participants in the Childhood Asthma Prevention Study (CAPS), a randomised trial investigating the primary prevention of asthma from birth to 5 years. We collected 3-day weighed food records, calculated nutrient intakes, classified recorded foods into major food groups, and further classified foods as either ‘core’ or ‘extras’ according to theAustralian Guide to Healthy Eating.

Setting

Pregnant women, whose unborn child was at risk of developing asthma because of a family history, were recruited from all six hospitals in western Sydney, Australia. Data for this study were collected in clinic visits and at participants’ homes at the 18-month assessment.

Participants

Four hundred and twenty-nine children participating in the CAPS study; 80% of the total cohort.

Results

The mean consumption of ‘extra’ foods was ∼150 g day− 1and contributed 25–30% of the total energy, fat, carbohydrate and sodium to the diets of the study children. ‘Extra’ foods also contributed around 20% of fibre, 10% of protein and zinc, and about 5% of calcium. Children in the highest quintile of ‘extra’ foods intake had a slightly higher but not significantly different intake of energy from those in the lowest quintile. However, significant differences were evident for the percentage of energy provided by carbohydrate and sugars (higher) and protein and saturated fat (lower). The intake of most micronutrients was also significantly lower among children in the highest quintile of consumption. The intake of ‘extra’ foods was inversely associated with the intake of core foods.

Conclusions

The high percentage of energy contributed by ‘extra’ foods and their negative association with nutrient density emphasise the need for dietary guidance for parents of children aged 1–2 years. These preliminary data on commonly consumed ‘extra’ foods and portion sizes may inform age-specific dietary assessment methods.

Bases para una alimentación complementaria adecuada de los lactantes y los niños de corta edad

Infants can be exclusively breast fed or formula fed for the first 6 months of life and their nutritional requirements are completely fulfilled. However, from 6 months onwards, human milk is not sufficient to supply all the nutrients necessary for infants and young children. Therefore, adequate supplementary feeding, in terms of both quantity and quality, should be provided. The present article aims to describe the scientific bases for practical recommendations on complementary feeding during infancy and early childhood, which may be useful to pediatricians and should serve to improve the health status of the infant population in Spain. In this sense, the new international recommendations for energy, protein and other nutrient requirements are reviewed. In Spain, the law applicable to manufacturing infant cereals and homogenized infant foods is that published by the European Union in specific directives. However, taking into consideration new advances in knowledge of nutritional requirements, we have considered a number of issues that could be relevant for the manufacture of these foods. Finally, we propose a series of basic principles that should serve as a guide for the complementary feeding of infants (whether breast fed, formula fed, or receiving mixed feeding) and young children. These recommendations are particularly addressed to pediatricians working in primary health services.

Effects of age and time on energy and macronutrient intake in German infants and young children: results of the DONALD study

OBJECTIVES

To describe effects of age and time on the intake of energy and macronutrients in infants and young children.

PATIENTS AND METHODS

The energy and macronutrient intake of 720 DONALD study participants between 1989 and 2003 was evaluated by analysing 3027 three-day weighed dietary records (including test weighing of breast milk consumption) at 3, 6, 9, 12, 18, 24 and 36 months. Mixed models and logistic regression analyses were used to investigate the effects of age and time on intake.

RESULTS

Age affected macronutrient patterns (percentage of energy intake, E%) more often in infants than in young children. The percentage of full and partial breast-fed infants increased between 1989 and 2003. Almost no time trends were found for energy intake. Macronutrient patterns changed with time; for example, protein intake decreased throughout infancy (between -0.05 and -0.17 E%/y). An increase in fat intake (0.23 and 0.40 E%/y) was compensated by a decrease in carbohydrates (-0.18 and -0.29 E%/y) in young infants (3 and 6 months). Opposite trends in macronutrient patterns were observed in infants and young children.

CONCLUSIONS

Increasing breast milk consumption over time was the most obvious factor influencing long-term trends in macronutrient patterns. In all of the age groups examined here, macronutrient patterns have come closer to the references over time.

Differences in weaning practice, food and nutrient intake between breast- and formula-fed 4-month-old infants in England

BACKGROUND

Breastfed infants may grow more slowly in the second half of infancy than formula-fed infants, differences in weaning practice may contribute.

METHODS

Dietary intakes of 4-month-old infants have been investigated cross-sectionally. Diet was assessed using a structured 1-day un-weighed dietary record in 852 white singletons (72% of those invited) from a random sub-sample of infants taking part in Avon Longitudinal Study of Parents and Children. Nutrient intakes of formula-fed infants were compared by sex and with UK reference values. Estimated mean energy and nutrient intakes, mean bodyweight and daily quantities of food consumed were compared by weaning practice.

RESULTS

In formula-fed infants mean energy intakes and intakes of most nutrients were adequate. There were significant differences in intakes of most nutrients by weaning practice; however, mean energy intake and body weight of breastfed infants was similar to formula-fed infants. Infants given formula milk were less likely to consume vegetables and fruit, and more likely to consume commercial infant drinks, compared with infants who were breastfed. In breastfed infants breast milk intake was lower if solids were given (905 g versus 818 g; P = 0.01); however, nutrient intake was not compromised. In formula-fed infants milk intake was not different in those having solids compared to those having milk only (810 g versus 795 g; P = 0.649).

CONCLUSIONS

Differences in weaning practice and patterns of food consumption were seen between breast- and formula-fed infants, these may contribute to later growth differences.

Intake of vitamin D by Finnish children aged 3 months to 3 years in relation to sociodemographic factors

OBJECTIVE

To study the total daily intake of vitamin D from food and supplements among Finnish children aged 3 months to 3 years, the dietary sources of vitamin D and the association between vitamin D intake and sociodemographic factors.

SUBJECTS AND METHODS

The subjects are participants in the Finnish Type I Diabetes Prediction and Prevention Nutrition Study born between October 1997 and October 1998. At the age of 3 and 6 months, 1, 2 and 3 years, 342 (72% of the invited families), 298 (63%), 267 (56%), 233 (49%) and 209 (44%) families, respectively, participated in the present study. Food consumption was assessed by a 3-day food record. A structured questionnaire was used to record the parents' socioeconomic status.

RESULTS

The mean dietary vitamin D intake exceeded the recommendation (10 microg/day) at the age of 3 (11.0 microg) and 6 months (12.0 microg), but decreased thereafter being 9.8, 5.0 and 4.1 microg at 1, 2 and 3 years of age, respectively. Among the children 91, 91, 81, 42 and 26% used vitamin D supplements at the age of 3 and 6 months, and 1, 2 and 3 years, respectively. In children not using vitamin D supplements, vitamin D intake was less than 10 microg/day at all ages. Vitamin D intake from food did not differ in children who used and did not use vitamin D supplements. Vitamin D supplements were the main source of vitamin D intake in all age groups studied, followed by vitamin D-fortified infant formula in 3-month-olds and infant formula and baby foods in 6-month-olds. After the age of 1 year, the most important food sources of vitamin D were margarine, fish, baby foods, low-fat milk and eggs. Sociodemographic factors, especially the number of children in the family and maternal age, were associated with the total vitamin D intake and vitamin D supplement use.

CONCLUSION

Vitamin D supplements are not used according to the dietary recommendations in a substantial proportion of Finnish children.

Feeding disorders related to nutrition

AIM

To study the relationship between early feeding disorders and nutritional intake during the second and third year of life.

METHODS

15 children, nine girls and six boys, with a feeding problem identified at the Specialist Child Health Care Unit at a mean age of 14.5 mo were matched with respect to age and sex with healthy control children. Four-day dietary records were collected at inclusion (time 1) and follow-up of the study (time 2). Measures of growth at birth, at times 1 and 2 of the study, and at 3 y of age were obtained from Child Health Centre records.

RESULTS

A lower intake of energy, carbohydrate and protein was evident at times 1 and 2 for the group of children with feeding disorders compared to the controls. Zinc and vitamin B6 were the only micronutrients that differed for the feeding disorder group compared to the control group at times 1 and 2. Children with feeding disorders decelerated in weight during the second year of life and in height during the third year of life as compared to controls.

CONCLUSION

The criterion of a persistent failure to eat adequately with a subsequent failure to gain weight, required for the diagnosis of feeding disorders in DSM-IV, was supported by the findings in this study. The relation between nutrition and growth in feeding disorders has not, to our knowledge, been reported in previous research.

Feeding Infants and Toddlers Study: meal and snack intakes of Hispanic and non-Hispanic infants and toddlers

OBJECTIVE

To describe meal and snack patterns of Hispanic and non-Hispanic infants and toddlers.

DESIGN

A cross-sectional telephone survey in which mothers or other primary caregivers reported their infants' and toddlers' food and beverage intake for a 24-hour period.

SUBJECTS/SETTING

Subjects were a subset of the national random sample of children aged 4-24 months who participated in the 2002 Feeding Infants and Toddlers Study. The Feeding Infants and Toddlers Study includes a stratified random sample of 3,022 infants and toddlers aged 4-24 months. Three hundred seventy-one Hispanic and 2,637 non-Hispanic children who had 24-hour dietary recalls are included in the subset.

ANALYSES

Means+/-standard errors of daily intakes of energy, nutrients, and nutrient densities were calculated, as were percentages of children consuming foods at each eating occasion.

RESULTS

Hispanic and non-Hispanic infants and toddlers, on average, were fed seven times per day. Overall, the percentages of children who ate snacks increased with age, and more than 80% of toddlers aged 12-24 months consumed afternoon snacks, with more than 90% of Hispanic children consuming an afternoon snack. In each age group, there were significant differences between ethnic groups in nutrient intakes by eating occasion. No significant difference was seen for energy across all meal occasions. At age 6-11 months, Hispanic children had a significantly lower intake of carbohydrate at dinner and lower intake of saturated fat at afternoon snacks compared with non-Hispanic children (P<.05). The main difference between Hispanic children's and non-Hispanic children's intakes by eating occasion is at age 12-24 months. Hispanics aged 12-24 months had significantly (P<.05) lower percentages of energy from fat and saturated fat and a significantly (P<.05) higher percentage of carbohydrate at lunch compared with non-Hispanic children. For dinner, Hispanic toddlers had significantly (P<.05) lower intakes of total fat and saturated fat compared with non-Hispanic toddlers at age 12-24 months. Overall fiber intake contributed 2 g/meal for both ethnic groups. Snacks contributed, on average, less than 1 g fiber, except Hispanic toddlers had significantly higher fiber intake at afternoon snacks (1.5 g) than non-Hispanic toddlers. Foods frequently consumed at meals and snacks were lacking in whole grains, vegetables, and fruits. Most nutrients were not significantly different between Hispanics and non-Hispanics for meals and snacks.

CONCLUSIONS

Considering the sizeable contribution that snacks make toward overall energy, parents and caregivers should plan toddlers' snacks to complement meals by including additional fruits, vegetables, and whole grains that are culturally appropriate rather than fruit drinks, cookies, and crackers. This will increase fiber intake and limit fat and sugar intakes. To develop healthful eating patterns, introduce toddlers to foods eight to 10 times to increase food acceptance and the likelihood of establishing healthful eating patterns. Dietetics professionals need to consider cultural differences when developing meal and snack patterns for Hispanic and non-Hispanic infants and toddlers.

Feeding Infants and Toddlers Study (FITS): development of the FITS survey in comparison to other dietary survey methods

OBJECTIVE

This article describes the steps in the planning and development of the 2002 Feeding Infants and Toddlers Study.

METHODS

We describe the study's rationale, sampling methodology, survey questionnaire development, dietary methodology, field data collection, and data processing and analysis. A brief review of existing national nutrition surveys and studies of infants and toddlers, and available study designs and dietary methods, is also included.

SUBJECTS/SETTING

Most national studies have been cross-sectional and assessed breastfeeding rates, dietary intake, and nutritional status among general and high-risk populations. Other specialized studies have been longitudinal and tracked dietary intake and nutritional status from infancy to the preschool years, or focused on studying a specific research topic, such as the relationship between fluoride intake and dental caries.

CONCLUSIONS

The 2002 Feeding Infants and Toddlers Study has advanced the knowledge base on infant and toddler nutrition by using state-of-the-art methodology and by providing researchers with updated information to develop further research questions. Our findings can be used by child health and nutrition organizations to develop dietary recommendations and improved nutrition education materials. Clinicians and practitioners in the fields of public health and wellness can use the information to provide practical advice to parents in a variety of settings to help give children a more healthful start.

Feeding Infants and Toddlers Study: characteristics and usual nutrient intake of Hispanic and non-Hispanic infants and toddlers

OBJECTIVE

To compare demographic and maternal characteristics and usual nutrient intakes of Hispanic and non-Hispanic infants and toddlers 4 to 24 months of age in the United States.

DESIGN

We conducted three interviews by telephone to collect information on sociodemographic and maternal characteristics, feeding practices, and dietary intake in the 2002 Feeding Infants and Toddlers Study. We collected 24-hour dietary recalls, including a second day's intake on a subsample, using the Nutrition Data System for Research. We used the Personal Computer version of the Software for Intake Distribution Estimation to estimate usual nutrient intake and nutrient adequacy and excess for three age subgroups-infants 4-5 months, infants 6-11 months, and toddlers 12-24 months-and Hispanic or non-Hispanic ethnicity.

SUBJECTS

A national sample of 3,022 infants and toddlers age 4-24 months, including 371 Hispanic and 2,637 non-Hispanic subjects.

STATISTICAL ANALYSIS

We compared means, percentile distributions, and percentages by age/Hispanic ethnicity subgroup, and applied the Dietary Reference Intakes to assess nutrient intakes.

RESULTS

Mothers of Hispanic infants and toddlers were younger, less likely to be married, and had lower education levels than mothers of non-Hispanic infants and toddlers (P<.01). Hispanic infants and toddlers had significantly higher rates of participation in the Special Supplemental Nutrition Program for Women, Infants, and Children than non-Hispanic infants and toddlers (42% to 23%) and were more likely to reside in urban areas and have lower annual household income levels (P<.01). There were no significant differences in usual energy intake between Hispanic and non-Hispanic infants and toddlers, and mean usual energy intake exceeded the mean estimated energy requirement for all age/ethnicity subgroups. Hispanic toddlers consumed a significantly higher proportion of energy from carbohydrate (56% to 53%, P<.01) and a significantly lower percentage of energy from fat (31% to 33%, P<.01) than non-Hispanics. Comparing usual mean intakes, Hispanic infants age 6 to 11 months had a significantly lower intake of calcium than non-Hispanics (means of 574 mg and 626 mg per day, respectively, P<.05) and a significantly higher intake of sodium compared with non-Hispanics of the same age (means of 647 mg to 476 mg per day, P<.01). For infants, mean usual intakes were adequate for all nutrients. For toddlers, the prevalence of nutrient inadequacy was low (<1%) with the exception of vitamin E, which was inadequate for 39% of Hispanic toddlers and 50% of non-Hispanic toddlers. For nutrients with defined Tolerable Upper Intake Levels, more than one third to almost half of toddlers exceeded the Tolerable Upper Intake Levels for vitamin A and zinc, and more than half (53% and 58% for Hispanics and non-Hispanic toddlers, respectively) exceeded the Tolerable Upper Intake Level for sodium. Usual mean intakes of vitamins A, C, and E and folate, potassium, and fiber were significantly higher among Hispanic toddlers compared with non-Hispanic toddlers.

CONCLUSIONS

The Feeding Infants and Toddlers Study data provide information that is useful to practitioners, Special Supplemental Nutrition Program for Women, Infants, and Children program staff, and parents for delivering nutrition education messages that are consistent with dietary guidance for infants and toddlers as well as compatible with cultural preferences.

Safety assessment and risk–benefit analysis of the use of azodicarbonamide in baby food jar closure technology: Putting trace levels of semicarbazide exposure into perspective – A review

The discovery of trace levels of semicarbazide (SEM) in bottled foods (especially baby foods) led to a consideration of the safety of this hydrazine compound by regulatory agencies worldwide. Azodicarbonamide, which is used in the jar-sealing technology known as Press On-Twist Off (or Push-Twist/PT) closures for the formation of a hermetic, plastisol seal, partially degrades with the heat of processing to form trace amounts of SEM. This review has evaluated the potential toxicological risks of resulting exposure to SEM and also the benefit of the PT technology (with azodicarbonamide) in the context of possible microbial contamination. It also considers the potential impact on infant nutrition if parents come to the conclusion that commercial baby foods are unsafe. SEM shows limited genotoxicity in vitro that is largely prevented by the presence of mammalian metabolic enzymes. Negative results were found in vivo in DNA alkaline elution, unscheduled DNA synthesis and micronucleus assays. This pattern is in contrast to the genotoxic hydrazines that also have been shown to cause tumours. Carcinogenicity studies of SEM are of limited quality, show a questionable weak effect in mice at high doses, which are not relevant to human exposure at trace levels, and show no effect in the rat. The IARC has assigned SEM as Group 3, 'Not classifiable as to its carcinogenicity to humans'. Based on estimates of exposure to infants consuming baby foods (with the assumption of SEM levels at the 95th percentile of 20 ng g(-1) in all of the consumed 'ready-to-eat' foods) compared with a no observed adverse effect level (NOAEL) in developmental toxicity studies, the margin of safety is more than 21 000. Since the risk of an adverse effect is negligible, it is clear that any theoretical risk is outweighed by the benefits of continuing use of the PT closure (with azodicarbonamide blowing agent) to ensure both the microbial integrity and availability of commercial baby foods as a valuable source of infant nutrition.

The relationship of dietary and lifestyle factors to bone mineral indexes in children

OBJECTIVE

To identify factors related to children's bone mineral indexes at age 8 years, and to assess bone mineral indexes in the same children at ages 6 and 8 years.

DESIGN

Bone mineral content (BMC [g]) and bone mineral density (BMD; calculated as g/cm 2 ) were measured by dual-energy x-ray absorptiometry (DEXA) in children and their mothers when the children were 8 years of age. A subset of children had an earlier DEXA assessment at age 6 years. Children's dietary intake, height, weight, and level of sedentary activity were assessed as part of a longitudinal study from ages 2 months to 8 years.

SUBJECTS/SETTING

Fifty-two healthy white children (25 male, 27 female) and their mothers. Main outcome measures Children's total BMC and BMD at age 8 years.

STATISTICAL ANALYSES PERFORMED

Correlations and stepwise multiple regression analyses.

RESULTS

Factors positively related to children's BMC at age 8 years included longitudinal intakes (ages 2 to 8 years) of protein, phosphorus, vitamin K, magnesium, zinc, energy, and iron; height; weight; and age ( P < or = .05). Factors positively related to children's BMD at age 8 years included longitudinal intakes of protein and magnesium ( P < or = .05). Female sex was negatively associated with BMC and BMD at age 8 years ( P < or = .05). Children's bone mineral indexes at ages 6 and 8 years were strongly correlated ( r =0.86, P < .0001 for BMC; r =0.92, P <.0001 for BMD).

CONCLUSIONS

Because many nutrients are related to bone health, children should consume a varied and nutrient-dense diet.

From milk to solids: a reference standard for the transitional eating process in infants and preschool children in Japan

OBJECTIVE

This paper aims to establish a potential reference standard for the process of transition from milk to solid food in infants and preschool children in Japan, using the transitional food process (TFP) scale described by Sakashita et al. The background for variation and delay in the process are also discussed.

DESIGN

A randomized sample survey covering entire Japan.

SETTING

Mailing self-completion of questionnaires.

SUBJECTS

Randomized sample of 14 000 children aged 0-6 y and their family from 13 prefectures in Japan, namely Hokkaido, Aomori, Iwate, Niigata, Tokyo, Saitama, Fukui, Nagano, Nagoya, Hyogo, Yamaguchi, Kagoshima, and Okinawa.

METHODOLOGY

Questionnaires requesting the TFP scale and background factors were sent to 14,000 children and families. The percentile ages were calculated. An eating ability index (EAI: number of accepted foods/total number of foods) x 100) was calculated. Regression analysis by analysis of covariance (ANCOVA; SPSS, 1997) was used to determine the influence of background factors on EAI.

RESULTS

From the 6747 (48.2%) effective answers received, percentile curves of the acceptability of each food on the scale were drawn, and used as initial reference standards. The 50 percentile age range of these 20 standard foods covers from 5 to 42 months after birth. The sensitive period for increasing the acceptance of foods in children was between 6 months and 2(1/2) y of age. ANCOVA regression model (R2=0.605) showed that EAI was mostly influenced by age (P=0.000), followed by feeding style (P=0.000), infant food preparation (P=0.000), information source (P=0.000), and birth order (P=0.003). The dominant cause of digestive system problems was shown to be infection, not too-hard food. It seems that breast feeding, bottle feeding with chewing-type nipples, and the manner of preparing infant foods from the family table promote the progress in acceptance. Children whose mothers followed the information given in books or magazines showed a slower progress.

CONCLUSIONS

It seems appropriate to use this reference standard in the study of the transitional process from milk to solid food in infants and preschool children in Japan.

Predictors of children's body mass index: a longitudinal study of diet and growth in children aged 2–8 y

OBJECTIVE

To identify longitudinal variables related to children's body mass index (BMI) (kg/m(2)) at age 8 y.

DESIGN

A longitudinal design, with nine interviews per child from ages 2 to 8 y.

SUBJECTS

In all, 70 white children (37 males, 33 females) who were continuous participants since infancy in the longitudinal study. Families were primarily middle and upper socioeconomic status.

MEASUREMENTS

At each interview, children's height and weight were measured, and mothers provided 3 days of the child's intake data (a 24-h recall and 2 days of food records).

ANALYSES

Analyses used were means+/-s.d., correlations, repeated measures analysis of variance, and forward stepwise regression. BMI at each interview was calculated and age of adiposity rebound was determined.

RESULTS

Children's BMI at 8 y was negatively predicted by age of adiposity rebound and positively predicted by their BMI at 2 y. Additionally, each model included one longitudinal dietary variable; mean protein and fat intakes recorded between 2 and 8 y were positive predictors of BMI at 8 y; mean carbohydrate intake over the same time period was negatively related to BMI at 8 y. R(2) values indicated that these three-variable models predicted 41-43% of the variability in BMI among children. BMI of 23% of the children exceeded the 85th CDC percentile.

CONCLUSIONS

The results of this study show that factors in early life are associated with children's BMI at age 8 y.

Longitudinal calcium intake is negatively related to children's body fat indexes

OBJECTIVE

To determine if dietary calcium was negatively related to children's body fat (BF), if BF indexes and calcium intakes changed over time, and to identify variables related to BF and calcium intake.

DESIGN

Percent BF and kg BF were assessed by dual energy x-ray absorptiometry (DEXA) in 8-year-old children. In a prospective design, height, weight, dietary intakes, and related variables were monitored longitudinally from ages 2 months to 8 years during in-home interviews.

SUBJECTS

Fifty-two white children, (n=25 boys, 27 girls) participated in a longitudinal study with their mothers. At 8 years of age, mean BMI was 17.3+/-2.1 (standard deviation) for boys and 17.1+/-2.5 for girls.

ANALYSES

Regression analysis of all variables, followed by further regression analysis on selected models.

RESULTS

At 8 years, percent BF was 22.7+/-6.7 for boys and 26.2+/-7.9 for girls, as assessed by DEXA. Dietary calcium (mg) and polyunsaturated fat intake (g) were negatively related to percent BF (P=.02 to.04) in 3 statistical models, which predicted 28% to 34% of the variability in BF among children. Variables positively associated with percent BF were total dietary fat (g) or saturated fat (g), female gender, sedentary activity (hours/day), father's BMI, and mothers' percent BF. Calcium intakes were significantly correlated over time. Dietary variety was positively related to calcium intake, and intakes of carbonated beverages and other sweetened beverages were negatively related.

APPLICATIONS/CONCLUSIONS

Children should be strongly encouraged to regularly include calcium-rich foods and beverages in their diets.

Micronutrient deficiencies and cognitive functioning

The relationship between four micronutrient deficiencies (iodine, iron, zinc and vitamin B-12) and children's cognitive functioning is reviewed. Iodine deficiency during pregnancy has negative and irreversible effects on the developing fetus. Although there is some evidence that postnatal iodine deficiency is associated with cognitive deficits, the findings are controversial. Iron deficiency is widespread and has been associated to cognitive deficits, but the results of prevention trials are inconsistent. Zinc deficiency has been linked with low activity and depressed motor development among the most vulnerable children. Associations with cognitive development are less clear and may be limited to specific neuropsychological processes. Vitamin B-12 deficiency has been associated with cognitive problems among the elderly, but little is known about its effect on children's cognitive functioning. Rates of vitamin B-12 deficiency are likely to be high because animal products are the only source of vitamin B-12. Although micronutrient deficiencies often co-occur in the context of poverty, little is known about the impact of multiple micronutrient deficiencies on cognitive development.

Nutrient intakes of infants and toddlers

OBJECTIVES

To assess the nutrient adequacy of the diets of US infants and toddlers 4 to 24 months of age.

DESIGN

Descriptive analysis of the usual nutrient intakes of infants and toddlers using 24-hour recall data from the 2002 Feeding Infants and Toddlers Study.

SUBJECTS

A national random sample of 3,022 infants and toddlers, with 2 days of recall available for 703 sample members. Sample sizes by age were: infants 4 to 6 months (n=862), infants 7 to 11 months (n=1,162), and toddlers 12 to 24 months (n=998).

STATISTICAL ANALYSES PERFORMED

Using the personal computer version of the Software for Intake Distribution Estimation, we estimated (where applicable) the percentage of infants and toddlers with usual intakes below the estimated average requirement, compared the means of usual nutrient intake distributions with adequate intake levels, and compared the 99th percentile of usual intake distributions with tolerable upper intake levels.

RESULTS

For infants under 12 months of age, mean usual intakes exceeded the adequate intake for all nutrients. For toddlers 12 to 24 months of age, the estimated prevalence of inadequacy was low for most nutrients; however, 58% of toddlers had usual vitamin E intakes less than the estimated average requirement. Mean energy intake exceeded the estimated energy requirement by 10% for infants 4 to 6 months, 23% for infants 7 to 12 months, and 31% for toddlers 12 to 24 months of age. The discrepancy between mean energy intake and the estimated energy requirement for infants 4 to 6 months of age was larger for infants fed solids than for infants consuming only breast milk or formula. Fiber intakes of toddlers were below the adequate intake.

APPLICATIONS

Studies should examine whether parents overreport foods consumed by infants and toddlers, and whether infants and toddlers are consuming more energy than required. Additional research is indicated to substantiate some of the new Dietary Reference Intakes for infants and children 1 to 3 years of age.

Transitions in infants’ and toddlers’ beverage patterns

OBJECTIVE

To describe transitions and patterns in infants' and toddlers' beverage intakes, with focus on nonmilk beverages.

DESIGN

A cross-sectional study was conducted by telephone to obtain a 24-hour dietary recall of infants' and toddlers' food intakes, as reported by mothers or other primary caregivers.

SUBJECTS

A nationwide sample of infants and toddlers (n=3,022) ages 4 to 24 months, who participated in the Feeding Infants and Toddlers Study (FITS).

ANALYSES

Beverages were categorized as total milks (ie, breast milk, infant formulas, cow's milk, soy milk, goat's milk), 100% juices, fruit drinks, carbonated beverages, water, and "other." Analyses included means +/- standard deviations, percentages, frequencies, nutrient densities, and linear regression.

RESULTS

Beverages provided 84% of total daily food energy for infants 4 to 6 months of age, decreasing to 36% at ages 19 to 24 months. Apple juice and apple-flavored fruit drinks were the most frequently consumed beverages in the 100% juice and fruit drink categories, respectively. Juices, fruit drinks, and carbonated beverages appeared to displace milk in toddlers' diets (P<.0001).

APPLICATIONS/CONCLUSIONS

This research shows that beverages make important contributions to infants' and toddlers' energy and nutrient needs, but they must be wisely chosen. Registered dietitians should advise parents and caregivers that excessive intakes of any beverage, including milks and 100% juices, may displace other foods and beverages in the diet and/or contribute to excess food energy (kcal). Further research is needed to define excessive amounts in each beverage category, and such guidance could be very useful to parents and caregivers of infants and toddlers.

Toddlers’ transition to table foods: impact on nutrient intakes and food patterns

OBJECTIVE

To describe the differential changes in average intakes of nutrients and food groups among higher versus lower table food consumers during the transition from baby foods to table foods.

DESIGN

A comparative analysis of food and nutrient intakes in the lowest versus highest quartile of energy from table foods based on 24-hour dietary recall data.

SUBJECTS

A national random sample of 1,677 US infants and toddlers 9 to 24 months in the 2002 Feeding Infants and Toddlers Study (FITS).

STATISTICAL ANALYSES

Mean and percentiles of energy intake from table foods; comparisons of mean daily nutrient intake and the percentages consuming various foods and beverages in the lowest versus highest quartile of energy from table foods, by age.

RESULTS

The mean percentage of energy from table foods increased from 25% at 9 to 11 months to 63% at 19 to 24 months. Mean intakes of energy, macronutrients, sodium, folate, and fiber were significantly higher for children 9 to 11, 12 to 14, and 15 to 18 months in the highest table food energy quartiles compared to the lowest. Mean calcium intakes were significantly lower among toddlers 15 to 24 months consuming high table food energy, and associated with lower milk consumption. A higher percentage of children in the lowest quartiles of energy from table food were consuming deep yellow vegetables among ages 9 through 14 months. The percentage of children consuming popular items such as pizza, carbonated sodas, French fries, candy and other sweets was higher among those who consumed more energy from table foods in every age group.

APPLICATIONS

The epidemic of overweight children mandates helping parents teach healthy eating habits early. Messages that educate parents and caregivers about toddler feeding include: (1) offer a wide variety of nutritious foods, particularly fruits and vegetables, in forms that are developmentally appropriate, (2) continue to feed foods that are good sources of iron, such as iron-fortified infant cereals, ready-to-eat cereals that are high in iron, and meats, (3) to ensure adequate calcium intake, build the habit of drinking milk, and (4) teach children to recognize and honor their hunger and satiety cues.

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

OBJECTIVE

To assess adherence to infant feeding recommendations among a sample of infants and toddlers four to 24 months of age in the United States.

DESIGN

Descriptive analysis of data collected in the 2002 Feeding Infants and Toddlers Study (FITS) based on telephone interviews and 24-hour dietary recalls collected with the Nutrition Data System for Research of the University of Minnesota.

SUBJECTS

A national random sample of 3,022 infants and toddlers age four to 24 months, including 2,024 infants age four to 11 months.

MAIN OUTCOME MEASURES

Breastfeeding, timing of introduction of complementary foods, and adherence to infant feeding recommendations.

STATISTICAL ANALYSES

Means and standard errors, percentile distributions, and percentages by age group (four to six months, seven to eight months, and nine to 11 months).

RESULTS

About 76% of infants and toddlers were fully or partly breastfed at birth. This percentage declined to 30% at six months and 16% at 12 months-short of Healthy People 2010 goals of 50% and 25%, respectively. The average duration of breastfeeding was 5.5 months for all who initiated breastfeeding. About two-thirds of infants had been introduced to complementary foods between four and six months-the period recommended by the American Academy of Pediatrics (AAP); 17% consumed juice before the AAP recommended age of six months or later. Twenty-two percent of infants nine to 11 months consumed cow's milk on a daily basis before the recommended age of 12 months or later, and one in 10 consumed french fries and/or sweetened beverages on any given day.

APPLICATIONS/CONCLUSIONS

More parents and caregivers can benefit from guidance about the introduction of developmentally appropriate, micronutrient-rich first solid foods such as iron-rich infant cereals, iron-fortified grain products, meats, soft fruits, and cooked vegetables and the importance of breastfeeding through the first year of life. A smaller proportion of parents and caregivers require guidance on delaying the introduction of juices until six months of age and cow's milk other than formula until one year of age.

Time trends in the consumption of dairy foods in German children and adolescents

OBJECTIVE

Examination of time trends in the consumption of dairy food and their impact on fat and calcium intakes in German children and adolescents.

DESIGN

Dietary records from the DONALD Study (DOrtmund Nutritional and Anthropometric Longitudinally Designed Study).

METHODS

A total of 5068 3-day weighed dietary records from 914 1 to 13-y-old children and adolescents collected between 1986 and 2001 were analysed using a mixed linear model, in which the means of the data and the covariance structure specific to the DONALD Study were modelled.

RESULTS

During the study period, the consumption of 'milk products' in children and adolescents >/=4 y remained stable, since the reduced consumption of 'fluid milk' (between -2.8 and -7.4 g/day/study year) was compensated for by an increased consumption of 'yoghurt' (between +2.4 and +3.3 g/day/study year). The consumption of 'cheese' increased in subjects >/=4 y (between +0.2 and +0.7 g/day/study year). In 1 to 3-y-old children, the decreased intake of 'fluid milk' (-6.5 g/day/study year) was not compensated for by the increased intake of 'formula' (+3.5 g/day/study year). The percentage of 'low-fat milk products' significantly increased (although not significant in 9-13-y-old boys) to nearly 25% of milk products. The impact of dairy food on fat intake (as percentage of energy intake) remained stable with the exception of a slight reduction in 4-8 y olds, the impact of dairy on calcium (as percentage of US adequate intake) decreased only in 1-3 y olds.

CONCLUSIONS

The consumption of dairy food remained widely stable over time in >/=4-y-old children and adolescents, but decreased in 1-3 y olds. A further decline in this age group would be undesirable as is the shift from common milk to formula. The intake of 'low-fat milk products' increased and should be continuously promoted.

Do food-related experiences in the first 2 years of life predict dietary variety in school-aged children?

OBJECTIVE

To determine if food-related experiences in the first 2 years of life predict dietary variety in school-aged children.

DESIGN/SETTING

Child/mother pairs were interviewed 7 or 8 times when children were 2 to 24 months using a randomized incomplete block design to schedule interviews. Each child/mother pair was interviewed when the child was ages 6, 7, and 8 years.

PARTICIPANTS

Child/mother pairs (n = 70) were continuous participants in the longitudinal study.

MAIN OUTCOME MEASURES

Dependent variables were children's vegetable and fruit dietary variety, assessed from 3 days of dietary data at ages 6, 7, and 8 years. Independent variables from the first 2 years of life were selected from the longitudinal data set.

ANALYSES

General linear models. Adjustments for age that vegetables (or fruits) were introduced in the diet.

RESULTS

Vegetable variety in the school-aged child was predicted by mother's vegetable preferences, R2 =.084. Fruit variety in the school-aged child was predicted by breast-feeding duration and either early fruit variety (R2 =.254) or fruit exposure (R2 =.246).

CONCLUSIONS/IMPLICATIONS

Nutrition education messages for mothers should emphasize the importance of early food-related experiences to school-aged children's acceptance of a variety of vegetables and fruits.

Children's food preferences: a longitudinal analysis

OBJECTIVE

To compare children's food preferences longitudinally and identify factors related to food preferences.

DESIGN

Mothers completed the Food Preference Questionnaire for children at 2 to 3 years of age (T1), 4 years (T2), and 8 years (T3) and for themselves at T1 and T3. Both groups completed a Food Neophobia Scale at T3.

SUBJECTS

70 child/mother pairs who had participated continuously in the longitudinal study.

STATISTICAL ANALYSES PERFORMED

Changes in food preferences over time were tested with paired t tests and correlations. Consistency percentages were calculated by summing the consistent matches (like/like) for each food between two time periods. Similarly, concordance percentages were calculated for child/mother pairs by summing the concordant matches for each food. General linear models were developed to identify influences on children's food preferences.

RESULTS

Although children liked most foods, the number of liked foods did not change significantly during the 5 to 5.7 years of the study. The strongest predictors of the number of foods liked at age 8 years (R2=0.74) were the number liked at 4 years (P<.0001) and the food neophobia score (P=.0003). Newly tasted foods were more likely to be accepted between T1 and T2 than T2 and T3. Mothers' and children's food preferences were significantly but moderately related. Foods disliked by mothers tended not to be offered to children.

APPLICATIONS/CONCLUSIONS

The important role of children's early food preferences is confirmed by this study. Mothers influence children via their own preferences, which may limit foods offered to children.