Dietary and Lifestyle Changes During COVID-19 and the Subsequent Lockdowns among Polish Adults: A Cross-Sectional Online Survey PLifeCOVID-19 Study

The present study aimed to identify patterns of dietary changes during the COVID-19 pandemic and their associations with sociodemographics, body mass index (BMI) before pandemic, and lifestyle changes in Polish adults and to examine the effects of lockdowns on dietary-lifestyle changes. This study used a cross-sectional online survey to collect data. The k-means algorithm was used to determine of patterns of dietary changes, and logistic regression analyses were performed. During the study period, 43% of respondents decreased physical activity (PA), 49%-increased screen time, and 34%-increased food consumption. Among the three dietary changes patterns, two opposite patterns were found: Prohealthy (28% participants) and Unhealthy (19% participants).The adherence to the Prohealthy pattern was negatively associated with age, but positively with being overweight (aOR 1.31) or obese before pandemic (aOR 1.64). Residing in a macroeconomic region with GDP > 100% decreased adherence to the Prohealthy (aOR 0.73) but increased adherence to the Unhealthy pattern (aOR 1.47). Adults over 40 years old, those living with children, unemployed, those living in a region with a higher GDP, and those not consuming homemade meals could be more exposed to unhealthy behaviors. From a public health perspective, enhancing the message "to be active" during the compulsory isolation period should be prioritized.

The Use of Added Salt and Sugar in the Diet of Polish and Austrian Toddlers. Associated Factors and Dietary Patterns, Feeding and Maternal Practices

Children aged <2 years should not be given meals with the addition of salt and sugar due to health risks and to promote healthier dietary habits. The aims of this study were: to assess the prevalence of the use of added salt (AS), sugar (ASu) and both salt and sugar (AS&Su) in the diets of Polish and Austrian toddlers aged 12-24 and 25-36 months; to explore the sociodemographic and early nutritional factors associated with the use of AS and ASu; to investigate the difference in dietary habits and maternal concerns about toddlers' eating regarding the use of AS and ASu in toddlers' diet. This cross-sectional anonymous study was conducted in 5893 mothers of children aged 12-36 months, recruited through social media in 2017-2019. The questionnaire consisted of questions about sociodemographics, early feeding practices and current children's nutrition (e.g., use of AS and ASu, food frequency questionnaire). Multivariate logistic regression and cluster analyses were applied. Austrian mothers more often used AS than mothers from Poland (at 2 years old: 74.8% vs. 52.8%; at 3 years old 87.4% vs. 74.4%, p ≤ 0.001), however Polish mothers were more prone to use ASu (at 2 years old: 34.7% vs. 27.7%; at 3 years old: 59.0% vs. 45.8%, p ≤ 0.001). In younger toddlers (12-24 months), the odds of using of AS, ASu, and AS&Su increased with toddlers' age, when the mother was a multipara, was not currently breastfeeding, or had exclusively breastfed for 4-5 months. This risk decreased when older toddlers (25-36 months) were introduced to solids by baby-led weaning (BLW). Toddlers from both countries who consumed meals with AS or ASu more often a followed Western-like dietary pattern. Our study emphasizes the need for parental nutritional education when beginning to introduce solid foods.

Analysis of Association between Breastfeeding and Vegetable or Fruit Intake in Later Childhood in a Population-Based Observational Study

Vegetable and fruit consumption in childhood remains below recommendations in many countries. As the intake of fruit and/or vegetables during childhood in a few studies was associated with breastfeeding, it may be suggested as a serious interfering factor while analyzing the association between breastfeeding and its long-term health effects. Thus, it may be important for creation and implementation of effective public health programs. The aim of this study was to evaluate the association between breastfeeding and consumption of fruit or vegetables in later childhood. The study was conducted within the Project “ABC of Healthy Eating—ABC of Kids and Parents” among a representative sample of 703 pairs of mothers and children aged 7–12 years in Poland. A systematic purposive-quota selection according to gender, age, place of residence, and region of Poland was applied. The study was conducted by interviewers in the respondents’ homes in 2017. Logistic regression analysis was conducted, and models adjusted for children’s age, BMI centile and gender, maternal education, employment status, and economic situation, as well as for EU–28 average Gross Domestic Product (GDP) region. Almost 86% of children were ever breastfed. Vegetables for breakfast, second breakfast, dinner, supper, and between meals were consumed by 23.9%, 18.6%, 47.4%, 26.7%, and 4.0% of children, whereas fruit was consumed by 13.9%, 46.1%, 7.7%, 12.9%, and 59.7% of children, respectively. Breastfeeding for a period of 4–6 months increased the chance of vegetable consumption for breakfast in the whole group (aOR 3.80, 95% CI 1.90–7.59, p ≤ 0.001) and particularly in girls (aOR 4.60, 95% CI 1.43–14.75, p ≤ 0.01) when compared to boys (aOR 3.17, 95% CI 1.32–7.63, p ≤ 0.01). Longer duration of breastfeeding (over 12 months) increased the chance of vegetable consumption for dinner in the total group (aOR 2.36, 95% CI 1.30–4.26, p ≤ 0.01) and particularly in girls (aOR 3.04, 95% CI 1.24–7.46, p ≤ 0.01) when compared to boys (aOR 2.20, 95% CI 1.01–4.95, p ≤ 0.05). We showed a positive association between breastfeeding and vegetable consumption for breakfast and dinner among children aged 7–12 years. These associations were gender-specific (stronger among girls) and were not diminished by socio-demographic factors.

Factors Influencing the Age of Complementary Feeding-A Cross-Sectional Study from Two European Countries

The timing of introducing complementary feeding affects nutritional status and children's health. The aim of this study was to determine sociodemographic and birth-related factors associated with the age of introducing complementary foods. This cross-sectional study investigated parents (n = 5815) of children aged 12-36 months from Poland (n = 4065) and Austria (n = 1750) using a single online questionnaire. During the study, detailed data about sociodemographic characteristics, variables related to pregnancy, and early feeding practices were collected. Univariate and multivariate logistic regression models were used to investigate factors associated with the introduction of complementary feeding before 4 completed months, between 4 and 6 months, and after 6 completed months separately for both countries. Complementary foods were introduced before 4 months in 3.0% of infants (2.4% in Poland and 4.3% in Austria), between 4 and 6 months in 65.0% (60.5% in Poland and 75.3% in Austria), and after 6 completed months in 32.1% of infants (37.1% in Poland and 20.4% in Austria). The factors related to earlier introduction of complementary feeding were lower maternal age (in Austria 25-29 years: aOR 2.21 (95% CI 1.06-4.65)) and education level (in Poland and Austria primary and vocational: aOR 14.49 (95% CI 3.73-56.35), aOR 2.13 (95% CI 1.10-4.11), respectively), preterm birth (in Poland and Austria: aOR 10.21 (95% CI 5.73-18.20); aOR 4.45 (95% CI 2.42-8.18), respectively), never breastfeeding (Poland: aOR 2.73 (95% CI 1.29 - 5.76)) and receiving an infant formula after hospital discharge (in both countries: aOR 3.73 (95% CI 2.06-6.75); aOR 3.65 (95% CI 1.87-7.12), respectively). These factors should be taken into account by health professionals in identifying mothers who are least likely to follow nutritional recommendations.

Association between Breastmilk LC PUFA, Carotenoids and Psychomotor Development of Exclusively Breastfed Infants

The first months of infant life are crucial for proper neurodevelopment, which may be influenced by several factors, including nutrition and nutrients (e.g., long-chain polyunsaturated fatty acids (LC PUFA) and carotenoids) of which the concentration in breastmilk is diet-dependent. This study analysed the relationship between the average concentrations of selected LC PUFA and carotenoids in breastmilk samples from the first and third months of lactation and the psychomotor development of exclusively breastfed infants at the sixth month of life. Infant psychomotor development was assessed using the Children Development Scale (DSR). The average age of infants during the assessment was 6.6 ± 0.2 months and 30.9 ± 3.8 years for mothers (n = 39 mother⁻infant pairs). The average concentration of docosahexaenoic acid (DHA) was 0.50% of fatty acids. The average concentration of carotenoids was 33.3 nmol/L for β-carotene, 121 nmol/L for lycopene and 33.3 nmol/L for lutein + zeaxanthin. The total results of the Performance scale and Motor subscale were 39 centiles and 4.1 points, respectively. Adjusted multivariate regression models revealed associations between breastmilk DHA and motor development (β = 0.275; p ≤ 0.05), α-linolenic acid (ALA; β = 0.432; p ≤ 0.05), n-3 LC PUFA (β = 0.423; p ≤ 0.05) and β-carotene (β = 0.359; p ≤ 0.05). In addition, an association between the Perception subscale and DHA was observed (β = 0.316; p ≤ 0.05; model 2). There were no significant associations between the overall Performance scale scores. Due to the positive association between concentrations of n-3 LC PUFA (ALA and DHA) and β-carotene in breastmilk and infant motor development, it is important to provide these nutrients with breastmilk. According to the diet-dependent concentration of these compounds in breastmilk, breastfeeding mothers should have a diet abundant in dietary sources of these nutrients, e.g., fish, nuts, seeds, vegetable oils, vegetables and fruits.

Carotenoid Content in Breastmilk in the 3rd and 6th Month of Lactation and Its Associations with Maternal Dietary Intake and Anthropometric Characteristics

Carotenoids are diet-dependent milk components that are important for the visual and cognitive development of an infant. This study determined β-carotene, lycopene and lutein + zeaxanthin in breastmilk and its associations with dietary intake from healthy Polish mothers in the first six months of lactation. Concentrations of carotenoids in breastmilk were measured by HPLC (high-performance liquid chromatography) (first, third, sixth month of lactation) and dietary intake was assessed based on a three-day dietary record (third and sixth month of lactation). The average age of participants (n = 53) was 31.4 ± 3.8 years. The breastmilk concentrations of carotenoids were not changed over the progress of lactation. Lycopene was a carotenoid with the highest content in breastmilk (first month 112.2 (95% CI 106.1⁻118.3)-sixth month 110.1 (103.9⁻116.3) nmol/L) and maternal diet (third month 7897.3 (5465.2⁻10329.5) and sixth month 7255.8 (5037.5⁻9474.1) µg/day). There was a positive correlation between carotenoids in breastmilk and dietary intake (lycopene r = 0.374, r = 0.338; lutein + zeaxanthin r = 0.711, r = 0.726, 3rd and 6th month, respectively) and an inverse correlation with maternal BMI in the third month of lactation (β-carotene: r = -0.248, lycopene: r = -0.286, lutein + zeaxanthin: r = -0.355). Adjusted multivariate regression models confirmed an association between lutein + zeaxanthin intake and its concentration in breastmilk (third month: β = 0.730 (0.516⁻0.943); 6th: β = 0.644 (0.448⁻0.840)). Due to the positive associations between dietary intake and breastmilk concentrations, breastfeeding mothers should have a diet that is abundant in carotenoids.

Reasons for non-exclusive breast-feeding in the first 6 months

BACKGROUND

Maternal sociodemographic, delivery- and infant-related factors as well as hospital practice are relevant for breast-feeding practice. The aim of this study was to identify the sociodemographic and delivery-related factors that may affect exclusive breast-feeding (EBF) of infants aged 0-6 months in Poland.

METHODS

A total of 446 mothers (18-42 years old) of infants aged 0-6 months were interviewed using the computer-assisted Web interview method. The questionnaire collected information about maternal sociodemographic situation and anthropometrics, delivery-related factors, and infant feeding-related factors. Data were analyzed using the chi-squared test and Mann-Whitney U-test. Predictors of non-exclusive breast-feeding (N-EBF) in the first 6 months of life were assessed on multivariate logistic regression.

RESULTS

A total of 43% of mothers did not breast-feed exclusively (n = 191; N-EBF group) and 57% did breast-feed exclusively during the study period (n = 255; EBF group). After adjustment for other potential risk factors, the highest risk factors for N-EBF were maternal age <20 years (OR, 6.12; P ≤ 0.01), and inadequate breast-feeding knowledge (OR, 3.43; P ≤ 0.01), whereas the lowest risk was associated with pre-pregnancy intention to breast-feed (OR, 0.35; P ≤ 0.01), very good knowledge about breast-feeding (OR, 0.45; P ≤ 0.001) and maternal age 26-30 years (OR, 0.48; P ≤ 0.001). In a multivariate model, maternal education, employment status and preterm delivery were no longer statistically significant.

CONCLUSIONS

Breast-feeding practice is influenced by a variety of factors, including sociodemographic and psychosocial conditions, maternal obesity and mode of delivery. Further work is needed to establish the role of education and prophylactic programs in modifying the aforementioned risk factors.