Weaning in Britain: practice, policy and problems

Complementary feeding: Attitudes, knowledge and practices of urban families in northern Thailand

AIM

Urban families in middle-income countries are currently facing cultural and lifestyle transition. Changing from an agricultural to an industrial society may affect family roles and child-care practices. The present study aims to reveal family attitudes, knowledge and practices focusing on complementary feeding (CF).

METHODS

A cross-sectional study was conducted in three Child Health Clinics in Chiang Mai, Thailand. Self-administered questionnaires were given to families caring for healthy infants and children less than 18 months of age during October to November 2016.

RESULTS

One-hundred and eight respondents completed questionnaires. The study found different attitudes and knowledge gaps between the respondents who were mothers and other family members ('others'). The 'others' were less likely to value CF as a crucial factor promoting child growth and development. Moreover, they had misperceptions about the benefits of animal-based protein and were less confident in their ability to feed the child properly. Most families reported timely introduction of complementary food, using proper milk products and encouraging age-appropriate feeding methods. However, there were undesirable practices including delaying introduction of animal-based protein, inadequate food diversity, the use of seasoning, feeding premasticated food and offering food as a reward.

CONCLUSIONS

These findings suggest that nutritional education should be extended to all caregivers involved in CF to improve the adherence to feeding recommendations.

Some aspects of the public health importance of measurement of growth

Growth is a fundamental process of life which in complex animals is influenced by genetic constitution, nurture and nutrition. Increase in size is accompanied by process of development and both growth and development are closely linked with time--the age of the individual. This paper considers ways in which simple measurements of different aspects of the growth of children have contributed, and are continuing to contribute, to our understanding of the origins of disease. The results of these measurements can help those involved in the care of children to identify individuals at risk of disturbances of growth and the possibility of the development of diseases associated with them. It can also help instigate preventative measures that may help children to develop more fruitful and longer disease-free lives.

The role of meat to improve the critical iron balance during weaning

BACKGROUND

Iron requirements during the weaning period are the highest per unit body weight during human life, and diet is often insufficient to cover iron needs. For the first time in infant nutrition the absorption of both nonheme and heme iron from a typical weaning gruel after addition of meat with and without ascorbic acid (AA) to improve bioavailability was studied.

METHODS

Nonheme and heme iron absorption from gruel was measured in 33 adults using 2 radioiron isotopes--an inorganic iron salt to label nonheme iron, the other biosynthetically labeled rabbit hemoglobin to label heme iron. Iron absorption was measured from the basal gruel (based on milkpowder and cereals) and from basal gruel added 20 g red powdered meat, alone and together with 20 mg AA in 4 different trials.

RESULTS

Nonheme iron absorption from the basal meal was 0.33 mg/1000 kcal and the increase from added 20 mg AA was 39%, whereas addition of red meat increased nonheme iron absorption by 85%. This latter increase was unexpectedly high. Total iron absorption was further increased by heme iron absorption of 0.23 mg Fe/1000 kcal. When adding both meat and AA, total iron absorption amounted to 1.08 mg iron/1000 kcal, ie, exceeding 1 mg/1000 kcal, a level estimated to correspond with daily iron requirements in 95% of infants aged 12 months.

CONCLUSIONS

Addition of powdered red meat to weaning gruels markedly increased total iron absorption. A weaning diet with added powdered meat and AA may serve as a viable option to satisfy the body's high iron requirements during this critical period.

Iron and breastfeeding

Given the importance of iron nutrition during the first year of life, there are surprisingly few true, randomized, controlled studies addressing this issue; however, it seems that iron deficiency is unlikely in full-term, breastfed infants during the first 6 months of life because these infants' body iron stores are sufficient to meet requirements. After this time, many infants exhaust their iron stores and become dependent on a secondary dietary iron supply. Although iron deficiency is a significant nutritional problem worldwide, most of the adverse effects of iron deficiency in this age group are hypothetical and rely on extrapolation from animal studies or studies at different ages. This, however, also is true of most of the adverse effects of iron excess in this age group. Given this uncertainty, it seems prudent to use the lowest dose of iron that prevents iron-deficiency anemia. Currently, the best evidence is that this is achieved by prolonged breastfeeding, avoidance of unfortified formulas and cow's milk, and the introduction of iron-fortified and vitamin C-fortified weaning foods at approximately 6 months of age. Despite much research, there are many areas of uncertainty regarding iron supplementation of infants, including that: 1. The optimal age for introducing iron-fortified supplemental foods is poorly defined and should be further evaluated. 2. The natural history of iron deficiency and iron-deficiency anemia during the first year of life is unclear, as are the possible long-term effects of this, especially on developmental outcome. 3. The biologic variability among infants and among their mothers that allows many infants who do not receive iron-fortified foods to prevent iron deficiency while receiving only human milk throughout the first year of life is intriguing and warrants additional study. 4. The iron requirements of small-for-gestational-age, term infants are unknown. Their iron requirements are likely to be higher than those of average term infants, but whether iron supplements are required is unclear. 5. The optimum amount of dietary iron in the weaning diet needs to be further defined. Similarly, the optimal source and amount of iron in infant formulas given to infants who receive a mixture of human milk and formula is unclear.