Production, acceptability, nutritional and pasting properties of orange-flesh sweet potato, cowpea and banana flour mix

Promoting the intake of foods rich in vitamin A is key to combating the increase in vitamin A deficiency. This research focused on the utilization of orange-fleshed sweet potatoes (a tuber-based food), cowpea (a pulse), and ripe bananas (a fruit) for the production of flour mix as a means to reduce Vitamin A deficiency in children. Different ratios of sweet potato-cowpea-banana (PCB) mix, resulting in 8 different blended samples, were optimized. The flour mix was evaluated for its overall acceptability, vitamin A content, beta-carotene, and other nutritional and functional properties. The panelists rated the sweet potato-cowpea banana blends labeled PCB8 (60% OFSP, 30% cowpea, 5% ripe banana flour, and 5% sugar) as most preferred and acceptable with average scores of 8.96 points for color, 8.75 points for flavor, 8.88 points for appearance, 8.33 points for taste, 8.07 points for texture, and 8.39 points for overall acceptability on a 9-point hedonic scale. The vitamin A and beta-carotene contents ranged 7.62 to 8.35 mg/100 g and 0.15-0.17 mg/100 g for all blends. A significant difference in the functional properties of the flour mix were observed with an increase in the ratio of sweet potato flour addition. Findings from this study show that the flour mix PCB4 (65% sweet potato, 30% cowpea, and 5% ripe banana flour) was acceptable (8.15) and is recommended based on its vitamin A content (8.35 mg/100 g), nutritional properties, and functional properties. The study showed that locally available food commodities have good nutritional value that will help reduce vitamin A deficiency in children.

Bisphenol analogues in infant foods in south China and implications for infant exposure

Bisphenol analogues (BPs) are commonly used as modifiers, stabilizers and photo-initiators in polymer materials, including those used in food packaging. Compared to adults, infants are more sensitive to chemicals because their bodies are growing and not fully developed. Therefore, it is essential to determine the concentrations of BPs in common infant foods to assess infant exposure and prevent hazards. We collected 54 infant formula (IF) samples, 90 complementary food (CMF) samples and 62 breastmilk samples from breastfeeding women in south China. Tandem mass spectrometry coupled to liquid chromatography separation (HPLC-MS/MS) was used to detect the concentrations of 8 BPs in the three types of food samples. The estimated daily intake (EDI) of infants was also assessed. The results showed that the detection frequency of bisphenol F (BPF), bisphenol S (BPS), bisphenol AF (BPAF) and bisphenol AP (BPAP) were relatively high among the different infant foods. BPF, BPP and BPS were predominant among the detected BPs. The lowest 95th EDI for BPA was 0.67 ng kg-bw-1 day-1, exceeding the tolerable daily intake (TDI) limit for BPA set by the European Food Safety Authority in 2023. Thus, BP exposure is a significant risk to infants. More attention should be paid to the presence of BPs in daily use products and food, and intake limits should be set for BPs other than BPA.

Avoidance of added salt for 6-12-month-old infants: A narrative review

Most nutrition guidelines recommend avoiding foods with added salt for infants aged 6-12 months. However, the reason for no added salt lacks enough and reliable evidence. We re-searched and re-studied the relevant evidence. We searched PubMed and the Cochrane database for English-language studies published from 1904 through 2021. We also searched the databases of the websites of different national institutions. Randomized clinical trials (RCTs), systematic reviews, observational studies, and dietary guidelines were included in this review. The kidneys of infants aged 6-12 months have adequate sodium excretion capacity. There is insufficient evidence that high salt (sodium) intake early in life might lead to hypertension or salty diet preference in adults. Infants aged 6-12 months might be at risk of low sodium intake of only 150-300 mg of sodium/day, which may not meet the body's needs, if their supplementary food is not adequately salted.

Changes in beef protein digestibility in an in vitro infant digestion model with prefreezing temperatures and aging periods

The protein digestibility of beef at three prefreezing temperatures (freezing at -20 °C, F20; freezing at -50 °C, F50; and freezing at -70 °C, F70) and aging periods (4, 14, and 28 days) was investigated using an in vitro infant digestion model. The increased cathepsin B activity in the frozen-then-aged treatments (P < 0.05) resulted in a higher content of 10% trichloroacetic acid-soluble α-amino groups than in the aged-only group on days 14 and 28 (P < 0.05). F50 had the most α-amino groups in the digesta and digested proteins under 3 kDa on day 28 (P < 0.05), with the disappearance of actin band in the digesta electrophoretogram. The secondary and tertiary structures of myofibrillar proteins revealed that F50 underwent irreversible denaturation (P < 0.05), especially in the myosin fraction, while F20 and F70 showed protein renaturation during aging (P < 0.05). In general, prefreezing at -50 °C then aging can improve the in vitro protein digestibility of beef through freezing-induced structural changes.

Processing and optimisation of complementary food blends from roasted pearl millet (Pennisetum glaucum) and soybean (Glycine max) using response surface modeling

Adequate nutrition is vital during infancy but the high cost of supplemented infant formulae has forced inhabitants of Central and West Africa to depend solely on low-nutrient gruels. Response Surface modelling was used to process a complementary food from roasted pearl millet and Soybean flour. A central composite design was adopted to study the effects of feed composition X1 (5.86-34.14%) and roasting temperature X2 (126-154 °C) on the micronutrients, functional, and sensory profiles of the different blends. The responses were significantly (p < 0.05) affected by the independent factors. For the vitamins in mg/100 g, the thiamin, riboflavin, folate, and β-carotene content ranged from 0.17-0.33, 24-53.50, 1.32-2.29, and 7-22.98, respectively. For the minerals in mg/100 g, the zinc, calcium, potassium, and iron content ranged from 0.35-0.54, 39.5-62.75, 1.2-1.8, and 0.017-0.18, respectively. The viscosity, bulk density, swelling capacity, water absorption capacity, and pH ranged from 1577.5-942.5 cP, 0.74-0.79 g/cm3, 0.10-0.30 ml/g, 1.2-1.4 ml/g, and 4.70-5.70, respectively. The sensory scores were rated highly by the panelists. The optimum processing conditions with a desirability of 0.50 gave 29.28% and 130.39 °C feed composition and roasting temperature, respectively.

Magnitude and determinants of animal source food consumption among children aged 6-23 months in Ethiopia: secondary analysis of the 2016 Ethiopian demographic and health survey

Background

Undernutrition puts children in a physical and cognitive disadvantage. Animal source foods (ASFs) are important components of nutritious diets and play a significant role in increasing dietary diversity and minimizing the risk of undernutrition among children. Ethiopia still suffers from child undernutrition and there’s no adequate information regarding consumption of ASFs. The objective of this study was to determine the magnitude and determinanats of ASF consumption among children 6–23 months of age.

Methodology

A total weighted sample of 2861 children drawn from the 2016 Ethiopian demographic and health survey was analyzed using “SVY” command of STATA 14.0. Multivariable logistic regression was used to determine the independent determinants of ASF consumption. The strength of the association was measured by odds ratio and 95% confidence interval and p-value < 0.05 was considered statistically significant.

Results

Nearly half (46.5%) of the children reported consuming any type of ASF. Religion, child age, number of household assets, number of livestock owned by a household, and ownership of land usable for agriculture were significant determinants of the outcome variable. The odds of ASF consumption were six times, twice, and 70% lower in orthodox children compared to other (catholic, traditional, or others), muslim, and protestant children, respectively. Household ownership of assets and livestock led to an increase in consumption of ASF by 19 and 2%, respectively. Children aged 18–23 months were more likely to consume ASF as compared to the younger age group (6–8 months old children). In the contrary, children from households that own land usable for agriculture were 33% less likely to consume ASFs as compared to those from households that do not own.

Conclusions

In Ethiopia, only nearly half of children aged 6–23 months consume any type of ASF. The findings of this study imply that ASF consumption can be increased through integrated actions that involve community and religious leaders and programs focused on empowering households’ capability of owning other socioeconomic entities including assets and livestock. This study also may contribute to the growing body of research works on the importance of ASF provision in preventing child undernutrition.

Freezing-then-aging treatment improved the protein digestibility of beef in an in vitro infant digestion model

In vitro protein digestibility of freezing-then-aged beef was investigated in an infant digestion model. The treatments were divided into freezing-then-aging (FA) and aging-only (AO) groups. Carbonyl and total free sulfhydryl contents were the same between both groups for 14-day aging. Freezing had no effect on beef myofibrillar protein tertiary structure. Although caspase-3 activity did not differ, the FA group showed higher cathepsin B activity than the AO group (p < 0.05). The 10% trichloroacetic acid-soluble α-amino content was higher in FA than AO group, on aging day 14 (p < 0.05). Post in vitro digestion of beef aged for 14 days, the FA group had a higher content, than the AO group, of α-amino groups and proteins digested under 3 kDa (p < 0.05). An electrophoretogram of the digesta showed improved digestion of actin in the FA group. Collectively, the freezing-then-aging process enhanced the protein digestibility of beef in this in vitro infant digestion model.

Duration of breastfeeding, age at introduction of complementary foods and allergy-related diseases: a prospective cohort study

Background

The influences of breastfeeding and infant diet in the prevention of allergy-related diseases are uncertain and many of the studies conducted on the topic are limited by methodological challenges. Our aim was to assess whether the duration of breastfeeding and age at complementary food introduction affected the prevalence of asthma, wheeze, allergic rhinoconjunctivitis (ARC) and eczema at two and six years of age.

Methods

We used information gathered between 2000 and 2014 through questionnaires in the Prevention of Allergy among Children in Trondheim (PACT) study, a prospective cohort study in Trondheim, Norway. The current study includes 6802 children who submitted questionnaires detailing breastfeeding duration and or age at introduction to complementary foods, as well as at least one of the child health questionnaires completed at two and six years of age. Adjusted odds ratios (aORs) were calculated for each combination of exposure and outcomes and sensitivity analyses were performed to assess the possible influence of recall bias and reverse causality.

Results

The mean duration of breastfeeding was 11 months (SD 5.6) in this study population and 5695 of 6796 (84%) infants had been breastfed for at least 6 months. We did not find any conclusive preventative effect of longer breastfeeding on parental reported doctor-diagnosed asthma, aOR 0.79 (95% CI 0.51, 1.21). However, at 6 years of age we observed a reduction in the less strictly defined outcome wheeze, aOR 0.71 (95% CI 0.53, 0.95). Longer breastfeeding was associated with a reduced risk of ARC at 2 years, aOR 0.65 (95% CI 0.49, 0.86), with a continued protective trend at 6 years, aOR 0.77 (95% CI 0.58, 1.04).

Conclusions

Longer breastfeeding resulted in a reduced risk of wheeze and a trend towards a protective effect on ARC up until school age. No conclusive associations were seen between the duration of breastfeeding or age at introduction to complementary foods and prevention of asthma, wheeze, ARC and eczema.

Trial registration

The trial is registered in Current Controlled Trials as ISRCTN28090297.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13006-020-00352-2.

Scaled-up nutrition education on pulse-cereal complementary food practice in Ethiopia: a cluster-randomized trial

Background

Improving children’s weight status through nutrition education (NE) for mothers about using pulses in complementary feeding has been demonstrated in pilot studies, but no effect on stunting was reported. The aim of the study was to assess the impact of a 9-month pulse-nutrition education program on improving mothers’ knowledge, attitude, and practices (KAP) towards pulses, as well as its effect on children’s diet diversity, and nutritional status. The NE was delivered by Health Extension Workers (HEWs).

Methods

A cluster randomized study was employed for the community-based interventional study. Twelve randomly selected villages in Sidama Zone, Southern Ethiopia were included in the study. A total of 772 mother-child pairs involved in the study; where 386 mother-child pairs in the intervention group received additional messages about pulse-cereal complementary food, and 386 pairs (the control) received only routine health education for 9 months. A survey on mothers’ KAP and anthropometric measurements of the children were taken at baseline, midpoint, and end point. ANOVA and descriptive statistics were used to analyzed data.

Results

At baseline and end point, maternal KAP and the dietary diversity score of the children (mean age at end point 18.8 ± 2.9 mo) were assessed. Intervention mothers’ KAP improved (p < 0.001) at midpoint and end point compared to that of the control group, as did frequency of pulse consumption and Dietary Diversity Score (DDS) among children. At 9 months, the prevalence of stunting, wasting, and underweight was significantly reduced in the intervention group compared to the control group (p = 0.001).

Conclusions

NE delivered by HEWs improved KAP of mothers regarding pulse consumption and dietary diversity of children led to improved nutritional status of the children. Training HEWs on the use of pulses for complementary food may be an effective way to improve the health of children in Ethiopian communities.

Trial registration

Clinicaltrials.gov #NCT02638571.

Date of registration: 12/18/2015.

Prospectively registered.

Feeding practices in 6-24-month-old children with chronic cholestatic liver diseases: a mixed-method study

Background

Children with chronic cholestatic liver diseases have a high risk of malnutrition. However, nutritional management in China has received little attention, and there has been limited evidence regarding improving these practices. This study aimed to evaluate the feeding status of chronic cholestatic children aged 6–24 months and to explore their parents’ experiences with feeding practices.

Methods

A mixed-method study was conducted among parents of 74 children with chronic cholestatic liver diseases. The Infant and Young Child Feeding Index (ICFI) was used to collect quantitative data of feeding practices. In-depth interviews with parents were performed to generate qualitative data. Multivariate analysis was conducted to identify predictors of inappropriate feeding practices. Qualitative data were analyzed using thematic analysis.

Results

Only 16.2% of the children had appropriate feeding practices. In terms of dairy products, the rate of breastfeeding, medium-chain triglyceride formula feeding, and regular formula feeding were 25.7, 39.2 and 44.6% respectively. The complementary feeding rate was 68.8%, and the age of adding complementary foods was 6.9 ± 1.7 months. Consumption of foods from animal sources was suboptimal, 66.7% of the children aged 6–8 months and 45.5% of the children aged 9–11 months had carbohydrates as a single source of complementary foods and had no intake of meat, eggs or bean products, while in the age group 12–24 months, 52.0% of the children had eggs less than 2 days/week, 60.0% had meat less than 2 days/week, and 60.0% had no intake of bean products. Low literacy of the primary care provider was significantly related to inappropriate feeding practices (adjusted OR 5.52; 95% CI 1.29, 23.66). The result of the interviews indicated that parents generally lacked the scientific knowledge of feeding and thought that the intake of animal source foods and oils would be a burden to the liver and cause damage to the liver functions.

Conclusion

Parents generally lacked science-based feeding knowledge and the feeding practices in 6–24-month-old children diagnosed with chronic cholestatic liver diseases fell short of the recommendations in current nutritional guidelines. Appropriate interventions targeting social and cultural family circumstances should therefore be included in supporting parents in feeding practices to improve children’s clinical outcomes.

Evaluating the nutritional content of an insect-fortified food for the child complementary diet in Ghana

BACKGROUND

Due to rising food insecurity, natural resource scarcity, population growth, and the cost of and demand for animal proteins, insects as food have emerged as a relevant topic. This study examines the nutrient content of the palm weevil larva (Rhynchophorus phoenicis), a traditionally consumed edible insect called akokono in Ghana, and assesses its potential as an animal-source, complementary food.

METHODS

Akokono in two "unmixed" forms (raw, roasted) and one "mixed" form (akokono-groundnut paste) were evaluated for their macronutrient, micronutrient, amino acid, and fatty acid profiles.

RESULTS

Nutrient analyses revealed that a 32 g (2 tbsp.) serving of akokono-groundnut paste, compared to recommended daily allowances or adequate intakes (infant 7-12 months; child 1-3 years), is a rich source of protein (99%; 84%), minerals [copper (102%; 66%), magnesium (54%; 51%), zinc (37%; 37%)], B-vitamins [niacin (63%; 42%), riboflavin (26%; 20%), folate (40%; 21%)], Vitamin E (a-tocopherol) (440%; 366%), and linoleic acid (165%; 108%). Feed experiments indicated that substituting palm pith, the typical larval diet, for pito mash, a local beer production by-product, increased the carbohydrate, potassium, calcium, sodium, and zinc content of raw akokono. Akokono-groundnut paste meets (within 10%) or exceeds the levels of essential amino acids specified by the Institute of Medicine criteria for animal-source foods, except for lysine.

CONCLUSIONS

Pairing akokono with other local foods (e.g., potatoes, soybeans) can enhance its lysine content and create a more complete dietary amino acid profile. The promotion of akokono as a complementary food could play an important role in nutrition interventions targeting children in Ghana.

Moisture sorption isotherm and shelf life prediction of complementary food based on amaranth-sorghum grains

The quantity and quality of complementary foods is one of the contributing factors to childhood under nutrition. Complementary food based on amaranth and sorghum grains was formulated. It was deemed to be superior nutritionally to the commonly used complementary foods in Kenya. Knowledge on storage and packaging is important for a long shelf life of the product to be achieved. Water activity and moisture content are key indicators of the stability of dried foods. To establish the proper storage conditions of the product, moisture sorption isotherms at 25 °C, 30 °C and 35 °C were determined over water activity range of 0.11-0.97 and data fitted with six sorption models. Water vapour permeability of common packaging materials was also determined at 25 °C and 35 °C and the data was used to predict the product's shelf life. The product exhibited type two sorption isotherm according to Brunner classification an indication of monolayer-multilayer sorption behavior. The critical storage moisture content of the complementary food corresponding to 0.6 water activity a point of microbiological stability was found to be 7.5%. Based on Heiss-Eichner model, a shelf life of 1423 days at 25 °C can be achieved with product initial moisture content of 5 g/100 g and packaged in 110 µm thick aluminum pouch. The shelf life of the product was shortened two to three fold at 35 °C in comparison to storage at 25 °C.

Study protocol to assess the impact of an integrated nutrition intervention on the growth and development of children under two in rural Bangladesh

Background

The period from birth to two years is the “critical window” for achieving optimal growth and development. An inadequate quality and quantities of complementary foods, poor child-feeding practices and infection negatively impact the growth of under-twos. Approximately one-third of under-fives in developing countries are stunted; many are also micronutrient deficient. An estimated 6% of mortalities among under-fives can be prevented by ensuring optimal complementary feeding. The objective of the study was to assess the ability of a 12-month integrated nutrition intervention to improve the nutritional status (length-for-age Z-score) of 6 to 12-month-old children in rural Bangladesh.

Methods

In this community-based randomized controlled trial, the intervention group received a package of interventions that includes, food vouchers; to prepare egg-based nutritious snacks (suji firni for < 1-year-olds, suji halwa for > 1-year-olds), micronutrient powder to fortify children’s food at home, child feeding counselling and water, sanitation and hygiene (WASH), behaviour change communication. The control group received routine health messages provided by the government. Baseline and endline surveys were conducted; Data collection was performed monthly on children’s growth, food voucher utilization, child feeding and morbidity. In addition, we assessed the cognitive development of the children after 12 months of intervention.

Conclusion

This trial aims to explore whether an integrated nutrition intervention can mitigate childhood stunting during the critical window of opportunity in rural Bangladesh. The results may provide robust evidence to improve the linear growth of children in developing countries.

Trial registration

The study was retrospectively registered on August 17, 2018 and is available online at ClinicalTrials.gov (ID: NCT02768181).

Effects of dietary intervention on vitamin B12 status and cognitive level of 18-month-old toddlers in high-poverty areas: a cluster-randomized controlled trial

Background

The local diet in high-poverty areas in China is mainly vegetarian, and children may be more vulnerable to vitamin B₁₂ deficiency.

Objective

The aims of this study were to explore the vitamin B₁₂ status of toddlers living in high-poverty areas of China and to observe the effects of different complementary foods on the vitamin B₁₂ status and cognitive level of these toddlers.

Methods

The study was nested within a cluster-randomized controlled trial implemented in 60 administrative villages (clusters) of Xichou County in which infants aged 6 months old were randomized to receive 50 g/d of pork (meat group), an equi-caloric fortified cereal supplement (fortified cereal group) or local cereal supplement (local cereal group) for one year. At 18 months, a subsample of the 180 toddlers (60 from each group) was randomly tested for serum vitamin B₁₂ and total homocysteine (tHcy) levels, and their neurodevelopment was evaluated.

Results

The median serum concentrations of vitamin B₁₂ and tHcy were 360.0 pg/mL and 8.2 μmol/L, respectively, in children aged 18 months. Serum vitamin B₁₂ concentrations less than 300 pg/mL were found in 62 (34.4%) children, and concentrations less than 200 pg/mL were found in 30 (16.7%) children. The median vitamin B₁₂ concentration was significantly different among the three groups (P < 0.001). The highest vitamin B₁₂ level was demonstrated in the fortified cereal group (509.5 pg/mL), followed by the meat group (338.0 pg/mL) and the local cereal group (241.0 pg/mL). Vitamin B₁₂ concentration was positively correlated with the cognitive score (P < 0.001) and the fine motor score (P = 0.023) of the Bayley Scales of Infant Development, 3rd Edition (BSID III) screening test. Compared to the local cereal group, children in the meat group had higher cognitive scores (P < 0.05).

Conclusion

In poor rural areas of China, vitamin B₁₂ deficiency in toddlers was common due to low dietary vitamin B₁₂ intake. Fortified cereal and meat could help improve the vitamin B₁₂ status of children and might improve their cognitive levels.

Trial registration

The larger trial in which this study was nested was registered at clinical trials.gov as NCT00726102. It was registered on July 31, 2008.

TAS2R38 bitter taste genotype is associated with complementary feeding behavior in infants

Background

Genetically mediated sensitivity to bitter taste has been associated with food preferences and eating behavior in adults and children. The aim of this study was to assess the association between TAS2R38 bitter taste genotype and the first complementary food acceptance in infants.

Parents of healthy, breastfed, term-born infants were instructed, at discharge from the nursery, to feed their baby with a first complementary meal of 150 mL at 4 to 6 months of age. They recorded the day when the child ate the whole meal in a questionnaire. Additional data included food composition, breastfeeding duration, feeding practices, and growth at 6 months. Infants’ TAS2R38 genotypes were determined at birth, and infants were classified as “bitter-insensitive” (genotype AVI/AVI) and “bitter-sensitive” (genotypes AVI/PAV or PAV/PAV).

Results

One hundred seventy-six infants and their mothers were enrolled; completed data were available for 131/176 (74.4%) infants (gestational age 39.3 ± 1.1 weeks, birth weight 3390 ± 430 g). Bitter-insensitive were 45/131 (34.3%), and bitter-sensitive were 86/131 (65.6%). Thirty-one percent of bitter-insensitive infants consumed the whole complementary meal at first attempt, versus 13% of bitter-sensitive ones (p = 0.006). This difference was significant independently of confounding variables such as sex, breastfeeding, or foods used in the meal. Growth at 6 months did not differ between the two groups.

Conclusions

Differences in TAS2R38 bitter taste gene were associated with acceptance of the first complementary food in infants, suggesting a possible involvement in eating behavior at weaning.

Nutritional and medicinal properties of underexploited legume trees from West Africa

This review concerns three legume trees (family Fabaceae, subfamily Caesalpinioideae) from West Africa, namely Detarium microcarpum, Parkia biglobosa and Dialium guineense, and illustrates their nutritional value and therapeutic properties. These species are an important source of nutrition for West African populations, but their agricultural exploitation is still incomplete. The survey was conducted on Scopus, Web of Science, and Medline, using scientific and common English names of the species as keywords and then selecting papers related to nutritional and medicinal properties. Main food products are fruit pulp and seeds, though leaves can also be used. Most relevant dietary features are high protein, vitamin, and micronutrient contents. Various therapeutic and nutritional benefits of these plants have been documented by ethnobotanical and experimental studies, stimulating an interest for their possible use as functional food or drug sources. Most studied medicinal properties include antidiabetic and antimicrobial activities of D. microcarpum, cardiovascular protective and antidiabetic activities of P. biglobosa, and bilharzia-preventing molluscicidal activity of D. guineense. Phytochemical characterizations have revealed potential sources of active drugs, such as D. guineense saponins and D. microcarpum diterpenes. Scientific results support popular uses of these legume trees, indicating a prominent nutritional and health value.

Determinants of exclusive breastfeeding in rural South India

Background

While breastfeeding rates have improved globally, disparities in breastfeeding practices persist particularly in rural and low resource settings. In India, only 56% of Indian mothers practice exclusive breastfeeding (EBF) for the recommended six months. As India leads the world in the number of preterm births, under 5 years of age malnutrition and neonatal mortality, understanding the factors associated with EBF can help improve the nutritional status for millions of infants. We assessed the factors associated with EBF in rural Mysore, India.

Methods

This cross-sectional analysis was nested within a cohort study assessing the feasibility and uptake of mobile prenatal care and HIV counseling and testing intervention in Mysore District. Multivariable logistic regression was used to identify the factors associated with EBF for infants between birth and six months. Exclusive breastfeeding was defined as breastfeeding with no other liquids or breastfeeding substitutes given to infants exceptfor medicine or oral rehydration solution, between birth and 6 months and was assessed at six months postpartum.

Results

We surveyed mothers who delivered in rural Mysore taluk between 2008 and March 2011. A total of 1292 mothers participated in the study. The overall breastfeeding rate at six months postpartum was 74.9% and the EBF rate was 48.5%. Factors associated with EBF included higher maternal age (Adjusted Odds Ratio[aOR] 1.04; 95% Confidence Interval [CI] 1.00, 1.09), lower maternal education (aOR1.56, 95% CI 1.10, 2.21), and 7–10 antenatal visits (aOR 1.57; 95% CI 1.09, 2.27). The most common reason for non-exclusive breastfeeding was the mother’s feeling that she did not have enough milk (23.7%). Infants that were not exclusively breastfed were most commonly fed formula/animal milk (42.6%) or castor oil/ghee (18.4%).

Conclusions

Less than half of the mothers in our sample reported exclusive breastfeeding in a rural region of Karnataka, India in the first six months, a rate lower than national and state level rates. Future interventions should evaluate whether antenatal education can improve breastfeeding outcomes. The only modifiable factor was number of antenatal visits. Breastfeeding education should be emphasized at every antenatal visit so that even mothers with fewer than 7–10 antenatal visits can learn the best techniques and benefits of breastfeeding.

Reducing micronutrient deficiencies in Pakistani children: are subsidies on fortified complementary foods cost-effective?

OBJECTIVE

To estimate the cost-effectiveness of price subsidies on fortified packaged complementary foods (FPCF) in reducing iodine deficiency, iron-deficiency anaemia and vitamin A deficiency in Pakistani children.

DESIGN

The study proceeded in three steps: (i) we determined the current lifetime costs of the three micronutrient deficiencies with a health economic model; (ii) we assessed the price sensitivity of demand for FPCF with a market survey in two Pakistani districts; (iii) we combined the findings of the first two steps with the results of a systematic review on the effectiveness of FPCF in reducing micronutrient deficiencies. The cost-effectiveness was estimated by comparing the net social cost of price subsidies with the disability-adjusted life years (DALY) averted.

SETTING

Districts of Faisalabad and Hyderabad in Pakistan.

SUBJECTS

Households with 6-23-month-old children stratified by socio-economic strata.

RESULTS

The lifetime social costs of iodine deficiency, iron-deficiency anaemia and vitamin A deficiency in 6-23-month-old children amounted to production losses of $US 209 million and 175 000 DALY. Poor households incurred the highest costs, yet even wealthier households suffered substantial losses. Wealthier households were more likely to buy FPCF. The net cost per DALY of the interventions ranged from a return per DALY averted of $US 783 to $US 65. Interventions targeted at poorer households were most cost-effective.

CONCLUSIONS

Price subsidies on FPCF might be a cost-effective way to reduce the societal costs of micronutrient deficiencies in 6-23-month-old children in Pakistan. Interventions targeting poorer households are especially cost-effective.

Egg introduction during complementary feeding according to allergic risk: not just for peanuts!

The relationship between the timing of introduction of complementary foods and later allergy is a topic of current discussion. Although the European Society for Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) has recently recommended that potentially allergenic foods may be introduced when complementary feeding is commenced, any time after 4 months, recommendations about egg introduction would be needed mainly for infants with high risk of developing food allergy. Before the first administration in these infants an adequate topical therapy and an evaluation of whole egg–specific IgE serum antibody levels or skin prick tests for egg should be recommended.

National survey showed that Chinese city children under two years of age had similar feeding patterns to developed countries

AIM

This 2015 study was a part of the National Growth Survey of Children under seven years of age, which has been carried out in nine Chinese cities every 10 years since 1975. Our aim was to assess children's feeding practices and nutritional supplements.

METHODS

This was a cross-sectional survey of 89 006 healthy children aged one to 24 months. All data were collected by face-to-face interviews during child health visits, using a questionnaire.

RESULTS

The exclusive breastfeeding rate was 53% in infants under six months of age, and the continued breastfeeding rate was 51% among infants who were 10-12 months and 5% when they were 21-24 months. Infants were weaned at a mean of 9.3 months in urban areas and 9.4 months in suburban areas. Cereals were provided as complementary food at a mean age of five months, eggs at six months, meat at eight and a half months and bean products at over 12 months. The most common nutritional supplements given to the children were vitamins A and D and calcium.

CONCLUSION

The feeding practices of Chinese city children were similar to those in developed countries, but strategies are needed to promote more rational consumption of nutritional supplements.

Introducing complementary foods in the first year of life

Introduction of solid foods is a fundamental step in the development of an individual. There are many implications that weaning contains not only on a nutritional plan, but also on the contingent and long-term health of an individual. Over time this nutritional passage has evolved through the acquisition of new knowledge about maturation of anatomical and neurosensory structures involved in all the phases of such a complex process. The understanding of a maturing taste of infant and cultural changes is another key to understand the evolution of introduction of solid foods in infants. What is contained in this text encapsulates thus the evolutionary path of weaning in recent years, showing current trends in the light of cultural changes and new scientific acquisitions.

Nutritional quality and sensory acceptability of complementary food blended from maize (Zea mays), roasted pea (Pisum sativum), and malted barley (Hordium vulgare)

The aim of this study was to evaluate the effect of blending ratio of malted barley, maize, and roasted pea flour on complementary food quality and sensory acceptability. D- Optimal mixture design was used to generate 14 formulations. Each ingredient had 55-90% maize, 20-35% pea and 4-12% malted barley. Pretreatments like debranning of maize, roasting of pea and dehusking of malted barley were done. The three component-constrained mixture design was conducted using Design-Expert® 6 (Stat-Ease). Ash, protein, fat, fiber, moisture, and carbohydrate contents were found in between range of 1.5-2.5%, 13.0-18.5%, 1.8-2.5%, 3.06-4.45%, 5.0-6.5%, and 68.9-74.1%, respectively. Significant difference (P < 0.05) among the treatments was observed for protein, moisture, odor, flavor and sensory overall acceptability. Lack-of-fit was significantly different only for fat (R2  = 0.90). Thus, the model generated can predict all attributes except for fat. The optimum values of high nutrient content and sensory acceptability were observed in the range of 55.0-68.5%, 27.5-35.0%, and 4.0-10.0% for maize, pea, and malted barley respectively.

Introduction of complementary foods in Sweden and impact of maternal education on feeding practices

OBJECTIVE

To describe the introduction of complementary foods in a population-based cohort in relation to recommendations and explore the possible impact of maternal education on infant feeding practices.

DESIGN

Prospective data from the All Babies in Southeast Sweden (ABIS) cohort study were used. The ABIS study invited all infants born in south-east Sweden during October 1997-October 1999 (n 21 700) to participate. A questionnaire was completed for 16 022 infants. During the infants' first year parents continuously filed in a diary covering introduction of foods.

SETTING

Sweden.

SUBJECTS

Infants (n 9727) with completed food diaries.

RESULTS

Potatoes, vegetables, fruits/berries and porridge were the foods first introduced, with a median introduction between 19 and 22 weeks, followed by introduction of meat, cow's milk, follow-on formula and sour milk/yoghurt between 24 and 27 weeks. Early introduction of any food, before 16 weeks, occurred for 27 % of the infants and was more common in infants of mothers with low education. Overall, potatoes (14·7 %), vegetables (11·1 %), fruits/berries (8·5 %), porridge (7·4 %) and follow-on formula (2·7 %) were the foods most frequently introduced early. The majority of infants (≥70 %) were introduced to potatoes, vegetables, fruits/berries and porridge during concurrent breast-feeding, but introduction during concurrent breast-feeding was less common in infants of mothers with low education.

CONCLUSIONS

Most infants were introduced to complementary foods timely in relation to recommendations. Low maternal education was associated with earlier introduction of complementary foods and less introduction during concurrent breast-feeding. Still, the results indicated exposure to fewer foods at 12 months in infants of mothers with low education.

Effect of fortified complementary food supplementation on child growth in rural Bangladesh: a cluster-randomized trial

Background: Growth faltering in the first 2 years of life is high in South Asia where prevalence of stunting is estimated at 40–50%. Although nutrition counselling has shown modest benefits, few intervention trials of food supplementation exist showing improvements in growth and prevention of stunting.

Methods: A cluster-randomized controlled trial was conducted in rural Bangladesh to test the effect of two local, ready-to-use foods (chickpea and rice-lentil based) and a fortified blended food (wheat-soy-blend++, WSB++) compared with Plumpy’doz, all with nutrition counselling vs nutrition counselling alone (control) on outcomes of linear growth (length and length-for-age z-score, LAZ), stunting (LAZ < −2), weight-for-length z-score (WLZ) and wasting (WLZ < −2) in children 6–18 months of age. Children (n = 5536) were enrolled at 6 months of age and, in the food groups, provided with one of the allocated supplements daily for a year.

Results: Growth deceleration occurred from 6 to 18 months of age but deceleration in LAZ was lower (by 0.02–0.04/month) in the Plumpy’doz (P = 0.02), rice-lentil (< 0.01), and chickpea (< 0.01) groups relative to control, whereas WLZ decline was lower only in Plumpy’doz and chickpea groups. WSB++ did not impact on these outcomes. The prevalence of stunting was 44% at 18 months in the control group, but lower by 5–6% (P ≤ 0.01) in those receiving Plumpy’doz and chickpea. Mean length and LAZ at 18 months were higher by 0.27–0.30 cm and 0.07–0.10 (all P < 0.05), respectively, in all four food groups relative to the control.

Conclusions: In rural Bangladesh, small amounts of daily fortified complementary foods, provided for a year in addition to nutrition counselling, modestly increased linear growth and reduced stunting at 18 months of age.