GRETA: Ernährung von Kleinkindern in Deutschland

Kommunal verankerte Versorgungsstrukturen zur Förderung der Ernährungsgesundheit in den ersten 1000 Tagen – eine Analyse des aktuellen Status quo

Ziel

Die Ernährung in den ersten 1000 Tagen stellt einen relevanten Einflussfaktor für eine gesunde (Gewichts)entwicklung von Kindern dar. Verhältnispräventive, kommunalbasierte Ansätze scheinen am Erfolg versprechendsten in der Bekämpfung von (kindlichem) Übergewicht bzw. nicht übertragbaren Erkrankungen zu sein. Ziel dieser Arbeit war es, Strategien zum Gelingen der Ernährungsgesundheit in den ersten 1000 Tagen herauszuarbeiten.

Methodik

Auf Basis einer internetbasierten Recherche möglicher kommunalbasierter Praxisprojekte wurden standardisierte, leitfadengestützte Interviews mit Expertinnen und Experten aus Wissenschaft und Praxis durchgeführt. Der Fokus lag auf der allgemeinen Einschätzung der Versorgungslage bzw. einem möglichen Handlungs- und Versorgungsbedarf sowie konkreten Handlungsempfehlungen unter besonderer Berücksichtigung von Schwangeren bzw. jungen Familien in belasteten Lebenslagen. 14 von 40 im Schneeballverfahren ausgewählten Personen nahmen teil.

Ergebnisse

Alle Teilnehmenden schätzen die aktuelle primärpräventive Versorgung als nicht ausreichend ein. Als kritisch wurden von ihnen v. a. die fehlenden strukturellen und politischen Rahmenbedingen, insbesondere die häufig bestehenden zeitlich begrenzten Programme, gesehen. Dadurch seien Maßnahmen zur Förderung der Ernährungsgesundheit oder vergleichbare Interventionen nicht erfolgreich zu etablieren. Gefordert wurde daher eine deutlichere Unterstützung durch politische und andere relevante Stakeholder, z. B. Krankenversicherungen und Vernetzung mit bzw. Einbettung dieses Themenfeldes in den öffentlichen Gesundheitsdienst.

Schlussfolgerung

Unsere Ergebnisse bestätigen aus Sicht von Expertinnen und Experten, dass die Förderung der Ernährungsgesundheit in den ersten 1000 Tagen sinnvoll und wichtig ist. Allerdings ist ein deutlicher Optimierungsbedarf hinsichtlich der Versorgungsstrukturen und der konkreten nachhaltigen Umsetzung von primärpräventiven Angeboten sowie niederschwelligen Zugängen für belastete Schwangere und Familien erkennbar.

KiESEL - The Children's Nutrition Survey to Record Food Consumption for the youngest in Germany

Background

With KiESEL, the Children’s Nutrition Survey to Record Food Consumption, the German Federal Institute for Risk Assessment (BfR) collected representative food consumption data for children aged six months up to five years. KiESEL was one of five modules of KiGGS Wave2 (German Health Interview and Examination Survey for Children and Adolescents) conducted by the Robert Koch Institute (RKI). The objective was to update the consumption data for children in Germany and to fill a data gap for the age group of five-year-old children. The study provides an up-to-date and comprehensive database that will be used for exposure assessment, as part of risk assessment of Germany’s youngest consumers.

Methods

In the years 2014 to 2017, 1104 children from all over Germany participated in KiESEL. During home visits, survey staff conducted a questionnaire-based interview including a food propensity questionnaire (FPQ) on seldom eaten foods and questions concerning consumption outside home, dietary habits and diet during first year. The interviewer measured the children’s height and weight. Families and childcare workers filled out a food record, covering three consecutive days and one independent day. Data are based on the FPQ and present consumption frequencies. Depending on the question, socioeconomic status (SES) and migration background were considered.

Results

1104 participants had an interview and filled out the questionnaire on usual food intake, seldom eaten foods and consumption away from home. They were included in sample1. 1008 of these participants additionally reported food consumption of at least three days (sample2). 91.2% of the children follow no special diet and 0.8% are vegetarians. 7% of the older children consuming soya-drink. For some foods differences in consumption across SES or migration status were noted. Children from families with higher SES consume more often soya-based substitute milk as families with lower SES (p < 0.00005).

Conclusions

KiESEL gathered up-to-date consumption data for more than 1000 children living in Germany, aged six month up to including five years. The data will be used for risk assessments of the BfR and provided to national and international partners.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40795-022-00527-6.

The Development and Evaluation of a Diet Quality Index for Asian Toddlers and Its Perinatal Correlates: The GUSTO Cohort Study

Early childhood diet may have lifelong influences on health outcomes, yet development of indices to assess diet quality is scarce in toddlers, especially in Asian countries. We aimed to develop and evaluate a Diet Quality Index (DQI) in a multi-ethnic Asian mother⁻offspring cohort and identify perinatal correlates of early childhood diet. Based primarily on the Singapore dietary guidelines, the DQI includes seven food components: rice, bread and alternatives; fruit; vegetables; meat and alternatives; milk and dairy products; whole grains; and foods high in sugar. The DQI was developed using parental report of Food Frequency Questionnaires (FFQ) data for 18-month-old toddlers (n = 561). The mean ± SD of DQI for the study toddlers was 44.2 ± 8.9 (theoretical range: 0⁻65). A higher DQI (better diet quality) was associated with higher intakes of several nutrients and food groups (e.g., vegetables, dietary fibre, and beta-carotene; all p < 0.001). Further construct validity was demonstrated by substantial agreement between the FFQ-DQI and 24-hour-recall-DQI (Intraclass-correlation-coefficient: 0.70). Independent predictors of lower DQI included higher maternal pre-pregnancy BMI [β(95% CI): -0.23(-0.39, -0.07)], Malay ethnicity [-1.88(-3.67, -0.09)], lower household income [-1.97(-3.91, -0.03)], lower education level [-2.57(-4.85, -0.28)] and never breastfeeding [-6.17(-11.06, -1.28)]. We developed a valid DQI for assessing the overall quality of the diets of Asian toddlers.

Commercial complementary food consumption is prospectively associated with added sugar intake in childhood

Given that commercial complementary food (CF) can contain high levels of added sugar, a high consumption may predispose to a preference for sweet taste later in life. This study examined cross-sectional associations between commercial CF consumption and added sugar intake in infancy as well as its prospective relation to added sugar intake in pre-school and primary-school age children. In all, 288 children of the Dortmund Nutritional and Anthropometric Longitudinally Designed Study with 3-d weighed dietary records at 0·5 and 0·75 (infancy), 3 and 4 (pre-school age) and 6 and 7 years of age (primary-school age) were included in this analysis. Individual commercial CF consumption as percentage of total commercial CF (%cCF) was averaged at 0·5 and 0·75 years. Individual total added sugar intake (g/d, energy percentage/d) was averaged for all three age groups. Multivariable logistic and linear regression models were used to analyse associations between %cCF and added sugar intake. In infancy, a higher %cCF was associated with odds for high added sugar intake from CF and for high total added sugar intake (>75th percentile, P<0·033). Prospectively, a higher %cCF was related to higher added sugar intake in both pre-school (P<0·041) and primary-school age children (P<0·039), although these associations were attenuated in models adjusting for added sugar intake in infancy. A higher %cCF in infancy may predispose to higher added sugar intake in later childhood by virtue of its added sugar content. Therefore, offering home-made CF or carefully chosen commercial CF without added sugar might be one strategy to reduce sugar intake in infancy and later on.

Fish and rapeseed oil consumption in infants and mothers: dietary habits and determinants in a nationwide sample in Germany

PURPOSE

Fish and rapeseed oil are major sources of omega-3 polyunsaturated fatty acids (n-3 PUFA) in complementary food, but little is known about current consumption in Germany.

METHODS

We conducted a nationwide consumer survey to assess the consumption habits of fish and rapeseed oil and their determining factors in 985 mother-child dyads in Germany.

RESULTS

One-fourth of infants ate fish as often as recommended, i.e. at least once per week. Half of the mothers stated that they mainly used rapeseed oil for self-prepared and/or commercial vegetable-potato-meat meals. In contrast, mothers more frequently met recommendations for fish consumption (41 %), but used rapeseed oil (34 %) less often for their own nutrition. Maternal eating behaviour was the most important predictor for both of these n-3 PUFA rich foods in infants' nutrition. In contrast to infants' fish consumption, rapeseed oil intake in infancy was found to be influenced by some further factors, i.e. mothers' social class and omega-3 knowledge, which were also key determinants of mothers' own fish and rapeseed oil consumption.

CONCLUSION

To promote fish with complementary feeding, programs should focus on families whose mothers rarely eat fish. Nutritional campaigns to improve omega-3 knowledge-especially focusing on lower social classes-could be effective in increasing rapeseed oil consumption, although these programs should be combined with environmental improvements as it has been already started through the use of rapeseed oil in commercial baby jars.

Development of an estimated food record for 9-36-month-old toddlers

OBJECTIVES

Adequacy of dietary intake in the sensitive period of toddler development is a key determinant of health in a short- and long-term perspective. Therefore, studies focussing the nutrition of toddlers are of importance. For this purpose, tailored dietary record methods are an important prerequisite. The objective of this work is to develop a toddler-specific estimated food record (EFR) in a booklet providing photographs of age-specific foods and portion sizes that should be accurate and simple.

SUBJECTS/METHODS

For a toddler study in Germany, a 7-day consecutive EFR was developed. Data were obtained from a sample of toddlers in Germany. The basis is an evaluation of 3-day weighing food records on food choice and portion size of the DONALD (Dortmund Nutritional and Anthropometric Longitudinally Designed) study for 227 toddlers (118 boys) aged 9-36 months from January 2004 to March 2008.

RESULTS

In the analysed food records, a total of 15.147 eating occasions with 24.820 dishes were reported and grouped in 17 food groups. To estimate the portion size, the median consumption amounts of the 194 most frequently consumed dishes were calculated and photographed. Formula and commercial complementary food are collected separately. EFR was structured into seven eating occasions of the day: before breakfast, breakfast, mid-morning, lunch, mid-afternoon, dinner, and before bed.

CONCLUSIONS

The EFR booklet provides a simple, feasible and validated instrument that can be used to update information on dietary habits during the transition from infant to childhood diet for families in different social classes.