Infant feeding patterns in the Finnish type I diabetes prediction and prevention nutrition study cohort

Prevalence and maternal determinants of early and late introduction of complementary foods: results from the Growing Up in New Zealand cohort study

A nationally generalisable cohort (n 5770) was used to determine the prevalence of non-timely (early/late) introduction of complementary food and core food groups and associations with maternal sociodemographic and health behaviours in New Zealand (NZ). Variables describing maternal characteristics and infant food introduction were sourced, respectively, from interviews completed antenatally and during late infancy. The NZ Infant Feeding Guidelines were used to define early (≤ 4 months) and late (≥ 7 months) introduction. Associations were examined using multivariable multinomial regression, presented as adjusted relative risk ratios and 95 % confidence intervals (RRR; 95% CI). Complementary food introduction was early for 40·2 % and late for 3·2 %. The prevalence of early food group introduction were fruit/vegetables (23·8 %), breads/cereals (36·3 %), iron-rich foods (34·1 %) and of late were meat/meat alternatives (45·9 %), dairy products (46·2 %) and fruits/vegetables (9·9 %). Compared with infants with timely food introduction, risk of early food introduction was increased for infants: breastfed < 6months (2·52; 2·19-2·90), whose mothers were < 30 years old (1·69; 1·46-1·94), had a diploma/trade certificate v. tertiary education (1·39; 1·1-1·70), of Māori v. European ethnicity (1·40; 1·12-1·75) or smoked during pregnancy (1·88; 1·44-2·46). Risk of late food introduction decreased for infants breastfed < 6 months (0·47; 0.27-0·80) and increased for infants whose mothers had secondary v. tertiary education (2·04; 1·16-3·60) were of Asian v. European ethnicity (2·22; 1·35, 3·63) or did not attend childbirth preparation classes (2·23; 1·24-4·01). Non-timely food introduction, specifically early food introduction, is prevalent in NZ. Interventions to improve food introduction timeliness should be ethnic-specific and support longer breast-feeding.

Milk feeding and first complementary foods during the first year of life in the TEDDY study

The aim was to describe milk feeding patterns and first weaning foods during the first year of life in a large prospective birth cohort of infants with increased genetic risk for Type 1 diabetes (T1D) recruited in 4 different countries: the United States, Finland, Germany, and Sweden. All enrolled children with dietary information (n = 8,673) were included in the analyses; 1,307 (15%) children who dropped out before the first birthday were excluded from some analyses. Supplementary milk feeding in the first 3 days of life was common in all the four countries, although the type of the supplementary milk differed by country and by maternal T1D. Donated human milk was commonly used only in Finland. In all the countries, the most common first supplementary food was cow's milk-based infant formula, especially among offspring of mothers with T1D. The use of specific types of infant formulas differed notably by country: Extensively hydrolysed formulas were most used in Finland, partially hydrolysed ones in the United States and in Germany, and soy formulas only in the United States. Infant formulas commonly included probiotics, prebiotics, and starches. During the first year of life, most of the infants received conventional cow's milk. Overall, milk feeding during the first 3 days of life and thereafter until the first birthday differed markedly by maternal T1D status and across countries. These descriptive data may be useful in understanding early infant feeding practices and in planning potential interventions, which affect infant feeding.

Food and Nutrient Intake and Nutrient Sources in 1-Year-Old Infants in Finland: A Cross-Sectional Analysis

The infant diet has short- and long-term health consequences. Updated data regarding the dietary intake of Finnish infants are lacking. The objectives of this study were to describe infant food and nutrient intake and to identify food sources of the nutrients. Altogether, 739 healthy infants were studied. Dietary intake and breastfeeding frequency were assessed with a three-day food record at 1 year of age. Dietary intake was calculated separately for non-breastfed and breastfed infants. One-third (36%) of the infants were partially breastfed and 95% consumed mass-produced baby foods. The infants' diet consisted mainly of infant formula, dairy milk, porridges, fruit and berry foods, and meat dishes. The mean vegetable, fruit and berry consumption was 199 g/day. Most nutrient intakes were adequate except for fat, linoleic acid, vitamin D and iron from food. Mean sucrose intake, as a percentage of total energy intake (E%), was 5-6 E%. High protein intake (>20 E%) was observed in 19% of non-breastfed infants. Overall, the infants' diet was favorable since vegetable and fruit consumption was reasonably high and nutrient intake was mostly adequate. However, the fat intake was lower, and protein intake higher than recommended. Increasing the consumption of vegetable oils and reducing the intake of red meat and dairy milk may further improve the diet of 1-year-olds.

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

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

Age at first introduction to complementary foods is associated with sociodemographic factors in children with increased genetic risk of developing type 1 diabetes

Infant's age at introduction to certain complementary foods (CF) has in previous studies been associated with islet autoimmunity, which is an early marker for type 1 diabetes (T1D). Various maternal sociodemographic factors have been found to be associated with early introduction to CF. The aims of this study were to describe early infant feeding and identify sociodemographic factors associated with early introduction to CF in a multinational cohort of infants with an increased genetic risk for T1D. The Environmental Determinants of Diabetes in the Young study is a prospective longitudinal birth cohort study. Infants (N = 6404) screened for T1D high risk human leucocyte antigen-DQ genotypes (DR3/4, DR4/4, DR4/8, DR3/3, DR4/4, DR4/1, DR4/13, DR4/9 and DR3/9) were followed for 2 years at six clinical research centres: three in the United States (Colorado, Georgia/Florida, Washington) and three in Europe (Sweden, Finland, Germany). Age at first introduction to any food was reported at clinical visits every third month from the age of 3 months. Maternal sociodemographic data were self-reported through questionnaires. Age at first introduction to CF was primarily associated with country of residence. Root vegetables and fruits were usually the first CF introduced in Finland and Sweden and cereals were usually the first CF introduced in the United States. Between 15% and 20% of the infants were introduced to solid foods before the age of 4 months. Young maternal age (<25 years), low educational level (<12 years) and smoking during pregnancy were significant predictors of early introduction to CF in this cohort. Infants with a relative with T1D were more likely to be introduced to CF later.

Infant Feeding and Timing of Complementary Foods in the Development of Type 1 Diabetes

Type 1 diabetes (T1D) is an autoimmune disease that results from the destruction of the β cells of the pancreas in genetically at-risk individuals. The autoimmune process that precedes the development of T1D is believed to be triggered by environmental factors, including nutrition. Early introduction of complementary foods has been implicated in the etiology of T1D as a possible explanation of the increasing incidence of the disease, particularly in children younger than 5 years of age. Infant feeding recommendations have been designed to promote adequate growth, provide essential nutrients, and reduce the risk of developing chronic illnesses. The World Health Organization and the American Academy of Pediatrics recommend exclusive breastfeeding to 6 months of age followed by continued breastfeeding as complementary foods are introduced. A lack of compliance with these recommendations has been observed in the general population as well as in infants at high risk for T1D. Dietary factors such as the provision of breast milk and duration of breastfeeding, the age at introduction of cow's milk and gluten-containing foods, as well as other complementary feeding have been investigated. However, the evidence that early infant feeding patterns are linked with T1D currently remains inconclusive.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Factors associated with early introduction of formula and/or solid, semi-solid or soft foods in seven Francophone West African countries

The aim of this study was to identify factors associated with early introduction of formula and/or solid, semi-solid or soft foods to infants aged three to five months in seven Francophone West African countries. The sources of data for the analyses were the most recent Demographic and Health Survey datasets of the seven countries, namely Benin (BDHS, 2012), Burkina Faso (BFDHS, 2010), Cote d'Ivoire (CIDHS, 2011-2012), Guinea (GDHS, 2012), Mali (MDHS, 2012-2013), Niger (NDHS, 2012) and Senegal (SDHS, 2010). The study used multiple logistic regression methods to analyse the factors associated with early introduction of complementary feeding using individual-, household- and community-level determinants. The sample was composed of 4158 infants aged between three and five months with: 671 from Benin, 811 from Burkina Faso, 362 from Cote d'Ivoire, 398 from Guinea, 519 from Mali, 767 from Niger and 630 from Senegal. Multiple analyses indicated that in three of the seven countries (Benin, Guinea and Senegal), infants who suffered illnesses, such as diarrhoea and acute respiratory infection, were significantly more likely to be introduced to formula and/or solid, semi-solid or soft foods between the age of three and five months. Other significant factors included infants who: were born in second to fourth position (Benin), whose mothers did not attend any antenatal clinics (Burkina Faso and Niger), were male (Cote d'Ivoire and Senegal), lived in an urban areas (Senegal), or were delivered by traditional birth attendants (Guinea, Niger and Senegal). Programmes to discourage early introduction of formula and/or solid, semi-solid or soft foods in these countries should target the most vulnerable segments of the population in order to improve exclusive breastfeeding practices and reduce infant mortality.

Determinants of early introduction of solid, semi-solid or soft foods among infants aged 3-5 months in four Anglophone West African countries

This study was conducted to explore and identify factors associated with the practice of early introduction of solid, semi-solid or soft foods among infants aged 3-5 months in four Anglophone West African countries. Data sources for the analyses were the latest Demographic and Health Survey datasets of the 4 countries, namely Ghana (GDHS, 2008), Liberia (LDHS, 2007), Nigeria (NDHS, 2013) and Sierra Leone (SLDHS, 2008). Multiple logistic regression methods were used to analyze the factors associated with early introduction of solid, semi-solid or soft foods among infants aged 3-5 months, using individual-, household- and community-level determinants. The sample consisted of 2447 infants aged 3-5 months from four Anglophone West African countries: 166 in Ghana, 263 in Liberia, 1658 in Nigeria and 360 in Sierra Leone. Multivariable analyses revealed the individual factors associated with early introduction of solid, semi-solid or soft foods in these countries. These included increased infant's age, diarrhea, acute respiratory infection and newborns perceived to be small by their mothers. Other predictors of early introduction of solid, semi-solid or soft foods were: mothers with no schooling, young mothers and fathers who worked in an agricultural industry. Public health interventions to improve exclusive breastfeeding practices by discouraging early introduction of solid, semi-solid or soft foods are needed in all 4 countries, targeting especially mothers at risk of introducing solid foods to their infants early.

Is type 1 diabetes a food-induced disease?

The incidence of type 1 diabetes among children has almost doubled during the last decades in Sweden. Type 1 diabetes is considered as an autoimmune disease with unknown aetiology. Here we propose that the immune reaction may be initiated by food-derived mechanisms. The incidence of diabetes parallels an increased consumption of pasta, white bread, meat, cheese, low-fat milk, exotic fruits, soda, and snacks. Simultaneously, the consumption of potatoes, butter, high-fat milk, and domestic fruit has decreased. Three categories of food related reaction mechanisms are discussed against the following items (1) proteins from wheat, meat, and milk, (2) fat from processed food, and (3) exotic fruits. The current food consumption is suggested to initiate a pro-inflammatory reaction in the intestine and thereby reduce the intestinal barrier function. This may influence tolerance development and thus pave the way for an autoimmune attack on pancreatic beta cells.

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

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

Nutrient intake variability and number of days needed to assess intake in preschool children

The duration of the period of time during which diet should be recorded for sufficiently accurate results on the usual intake of an individual is an especially challenging issue in prospective studies among children. We set out to describe nutrient intake variability in preschoolers and to determine the number of record days required (D) to estimate intake of energy and thirty-two nutrients. The diet and the use of dietary supplements were assessed with three consecutive daily food records including one weekend day in 1639 children participating in the population-based birth cohort of the Type 1 Diabetes Prediction and Prevention Project (DIPP) in Finland. Variance ratios and D stratified by sex and age groups were calculated for 455 (1-year-old), 471 (3-year-old) and 713 (6-year-old) children (born between 1998 and 2003). Within:between variance ratios and D increase with increasing age, and are slightly higher for girls. Vitamin A, cholesterol, n-3 and n-6 fatty acids, β-carotene and folate intakes require the most replicates. Including supplemental intake has an impact on the variance estimates according to the proportion of supplement users. In the DIPP Nutrition Study with 3 d food records, the correlation coefficients between observed and true intakes of energy and thirty-two nutrients averaged 0·91 in 1-year-old children, 0·79 in 3-year-old children and 0·74 in 6-year-old children. For providing accurate nutrient intake estimates, three replicates of food records are reasonable in 1-year-old children but must be questioned for several nutrients in 3- and 6-year-old children. The accuracy of ranking boys is greater than that for girls.

Feasibility and compliance in a nutritional primary prevention trial in infants at increased risk for type 1 diabetes

AIM

The international Trial to Reduce IDDM in the Genetically at Risk (TRIGR) was launched to determine whether weaning to a highly hydrolysed formula in infancy reduces the incidence of type 1 diabetes in children at increased genetic disease susceptibility. We describe here the findings on feasibility and compliance from the pilot study.

METHODS

The protocol was tested in 240 children. The diet of the participating children was assessed by self-administered dietary forms, a structured questionnaire and a food record. Blood samples were taken and weight and height measured at birth and at 3, 6, 9, 12, 18 and 24 months.

RESULTS

A majority of the subjects (84%) were exposed to the study formula at least for 2 months. Linear growth or weight gain over the first 2 years of life was similar in the two study groups. The levels of IgA and IgG antibodies to cow's milk and casein were higher in the cow's milk-based formula group than in the hydrolysed formula group during the intervention period (p<0.05), reflecting the difference in the intake of cow's milk protein.

CONCLUSION

This randomized trial on infant feeding turned out to be feasible, and dietary compliance was acceptable. Valuable experience was gained for the planning and sample size estimation of the study proper.

Toddlers get slimmer while adolescents get fatter--BMI distribution in five birth cohorts from four decades in Finland

AIM

To investigate the trends in the size of Finnish children in five birth cohorts from four decades.

METHODS

This is a retrospective longitudinal growth pattern study on children representing five birth cohorts: 1974, 1981, 1991, 1995 and 2001 from the city of Tampere and three rural municipalities. Growth data were collected from birth to 15 years of age, except in birth cohorts 1995 and 2001 until 12 and 5 years. Body mass index (BMI, kg/m²) was calculated. Pearson's chi-square test was used in analysis.

RESULTS

The 50th percentile of BMI at birth varied between the 1970's and 2000's (boys: p<0.001, girls: p=0.02), with increase seen in girls. The 50th BMI percentile remained unchanged in 6-month-aged boys, whereas in girls, it varied inconsistent (p=0.04). At 1 and 2 years of age, the 15th, 50th, 85th and 95th BMI percentiles decreased (p=0.26 to <0.001). The 50th BMI percentile remained fairly constant at 5 and 7 years of age. In 12- and 15-year-old boys, the 50th, 85th and 95th percentiles of BMI showed a marked increase (p=0.01 to <0.001). In 12-year-old girls, only the 85th BMI percentile increased (p=0.03).

CONCLUSIONS

During the last three decades, Finnish toddlers have become markedly slimmer. Concurrently, an opposite change has taken place in adolescent boys.

Nutrition and human health from a sex-gender perspective

Nutrition exerts a life-long impact on human health, and the interaction between nutrition and health has been known for centuries. The recent literature has suggested that nutrition could differently influence the health of male and female individuals. Until the last decade of the 20th century, research on women has been neglected, and the results obtained in men have been directly translated to women in both the medicine and nutrition fields. Consequently, most modern guidelines are based on studies predominantly conducted on men. However, there are many sex-gender differences that are the result of multifactorial inputs, including gene repertoires, sex steroid hormones, and environmental factors (e.g., food components). The effects of these different inputs in male and female physiology will be different in different periods of ontogenetic development as well as during pregnancy and the ovarian cycle in females, which are also age dependent. As a result, different strategies have evolved to maintain male and female body homeostasis, which, in turn, implies that there are important differences in the bioavailability, metabolism, distribution, and elimination of foods and beverages in males and females. This article will review some of these differences underlying the impact of food components on the risk of developing diseases from a sex-gender perspective.

Change in prevalence of overweight and obesity in Finnish children - comparison between 1974 and 2001

OBJECTIVE

To analyse the possible changes in the prevalence of overweight and obesity comparing birth cohorts from four different decades in Finland.

DESIGN

A retrospective longitudinal growth study.

METHODS

The subjects representing five birth cohorts: 1974 (n = 1109), 1981 (n = 987), 1991 (n = 586), 1995 (n = 856) and 2001 (n = 766) in the city of Tampere and three rural municipalities in Finland. Data included five consecutive height and weight measurements from 2 to 15 years of age. Normal weight, overweight and obesity at the time points were classified by body mass index (BMI, kg/m(2) ) according to international age- and gender-specific BMI cut-off points. The chi-square test was used to analyse the differences in the between birth cohorts.

RESULTS

The combined prevalence of overweight and obesity decreased significantly in 2-year-old boys (p = 0.009) and girls (p = 0.002) from 1974 to 2001. Insignificant fluctuation was seen in 5- and 7-year-old children. Both the prevalence of obesity and the combined prevalence of overweight and obesity showed a significant increase in 12- (p = 0.031 and p < 0.001) and 15-year-old boys (p < 0.001 in both) from the 1970s to 2000s. In girls, the prevalence of obesity as well as the combined prevalence of overweight and obesity increased significantly in the age group of 12 years (p = 0.023), but not in that of 15 years.

CONCLUSIONS

During the last three decades, overweight and obesity have become clearly more prevalent in Finnish young adolescents. This trend has been more obvious in boys than in girls. At the same time, 2-year-old children have shown an opposite trend.

Factors associated with exclusive breast-feeding and breast-feeding in Norway

OBJECTIVE

To identify factors associated with exclusive breast-feeding and breast-feeding during the first year of life among Norwegian infants.

DESIGN

Data on breast-feeding practices were collected by a semi-quantitative FFQ.

SETTING

In 2006-2007 about 3000 infants were invited to participate in a population-based prospective cohort study in Norway.

SUBJECTS

A total of 1490 mothers/infants participated at both 6 and 12 months of age.

RESULTS

Exclusive breast-feeding at 4 months was associated with parental education, parity and geographical region, while exclusive breast-feeding at 5·5 months was associated only with maternal age. At both ages, a negative association with exclusive breast-feeding was observed for maternal smoking. Breast-feeding at 6 months was associated with parental education, maternal age and marital status. Breast-feeding at 12 months was associated with maternal education, maternal age and number of children. At both ages, negative associations with breast-feeding were observed for maternal smoking and descending birth weight. At 12 months, a negative association was also observed for having day care by other than the parents.

CONCLUSIONS

Even though Norway has an extensive and positive breast-feeding tradition and a maternal leave system that supports the possibility to breast-feed, factors like maternal education, maternal age and maternal smoking are strongly associated with duration of exclusive breast-feeding and breast-feeding. Research to better understand the reasons for inequalities in breast-feeding is needed to facilitate the development of more effective breast-feeding promotion strategies. This again may improve compliance with recommendations and reduce inequalities in infant feeding practices.

Breastfeeding patterns of mothers with type 1 diabetes: results from an infant feeding trial

BACKGROUND

Both the initiation and maintenance of breastfeeding have been reported to be negatively affected by maternal type 1 diabetes (T1D). The aim of this study was to prospectively examine the breastfeeding patterns among mothers with and without T1D participating in a large international randomized infant feeding trial (TRIGR).

METHODS

Families with a member affected by T1D and with a newborn infant were invited into the study. Those who had HLA-conferred genetic susceptibility for T1D tested at birth with gestation > 35 weeks and were healthy were eligible to continue in the trial. Among the 2160 participating children, 1096 were born to women with T1D and 1064 to unaffected women. Information on infant feeding was acquired from the family by frequent prospective dietary interviews.

RESULTS

Most (>90%) of the infants of mothers with and without T1D were initially breastfed. Breastfeeding rates declined more steeply among mothers with than without T1D being 50 and 72% at 6 months, respectively. Mothers with T1D were younger, less educated and delivered earlier and more often by caesarean section than other mothers (p < 0.01). After adjusting for all these factors associated with the termination of breastfeeding, there was no difference in the duration of breastfeeding among mothers with and without T1D.

CONCLUSIONS

Maternal diabetes status per se was not associated with shorter breastfeeding. The lower duration of breastfeeding in mothers with T1D is largely explained by their more frequent caesarean sections, earlier delivery and lower age and education.

Predictors of the early introduction of solid foods in infants: results of a cohort study

BACKGROUND

The early introduction of solid foods before 4 months of age has been associated with an increased risk of diarrhoea in infancy and a greater risk of wheeze and increased percentage body fat and weight in childhood. The purpose of this study was to identify the level of compliance with national recommendations related to the timing of the introduction of solid foods and to describe the maternal and infant characteristics associated with the timing of the introduction of solids.

METHODS

Subjects were 519 participants in the second longitudinal Perth Infant Feeding Study (PIFS II) recruited from two maternity hospitals in Perth, Western Australia in 2002/3. Data collected prior to, or shortly after discharge from hospital, and at 4, 10, 16, 22, 32, 40 and 52 weeks postpartum included timing of the introduction of solid foods and a variety of maternal and infant characteristics associated with the introduction of solid foods. Multivariate logistic regression was used to identify those factors associated with the risk of introducing solid foods early, which for the purposes of this study was defined as being before 17 weeks.

RESULTS

The median age of introduction of solid foods was 17.6 weeks. In total, 44% of infants had received solids before 17 weeks and 93% of infants had received their first solids before 26 weeks of age. The strongest independent predictors of the early introduction of solids were young maternal age, mother smoking prior to pregnancy and not fully breastfeeding at 4 weeks postpartum. In general, mothers introduced solids earlier than recommended because they perceived their baby to either need them or be ready for them.

CONCLUSION

This study showed a high level of non-compliance among Australian mothers with the infant feeding recommendation related to the timing of solids that was current at the time. In order to improve compliance health professionals need to be aware of those groups least likely to comply with recommendations and their reasons for non-compliance. Infant feeding recommendations need to be evidence-based, uniformly supported by professionals and widely, clearly and consistently articulated if higher rates of compliance are to be achieved in the future.

Some similarities in dietary clusters of pre-school children and their mothers

The diet of pre-school children is determined by the parents and carers. The aim of the present study was to describe dietary clusters of pre-school children and their mothers in Finland, and analyse the similarity of dietary clusters within child–mother pairs. The present study comprised the mothers (n 4862) whose child was recruited in the Type 1 Diabetes Prediction and Prevention Nutrition Study and the children belonging to selected, cross-sectional age groups of 1 year (n 719), 3 years (n 708) and 6 years (n 841). The dietary data were collected from children by 3-d food records and from mothers by a FFQ validated for pregnant women. The food consumption data were analysed for patterns by hierarchical cluster analysis. Three main dietary clusters were identified in children: ‘healthy’ and ‘traditional’ in all three age groups, and ‘ready-to-eat baby foods’ in 1-year-olds and ‘fast foods, sweet’ in the older children. Six main clusters were identified among the mothers who completed a FFQ for their diet during pregnancy. Some familial dependence between dietary clusters of mother–child pairs was observed in 6-year-old children but not in younger children. Younger age and lower educational level of the mother were associated with the cluster ‘fast food, sweet’ only at the age of 3 years. The diets of pre-school children vary by age and only a slight similarity within dietary clusters of mother–child pairs was observed.

Initiation of postpartum contraception: a survey among health centre physicians and nurses in Finland

OBJECTIVE

To examine self-reported professional practices of postpartum contraceptive counselling at Finnish community health centres.

DESIGN

A survey study with self-administered online questionnaires.

SETTING

All local municipalities (n = 107) in the Expert Responsibility Area of Tampere University Hospital in Western Finland in 2005.

SUBJECTS

A total of 69 (64% of 107) health centre physicians and 80 (75%) nurses performing postpartum check-ups.

MAIN OUTCOME MEASURES

Contraceptive method most often initiated or recommended to breastfeeding women at postpartum visit; timing of postpartum initiation of hormonal and intrauterine contraceptive methods in relation to breastfeeding and resumption of menses.

RESULTS

The most common contraceptive method initiated or recommended to breastfeeding women by both physicians (41%) and nurses (45%) was the condom, followed by progestin-only pills and intrauterine contraception. Few professionals recommended breastfeeding (lactational amenorrhea) as the only contraceptive method. Only eight (12%) physicians inserted a copper-releasing intrauterine device and five (7%) a levonorgestrel-releasing intrauterine system typically at the postpartum visit; the majority delayed the insertions until the resumption of menses. Fifty-three (77%) physicians initiated combined oral contraceptives mostly when breastfeeding was terminated and menses had returned. Over half of the municipalities involved in the study did not provide any medical contraceptives free of charge postpartum.

CONCLUSION

Professionals' reports indicate that initiation of effective contraceptive methods is delayed after childbirth. In order to promote better postpartum contraception practices, updated evidence-based guidelines are needed.

Breastfeeding duration in families with type 1 diabetes compared to non-affected families: results from BABYDIAB and DONALD studies in Germany

BACKGROUND

There are only a few small studies that compare breastfeeding rates in mothers with and without type 1 diabetes (T1D).

STUDY DESIGN

We studied breastfeeding duration in 665 German infants whose mother and/or father had T1D from the BABYDIAB Study (data collected between 1992 and 2000) and compared it with data from 268 German infants of unaffected parents from the DONALD Study.

RESULTS

Infants with a parent who had T1D were less likely to be breastfed and breastfed for shorter lengths of time than infants from unaffected families. Mothers with T1D showed a positive long-term breastfeeding time trend, but did not reach the rates of the DONALD Study.

CONCLUSIONS

This study identified minor secular trends influencing the differences in breastfeeding initiation and duration between families affected with T1D and those without.

Maternal diet during pregnancy and islet autoimmunity in offspring

BACKGROUND

Recent studies on the etiology of type 1 diabetes mellitus (T1DM) suggest that the components of the infant diet are associated with islet autoimmunity (IA), a precursor of T1DM. The role of prenatal nutritional exposures has not been thoroughly investigated.

METHODS

The Diabetes Autoimmunity Study in the Young has enrolled newborns from 1993 to 2004 at increased risk for T1DM based on human leukocyte antigen (HLA) genotype and family history of T1DM. The child is tested for islet autoantibodies at 9 and 15 months, 2 yr, and annually thereafter. We conducted a cohort study of 642 subjects for whom a Willett food frequency questionnaire for the mother's third trimester diet was completed. A case is defined as a subject who tests positive for islet autoantibodies at two consecutive blood draws and is still positive (or diabetic) at last follow-up (n = 27). Maternal consumption frequencies of potatoes, other root vegetables, gluten-containing foods, non-gluten cereal grains, cow's milk and cow's milk products, fruits, vegetables, meat and poultry, and fish were analyzed in a survival analysis.

RESULTS

Adjusting for breast-feeding duration, age at first cereal introduction, ethnicity, HLA genotype, family history of T1DM, and total caloric intake, higher maternal intake of potatoes (hazard ratio for one standard deviation difference: 0.49, 95% confidence interval: 0.28-0.86) was associated with a delayed time to IA onset. No other food groups ingested during pregnancy were associated with IA in the child.

CONCLUSIONS

The composition of the maternal diet during pregnancy may play a role in the offspring's risk of development of IA and potentially T1DM.

The age at diagnosis of type 1 diabetes continues to decrease in Belgian boys but not in girls: a 15-year survey

BACKGROUND

The age at clinical onset of type 1 diabetes is decreasing. Preliminary Belgian data suggested that this anticipation occurred preferentially in boys. We investigated whether this gender-specific anticipation could be confirmed over a 15-year observation period.

METHODS

In Antwerp, we studied incidence trends between 1989 and 2003 in 746 type 1 diabetic patients under age 40. For 2928 antibody-positive patients diagnosed nationwide during the same period, age at diagnosis was analysed according to gender and calendar year.

RESULTS

In Antwerp, the incidence of type 1 diabetes under age 15 increased significantly with time from 10.9/100 000/year in 1989-1993 to 15.8/100 000/year in 1999-2003 (p = 0.008). The rising incidence in children was largely restricted to boys under age 10 where the incidence more than doubled during the 15-year period (6.8/100 000/year in 1989-1993 vs 17.2/100 000/year in 1999-2003; p < 0.001). Such an increase was not found in girls under age 10 (p = 0.54). This selective trend toward younger age at diagnosis in boys was confirmed in the larger group of Belgian patients where the median age at diagnosis decreased in boys-but not in girls-from 20 years in 1989-1993 to 15 years in 1999-2003 (p < 0.001).

CONCLUSIONS

Over a 15-year observation period, a selective anticipation of clinical onset of type 1 diabetes was found in boys but not in girls. This suggests that an environmental factor may preferentially accelerate the sub-clinical disease process in young boys.

Infant feeding and childhood atopy: does early introduction of non-milk fluids matter?

Studies on the role of non-milk fluids in the development of child atopic disease are scarce. We had a unique opportunity to investigate prospective association between the introduction of fruit syrup, orange juice, sterilized water, vitamins and honey at 1 month and the development of child atopic disease. The exposure of interest was measured by parental report of non-milk fluids introduction to infants aged 1 month at the Tasmanian Infant Health Survey, 1988-89, Tasmania. Data on the outcomes of interest (atopic sensitization, asthma, eczema and hay fever) were collected during the 1997 Childhood Allergy and Respiratory Health Study when children were 8 yr old. Relative risks were derived from generalized linear model with a log link function and binomial error structure. None of the non-milk fluids appeared to be a significant predictor of atopic sensitization. Only sterilized water was a significant risk factor for asthma (adjusted relative risk = 1.59; 95% confidence intervals: 1.14-2.22), which may be partly because of associated overall better hygienic conditions and decreased exposure to early infections in the household. In summary, we were unable to find evidence for an association between introduction of non-milk fluids in infancy and childhood atopic disease.

Environmental factors in the development of Type 1 diabetes

Environmental factors appear to play an important role in the pathogenesis of childhood-onset type 1 diabetes (T1D). The most important factors are thought to be infectious, dietary, perinatal, and psychosocial. Enteroviruses (especially Coxsackie B virus), breastfeeding, the early presence or lack of certain foods, birth weight, childhood over-nutrition, maternal islet autoimmunity, and negative stress events have been shown to be related to the prevalence of T1D. However, clear conclusions to date are limited because most studies lacked power to detect exposure/disease associations, were not prospective or long-term, did not start in infancy, had imprecise or infrequent exposure estimates, had confounding exposures, and failed to account for genetic susceptibility. In addition to the identification of specific antigenic triggers, several more general hypotheses, including the accelerator and hygiene hypotheses, are testable approaches worth pursuing.

Food consumption and feeding patterns of Czech infants and toddlers living in Prague

OBJECTIVE

To describe feeding patterns during first two years of life and their relation to sociodemographic factors.

DESIGN

Longitudinal study.

SETTING

Prague, Czech Republic.

SUBJECTS

Ninety-seven full-term healthy singletons enrolled at maternity ward, of which 90.7% completed the study.

METHODS

Diet was assessed at 9, 12 and 24 months of age using a structured 3-day dietary record. Additional information was obtained from questionnaires completed at birth and at 6 months.

RESULTS

The median duration of exclusive breastfeeding was 5 months, and that of total breastfeeding 9 months. Breastfeeding rate 47.4% at 9 months declined to 4.5% at 24 months. Total duration of breastfeeding was positively associated with maternal education and marital status but not with maternal age, gender or birth order. Breastfeeding frequency at 9, 12 and 24 months was 4.8, 4 and 3.7, respectively. The complementary food feeding frequency increased significantly with age (4.5, 4.7 and 5.9 times per day, respectively). All children at any age point consumed fruits, cereal and milk products. The proportion of children consuming meat and vegetables had increased with age but between ages 9 and 24 months, at least 23-38% children did not consume vegetables daily and 28-40% did not consume foods from meat/fish/poultry/eggs group daily. The proportion of children consuming milk and foods associated with the early complementary feeding period had fallen with age while the consumption of cereal foods other than porridge had increased. Values of indicators of adequate complementary feeding practices tentatively suggested in the context of WHO expert consultation had closely reflected breastfeeding rates.

CONCLUSIONS

Breastfeeding duration is shorter than WHO recommends. It is influenced by maternal education and marital status. Compliance with complementary feeding recommendations is relatively good. Continued promotion of healthy infant and young child feeding practices is needed. Indicators evaluating complementary feeding practices should assess breastfeeding separately from other aspects.

SPONSORSHIP

Ministry of Health, 1st Faculty of Medicine, Charles' University of Prague.