Exclusive breastfeeding duration and later intake of vegetables in preschool children

Human Milk Feeding and Ultraprocessed Food Intake in Toddlerhood

Objective: The objective of the study was to estimate associations between early-life human milk feeding and ultraprocessed food (UPF) intake at two timepoints during toddlerhood among children born at <35 weeks' gestation. Study Design: Children were enrolled in the Omega Tots trial (2012-2017, Ohio) at 10-17 months' corrected age after having discontinued human milk and formula feeding. Caregivers reported children's human milk feeding history at baseline and past month diet through a food frequency questionnaire at baseline and follow-up (180 days later). We used the NOVA classification system to estimate UPF intake. We estimated covariate-adjusted associations between human milk feeding (ever and duration) and UPF intake at baseline and follow-up using linear and logistic regression. Results: Nearly 89% (n = 295) of 333 toddlers had received human milk but only 4.2% (n = 14) were fed exclusively human milk to 6 months of age. UPFs represented 37.7 (standard deviation [SD] = 13.2)% and 43.4 (SD = 11.3)% of total calories at the two timepoints. Human milk feeding (exclusive or otherwise) was unassociated with UPF intake in toddlerhood (e.g., months of exclusive human milk feeding with the number of daily servings of UPFs at follow-up: β = -0.09, 95% confidence interval [CI]: -0.26, 0.08). Conclusion: In this sample of toddlers born preterm, any exposure to as well as the duration of human milk feeding was unassociated with UPF intake during the second year of life. These results require replication in larger samples given the small number of children in some human milk feeding categories.

Associations between breastfeeding duration and adherence to complementary feeding recommendations in Scotland

We aimed to describe how breastfeeding relates to adherence to complementary feeding (CF) recommendations, diet diversification and feeding skills development and whether sociodemographic factors explain any differences observed. The Scottish Maternal Infant and Nutrition Survey for infants aged 8-12 months collected breastfeeding history, CF practices, diet and sociodemographic data using a self-completion questionnaire. Non-healthful CF practices were starting CF < 6 months, any consumption of sugar-sweetened beverages (SSBs), sweet or salty snacks (treats) or unmodified cow's milk and regular consumption of commercial baby foods. Diet diversification and feeding skills were assessed by amount of self-feeding and number of food groups, meals and snacks eaten daily. Of the 2730 mothers, 20% were solely infant formula fed (IFF) and 48% continued breastfeeding ≥6 months. Compared to IFF babies, mothers who gave any breast milk ≥6 months were more likely to start CF ≥ 6 months compared to those IFF (66% vs. 37%) and less likely to give treats (15% vs. 45%), SSBs (11% vs. 20%) and commercial baby foods (31% vs. 53%). These associations remained highly significant (p < 0.001) even after sociodemographic factor adjustment. Despite starting CF later, infants breastfed ≥6 months ate the same number of food groups and meals as those IFF, were just as likely to self-feed purees and more likely to self-feed finger foods daily (87% vs. 81% p < 0.001). Mothers who breastfeed beyond 6 months adhere more to CF recommendations and start CF later compared to IFF, but their babies eat a similarly diverse diet and have similar feeding skills.

The mediation effect of breastfeeding duration on the relationship between maternal preconception BMI and childhood nutritional risk

BACKGROUND

Higher maternal preconception body mass index (BMI) is associated with lower breastfeeding duration, which may contribute to the development of poor child eating behaviours and dietary intake patterns (components of nutritional risk). A higher maternal preconception BMI has been found to be associated with higher child nutritional risk. This study aimed to determine whether breastfeeding duration mediated the association between maternal preconception BMI and child nutritional risk.

METHODS

In this longitudinal cohort study, children ages 18 months to 5 years were recruited from The Applied Research Group for Kids (TARGet Kids!) in Canada. The primary outcome was child nutritional risk, using The NutriSTEP®, a validated, parent-reported questionnaire. Statistical mediation analysis was performed to assess whether total duration of any breastfeeding mediated the association between maternal preconception BMI and child nutritional risk.

RESULTS

This study included 4733 children with 8611 NutriSTEP® observations. The mean (SD) maternal preconception BMI was 23.6 (4.4) and the mean (SD) breastfeeding duration was 12.4 (8.0) months. Each 1-unit higher maternal preconception BMI was associated with a 0.081 unit higher nutritional risk (95% CI (0.051, 0.112); p < 0.001) (total effect), where 0.011(95% CI (0.006, 0.016); p < 0.001) of that total effect or 13.18% (95% CI: 7.13, 21.25) was mediated through breastfeeding duration.

CONCLUSION

Total breastfeeding duration showed to mediate part of the association between maternal preconception BMI and child nutritional risk. Interventions to support breastfeeding in those with higher maternal preconception BMI should be evaluated for their potential effect in reducing nutritional risk in young children.

Any Infant Formula Amount, but Not Infant Formula Type, Is Associated with Less Healthful Subsequent Beverage Intake among Special Supplemental Nutrition Program for Women, Infants, and Children-Participating Children

Background

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides nutrition assistance to low-income households, including infant formula for infants not fully breastfeeding. Issuance of lactose-reduced infant formula made with corn syrup solids (CSSF) is associated with elevated risk of obesity in early life, but associations between formula type and dietary intake have not been examined.

Objectives

To evaluate associations between infant formula (amount and type) issued by WIC with subsequent child diet at ages 12-59 mo.

Methods

Dietary data from 2014, 2017, and 2020 Los Angeles County WIC Survey respondents (n = 1339 children, 12-59 mo of age) were merged with WIC administrative data on infant feeding (amount and type of infant formula at ages 0-12 mo). Intake frequencies were available for sweetened beverages, sweets, juice, fast food, water, fruit, vegetables, and milk. Infant feeding was categorized by amount of WIC-issued formula (descending: fully formula fed, mostly formula fed, mostly breastfed, fully breastfed) and issuance of a CSSF (any, none). Associations between infant feeding (infant formula amount and type) and child diet were evaluated in multivariable generalized estimating equation negative binomial regression models, stratified by child age (12 to <24 mo, 24 to <60 mo).

Results

Any infant formula issuance in the first year of life was adversely associated with subsequent dietary intake. This included 21%-23% higher 100% juice intake at 24 to <60 mo and 11%-13% (at 24 to <60 mo) or 20%-22% (at 12 to <24 mo) lower water intake. CSSF receipt compared with only other infant formula was not consistently associated with subsequent child diet.

Conclusions

Any infant formula amount, but not CSSF receipt compared with other formula types, was associated with less healthful beverage intake patterns among WIC-participating children. WIC nutrition education may have a stronger impact if tailored based on infant feeding practices.

Longer Breastfeeding Duration is Associated With Lower Consumption of Ultraprocessed Foods in a Sample of Spanish Preschoolers: The SENDO Project

BACKGROUND

Breastfeeding has been linked to a higher consumption of fruit and vegetables at ages 4 to 5 years. More recently, it has been suggested that it may also be associated with lower ultraprocessed food (UPF) consumption in childhood.

OBJECTIVE

The aim of this study was to assess whether breastfeeding duration was associated with consumption of UPF in a sample of Mediterranean preschoolers.

DESIGN

This study involved a cross-sectional analysis of baseline information of children in the Child Follow-Up for Optimal Development cohort. Children were enrolled at ages 4 to 5 years and information was gathered through an online questionnaire completed by parents. Dietary information was collected with a previously validated semi-quantitative food frequency questionnaire and foods were classified based on the degree of processing according to the NOVA classification.

PARTICIPANTS/SETTING

This study used baseline information for 806 participants enrolled in the Child Follow-Up for Optimal Development cohort between January 2015 and June 2021 in Spain.

MAIN OUTCOMES MEASURES

Main study outcome measures were difference in grams per day and in the percentage of total energy intake from UPF consumption related to breastfeeding duration, and odds ratio that UPF represents a high percentage of total energy intake.

STATISTICAL ANALYSES

Crude and multivariable adjusted estimates were calculated with generalized estimating equations to account for intracluster correlation between siblings.

RESULTS

The prevalence of breastfeeding in the sample was 84%. After adjusting for potential confounders, children who were breastfed for some time reported significantly lower consumption of UPF than children who were not breastfed at all. The mean differences were -19.2 g (95% CI -44.2 to 10.8) for children who were breastfed for <6 months, -42.5 g (95% CI -77.2 to -7.80) for those who were breastfed for 6 to 12 months, and -43.6 g (95% CI -79.8 to -7.48) for those who were breastfed for 12 months or more (P value for trend = 0.01). After adjusting for potential confounders, compared with children who were not breastfed, those who were breastfed for ≥12 months had consistently lower odds of UPF representing more than 25%, 30%, 35%, and 40% of total energy intake.

CONCLUSIONS

Breastfeeding is associated with lower consumption of UPF in Spanish preschoolers.

Understanding the relationship between orofacial structures and feeding habits of preschoolers: A multivariate analysis

The understanding of the relationship between orofacial structures and feeding habits in preschoolers is helpful for health professionals and those dedicated to food science. The hypothesis tested was whether this relationship is already present even at a very young age. This cross-sectional study included 91 healthy caries-free children (50 girls/41 boys; 3.4-6.2 years; mean 4.1 years) and a comprehensive evaluation of the stomatognathic system was performed: dietary intake, facial and occlusal morphology, gustatory sensitivity, bite and lip forces, and orofacial myofunctional aspects (mastication, swallowing and breathing functions). Principal component analysis summarized the variables related to the form and function of the orofacial aspects; further, K-means analysis identified two clusters of participants with similar aspects. Cluster 1 ("Low orofacial myofunctional functioning"; n = 51) was characterized by children who showed the worst performance of mastication, swallowing and breathing functions and whose parents reported the consumption of sweets, cookies, chocolate, but not fresh fruits the day before, in addition to the higher bottle-feeding and pacifier use duration. This cluster also showed higher sweet taste threshold. Cluster 2 ("High orofacial myofunctional functioning"; n = 40) showed lower bottle-feeding and pacifier use duration, higher gustatory sensitivity, greater maxillo-mandibular dimensions, and better orofacial function performance. The variables sex and BMI did not associate to clusters profile. The frequencies of open bite and current sucking habit (pacifier) also differed between clusters. The results showed that an association between form and function of the structures that comprise the stomatognathic system and dietary intake is already present in children with primary dentition.

Association between breast-feeding exposure and duration with offspring's dietary patterns over 1 year of age: a systematic review of observational studies

Some evidence suggests that breast-feeding may modify food preferences in the later years of life. The present study aimed to provide a systematic review of observational studies investigating the association between exposure to breast milk and its duration with data-driven or hypothesis-driven (or diet quality scores) dietary patterns over 1 year of age. The databases of PubMed, Scopus and Web of Science were searched for observational studies published from January 2010 until July 2021, which led to the identification of twenty-two eligible articles. There was considerable heterogeneity between studies in terms of assessment of exposure and outcome. Of the eleven studies that assessed data-driven dietary patterns, ten reported a significant association for at least one identified dietary pattern. Overall, being breast-fed and a longer duration of any/exclusive breast-feeding were associated with higher scores on healthy dietary patterns characterised mainly by high loadings of fruits, vegetables and whole grains. In comparison, a negative association was found for unhealthy dietary patterns rich in foods with high content of added sugar, salt and saturated fats. In terms of diet quality scores, nine out of eleven studies reported a significant positive association between the duration of any breast-feeding and adherence to recommended healthy diets or dietary guidelines. In conclusion, the evidence from this review was generally in support of the hypothesis indicating breast-feeding is associated with healthy dietary patterns at later ages. However, due to the methodological limitations in the available studies, further research is warranted to elucidate solid evidence on this topic.

Is the duration of breastfeeding associated with eating behavior in early childhood?

INTRODUCTION

Eating behavior can be defined as the relationship between human and food and involves a multifaceted network of genetic and environmental influences. The eating behavior acquired in childhood, when dysfunctional, can affect children's health and seems to influence adult eating behavior. This study aimed to analyze the breastfeeding influence on eating behavior in early childhood.

METHODS

In this longitudinal observational study, data about sociodemographic and breastfeeding practices were collected through questionnaire developed by the researchers and eating behavior was assessed with the Children's Eating Behavior Questionnaire when the children have 3-5 years of age. This instrument was divided into 'food approach' and 'food avoidant' scales, with 'food approach' being linked to overweight/obesity and 'food avoidant' to selectivity.

RESULTS

Data on 107 mother-child pairs were analyzed, of whom 98.1% (n= 105) were breastfed and 46.7% (n= 50) received infant formula. There was a significant association between lower scores in the 'food approach' scale, eating behavior, and total breastfeeding duration > 6 months (p= 0.033), as well, as with exclusive breastfeeding duration > 3 months (p= 0.001). This relationship was confirmed in a linear regression model, after adjusting for sociodemographic variables and infant nutritional status. It was observed that a one-day increase in total breastfeeding and exclusive breastfeeding was associated with a -0.044 decrease in total score on the 'food approach' scale ([95% CI: -0.08; -0.01]; p= 0.027 and [95% CI: -0.08; -0.01]; p= 0.010, respectively).

CONCLUSION

The total and exclusive breastfeeding duration are related to child feeding behavior, while a longer period of breastfeeding can be an influencing factor against 'food approach' scale.

Maternal feeding practices and toddlers' fruit and vegetable consumption: results from the DIT-Coombe Hospital birth cohort in Ireland

Background

Health benefits of fruit and vegetable have been well recognized. However, insufficient consumption of fruit and vegetable is prevalent among toddlers, and has become a global public health issue. Maternal feeding practices are potential factors influencing toddlers’ dietary intake, including fruit and vegetable intake. This study was conducted to explore the influence of maternal feeding practices on toddlers’ fruit and vegetable consumption in Ireland.

Methods

A follow-up to the DIT-Coombe Hospital birth cohort was conducted. Mothers in the original cohort were invited to participate in the present follow-up study by phone. A questionnaire assessing maternal feeding behavior and the child’s 3-day food diary was sent to mothers who agreed to take part in the present study by post, together with a self-addressed stamped envelope.

Results

There were 193 mother-children pairs included in the analysis, and the mean age of children was 2.4 (SD 0.7) years old. Toddlers’ mean daily intakes of vegetable and fruit were 67.57 (SD 45.95) g and 213.35 (SD 170.78) g, respectively. Logistic regression analyses showed that maternal practice of breastfeeding for more than 4 weeks was positively associated with fruit (OR = 2.93, 95% CI: 1.29–6.64) and vegetable (OR = 1.95, 95% CI: 1.00–3.81) intake or the contribution of fruit (OR = 2.62, 95% CI: 1.19–5.80) and vegetable (OR = 2.02, 95% CI: 1.02–3.99) to the total diet. Letting the child eat with other family members was associated with high vegetable intake (OR = 5.45, 95%CI: 1.69–17.61) and high contribution of vegetable to total diet (OR = 3.78, 95% CI: 1.04–13.82). Not being too worried about the child’s refusal to eat was positively associated with toddlers’ vegetable intake (OR = 2.10, 95%CI: 1.09–4.05).

Conclusions

To increase children’s fruit and vegetable intake, and develop good eating habits, parents should eat with their toddlers, be patient and not put much pressure on their children in the context of meal feeding.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12937-021-00743-z.

Towards a More Sustainable Nutrition: Complementary Feeding and Early Taste Experiences as a Basis for Future Food Choices

The concept of sustainable nutrition considers different fields: from human health to environmental, economic and socio-cultural aspects. Currently, in Europe, the diets that reflect the assumptions of the sustainable diet are the Mediterranean Diet and the New Nordic Diet. They both encourage the consumption of vegetable, organic and minimally processed foods, as well as regional, seasonal and Fair-Trade products, reducing the ecological impact of the production chain. These eating habits could be established starting from the prenatal period and from infancy during the complementary feeding stage, aiding children to accept of a more variable diet in terms of flavor, taste and texture. In particular, the positive parental role model is an effective method for improving a child’s diet and behaviors. Two healthy plates representing a sustainable diet in early infancy, at 6 and 24 months, are here proposed, in line with the “Planetary Health Diet” approved by the EAT-Lancet Commission. Our work aims to highlight how a sustainable diet is possible since infancy, since the introduction of solid foods.

Differences in Early Childhood Dietary Behaviors by Infant Feeding Type and Sex

BACKGROUND

Type of infant feeding has been linked to later nutritional outcomes, including dietary diversity and obesity in childhood. Little is known about how introduction to complementary feeding and diet quality in early childhood vary by infant feeding type and sex.

OBJECTIVE

Our objective was to investigate whether early childhood dietary patterns vary by infant feeding type and sex.

METHODS

Data from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Infants and Toddler Feeding Practices Study 2 (ITFPS-2) was used, including children with complete information on the WIC infant food package received at ages 1, 7, and 11 mo (N = 2839). Based on this information, children were grouped as fully breastfed, mostly breastfed, mostly formula fed, and fully formula fed. Outcomes include introduction of complementary foods; caloric intake aged between 1 and 36 mo; and Healthy Eating Index (HEI)-2015 between 13 and 36 mo. Mixed models were used adjusting for child's, mother's, and family's sociodemographic characteristics.

RESULTS

Across all infant feeding groups, the mean age of introduction to any solids was before the age of 6 mo; fully breastfed children were introduced to complementary foods closer to the recommended age (mean 5.1-5.2 mo) compared with other feeding groups (mean 4.6-4.8 mo). Fully formula fed infants consumed significantly more energy than fully breastfed infants at ages 1 mo (boys = 55 kcal/d, girls = 47 kcal/d), 12 mo (boys = 68 kcal/d, girls = 59 kcal/d), 24 mo (boys = 81 kcal/d, girls = 71 kcal/d), and 36 mo (boys = 95 kcal/d, girls = 83 kcal/d). No meaningful differences were observed for HEI-2015 between infant feeding groups or child sex, with average scores of HEI-2015 for all children being 61-63 out of 100.

CONCLUSION

Early childhood dietary patterns were slightly better among children who were fully breastfed as infants, compared with children in other infant feeding groups. The diets of all WIC-participating children could be improved.

High intake of added sugars is linked to rapid weight gain in infancy, breastfeeding ≥12 months may protect against this: A preliminary investigation

BACKGROUND

Consumption of added sugars is linked to excess adiposity in older age groups and breastfeeding has been shown to protect against later obesity.

OBJECTIVES

This investigation aimed to determine whether intake of added sugars associates with rapid weight gain in individuals under 2 years of age, if intake of added sugars associates with breastfeeding duration, and how both influence body weight.

METHODS

A cross-sectional analysis of data from three 24-hours dietary recalls collected from 141 infants/toddlers (age 11.9 ± 1.9 months, 44.7% male) was performed. Multivariable regressions assessed relationships between added sugar intakes, breastfeeding duration, and weight status. Hierarchical regressions examined added variance accounted for in rapid weight gain (specifically, upward weight-for-age percentile [WFA %tile] crossing) through the interaction of added sugars * breastfeeding duration.

RESULTS

Added sugars correlated positively with upward WFA %tile crossing (r = 0.280, P < .001) and negatively with breastfeeding duration (r = -0.468, P < .001). Consumption of added sugars was a significant predictor of rapid weight gain when breastfeeding duration was short (<12 months, β = 0.020, P = .029), but not long (≥12 months, β = 0.001, P = .875).

CONCLUSIONS

A high intake of added sugars in individuals below age 2 associates with rapid weight gain, though breastfeeding ≥12 months appears protective against this. Further studies are necessary to substantiate these findings and provide insight into underlying mechanisms.

Breastfeeding duration in infancy and dietary intake in childhood and adolescence

Although several studies have focused on associations between breastfeeding and child obesity, few have focused on associations with dietary intake. We examined associations between breastfeeding duration in infancy and dietary intake in childhood and explored whether associations are still observed in adolescence. The QUALITY (QUebec Adipose and Lifestyle InvesTigation in Youth) cohort includes 630 children aged 8-10 years at baseline (T1) who have at least one parent with obesity. A follow-up assessment was done 7 years later (T2) when participants were aged 15-17 years (n=377). Non-exclusive breastfeeding duration was evaluated at T1 using a parent questionnaire (never, < 3 months, 3-6 months, > 6 months). Dietary intake was assessed at T1 and T2 using three 24-h diet recalls, namely daily servings of vegetables (≥ 2 vs < 2), fruits (≥ 2 vs < 2), vegetables and fruits combined (≥ 5 vs < 5), sugar-sweetened beverages (SSB) (none vs any), and an overall diet quality index (DQI-I) (good vs poor). Multiple logistic regressions, adjusted for age, sex and total kilocalorie intake of the child, for age and body mass index of the mother, and for parental education and income were used. Compared to children breastfed > 6 months (reference group), those never breastfed or breastfed for 3-6 months were 42% (OR = 0.58, 95% CI: 0.34-0.96) and 38% (OR = 0.62, 95% CI: 0.39-1.00) less likely to consume ≥ 2 servings of vegetables per day at 8-10 years, respectively, while no association was found for those breastfed < 3 months. Compared to children breastfed > 6 months, those never breastfed were 1.8 times more likely to drink any SSB (OR = 1.82, 95% CI: 1.03-3.22). No associations were found for other diet indicators, and associations observed in childhood were no longer found by adolescence. In this cohort, breastfeeding was associated with greater vegetable intake and the avoidance of SSB in childhood, but not in adolescence, nor were associations found for fruit intake or overall diet quality.

Breastfeeding and caring for children: a qualitative exploration of the experiences of mothers with physical impairments in Ghana

Background

Breastfeeding and caring for children demand time, energy and effort. Mothers with physical impairments in Ghana require special needs to be able to achieve optimal motherhood as society demands. Globally, literature on breastfeeding and caring for children among mothers with physical disabilities is limited. Similarly, there is dearth of literature on the experiences of mothers with physical impairments in Ghana. Therefore, this study sought to add to literature by exploring the experiences of mothers with physical impairments with regards to breastfeeding and how they care for their children.

Methods

Qualitative descriptive exploratory design was used. Twelve mothers with physical impairments who had been purposively sampled gave informed consent before data was collected through in-depth one-on-one interviews. Data was recorded, transcribed and analyzed inductively using the content analysis technique.

Results

Mothers with physical impairments perceived breastfeeding as difficult and expensive due to issues relating to disruption of sleep, dysfunctional limbs and the need for breastfeeding mothers to eat nutritionally balanced meals. Participants felt prejudged and discriminated at different points in their daily encounters.

Conclusion

Mothers with physical impairments have challenges. Therefore, attitudinal change should be advocated in the Ghanaian society with respect to issues concerning people living with disabilities.

Analysis of Association between Breastfeeding and Vegetable or Fruit Intake in Later Childhood in a Population-Based Observational Study

Vegetable and fruit consumption in childhood remains below recommendations in many countries. As the intake of fruit and/or vegetables during childhood in a few studies was associated with breastfeeding, it may be suggested as a serious interfering factor while analyzing the association between breastfeeding and its long-term health effects. Thus, it may be important for creation and implementation of effective public health programs. The aim of this study was to evaluate the association between breastfeeding and consumption of fruit or vegetables in later childhood. The study was conducted within the Project “ABC of Healthy Eating—ABC of Kids and Parents” among a representative sample of 703 pairs of mothers and children aged 7–12 years in Poland. A systematic purposive-quota selection according to gender, age, place of residence, and region of Poland was applied. The study was conducted by interviewers in the respondents’ homes in 2017. Logistic regression analysis was conducted, and models adjusted for children’s age, BMI centile and gender, maternal education, employment status, and economic situation, as well as for EU–28 average Gross Domestic Product (GDP) region. Almost 86% of children were ever breastfed. Vegetables for breakfast, second breakfast, dinner, supper, and between meals were consumed by 23.9%, 18.6%, 47.4%, 26.7%, and 4.0% of children, whereas fruit was consumed by 13.9%, 46.1%, 7.7%, 12.9%, and 59.7% of children, respectively. Breastfeeding for a period of 4–6 months increased the chance of vegetable consumption for breakfast in the whole group (aOR 3.80, 95% CI 1.90–7.59, p ≤ 0.001) and particularly in girls (aOR 4.60, 95% CI 1.43–14.75, p ≤ 0.01) when compared to boys (aOR 3.17, 95% CI 1.32–7.63, p ≤ 0.01). Longer duration of breastfeeding (over 12 months) increased the chance of vegetable consumption for dinner in the total group (aOR 2.36, 95% CI 1.30–4.26, p ≤ 0.01) and particularly in girls (aOR 3.04, 95% CI 1.24–7.46, p ≤ 0.01) when compared to boys (aOR 2.20, 95% CI 1.01–4.95, p ≤ 0.05). We showed a positive association between breastfeeding and vegetable consumption for breakfast and dinner among children aged 7–12 years. These associations were gender-specific (stronger among girls) and were not diminished by socio-demographic factors.

Breastfeeding reduces ultra-processed foods and sweetened beverages consumption among children under two years old

BACKGROUND

Breastfeeding and adequate complementary feeding are associated with healthy eating habits, prevention of nutritional deficiencies, obesity and non-communicable diseases. Our aim was to identify feeding practices and to evaluate the association between breastmilk intake and complementary feeding, focusing on ultra-processed foods (UPF) and sweetened beverages, among children under 2 years old.

METHODS

We conducted a cross-sectional study including 847 children from 20 Primary Health Units. We evaluated children's food consumption using a food intake markers questionnaire. We conducted a logistic regression to evaluate the effect of breastmilk intake on feeding practices.

RESULTS

The breastmilk intake was associated with lower odds of consuming non-recommended foods, such as cookies or crackers (OR: 0.29; IC 95%: 0.20-0.41) for children under 6 months, yogurt (OR: 0.33; CI 95%: 0.12-0.88) for children between 6 and 12 months and soft drinks (OR: 0.36; CI 95%: 0.17-0.75) for children between 12 and 24 months. Moreover, the breastmilk intake was associated with lower odds of consuming UPF (OR: 0.26; CI 95%: 0.09-0.74) and sweetened beverages (OR: 0.13; CI 95%: 0.05-0.33) for children under 6 months. For children between 12 and 24 months, breastmilk intake was associated with lower odds of consuming sweetened beverages (OR: 0.40; CI 95%: 0.24-0.65).

CONCLUSION

Breastmilk intake was associated with a reduced consumption of UPF and sweetened beverages. Investment in actions to scale up breastfeeding can generate benefits, besides those of breastmilk itself, translating into better feeding habits and preventing health problems in childhood.

Relação entre os tipos de aleitamento materno e o consumo de vitamina A e ferro em crianças de 6 a 12 meses

Resumo O objetivo deste artigo é analisar a associação entre o tipo de aleitamento no primeiro semestre de vida e o consumo de vitamina A e ferro do 6º ao 12º mês. Estudo de coorte com 226 crianças. Avaliou-se o tipo de aleitamento do 1º ao 6º mês de vida e o consumo alimentar do 6º ao 12º mês. O consumo de nutrientes entre os grupos foi comparado pelo teste Kruskal-Wallis. A análise da associação entre o consumo de nutrientes e o tipo de aleitamento se deu pela Regressão de Poisson. O consumo abaixo da recomendação de vitamina A e ferro foi de 33,6% e 67,7%, respectivamente. Crianças amamentadas de maneira exclusiva e predominante no 1º e 2º mês tiveram maior ingestão de vitamina A do 6º ao 12º mês de vida. Já as que estavam em aleitamento materno no 6º mês tiveram maior ingestão de vitamina A e menor de ferro na análise bivariada. O grupo que recebeu aleitamento materno misto e artificial no 1º mês e os não amamentados no 6º mês tiveram consumo de vitamina A abaixo do recomendado do 6º ao 12º mês de vida. Os resultados reforçam a importância do aleitamento materno exclusivo nos seis primeiros meses de vida, contribuindo para o maior consumo de vitamina A. O consumo de ferro foi menor entre as crianças amamentadas, porém, a biodisponibilidade desse nutriente no leite materno é maior.

Appropriate age range for introduction of complementary feeding into an infant's diet

Following a request from the European Commission, the Panel on Nutrition, Novel Foods and Food Allergens (NDA) revised its 2009 Opinion on the appropriate age for introduction of complementary feeding of infants. This age has been evaluated considering the effects on health outcomes, nutritional aspects and infant development, and depends on the individual's characteristics and development. As long as foods have an age-appropriate texture, are nutritionally appropriate and prepared following good hygiene practices, there is no convincing evidence that at any age investigated in the included studies (< 1 to < 6 months), the introduction of complementary foods (CFs) is associated with adverse health effects or benefits (except for infants at risk of iron depletion). For nutritional reasons, the majority of infants need CFs from around 6 months of age. Infants at risk of iron depletion (exclusively breastfed infants born to mothers with low iron status, or with early umbilical cord clamping (< 1 min after birth), or born preterm, or born small-for-gestational age or with high growth velocity) may benefit from earlier introduction of CFs that are a source of iron. The earliest developmental skills relevant for consuming pureed CFs can be observed between 3 and 4 months of age. Skills for consuming finger foods can be observed in some infants at 4 months, but more commonly at 5-7 months. The fact that an infant may be ready from a neurodevelopmental perspective to progress to a more diversified diet before 6 months of age does not imply that there is a need to introduce CFs. There is no reason to postpone the introduction of potentially allergenic foods (egg, cereals, fish and peanut) to a later age than that of other CFs as far as the risk of developing atopic diseases is concerned. Regarding the risk of coeliac disease, gluten can be introduced with other CFs.

Analysis of Fruit and Vegetable Consumption by Children in School Canteens Depending on Selected Sociodemographic Factors

Background and Objectives: Eating habits acquired or changed during childhood are likely to track into adulthood. Due to the fact that nutritional behaviours are not so strongly formed among children, it is easier to change and develop them in children than in adults. The aim of this study was to assess the impact of selected sociodemographic factors affecting fruit and vegetable consumption (i.e., age, parents' body mass index, parents' level education, duration of breastfeeding, child's time spent in front of computer/television) among children in school canteens. Materials and Methods: The sample consisted of 106 participants (52 girls, 54 boys) aged 6-12. The frequency of consuming fruits and vegetables at a school canteen was assessed using bar code cards for two weeks. Body composition estimates were obtained using a foot-to-foot bioelectrical impedance analysis, body height was measured using a stadiometer Seca 213. The questionnaire contained questions about selected factors which can have an influence on fruit and vegetable consumption. In the study group, 13.2% of participants were overweight and 17.9% were obese. Results: Our results showed a statistically significant relationship between age and fruit and vegetable consumption, and it increased with age in both sexes. Conclusions: Bearing in mind the various conditions discussed when shaping the eating habits of pre-school- and early-school-aged children, the importance of proper nutritional education should be stressed both among children and parents.

Maternal diet during lactation and breast-feeding practices have synergistic association with child diet at 6 years

OBJECTIVE

Children breast-fed during infancy consume more fruits and vegetables than formula-fed children. This pattern is likely due, in part, to infant learning from flavours of the mother's diet transmitted through breast milk, but more research is needed to understand associations between early flavour exposures and later dietary patterns. We examined whether breast-feeding and maternal fruit and vegetable consumption during nursing were synergistically associated with higher child fruit and vegetable consumption.

DESIGN

Prospective cohort study of breast-feeding duration, maternal diet postpartum and child diet. Complete breast-feeding and maternal diet data were available for 1396 mother-child dyads; multiple imputation was used for missing data in other variables. In separate multivariable logistic regression models, we estimated the adjusted odds of high child fruit or vegetable consumption at 12 months or 6 years as a function of breast-feeding duration, maternal fruit or vegetable consumption during nursing, and their interaction.

SETTING

The Infant Feeding Practices Study II and Year 6 Follow-Up.

PARTICIPANTS

Mother-child dyads followed from birth to 6 years during 2005-2012 in the USA.

RESULTS

Longer breast-feeding duration was associated with high child fruit and vegetable consumption at 12 months. At 6 years, the interaction between breast-feeding duration and maternal vegetable consumption was associated with high child vegetable consumption.

CONCLUSIONS

Higher maternal vegetable consumption and longer breast-feeding duration were synergistically associated with high child vegetable consumption at 6 years, independent of sociodemographic characteristics and fruit and vegetable availability. Exposures to vegetable flavours through breast milk may promote later child vegetable consumption.

Association of Infant Feeding Patterns with Taste Preferences in European Children and Adolescents: A Retrospective Latent Profile Analysis

The aim was to investigate associations between the duration of infant feeding practices (FP) and taste preferences (TP) in European children and adolescents. A total of 5526 children (6-16 years old) of the I.Family study completed a Food and Beverage Preference Questionnaire to measure their preferences for sweet, fatty and bitter tastes. Mothers retrospectively reported the FPs duration in months: exclusive breastfeeding (EBF), exclusive formula milk feeding (EFMF), combined breastfeeding (BF&FMF) and the age at the introduction of complementary foods (CF). Using logistic regression analyses and latent class analysis (latent profiles of FP and CF were identified), we explored associations between profiles and TP, adjusting for various covariates, including the Healthy Diet Adherence Score (HDAS). A total of 48% of children had short durations of EBF (≤4 months) and BF&FMF (≤6 months) and were introduced to CF early (<6 months). No significant relationship was observed between the single FPs and TP, even when considering common profiles of FP. HDAS was inversely associated with sweet and fatty TP, but positively with bitter TP. Contrary to our hypotheses, we did not observe associations between FP and children's TP later in life. Further studies with higher FP variation and longitudinal design are needed to investigate the causal associations between infant FP and taste preferences later in life.

Home environment predictors of vegetable and fruit intakes among Australian children aged 18 months

Suboptimal vegetable and fruit consumption by young children is common. Identifying predictors of vegetable and fruit intakes is important for informing strategies to promote sufficient intakes of these foods from early life. The aim of the present study was to examine predictors of toddlers' vegetable and fruit intakes at age 18 months. This study involved secondary analysis of data from 361 child-mother dyads participating in the Melbourne Infant Feeding, Activity and Nutrition Trial in 2008-2010 at child ages four, nine and 18 months. Children's vegetable and fruit intakes were assessed at age 18 months using multiple 24-h dietary recalls. Data on potential predictor measures were collected via parent-completed questionnaires when children were four or nine months of age. Bivariate and multivariable linear regression models were used to test associations between children's average daily vegetable or fruit intake and potential predictors controlling for treatment arm and clustering by parent group. Multivariable models also controlled for covariates and potential confounders. Home availability of vegetables at age nine months was found to predict children's vegetable intake at age 18 months and remained significant (β = 20.19, 95% CI:7.23, 33.15, p = 0.003) in the multivariable model. Children's average daily fruit intake at age 18 months was predicted by maternal education at child age four months and the availability of fruits in their home at child age nine months. Maternal education remained significant (β = 30.83, 95% CI:12.17, 49.48, p = 0.002) in the multivariable model. Strategies to promote adequate vegetable and fruit intakes among young children should address known barriers to the availability of vegetables and fruits in the home from early in life. Additionally, messages encouraging fruit consumption may need to be tailored to mothers with lower levels of education.

Breast-feeding duration and child eating characteristics in relation to later vegetable intake in 2-6-year-old children in ten studies throughout Europe

OBJECTIVE

Breast-feeding is thought to facilitate young children's acceptance of new foods, including vegetables, but the evidence for this relationship appears inconsistent across studies. Increasing children's vegetable intake remains challenging; therefore the present study aimed to investigate whether breast-feeding duration predicts vegetable intake in 2-6-year-old children.

DESIGN

Actual vegetable intake was measured in studies across three European countries. General linear model analyses with breast-feeding duration, sex and age of the child and maternal education as variables were used to predict children's vegetable intake per country. Additionally, the relationships between child eating behaviour characteristics (asked through the Child Eating Behaviour Questionnaire) and vegetable intake were investigated via Pearson correlations.

SETTING

Daycare centres, schools and home settings in Denmark, Greece and the Netherlands.

SUBJECTS

Children aged 2-6 years (n 750).

RESULTS

Breast-feeding duration was positively associated with children's vegetable intake at 2-6 years old in Denmark (P<0·01) and the Netherlands (P<0·05), but not in Greece (P=0·17). Age of the child, maternal education and sex of the child did not predict vegetable intake in our sample. All countries showed an inverse relationship between food neophobia and children's vegetable intake and a positive relationship between vegetable liking and intake.

CONCLUSIONS

The present study found that breast-feeding duration is a predictor of later vegetable intake, but that current child eating behaviour characteristics, such as vegetable liking, food neophobia and enjoyment of food, also influence vegetable intake. Besides encouragement of breast-feeding duration, strategies that support vegetable liking and food enjoyment and decrease food neophobia are needed to support young children's vegetable intake.

Duration of exclusive breastfeeding may be related to eating behaviour and dietary intake in obesity prone normal weight young children

Infants who are breastfed are introduced to a variety of flavours from the maternal milk, and thus the transition from maternal milk to complementary foods may be easier for these children. The aim of this study was to investigate if duration of exclusive breastfeeding was associated with pickiness or dietary intake of vegetables, fruit, starchy foods or sugar sweetened beverages among obesity prone normal weight children aged 2–6 years. This cohort study was based on data from the Healthy Start primary intervention study, the Danish Medical Birth registry and the Danish Health Visitor’s Child Health Database. Infant feeding was registered by health nurses while home-visiting the mother and child up to four times within the first year. Information on eating behaviour and diet intake at age 2–6 years was obtained by parents. Crude and adjusted logistic and general linear regression models were used to investigate associations. A total of 236 children had complete information on all variables. Data showed lower odds of picky eating behaviour when exclusively breastfed until age 4–5 months compared to exclusively breastfed for 0–1 months (OR = 0.35, 95CI = 0.16;0.76, p = 0.008). In the crude analysis only, exclusively breastfed until age 6–10 months was associated with a higher daily intake of vegetables (p = 0.04). This study suggests that exclusive breastfeeding duration seems to influence pickiness and may contribute to facilitate the consumption of more vegetables in later childhood in obesity prone normal weight children.

The Development and Public Health Implications of Food Preferences in Children

Food preferences are a primary determinant of dietary intake and behaviors, and they persist from early childhood into later life. As such, establishing preferences for healthy foods from a young age is a promising approach to improving diet quality, a leading contributor to cardiometabolic health. This narrative review first describes the critical period for food preference development starting in utero and continuing through early childhood. Infants’ innate aversion to sour and bitter tastes can lead them to initially reject some healthy foods such as vegetables. Infants can learn to like these foods through exposures to their flavors in utero and through breastmilk. As solid foods are introduced through toddlerhood, children’s food preferences are shaped by parent feeding practices and environmental factors such as food advertising. Next, we discuss two key focus areas to improve diet quality highlighted by the current understanding of food preferences: (1) promoting healthy food preferences through breastfeeding and early exposures to healthy foods and (2) limiting the extent to which innate preferences for sweet and salty tastes lead to poor diet quality. We use an ecological framework to summarize potential points of intervention and provide recommendations for these focus areas, such as worksite benefits that promote breastfeeding, and changes in food retail and service environments. Individuals’ choices around breastfeeding and diet may ultimately be influenced by policy and community-level factors. It is thus crucial to take a multilevel approach to establish healthy food preferences from a young age, which have the potential to translate into lifelong healthy diet.

Early feeding practices and consumption of ultraprocessed foods at 6 y of age: Findings from the 2004 Pelotas (Brazil) Birth Cohort Study

Objective

The aim of this study was to examine the association between early feeding practices and consumption of ultraprocessed foods in children at age 6 y.

Methods

This was a prospective cohort study using data from 3427 children who participated in the 2004 Pelotas Cohort Study and who had available food frequency questionnaire information at 6 y. Information about exclusive and total breastfeeding duration as well as age at introduction of semisolid and solid foods was used to define early feeding practices. Consumption of ultraprocessed foods was defined as proportion of total daily energy intake that came from ultraprocessed foods at age 6 y. Crude and adjusted linear regression models were employed to analyze the effect of early feeding practices on ultraprocessed foods consumption.

Results

It was determined that 40.3% of total daily energy intake at 6 y came from ultraprocessed foods. In crude linear regression models, early feeding practices (exclusive and total breastfeeding duration, and age at introduction of semisolid and solid foods) were negatively associated with ultraprocessed foods consumption. After adjustment, only exclusive breastfeeding duration and age at introduction of solid foods remained associated with consumption of ultraprocessed foods, although the observed effects size was small. Children exclusively breastfed for ≥3 mo and those who had solid foods introduced at ≥4 mo consumed a lower proportion of daily energy intake from ultraprocessed foods.

Conclusion

This study supports the need to promote healthy early feeding practices including the support of breastfeeding to promote healthier eating habits later in childhood.

•

Newborn infants from southern Brazil were followed up in infancy and childhood.

•

Breastfeeding duration and timing of introduction of foods were recorded.

•

Ultraprocessed food intake was evaluated by a food frequency questionnaire.

•

Introduction of solid foods was related with consumption of ultraprocessed foods.

•

Longer exclusively breastfed infants had lower ultraprocessed food consumption later.

[Effect of a healthy eating intervention on compliance with dietary recommendations in the first year of life: a randomized clinical trial with adolescent mothers and maternal grandmothers]

The objective was to evaluate the effect of a healthy eating intervention targeting adolescent mothers and maternal grandmothers on compliance with dietary recommendations in the first year of life. This was a randomized clinical trial involving 320 adolescent mothers, their infants, and 169 maternal grandmothers (when the three generations were living together), randomly assigned to the intervention versus control group. The intervention consisted of six counseling sessions on healthy feeding during the child's first year of life, the first of which held at the maternity ward and the others at 7, 15, 30, 60, and 120 days, at the homes. Information on the infant's diet was obtained monthly during the first 6 months and then every 2 months until the child reached 12 months of age, using a Food Frequency Questionnaire, in addition to questions on mealtimes, consistency of the foods, hygiene, preparation of meals, conservation of foods, and the mother's or grandmother's approach to the child's diet in the presence of illness. The outcome was defined as meeting the Ten Steps to a Healthy Diet: A Food Guide for Children Under Two Years Old, assessed by a score. The mean sum of the scores for each step obtained in the intervention group was higher than in the control group; the intervention doubled the odds of the total score being greater than or equal to the median. Living with grandmother did not influence the score either in the intervention group or the control group. The proposed intervention had a positive effect on meeting the Ten Steps, independently of participation by the maternal grandmother, showing that educational interventions can improve quality of diet for children in the first year of life.

INSIGHT responsive parenting intervention is associated with healthier patterns of dietary exposures in infants

OBJECTIVE

To determine whether a responsive parenting (RP) intervention affects infant dietary patterns.

METHODS

Primiparous mother-newborn dyads (n = 291) were randomized to the Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) RP intervention or control. Curricula were delivered at nurse home visits at ages 3, 16, 28, and 40 weeks. RP group feeding guidance advised responsive feeding, delayed introduction of solids, repeated exposure to novel foods, and age-appropriate portion sizes. Latent class analysis identified patterns of dietary exposure at 9 months. Class membership at 9 months was used to predict BMI percentile at 2 years.

RESULTS

Five dietary patterns were identified: "Breastfed, Fruits and Vegetables," "Breastfed, Low Variety," "Formula, Fruits and Vegetables," "Formula, Low Variety," and "Formula, High Energy Density." Over 60% of infants had patterns low in fruits and vegetables or high in energy-dense foods. RP group infants were less likely than control to be in the "Formula, Low Variety" class (OR = 0.40, 95% CI 0.23-0.71) or "Formula, High Energy Density" class (OR = 0.28, 95% CI 0.12-0.61) relative to the "Formula, Fruits and Vegetables" class. Dietary pattern at 9 months was significantly associated with BMI percentile at 2 years.

CONCLUSIONS

While a majority of infants consumed diets low in fruits and vegetables, the INSIGHT RP intervention was associated with healthier dietary patterns.

Adherence to dietary recommendations for preschoolers: clinical trial with teenage mothers

OBJECTIVE

To assess the effect of educational dietary intervention offered in the child’s first year of life, as well as teenage mothers and grandmothers in carrying out the dietary recommendations at four to seven years.

METHODS

Randomized clinical trial initiated in 2006, in Porto Alegre, RS, involving 323 teenage mothers and grandmothers who cohabited. The intervention consisted of six counseling sessions on breastfeeding and healthy complementary feeding. The first session occurred in the maternity ward and the other ones in the households of mothers at seven, 15, 30, 60, and 120 days of the child’s life. The information about the child’s diet were obtained on a monthly basis in the first six months, every two months in the second half-year, and at four to seven years, using a food frequency questionnaire. To assess the adequacy of food consumption to the recommendations from the Ministry of Health, we elaborated a score system that would reflect the compliance with the Ten Steps for Healthy Toddlers from 2 to 10 Years. The average scores of intervention and control groups were compared using the t-test.

RESULTS

Low adherence to recommendations on child nutrition was found in the study population, with no difference in implementation the steps between the groups. The score on the compliance with the steps was similar in both groups (9.6 [SD = 1.63] and 9.3 [SD = 1.60] in the intervention and control groups, respectively) and no influence of the cohabitation with the grandmother was found.

CONCLUSIONS

Educational dietary intervention in the first four months of the child’s life for teenage mothers and grandmothers had no effect on the compliance with the recommendations at four to seven years of the child’s life.

Complementary Feeding Strategies to Facilitate Acceptance of Fruits and Vegetables: A Narrative Review of the Literature

Complementary feeding (CF), which should begin after exclusive breastfeeding for six months, according to the World Health Organization (WHO), or after four months and before six months according to the European Society for Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN), is a period when the infant implicitly learns what, when, how, and how much to eat. At the onset of CF, the brain and the gut are still developing and maturing, and food experiences contribute to shaping brain connections involved in food hedonics and in the control of food intake. These learning processes are likely to have a long-term impact. Children’s consumption of fruit and vegetables (FV) is below recommendations in many countries. Thus, it is crucial to establish preferences for FV early, when infants are learning to eat. The development of food preferences mainly starts when infants discover their first solid foods. This narrative review summarizes the factors that influence FV acceptance at the start of the CF period: previous milk feeding experience; timing of onset of CF; repeated exposures to the food; variety of foods offered as of the start of the CF period; quality and sensory properties of the complementary foods; quality of the meal time context; and parental responsive feeding.

Factors associated with sugar intake and sugar sources in European children from 1 to 8 years of age

BACKGROUND/OBJECTIVES

The World Health Organization recommends to limit intake of free sugars to 5% of total energy per day because of the great impact of high sugar intake on body fat deposition, adiposity and dental caries. However, little data exist about total intake and sources of sugar in European children. Therefore, this paper aims to describe sugar intake and dietary sugar sources and associated factors.

SUBJECTS/METHODS

Three-day weighed dietary records were obtained at eight time points from children 1 to 8 years of age (n=995) in five European countries. Food items were classified into subgroups according to food composition. Linear mixed models were used to examine associated factors.

RESULTS

Total sugar intake increased from 65 g/day (30.0% of energy intake (E%)) at 12 months of age to 83 g/day (20.9 E%) at 96 months of age. Around 80% of children's sugar intake was derived from the following sources: milk and dairy products, fruits and fruit products, confectionary and sugar sweetened beverages (SSB). Total sugar intake and dietary sugar sources varied significantly by country of residence. Boys had a significantly (P=0.003) higher total sugar consumption than girls.SSB consumption was significantly higher in children from young mothers while sugar intake from fruit products was lower in children from mothers with lower educational status and those with higher birth order.

CONCLUSIONS

Sugar intake in our population was lower than in other studies. Total sugar intake was associated with country of residence and gender, while dietary sugar sources varied by country of residence, maternal age, education and birth order.

Tracking of toddler fruit and vegetable preferences to intake and adiposity later in childhood

This study examined whether toddlers' liking for fruit and vegetables (FV) predicts intake of FV later in childhood, how both relate to childhood adiposity and how these were moderated by factors in infancy. Children in the Gateshead Millennium Study were recruited at birth in 1999-2000. Feeding data collected in the first year were linked to data from a parental questionnaire completed for 456 children at age 2.5 years (30 m) and to anthropometry, skinfolds and bioelectrical impedance and 4-day food diary data collected for 293 of these children at age 7 years. Aged 30 months, 50% of children were reported to like eight different vegetables and three fruits, but at 7 years, children ate a median of only 1.3 (range 0-7) portions of vegetables and 1.0 portion of fruit (0-4). Early appetite, feeding problems and food neophobia showed significant univariate associations with liking for FV aged 30 m, but the number of vegetables toddlers liked was the only independent predictor of vegetable consumption at age 7 years (odds ratio (OR) 1.28 p < 0.001). Liking for fruit aged 30 m also independently predicted fruit intake (OR = 1.31, p = 0.016), but these were also related to deprivation (OR = 2.69, p = 0.001) maternal education (OR = 1.28, p = 0.039) and female gender (OR = 1.8, p = 0.024). Children eating more FV at age 7 years had slightly lower body mass index and skinfolds. An early liking for FV predicted increased later intake, so increasing early exposure to FV could have long term beneficial consequences.

The Lasting Influences of Early Food-Related Variety Experience: A Longitudinal Study of Vegetable Acceptance from 5 Months to 6 Years in Two Populations

Children's vegetable consumption falls below current recommendations, highlighting the need to identify strategies that can successfully promote better acceptance of vegetables. Recently, experimental studies have reported promising interventions that increase acceptance of vegetables. The first, offering infants a high variety of vegetables at weaning, increased acceptance of new foods, including vegetables. The second, offering an initially disliked vegetable at 8 subsequent meals markedly increased acceptance for that vegetable. So far, these effects have been shown to persist for at least several weeks. We now present follow-up data at 15 months, 3 and 6 years obtained through questionnaire (15 mo, 3y) and experimental (6y) approaches. At 15 months, participants who had been breast-fed were reported as eating and liking more vegetables than those who had been formula-fed. The initially disliked vegetable that became accepted after repeated exposure was still liked and eaten by 79% of the children. At 3 years, the initially disliked vegetable was still liked and eaten by 73% of the children. At 6 years, observations in an experimental setting showed that children who had been breast-fed and children who had experienced high vegetable variety at the start of weaning ate more of new vegetables and liked them more. They were also more willing to taste vegetables than formula-fed children or the no or low variety groups. The initially disliked vegetable was still liked by 57% of children. This follow-up study suggests that experience with chemosensory variety in the context of breastfeeding or at the onset of complementary feeding can influence chemosensory preferences for vegetables into childhood.

Effect of Pattern and Duration of Breastfeeding on the Consumption of Fruits and Vegetables among Preschool Children

Background

The duration and pattern of breastfeeding can influence the consumption of fruits and vegetables in later childhood.

Objective

To investigate the association between pattern and duration of breastfeeding and consumption of fruits and vegetables in children aged between 4 and 7 years.

Methods

We conducted a secondary analysis using data from a former randomized clinical trial with 323 adolescent mothers, their children, and maternal grandmothers, when they cohabited. Information on infant feeding was collected monthly during the first 6 months of life, every two months until the child was 1 year old over and when children were between 4 and 7 years old. The associations between duration of breastfeeding and exclusive breastfeeding and consumption of fruits and vegetables were tested by a logistic regression model.

Results

Approximately 60% and 45% of children consumed fruits and vegetables, respectively, five or more times a week. Consumption of vegetables among 4-7-year-old children was higher in children who were breastfed for 12 months or longer (OR 2.7; 95%CI 1.49–4.93); however, exclusive breastfeeding duration did not have a significant association with consumption of vegetables (OR 1.5; 95%CI 0.70–3.04). There was no association between weekly consumption of fruits and duration of breastfeeding (OR 1.3; 95%CI 0.71–2.30) or exclusive breastfeeding (OR 0.7; 95%CI 0.34–1.44).

Conclusions

Longer duration of breastfeeding was positively associated with consumption of vegetables in children aged 4–7 years; however, there was no association with consumption of fruits. Exclusive breastfeeding duration did not have influence on consumption of fruits or vegetables.

Increasing vegetable intakes: rationale and systematic review of published interventions

Purpose

While the health benefits of a high fruit and vegetable consumption are well known and considerable work has attempted to improve intakes, increasing evidence also recognises a distinction between fruit and vegetables, both in their impacts on health and in consumption patterns. Increasing work suggests health benefits from a high consumption specifically of vegetables, yet intakes remain low, and barriers to increasing intakes are prevalent making intervention difficult. A systematic review was undertaken to identify from the published literature all studies reporting an intervention to increase intakes of vegetables as a distinct food group.

Methods

Databases—PubMed, PsychInfo and Medline—were searched over all years of records until April 2015 using pre-specified terms.

Results

Our searches identified 77 studies, detailing 140 interventions, of which 133 (81 %) interventions were conducted in children. Interventions aimed to use or change hedonic factors, such as taste, liking and familiarity (n = 72), use or change environmental factors (n = 39), use or change cognitive factors (n = 19), or a combination of strategies (n = 10). Increased vegetable acceptance, selection and/or consumption were reported to some degree in 116 (83 %) interventions, but the majority of effects seem small and inconsistent.

Conclusions

Greater percent success is currently found from environmental, educational and multi-component interventions, but publication bias is likely, and long-term effects and cost-effectiveness are rarely considered. A focus on long-term benefits and sustained behaviour change is required. Certain population groups are also noticeably absent from the current list of tried interventions.

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.

The Effect of a Pro-Breastfeeding and Healthy Complementary Feeding Intervention Targeting Adolescent Mothers and Grandmothers on Growth and Prevalence of Overweight of Preschool Children

Introduction

The pattern and duration of breastfeeding (BF) and the age at onset of complementary feeding, as well as its quality, have been associated with the prevalence of overweight in childhood.

Objective

To assess the effect of a pro-BF and healthy complementary feeding intervention, targeted to adolescent mothers and maternal grandmothers, on growth and prevalence of overweight and obesity in children at preschool age. This intervention had a positive impact on duration of BF and timing of onset of complementary feeding.

Methods

This randomized clinical trial involved 323 adolescent mothers, their infants, and the infants’ maternal grandmothers, when they cohabited. Mothers and grandmothers in the intervention group received counseling sessions on BF and healthy complementary feeding at the maternity ward and at home (7, 15, 30, 60, and 120 days after delivery). When children were aged 4 to 7 years, they underwent anthropometric assessment and collection of data on dietary habits. Multivariable Poisson regression with robust estimation was used for analysis.

Results

BMI-for-age and height-for-age were similar in the intervention and control groups, as was the prevalence of overweight (39% vs. 31% respectively; p=0.318). There were no significant between-group differences in dietary habits.

Conclusion

Although the intervention prolonged the duration of exclusive BF and delayed the onset of complementary feeding, it had no impact on growth or prevalence of overweight at age 4 to 7 years.

Trial Registration

ClinicalTrials.gov NCT00910377

Feeding practices in early life and later intake of fruit and vegetables among Japanese toddlers: the Osaka Maternal and Child Health Study

OBJECTIVE

A growing body of evidence from Western countries shows that infant feeding practices are associated with later childhood dietary habits, but little is known about these relationships in non-Western countries with different food cultures. We examined the association of breast-feeding duration and age at introduction of solid foods with later intake of fruit and vegetables among Japanese toddlers.

DESIGN

Information on breast-feeding duration, age at introduction of solid foods and child's intake frequency of fruit and vegetables were collected with a self-administered questionnaire at 16-24 months postpartum. Logistic regression analysis was used to calculate odds ratios of low intake (<1 time/d) of fruit or vegetables for each infant feeding practice.

SETTING

Japan.

SUBJECTS

Japanese mother-child pairs (n 763) from a prospective birth cohort study.

RESULTS

Neither breast-feeding duration nor age at introduction of solid foods was associated with fruit intake at 16-24 months of age. Breast-feeding duration, but not age at introduction of solid foods, was associated with later intake of vegetables. When breast-feeding duration was categorized into two groups with the cut-off at 6 months, children who were breast-fed for ≥6 months had a significantly decreased risk of low intake of vegetables (OR=0·53; 95% CI 0·34, 0·84) than those breast-fed for <6 months. This association was independent of potential confounders including maternal education and maternal vegetable intake (OR=0·59; 95% CI 0·36, 0·97).

CONCLUSIONS

This finding suggests that ≥6 months of breast-feeding may prevent low intake of vegetables in early childhood among Japanese toddlers.

Does Breastfeeding Protect Against Childhood Obesity? Moving Beyond Observational Evidence

Human milk is the optimal feeding choice for infants, as it dynamically provides the nutrients, immunity support, and other bioactive factors needed for infants at specific stages during development. Observational studies and several meta-analyses have suggested that breastfeeding is protective against development of obesity in childhood and beyond. However, these findings are not without significant controversy. This review includes an overview of observational findings to date, then focuses on three specific pathways that connect human milk and infant physiology: maternal obesity, microbiome development in the infant, and the development of taste preference and diet quality. Each of these pathways involves complex interactions between mother and infant, includes both biologic and non-biologic factors, and may have both direct and indirect effects on obesity risk in the offspring. This type of integrated approach to examining breastfeeding and childhood obesity is necessary to advance research in this area beyond observational findings.

A step-by-step introduction to vegetables at the beginning of complementary feeding. The effects of early and repeated exposure

Breastfeeding (BF) is associated with willingness to accept vegetables. This may be due to the variety of flavours delivered via breast milk. Some mothers add vegetables to milk during complementary feeding (CF) to enhance acceptance. The present study tested a step-by-step exposure to vegetables in milk then rice during CF, on intake and liking of vegetables. Just before CF, enrolled mothers were randomised to an intervention (IG, n = 18; 6 BF) or control group (CG, n = 18; 6 BF). IG infants received 12 daily exposures to vegetable puree added to milk (days 1-12), then 12 × 2 daily exposures to vegetable puree added to rice at home (days 13-24). Plain milk and rice were given to CG. Then both received 11 daily exposures to vegetable puree. Intake was weighed and liking rated on days 25-26 and 33-35 after the start of CF in the laboratory, supplemented by the same data recorded at home. Vegetables were rotated daily (carrots, green beans, spinach, broccoli). Intake, liking and pace of eating were greater for IG than CG infants. Intake and liking of carrots were greater than green beans. However, at 6m then 18m follow up, vegetable (carrot > green beans) but not group differences were observed. Mothers reported appreciation of the structure and guidance of this systematic approach. Early exposure to vegetables in a step-by-step method could be included in CF guidelines and longer term benefits assessed by extending the exposure period.

Breastfeeding duration is associated with child diet at 6 years

BACKGROUND AND OBJECTIVE

Breastfeeding has been associated with early infant food preferences, but less is known about how breastfeeding is associated with later child diet. The objective of this study was to assess whether any and exclusive breastfeeding duration are associated with child diet at 6 years.

METHODS

We linked data from the Infant Feeding Practices Study II and Year 6 Follow-Up. We used approximately monthly questionnaires throughout infancy to calculate any and exclusive breastfeeding duration (n = 1355). We calculated median daily frequency of intake of water, milk, 100% juice, fruits, vegetables, sugar-sweetened beverages, sweets, and savory snacks at 6 years from a dietary screener and examined frequency of consumption of each food or beverage group by any and exclusive breastfeeding duration. We used separate multivariable logistic regression models to calculate odds of consuming more than the median daily frequency of intake of food or beverage items, adjusting for confounders.

RESULTS

Intake of milk, sweets, and savory snacks at 6 years was not associated with any or exclusive breastfeeding duration in unadjusted analyses. Frequency of consumption of water, fruits, and vegetables was positively associated, and intake of sugar-sweetened beverages was inversely associated with any and exclusive breastfeeding duration in adjusted models; 100% juice consumption was inversely associated with exclusive breastfeeding duration only.

CONCLUSIONS

Among many other health benefits, breastfeeding is associated with a number of healthier dietary behaviors at age 6. The association between breastfeeding and child diet may be an important factor to consider when examining associations between breastfeeding and child obesity and chronic diseases.