Nutrient intakes of infants and toddlers from maternal and child care centres in urban areas of China, based on one 24-hour dietary recall

Complementary Feeding Practices among Young Children in China, India, and Indonesia: A Narrative Review

Under- and overnutrition are co-existing health issues in several countries across Asia. Poor complementary feeding (CF) is a significant determinant of malnutrition in children and a major cause of morbidity and mortality. The purpose of this narrative review is to summarize the most recent evidence regarding the CF practices in 3 countries with a high prevalence of stunting and overweight, and currently undergoing rapid economic and nutritional transition: China, India, and Indonesia. We focused particularly on the adequacy of CF, based on the WHO feeding indicators (2021) regarding timing, frequency, diversity, as well as the consumption of specific food groups. According to the findings, the majority of infants in the 3 countries are introduced to CF at an inappropriate time: either too early (particularly in urban/rural areas of China and Indonesia) or too late (India) compared with the WHO recommendation. Furthermore, in all countries, diets are characterized by a low variety and frequency of CF and consist mainly of staple foods with poor nutritional quality, such as rice, cereals, or noodles. Nutrient-dense and protein-rich foods, such as foods of animal origin, are either inadequately consumed (rural areas of China and India) or introduced too late (urban areas of China and Indonesia) in the diets of children. In all countries, the consumption of fruit and vegetables, especially during the early CF period, is poor. In contrast, a significant proportion of both urban and rural children, particularly in Indonesia and India, are consuming energy-dense/nutrient-poor snacks and sugary drinks during the CF period. The described practices may pose a significant risk for the development of energy and/or nutrient gaps, magnifying the double and triple burden of malnutrition present in these countries. Further research is warranted to understand the significance of the observed practices for stunting and/or overweight/obesity risk.

Diet structure and academic achievement of children from difficult families: a cross-sectional study of Chinese children

OBJECTIVES

Welfare policy focuses on vulnerable populations, such as children with difficult family backgrounds. Education is a crucial way to reduce poverty. This study explored the relationship between children's diet structure and academic achievement and compared these across different family backgrounds.

DESIGN

A cross-sectional study was conducted to survey the health status of children from difficult families based on a random sampling method in 2018. Survey data were collected from children and their guardians with a questionnaire. A multi-sample latent class model and an ordinal logistic model were applied for data analysis.

SETTING

This study was conducted in 31 provinces nationwide. Two provinces in the Central (Shandong and Jiangxi), Eastern (Hebei and Henan) and Western (Chongqing and Shanxi) regions and one province in the Northeast (Liaoning) were selected considering different stratum of economic development.

PARTICIPANTS

A total of 2099 children with difficult family backgrounds and 666 children from ordinary families were surveyed.

RESULTS

The dietary structure of children from ordinary families was significantly better than that of children with difficult or unstable family backgrounds ([Formula: see text] =9.178, p<0.01). Children from difficult families had an intake of dairy products and fruits below dietary standards. The difference in academic achievement between children in the balanced and deprived groups was statistically significant (OR=0.640, 95% CI 0.429 to 0.955). Other determinants of the academic achievement of children in difficult families were parents' education level (OR=1.331, 95% CI 1.162 to 1.525), family economic status (OR=0.835, 95% CI 0.748 to 0.932) and parents' academic concern (OR=0.373, 95% CI 0.252 to 0.553).

CONCLUSIONS

To address the differences between children from difficult families and ordinary families, policymakers should develop support policies for difficult children, guide the formation of a reasonable dietary structure. Besides, enhancing family closeness and fostering family nurturing behaviours are the keys to promote the good academic development of children from difficult families.

Process Evaluation of an Application-Based Salt Reduction Intervention in School Children and Their Families (AppSalt) in China: A Mixed-Methods Study

Background

Salt reduction is a cost-effective, and rather challenging public health strategy for controlling chronic diseases. The AppSalt program is a school-based multi-component mobile health (mhealth) salt reduction program designed to tackle the high salt intake in China. This mixed-methods process evaluation was conducted to investigate the implementation of this program across sites, identify factors associated with the implementation, and collect evidence to optimize the intervention design for future scale-up.

Methods

Mixed methods were used sequentially to collect data regarding five process evaluation dimensions: fidelity, dose delivered, dose received, reach, and context. Quantitative data were collected during the intervention process. Participation rate of intervention activities was calculated and compared across cities. The quantitative data was used for the selection of representative intervention participants for the qualitative interviews. Qualitative data were collected in face-to-face semi-structured interviews with purposively selected students (n = 33), adult family members (n = 33), teachers (n = 9), heads of schools (n = 9), key informants from local health, and education departments (n = 8). Thematic analysis technique was applied to analyze the interview transcripts using NVivo. The qualitative data were triangulated with the quantitative data during the interpretation phase.

Results

The total number of families recruited for the intervention was 1,124. The overall retention rate of the AppSalt program was 97%. The intervention was implemented to a high level of fidelity against the protocol. About 80% of intervention participants completed all the app-based salt reduction courses, with a significant difference across the three cities (Shijiazhuang: 95%; Luzhou: 73%; Yueyang: 64%). The smartphone app in this program was perceived as a feasible and engaging health education tool by most intervention participants and key stakeholders. Through the interviews with participants and key stakeholders, we identified some barriers to implementing this program at primary schools, including the left-behind children who usually live with their grandparents and have limited access of smartphones; perceived adverse effects of smartphones on children (e.g., eyesight damage); and overlooked health education curriculum at Chinese primary schools.

Conclusion

This process evaluation demonstrated the feasibility and acceptability of using smartphone applications delivered through the education system to engage families in China to reduce excessive salt intake.

Clinical Trial Registration

The AppSalt study was registered at www.chictr.org.cn, identifier: ChiCTR1800017553. The date of registration is August 3, 2018.

Vpliv izbirčnosti v prehrani na prehranjenost otrok

Uvod: Vse pogosteje zaznavamo različne težave z načinom prehranjevanja pri otrocih. Otroci med 10. in 14. letom intenzivno rastejo in se razvijajo. Namen raziskave je bil ugotoviti vpliv izbirčnosti v prehrani otrok na njihovo prehranjenost v omenjeni starosti.Metode: Uporabljena je bila presečna opisna raziskava. Zajet je bil priložnostni vzorec osnovnošolcev zadnjega triletja. V raziskavi je sodelovalo 62 (49,2 %) učencev moškega in 64 (50,8 %) učencev ženskega spola zadnjega triletja ene izmed osnovnih šol v Sloveniji. Za zbiranje podatkov smo uporabili anketni vprašalnik, pridobili pa smo tudi podatke o telesni masi in višini. Uporabili smo opisno in sklepno statistiko (dvostranski test ANOVA).Rezultati: 37 (53,6 %) deklet in 28 (44,4 %) fantov je trdilo, da so izbirčni. Z dvostranskim testom ANOVA smo ugotovili, da obstaja povezava med izbirčnostjo in prehranjenostjo (p = 0,014). Pri dekletih je vidno večje odstopanje od prehranjenosti kot pri fantih.Diskusija in zaključek: Izbirčno prehranjevanje je v današnjem času zelo pogost problem, saj se je v njem prepoznala skoraj polovica vključenih učencev. Izbirčnost ima lahko negativne posledice v odrasli dobi. V starosti 10–14 let se ustvarjajo prehranjevalne navade, ki so lahko prisotne celotno življenje, zato je bistveno, da delujemo preventivno in s tem preprečimo negativne posledice. V prihodnosti bi bilo treba raziskovanje usmeriti v preventivne dejavnosti in promocijo zdravega prehranjevanja.

Nurturing the Early Life Gut Microbiome and Immune Maturation for Long Term Health

Early life is characterized by developmental milestones such as holding up the head, turning over, sitting up and walking that are typically achieved sequentially in specific time windows. Similarly, the early gut microbiome maturation can be characterized by specific temporal microorganism acquisition, colonization and selection with differential functional features over time. This orchestrated microbial sequence occurs from birth during the first years of age before the microbiome reaches an adult-like composition and function between 3 and 5 years of age. Increasingly, these different steps of microbiome development are recognized as crucial windows of opportunity for long term health, primarily linked to appropriate immune and metabolic development. For instance, microbiome disruptors such as preterm and Cesarean-section birth, malnutrition and antibiotic use are associated with increased risk to negatively affect long-term immune and metabolic health. Different age discriminant microbiome taxa and functionalities are used to describe age-appropriate microbiome development, and advanced modelling techniques enable an understanding and visualization of an optimal microbiome maturation trajectory. Specific microbiome features can be related to later health conditions, however, whether such features have a causal relationship is the topic of intense research. Early life nutrition is an important microbiome modulator, and 'Mother Nature' provides the model with breast milk as the sole source of nutrition for the early postnatal period, while dietary choices during the prenatal and weaning period are to a large extent guided by tradition and culture. Increasing evidence suggests prenatal maternal diet and infant and child nutrition impact the infant microbiome trajectory and immune competence development. The lack of a universal feeding reference for such phases represents a knowledge gap, but also a great opportunity to provide adequate nutritional guidance to maintain an age-appropriate microbiome for long term health. Here, we provide a narrative review and perspective on our current understanding of age-appropriate microbiome maturation, its relation to long term health and how nutrition shapes and influences this relationship.

Patterns of the Consumption of Young Children Formula in Chinese Children Aged 1-3 Years and Implications for Nutrient Intake

The consumption of young children formula (YCF) is associated with reduced risk of inadequacies of nutrients that are frequently lacking in the diets of young children. In this study, we assessed the role of YCF in children’s diets and whether meeting dairy intake recommendations would improve nutrient intake in young Chinese children aged 12–36 months. Dietary intake data for children from the 2012 China Maternal and Infant Nutrition and Growth study were analyzed (n = 910). Nutrient intake was compared between YCF consumers and non-consumers, and the theoretical impact of meeting dairy intake recommendations by adding cow’s milk or YCF to children’s diets was assessed using diet modelling. The percent of children consuming YCF was 64.5% and was positively associated with family income and mother’s education level. Compared to non-consumers, YCF consumers had higher intakes of minerals (e.g., calcium, iron) and vitamins (e.g., C, D, B6) that are important for growth and immune function, and lower intakes of saturated fat. To meet dairy intake recommendations by adding either cow’s milk or YCF to children’s diets would improve intakes of vitamins and minerals in young Chinese children. YCF consumption contributes to the improvement of nutrient intakes in children aged 12–36 months in China.

Harmonizing Micronutrient Intake Reference Ranges for Dietary Guidance and Menu Planning in Complementary Feeding

There are no published harmonized nutrient reference values for the complementary feeding period. The aim of the study was to develop proposals on adequate and safe intake ranges of micronutrients that can be applied to dietary guidance and menu planning. Dietary intake surveys from 6 populous countries were selected as pertinent to the study and reviewed for data on micronutrients. The most frequently underconsumed micronutrients were identified as iron, zinc, calcium, magnesium, phosphorus, potassium, and vitamins A, B6, B12, C, D, E, and folate. Key published reference values for these micronutrients were identified, compared, and reconciled. WHO/FAO values were generally identified as initial nutrient targets and reconciled with nutrient reference values from the Institute of Medicine and the European Food Standards Authority. A final set of harmonized reference nutrient intake ranges for the complementary feeding period is proposed.

Measuring food provision in Western Australian long day care (LDC) services: a weighed food record method/protocol at a service level

Background

There are currently 1.3 million children utilising Early Childhood Education and Care (ECEC) services in Australia. Long day care (LDC), family day care and out of school hours care currently provide this service in different environments. This research reports findings from a LDC perspective. Children can consume 40–67% of their food intake whilst at LDC services, this highlights the importance of monitoring food provision at a service level. There are several methods to measure food provision which typically focus on intake at an individual level. There is limited evidence of measuring food provision accurately at a service level and for young children. Accurate and consistent dietary assessment methods are required to determine compliance with dietary guidelines and to provide rigour for comparison between studies.

Methods

Convenience sampling was used to recruit 30 LDC services and food provision assessed over two consecutive days. To ensure consistency, trained researchers weighed raw food ingredients used in food preparation at each service. Food and food weights were allocated to food groups to determine average serves of food group provision at morning tea, lunch and afternoon tea per child. All data were entered into Foodworks for dietary analysis and compliance with dietary guidelines was assessed using Wilcoxon signed-rank and one-sample t-tests (SPSS).

Discussion

This paper outlines the process of data collection for the measurement and auditing of food provision and food waste at a service level. There is an urgent need to ensure that food provision at a service level complies with current dietary guidelines and is accurately assessed. Following a standard method of data collection will allow a more accurate comparison between studies and allow change to be monitored more accurately over time to guide decision makers.

Trial registration

As this research project is conducted at a service level and not a clinical trial, registration was not required.

Perceptions of food intake and weight status among parents of picky eating infants and toddlers in China: A cross-sectional study

BACKGROUND

Previous studies have suggested that children that are picky eaters may have a different and less varied diet than non-picky children, but the literature on picky eating in Chinese children is limited.

OBJECTIVES

To assess the prevalence of picky eating in 6-35 month-old Chinese children, and to explore how parents' perceptions of picky eating relate to children's intake and body composition.

METHODS

1414 6-35 month-old infants and toddlers from 8 Chinese cities were included in this study. Questionnaires were used to collect information on family demographic factors, child picky eating behaviors, food group rejection, and parents' perception of child weight status. Dietary intake data was collected via 24-h recall. Children's length/height and weight were measured.

RESULTS

The reported prevalence of picky eating was higher in 24-35 month-olds (36% of children) compared to 6-11 month-olds (12%). There were no consistent significant differences in dietary intakes of nutrients between picky and non-picky eaters. Picky eating children whose parents indicated that they avoided eggs had lower intake of this food group compared to non-picky eaters, whereas those reported to avoid grains or meat had higher intakes of those food groups. Weight status was underestimated by parents of both picky and non-picky children.

CONCLUSIONS

Picky eating seems to occur at similar prevalence rates in China as has been reported in other countries. Parents' perceptions of food refusal do not reflect actual intakes, nor do nutrient intakes of picky eaters show additional gaps compared to non-picky eating children. In healthy children with typical growth patterns, picky eating seems to be a normal phase of development experienced by some children, without substantial consequences on their nutrient or food group intakes.

Food groups consumed by infants and toddlers in urban areas of China

Background

Food consumption patterns of young children in China are not well known.

Objective

Characterised food groups consumed by infants and young children in urban China using data from the Maternal Infant Nutrition Growth (MING) study.

Design

One 24-h dietary recall was completed for 1,350 infants and young children (436 infants aged 6–11 months and 914 young children aged 12–35 months), who were recruited from maternal and child care centres in eight cities via face-to-face interviews with the primary caregiver. All foods, beverages and supplements reported were assigned to one of 64 food groups categorised into the following: milk and milk products, grains, vegetables, fruits, protein foods and desserts/sweets. The percentage of infants and young children consuming foods from specific food groups was calculated, regardless of the amount consumed.

Results

Less than half of infants consumed breast milk (47%), whereas 59% of infants consumed infant formula and 53–75% of young children consumed growing-up (fortified) milk. Rice was the number one grain food consumed after 6 months (up to 88%) and the consumption of infant cereal was low. About 50% of infants did not consume any fruits or vegetables, and 38% of young children did not consume any fruits on the day of the recall. Only 40% of all children consumed dark green leafy vegetables and even fewer consumed deep yellow vegetables. Eggs and pork were the most commonly consumed protein foods.

Conclusions

The data provide important insight for developing detailed food consumption guidelines for this population group. Mothers of infants should be encouraged to continue breastfeeding after the first 6 months. Parents should be advised to offer a wide variety of vegetables and fruits daily, particularly dark green leafy and deep yellow vegetables and colourful fruits. The consumption of fortified infant cereal should be advocated to improve the iron intake of Chinese infants.