Nutritional survey on a sample of one-year-old infants in milan: intake of macronutrients

Early nutrition patterns and diseases of adulthood: a plausible link?

In the last decades several studies tested the hypothesis that at early development stages certain foods or nutrients, in specific amounts, fed during limited sensitive periods, may determine an endocrine metabolic asset leading to clinical alterations that take place decades later (early nutritional programming of long term health). Evidence is mounting for programming effects of infant feeding. Observational studies indicate that breast feeding, relative to formula feeding, reduces the risk for obesity at school age by about 20% even after adjustment for biological and sociodemographic confounders. Moreover, breastfeeding is constantly associated with increased neurodevelopmental scores up to early adulthood, while its outcome in terms of delayed decay of brain function is still unknown. Besides the environment surrounding breastfeeding, specific nutrients within human milk may play a direct role. With the introduction of solids the major changes in diet are represented by the sudden decrease of fat intake from 50 to 30% of total energy. A protein excess, commonly found throughout all European Countries, has been associated to a higher risk of adiposity in early childhood, as confirmed by first reports from a large European trial. The amount of fat does not seem to be associated with later adiposity, while its quality may affect blood lipoproteins, blood pressure and neurodevelopmental performance. Early intake of dietary fibers might also have beneficial effects. Epidemiologic data show that episodes of rapid growth (growth acceleration hypothesis), whichever the dietary habits, are associated with later unfavorable health conditions and should be prevented.

Amount and quality of dietary proteins during the first two years of life in relation to NCD risk in adulthood

During late infancy many infants have a protein intake, which is more than three times as high as the physiological need. Several observational studies have shown an association between a high-protein intake (>15 energy %) early in life and an increased risk of developing obesity and thereby non-communicable diseases (NCDs) later in life. This effect was supported by a recent intervention study with infant formulas with two levels of protein, showing that a higher protein intake during the first year of life resulted in a higher body mass index (BMI) at age 2 years. It is also plausible that an important reason for the slower growth in breast-fed infants is the lower content of protein in breastmilk, but other qualities of breastmilk could also play a role. A high intake of protein, especially dairy protein, stimulates the growth factors insulin-like growth factor (IGF-I) and insulin, and it has been suggested that the lower risk of NCDs in breast-fed infants is mediated through a regulation of IGF-I. A low quality of protein, as in cereal-based diets with no animal foods as often seen in low-income countries, may contribute to undernutrition, which can also result in an increased risk of NCDs later in life. In conclusion, there is some evidence that a high protein intake during the complementary feeding period is associated with increased risk of NCDs and that avoidance of a high protein intake could reduce the risk of obesity. In low-income countries, emphasis should be on providing sufficient amounts of high-quality protein to improve survival, growth and development.

Role of fats in the first two years of life as related to later development of NCDs

AIMS

Compared to exclusive breastfeeding, the introduction of solids leads to a reduction of dietary fats. We explore the hypothesis that dietary fats consumed in the 6-24-month period might have later effects on non-communicable disorders and health.

DATA SYNTHESIS

We have considered studies on dietary fats as substrate for oxidation and energy production, effects on adiposity, blood lipoprotein levels and features of the metabolic syndrome, and the possible influences on brain development and function. Fat oxidation, despite a high initial dietary supply, is greatly suppressed and only gradually increases after birth. There is no evidence of any convincing association between fat intake during the 6-24-month period and later indices of adiposity. Fat quality may affect the blood lipoprotein picture at short-term through the first 12 months of life. In a large Finnish trial, a moderately restricted fat diet started at 7 months, with an increased unsaturated/saturated fat ratio, has shown favourable effects on serum cholesterol values, indices of insulin resistance and endothelial function especially in boys, and had no negative effects until the age of 18 years. The dietary supply of docosahexaenoic acid might affect brain development as well as some features of the metabolic syndrome.

CONCLUSIONS

In the 6-24-month period, the amount of fat intake does not show associations with later health conditions, and relatively high-fat diets do not seem to be harmful. Fat quality may have later effects on chronic-degenerative processes that need to be explored more in depth.

The role and requirements of digestible dietary carbohydrates in infants and toddlers

Digestible carbohydrates are one of the main sources of dietary energy in infancy and childhood and are essential for growth and development. The aim of this narrative review is to outline the intakes of digestible carbohydrates and their role in health and disease, including the development of food preferences, as well the consequences of excess carbohydrate. Key experts in these fields provided up-to-date reviews of the literature. A search of available information on dietary intakes of children below the age of 4 years was conducted from 1985 up to 2010. Articles and reports including information about sugars and/or starch intakes were selected. A number of factors limit the ability to obtain an overall picture of carbohydrate intakes and food sources in this age group. These include small numbers of intake studies, differing approaches to analysing carbohydrate, a variety of terms used to describe sugars intakes and a dearth of information about starch intakes. Data suggest that sweet taste is preferred in infancy and later food choices. There are few established adverse consequences of high intakes of digestible carbohydrate for young children. The greatest evidence is for dental caries, although this is influenced by high intake frequency and poor oral hygiene. Evidence for detrimental effects on nutrient dilution, obesity, diabetes or cognition is limited. In infants, minimum carbohydrate (mainly lactose) intake should be 40% of total energy, gradually increasing to 55% energy by the age of 2 years.

Dietary habits and plasma fatty acids levels in a population of Italian children: is there any relationship?

The relationships between dietary habits and the blood fatty acid (FA) profile have been poorly explored, particularly in children. Aim of the present investigation was to look at the associations between dietary habits and the plasma pattern of FA in a school-age population. In 105 healthy 8-years old children, the nutritional habits have been evaluated by means of a Food Frequency Questionnaire and a 24-h recall. FA analyses (expressed as FA%) were performed by means of capillary gas chromatography.

STATISTICS

non-parametric tests. The children with high pasta and low red meat consumption (n = 9), compared to those with either medium or low pasta and either high or medium red meat consumption (n = 96), showed lower levels of total saturated (29% vs. 35%, P = 0.001) and higher levels of total monounsaturated (30% vs. 24%, P = 0.04) FA in plasma. They also showed lower levels of LDL cholesterol (90 vs. 109 mg/dl, P = 0.08) and fasting insulin (4.0 vs. 6.3 microU/ml, P = 0.04) in blood. A high consumption of pasta coupled with a low intake of red meat may be marker of a food behaviour and/or lifestyle associated with a more favourable pattern of circulating FA and hematochemical metabolic markers.

Prolonged breast-feeding (six months or more) and milk fat content at six months are associated with higher developmental scores at one year of age within a breast-fed population

Since dietary fats may affect brain composition and function in early life, we evaluated developmental indices at 1 year of age in relation to the duration of breast-feeding and the milk fat composition in a breast-fed population. A blinded monitor administered the Bayley test (2nd edition) to 1-year-old subjects born at term and exclusively breast-fed for at least 3 months. Weaning foods were introduced from the 5th month onward. Mothers' milk lipid composition (fat [wt/dL], fatty acid [wt/dL], FA% [% of total fatty acids]) was determined at 0, 1, 3, 6, 9, and 12 months. Statistics used were Student's t-test, Pearson's r, and multiple regression. Forty-four infants out of 95 recruited at birth met inclusion criteria. There was a progressive reduction of the number of breast-fed babies to 29 (6 mo), 17 (9 mo), and 10 (12 mo). Breast-feeding for 6 months or longer gave a 6.6-point advantage (95% confidence interval, -0.6, 13.8; P = 0.07 for the Bayley psychomotor developmental index (PDI) and 2.0 for the Bayley mental developmental index (MDI) (95% confidence interval, -3.2, 7.3; NS) compared with the 15 subjects breast-fed for fewer than 6 months. Among the milk lipid factors, the fat weight (mg/dL) at 6 months showed the highest association with the MDI (r = 0.55, P = 0.002). Thus, prolonged breast-feeding during the weaning process may result in a better developmental performance at 12 months, possibly due to the supply of fats contributing energy and/or affecting brain composition.

Breastfeeding duration, milk fat composition and developmental indices at 1 year of life among breastfed infants

The associations of breastfeeding duration and milk fat composition with the developmental outcome at 1 year of age were measured within 44 infants exclusively breastfed for 3 months, out of 95 recruited at birth. Pooled breast milk (hindmilk) of the mothers was analysed at colostrum, 1, 3, 6, 9, and 12 months for total fat and fatty acid content. Infants were examined at 12 months by means of the Bayley test. There was a progressive reduction of the number of breastfed babies after the introduction of solids to 29 (6 months), 17 (9 months) and 10 (12 months). After adjusting for major confounders, infants breastfed for 6 months or longer showed a trend to have an advantage at the Bayley psychomotor developmental index compared to those breastfed >3 and <6 months (95% CI for difference: - 0.6, 13.8; P= 0.07) while the Bayley mental developmental index (MDI) was just 2.1 points higher. Among the milk fat components considered for each time-point, the total fat content at 6 months showed the strongest association with the MDI at 12 months (r=0.59, P=0.001). Prolonging breastfeeding during the weaning process may result in a better developmental performance at 12 months, possibly due to the supply of fats affecting brain composition.

Dietary fats and cholesterol in italian infants and children

The fat intake of Italian infants has peculiar characteristics that begin quite early because their mothers' milk has a monounsaturated fat content (45%) at the upper limit of the values found in Europe. Comparison studies in breast-fed and formula-fed infants were conducted to evaluate growth and developmental correlates and differences in fat intakes in the early months of life. Breast-fed infants have higher blood lipid concentrations at 4 mo of age than do formula-fed infants. The addition of long-chain polyunsaturated fatty acids (LCPUFAs) and cholesterol to formulas for term infants may affect concentrations of circulating blood lipids as well as the LCPUFA composition of the lipids during the breast-feeding period. The addition of LCPUFAs does not seem to affect the growth rate of formula-fed infants. Although an initial benefit of LCPUFA feeding on eye-hand coordination was observed, this effect was not sustained; by 24 mo, different feeding groups had similar developmental scores. Other peculiarities of the Italian experience are presented, including body weights from infancy to early childhood in 147 children, the nutrient densities of different diets in Italian schoolchildren, and the effects of nutritional education on dietary intakes. The diets of these children were high in animal protein and supplied approximately 30-35% of energy from fats throughout childhood. Both the dietary protein intakes at 1 y of age and parental body mass indexes were associated with 5-y body mass index values. Classroom education may be useful to lower the plasma lipid concentrations in healthy, primary school-age children. It is not known whether this early modification can be maintained and whether it influences the later development of cardiovascular disorders.

Early macronutrient intake and overweight at five years of age

OBJECTIVE

To examine the influence of the macronutrient intake in early life on the development of overweight in children.

DESIGN AND SUBJECTS

An ongoing longitudinal study including 147 randomized healthy children followed up from birth.

MEASUREMENTS

Anthropometric parameters were measured at birth, 1 and 5 y of age. Dietary habits at the age of 1 and 5 were assessed by age-adjusted food-frequency questionnaires and 24 h recalls. Parents' body mass index (BMI) was also recorded.

RESULTS

Parental overweight was observed for 51% children. The prevalence of overweight at the age of 5 y was higher in children with than without parental overweight (37.3% vs 8.3%, P<0.0001). Five-year old overweight children had a higher percentage intake of proteins at the age of 1 y than non overweight children (22% vs 20%, P=0.024) and lower intake of carbohydrates (44% vs 47%, P=0.031). Multiple logistic analysis confirmed that protein intake at 1 y of age was associated with overweight at 5 y (P=0.05). In children born from overweight mothers, prevalence of overweight at the age of 5 y tended to be higher in bottle-fed than in breast-fed ones (62.5% vs 23.3%, P=0.08).

CONCLUSION

Parental overweight is a major risk factor for childhood overweight in the first years of life, but an early high protein intake may also influence the development of adiposity.

Protein intake and metabolism in formula-fed infants given Swedish or Italian weaning foods

The aim of the study was to compare protein intake and metabolism between infants from two countries given similar infant formulae but different weaning foods. Healthy Swedish and Italian infants were studied between 3 and 12 mo. Infants in both populations were assigned to 1 of 3 infant formulae, containing 13, 15 or 18/20 g l(-1) of protein, given in addition to Swedish or Italian weaning foods. Protein intake from weaning foods was higher in Italian than in Swedish infants at 6 and 12 mo, whereas protein intake from formula at 6 mo and from formula/milk at 12 mo was similar in both populations. Plasma isoleucine, leucine, lysine, histidine and valine at 6 mo were lower in Italian than in Swedish infants fed formula with 13 g l(-1) of protein. All essential plasma amino acids were similar in Italian and Swedish groups at 12 mo. Serum urea was similar at 6 mo in corresponding formula groups, but was higher at 12 mo in the Italian than in the Swedish formula group. Serum albumin and growth were normal in both populations throughout infancy. In conclusion, formula with protein content of 13 g l(-1) seems to provide sufficient protein intake when combined with Swedish or Italian weaning foods during the second half of infancy, as indicated by normal serum albumin and normal growth. However, the bioavailability of protein and amino acids from weaning foods, in addition to their protein content, should be considered, as indicated by some indices of protein metabolism in the Italian infants.

Growth and nutrient intake in three- to twelve-month-old infants fed human milk or formulas with varying protein concentrations

BACKGROUND

Results on growth and nutrient intake in infants in the second half of infancy fed human milk or formulas with varying protein concentrations in combination with supplementary foods have not previously been reported.

METHODS

Seventy-one healthy infants were studied from 3 to 12 months of age. They were exclusively breast-fed until 3 months and were then randomly assigned to one of three feeding groups, F13, F15, or F18, indicating formulas with 13, 15 or 18 g/l of protein, respectively. Formula was gradually introduced when breast-feeding was terminated. Infants fed breast milk only were included in the breast-fed group, and those with breast milk and formula were included in the mixed-fed group. The same supplementary foods were provided to all infants.

RESULTS

There were no differences in growth between the feeding groups. Total protein intake exceeded minimum recommendations in all groups at all ages and was higher at 6 months in F18 than in F13 (2.3 vs. 1.9 g/kg per day; p < 0.01), whereas formula protein intake was higher at all ages in F18 compared with F13. Intake of protein from supplementary foods increased, but that from formula decreased between 6 and 12 months in all groups.

CONCLUSIONS

Intake of breast milk or infant formula with 13 g/l of protein along with high-protein supplementary foods provided enough protein with no adverse effect on growth. Infants fed formulas with higher protein concentrations had similar growth, despite higher intakes of formula protein.

Nutritional composition of home-prepared baby meals in Madrid. Comparison with commercial products in Spain and home-made meals in England

The nutritional value of 50 home-prepared meat-based baby meals for infants of 7 and 8 months old in Madrid was evaluated. Chemical analysis showed the meals to have a low energy density (mean 50 kcal 100 g-1), mainly due to the low fat content of the meals (mean 2.5 g 100 kcal-1). Protein content was high in proportion to the energy provided (mean 9.1 g 100 kcal-1). The addition of fat would have considerably improved the relation between the three macronutrients. About 20% of the meals had a higher than desired sodium level (> 200 mg 100 kcal-1) when assessed against guidelines for commercial baby meals. The English home-made baby meals had a higher energy density, a lower protein content, the same low fat content, and a wider range between minimum and maximum values observed for each nutrient compared to the Spanish home-prepared meals. The commercial baby meals had a higher energy density, a better ratio between the macronutrients and a smaller variation in the nutrient content.

Fatty acids in pediatric nutrition

The past 20 years have shown that dietary FA molecules are able to mediate and condition biologic functions in an increasing number of biochemical contexts. Different diet interventions can induce measurable alterations at the ultrastructural level of lipid moieties and circulating FAs. This has many consequences for prevention, for therapy, and, in particular, for the management of chronic degenerative disease. From the earliest stages of life, an adequate availability of the n-6 and n-3 series LCP seems essential to ensure the adequate structural and functional development of the various tissues, especially the central nervous system tissues. Recognition of the numerous steps involved in intermediate FA metabolism should induce us to further our understanding of the manifold possibilities open for intervention on FA profile and balance and stress the need for an interdisciplinary approach.

Determination of intra- and inter-individual variability and its effect on the number of days required to assess the usual intake of a 1-year-old infant population

Diet variability influences the accuracy of the assessment of the relationship between nutrient intake and disease. The present study investigates intra- and inter-individual variability in an infant population at 12 months. The mothers of 79 infants completed a 7-day weighted food record. No significant difference in nutrient intake was observed between males and females. For some nutrients an intra-/inter-individual variability ratio > 1 was found. Adjustment for total calorie intake slightly altered the intra-/inter-individual variability ratio of many nutrients. An error margin of 10% or less for calories can be expected within an 18-day study. Most nutrients however would need to be studied for over 30 days to give an error margin < or = 10%. For dietary cholesterol, vitamins A, B6, C, and E, bracketing the error within the 10% margin would require an unrealistic time frame. Adjustments for calorie intake reduced the number of days in the dietary record for some nutrients. A lower intra/inter-individual variability ratio was seen when data for adults and older infants were compared.

Fat needs of term infants and fat content of milk formulae

Term infants have precise dietary fat requirements for their metabolic, energy and structural needs. The fat content of commercial milk formulae differs from maternal milk in that it contains no long-chain polyunsaturated derivatives or cholesterol. Artificially fed children thus have less of these molecules available for their biological needs, and hence lower levels of long-chain polyunsaturated derivatives in circulating and membrane lipids than breast-fed children. The functional effects of this difference have not been investigated thoroughly in term infants. Dietary lack of essential fatty acids and their derivatives is evident also in weaned children during the second half of their first year of life. Qualitative changes in the fat content of commercial milk formulae could help to correct some widely encountered dietary imbalances, using the pattern of fats provided in breast milk as the ideal.

Follow-on formulae

Follow-on formulae are recommended as part of the liquid intake of the weaning diet for infants from 6 months on and children aged 12-36 months. The amount of energy and nutrients absorbed by infants from Beikost and milk differs enormously depending on a number of factors and therefore the recommended composition of follow-on formulae varies accordingly. In the future a greater understanding of the nutritional needs of infants and the possibility of choosing between high- or low-protein content formulae may provide infants with a better balanced diet.

Vegetable foods in weaning

Vegetable foods (cereals, non-starchy vegetables, legumes) make a unique nutritional and metabolic contribution during weaning. They provide proteins that are of low biological value individually but whose value can be raised by consuming appropriate combinations: minimal amounts of lipids, mostly essential polyunsaturated fats; complex carbohydrates; and soluble fibre, which are fermented by colonic flora to short-chain fatty acids that have beneficial effects. Insoluble fibre, minerals, trace elements and vitamins are also nutritionally important components of vegetable foods. Vegetable foods lower the calorific density of meals, modulate nutrient and antigen absorption, and promote a physiological copropoiesis. Recent nutritional surveys have shown that 12-month old children eat an excessive amount of animal proteins. Whole cereals and non-starchy vegetables, including whole legumes, should be routinely eaten during weaning to improve nutritional balance and to make children accustom to eating fibre, which has prophylactic properties. The daily intake of fibre should be progressively increased to 5 g during the first year of life.