Maternal and child characteristics associated with infant and toddler feeding practices

Complementary feeding challenges: Insights from Swiss parents' perspectives

Parents play a crucial role in deciding what foods to introduce to their infants during the transition from milk to solids. This study examined the challenges they face, including adherence to official complementary feeding recommendations and the struggles and concerns across different stages of feeding. Specifically, this study focused on the initial stage (transition from breastmilk/formula to mashed foods), middle stage (consumption of mashed foods and some fingerfoods, transitioning towards family foods) and late stage (complete transition to family diet). Findings from 22 semi-structured interviews with Swiss parents reveal that, despite being well-informed, practical obstacles such as returning to work, limited time for preparing homemade foods, managing multiple children, and food preferences often hinder adherence. Safety concerns like allergies and choking were prominent early on but decreased as infants grew older and parents gained confidence. In the middle phase, concerns shifted towards pesticides, indicating a growing awareness of food quality. Maintaining a healthy diet was a constant concern, with early reassurance from breastfeeding or formula feeding giving way to worries about balanced nutrition as solids became more prominent. Time constraints were particularly significant in the first two stages, due to the effort of preparing small amounts of mash and later cooking separate meals. Tailored support and clear communication can help parents navigate these challenges and promote healthier feeding practices.

Food neophobia scores at 8 Years and associations with nutrition-related behaviors at home in early life: Findings from a New Zealand contemporary birth cohort

Food neophobia (FN) reduces nutritional adequacy and variety which poses a significant concern for children's health and well-being We described the FN scores among 8-year-olds and examined its associations with nutrition-related behaviors at 45 months within the Growing Up in New Zealand cohort (n = 4621). FN was estimated using the Food Neophobia Scale (FNS). Mean FNS scores between variable categories were compared using t-tests for independent samples and ANOVA. Associations between FNS scores at 8 years and nutrition-related behaviors at 45-months were examined using multivariate linear regression. The mean (standard deviation) FN score was 46.2 (15.2) with statistically significant differences by sex (boys = 47.6 (15.7), girls = 43.8 (14.2), p=<0.001). For all children, in models adjusted by breastfeeding duration and sociodemographic characteristics: children who sometimes and never/almost never ate the same foods as their parents, scored, on average, 5.8 and 11 points higher in the FNS (versus those who did always/almost always); children who occasionally/never found mealtimes enjoyable scored on average 3.6 points lower in the FNS (versus mostly/quite often); children who always/almost always had the television on during mealtimes scored on average 2.7 higher in the FNS (versus never/almost never). In comparison to children who mostly/quite often had time to talk to others during mealtimes, those who never/occasionally did it scored on average higher points in the FNS overall (1.46 points higher) and within girls (1.73 points higher). These findings support the eating behavior statements in the National Children's Food and Nutrition Guidelines, which emphasize early exposure to food variety, limiting mealtime distractions, and acknowledge that parental role modeling shapes children's nutrition-related behaviors. Early adoption of preventative interventions for reducing FN in early and middle childhood are needed.

Spatial Variation and Determinants of Inadequate Minimum Meal Frequency among Children Aged 6-23 Months in Ethiopia: Spatial and multilevel analysis using Ethiopian Mini Demographic and Health Survey (EMDHS) 2019

Introduction: Minimum meal frequency is the number of times children eat in a day. Without adequate meal frequency, infants and young children are prone to malnutrition. There is little information on the spatial distribution and determinants of inadequate meal frequency at the national level. Therefore, we aimed to investigate the spatial distribution and determinants of inadequate meal frequency among young children in Ethiopia. Methods: The most recent Ethiopian demographic and health survey data was used. The analysis was conducted using a weighted sample of 1,610 children aged 6-23 months old. The Global Moran's I was estimated to assess the regional variation in minimum meal frequency. Further, a multivariable multilevel logistic regression model was fitted to identify factors associated with inadequate meal frequency. The AOR (adjusted odds ratio) at 95% CI (confidence interval) was computed to assess the strength and significance of the relationship between explanatory variables and the outcome variable. Factors with a p-value of <0.05 are declared statistically significant. Results: This study revealed that the prevalence of inadequate meal frequency was found to be 30.56% (95% CI: 28.33-32.88). We identified statistically significant clusters of high inadequate meal frequency, notably observed in Somalia, northern Amhara, the eastern part of southern nations and nationalities, and the southwestern Oromia regions. Child age, antenatal care (ANC) visit, marital status, and community level illiteracy were significant factors that were associated with inadequate meal frequency. Conclusion: According to the study findings, the proportion of inadequate meal frequency among young children in Ethiopia was higher and also distributed non-randomly across Ethiopian regions. As a result, policymakers and other concerned bodies should prioritize risky areas in designing intervention. Thus, special attention should be given to the Somalia region, the northern part of Amhara, the eastern part of Southern nations and nationalities, and southwestern Oromia.

Socioeconomic Characteristics and the Home Food Environment Are Associated With Feeding Healthful and Discretionary Foods During the First Year of Life in the Pregnancy Eating Attributes Study

BACKGROUND

Feeding of nutrient-poor foods begins in infancy and may adversely influence long-term food preferences.

OBJECTIVE

To examine associations of socioeconomic characteristics, childbearing parent eating behaviors, and home food environment with infant feeding characteristics.

DESIGN

Secondary analysis of a prospective cohort study from first trimester of pregnancy through 12 months postpartum.

PARTICIPANTS/SETTING

Participants with uncomplicated singleton pregnancies and no major chronic illness were enrolled from November 2014 through October 2016 from 2 university-based obstetrics clinics in Chapel Hill, NC. Of 458 enrolled, 321 were retained through 12 months postpartum.

MAIN OUTCOME MEASURES

Participants completed infant food frequency questionnaires indicating age at introduction and frequency of consuming multiple food groups. Exposures included childbearing parent socioeconomic characteristics, hedonic hunger, addictive-like eating, Healthy Eating Index 2015 calculated from three 24-hour diet recalls, and home food environment fruit/vegetable and obesogenic scores.

STATISTICAL ANALYSES PERFORMED

Multiple imputation using Heckman selection model; linear and logistic regressions examining associations with infant feeding characteristics.

RESULTS

Lower education and income were associated with later infant age at introduction to, and lower frequency of consuming fruits and vegetables at age 12 months. Socioeconomic characteristics were not associated with age at introduction to discretionary solid foods; however, lower education and income were associated with greater infant frequency of intake of discretionary foods and greater odds of introducing fruit juice and sweetened beverages by age 12 months. Childbearing parent Healthy Eating Index 2015, hedonic hunger, and addictive-like eating were not consistently associated with infant feeding characteristics. A more obesogenic food environment was associated with greater frequency of intake of discretionary foods, lower frequency of intake of fruit, and greater odds of fruit juice introduction by age 12 months.

CONCLUSIONS

Infant feeding characteristics may be important intervention targets for addressing socioeconomic disparities in child diet quality. Efforts to reduce routine feeding of discretionary foods across socioeconomic groups are needed; modifying the home food environment may promote healthful infant feeding.

Breastfeeding and less healthy beverage intake during the first year of life

BACKGROUND AND OBJECTIVES

Breastfeeding during infancy is associated with healthier beverage consumption later in childhood, but little is known about this relation during infancy. This was a longitudinal study of breastfeeding and less healthy beverage consumption during the first year of life, in a birth cohort study conducted 2013-2018 in the Southeastern United States (n = 666).

METHODS

We estimated monthly rates of 100% juice and sugar-sweetened beverage (SSB) consumption comparing infants who were exclusively or partially breastfed, versus those who were not, in multivariable adjusted models.

RESULTS

Mothers had a median age of 26.5 years, 71% identified as Black/African-American, and 61% reported household incomes <$20 000/year. The prevalence of any breastfeeding during the first month was 78.2% and 18.7% at month 12. By age 12 months, infants consumed juice a mean (SD) 9.1 (10.1) times per week and SSBs 3.6 (9.5) times per week. Breastfed infants had a 38% lower incidence rate of weekly juice consumption (95% CI 52%, 15%, p = 0.003) and a 57% lower incidence rate of weekly SSB consumption (95% CI 76%, 22%, p = 0.006), compared with infants who were not breastfed.

CONCLUSIONS

Research on early-life correlates of dietary health should focus on the earliest beverages, given evidence that consumption of obesogenic beverages may begin prior to age 1 year.

The complementary feeding practices of low-income Black mothers with infants between 6 and 24 months of age: A qualitative study

BACKGROUND

The period from 6 to 24 months in an infant's life presents a critical window for understanding feeding practices and for designing culturally appropriate interventions. However, little is known about the complementary feeding practices of Black mothers and how this period can be used to optimise the long-term health of their children. The present study aimed to identify factors that influence the complementary feeding practices of low-income Black mothers with children aged 6-24 months.

METHODS

Participants were recruited through Research Match, Facebook advertising, flyers, and snowballing techniques. Low-income, Black mothers, with a 6-24-month-old infant, and who lived in Franklin County, Ohio, USA, were eligible for the study. A cross-sectional design using in-depth interviews was used. Reflexive thematic analysis was utilised to analyse and interpret the feeding practices of Black mothers.

RESULTS

Mothers (n = 8) were aged between 18 and 30 years old and most completed college or had some college education (n = 6). Half (n = 4) were married, employed, and rated their diet quality and their children's as very good. Three themes emerged: (a) complementary feeding at ≥ 6 months of age; (b) involvement of health care providers and service organisations in feeding decisions; and (c) use of responsive feeding cues.

CONCLUSIONS

All mothers breastfed exclusively and most (n = 6) initiated complementary feeding at 6 months. Paediatricians, other health providers and service organisations were instrumental in helping Black mothers adopt complementary feeding practices. Mothers also engaged in responsive feeding practices. These findings point to the critical nature of access and education in helping Black mothers in the study achieve feeding recommendations for their infants.

Prevalence of Sugar-Sweetened Food Consumption in Rural Bangladeshi Children Aged 6-24 Months

BACKGROUND

While the prevalence of undernutrition in children has decreased in many low- and middle-income countries since the 1990s, prevalences of overweight and obesity have increased. Frequent consumption of sugar-sweetened food might have contributed to this change, although very little is known about sugar-sweetened food consumption in early life.

OBJECTIVES

The objective of this study was to explore the associations between individual, household, and maternal factors and the prevalence of sugar-sweetened food consumption in 6- to 24-month-old children in Bangladesh.

METHODS

Multistage sampling was used to select households with children aged 6-24 months in rural Chatmohar, a subdistrict of Bangladesh (n = 1635). Research assistants conducted a 24-hour qualitative dietary recall questionnaire with the enrolled child's primary caregiver to measure maternal and child dietary patterns. We examined factors associated with the prevalence of child sugar-sweetened food consumption with multivariate logistic regression models. We conducted tests of heterogeneity to explore differential associations between the child sugar-sweetened food consumption prevalence and household income by maternal nutrition knowledge and wealth.

RESULTS

Primary caregivers reported that 62% of toddlers had consumed sugar-sweetened food in the past 24 hours. A higher prevalence of child sugar-sweetened food consumption was associated with both a higher dietary diversity score (OR, 1.19; 95% CI, 1.09-1.29) and a higher prevalence of maternal sugar-sweetened food consumption (OR, 2.54; 95% CI, 1.97-3.28). At higher levels of maternal nutrition knowledge and wealth, more household income was associated with a lower prevalence of child sugar-sweetened food consumption.

CONCLUSIONS

Almost two-thirds of 6- to 24-month-old children in rural Chatmohar, Bangladesh, had consumed sugar-sweetened food in the last day. This is a high and concerning prevalence, and the associated factors identified in this study should be investigated further to identify potential areas of intervention to decrease the prevalence of child sugar consumption in Bangladesh.

Associations between infant and maternal characteristics measured at child age 5 months and maternal feeding styles and practices up to child age two years

Facilitating positive feeding practices from infancy may be an important strategy to prevent childhood overweight and obesity. Since the feeding situation early in life constitutes a bidirectional relationship, it is important to understand the impact of both maternal and infant characteristics on maternal feeding practices to intervene in a customized and tailored way. Few studies have concurrently examined associations between maternal and infant characteristics in relation to early maternal feeding practices. The aim of the present study was to explore potential associations between infant and maternal characteristics measured at child age five months, and maternal feeding styles and practices during the child’s first two years. Cross-sectional data from a Norwegian randomized controlled trial in which participants responded to questionnaires at child age 5 months (n = 474), 12 months (n = 293) and 24 months (n = 185) were used to explore potential associations. All maternal and child predictor variables were collected at child age five months. Maternal feeding styles and practices were mapped using subscales from the Infant Feeding Questionnaire at child age 5 and 12 months and the Child Feeding Questionnaire and the Parental Feeding Style Questionnaire at child age 24 months. The subscale-scores were split into roughly equal tertiles, and the upper or lower tertile for the outcome of interest were used to create binary outcome variables. Multivariable binary logistic regression models were conducted for each outcome. We found that maternal education and mental health symptoms as well as infant weight, temperament and feeding mode were associated with maternal feeding styles and practices over time. Our findings indicate that risk factors which may have long-term implications for child weight and health outcomes can be identified early. Larger, population-based studies with a longitudinal design are needed to further explore these pathways.

Associations between mother-child dyad dietary patterns and child anthropometric measures among 6-year-old children

The goals of this study were to study relationships between maternal and children's dietary patterns (DPs) and to assess how children's DP was associated with child anthropometry. This cross-sectional study included 788 pairs of 6-year-old girls and mothers in health centers in Tehran, Iran. Information on dietary intake was collected with a 168-item food frequency questionnaire. Principal component factor analysis was performed to label different data-driven dietary patterns. Three different binary logistic regression models were used to evaluate the associations between child's DPs and child anthropometry. A positive correlation was found between all maternal patterns and child's Western DP (p < 0.001). Maternal prudent and Western DPs were correlated with child's high-protein DP (p < 0.001). Children's high-protein DP was negatively correlated with maternal high fat DP (p < 0.001). Maternal prudent and high fat DPs were correlated with prudent DP in children (p < 0.001). In adjusted models, a child being in the highest compared to the first quartile of the high-protein DP was associated with decreased odds of underweight and wasting (OR 0.43; 95% CI 0.23-0.80).Conclusion: The present study showed inverse associations between a high-protein DP in children and being underweight and wasted. Also, a positive correlation was found between all maternal DPs and children's Western DPs. This correlation should be taken into account while managing child nutrition by means of educating parents on the influence of their own dietary pattern on their children. Moreover, getting enough protein through a balanced diet should be considered in children. What is Known: • Some research exists on the intake of specific foods in relation to risk of abnormal growth in children. • Less is known about the relationship between mothers' and children's food intake. What is New: • Better adherence to a high-protein dietary pattern was significantly associated with lower risk of being both underweight and wasted. • This study suggests that correlation between mothers' and their children's dietary patterns exists, which should be taken into consideration when managing child nutrition.

Trends and inequalities in breastfeeding continuation from 1 to 6 weeks: findings from six population-based British cohorts, 1985-2010

BACKGROUND

Understanding inequalities in breastfeeding practices may help to explain the UK's persistently low breastfeeding rates. A recent study using the quinquennial UK Infant Feeding Surveys (IFS) found that sociodemographic inequalities in breastfeeding initiation persisted between 1985 and 2010. The present study investigates the sociodemographic inequalities in breastfeeding continuation at 6 weeks after birth among mothers who initiated and maintained breastfeeding at 1 week in 1985-2010.

METHODS

Data were drawn from the 1985 to 2010 IFS and restricted to mothers who were breastfeeding at 1 week after birth. Time trends in the proportion of mothers in each sociodemographic group were examined. Logistic regression was used to estimate associations between breastfeeding at 6 weeks and sociodemographic factors, adjusting for confounders. Heterogeneity test was used to assess changes in these associations over time.

RESULTS

Sociodemographic inequalities in breastfeeding continuation at 6 weeks persisted over the 25-year period. In most survey years, mothers were most likely to breastfeed at 6 weeks if they were 30 or older versus under 25 (OR 1.49-1.99 across survey years, I²= 0%, heterogeneity P = 0.45); completed full-time education over age 18 compared to 18 or younger (OR 1.56-2.51, I²= 58.7%, P = 0.03); or of Black, Asian, Mixed, or other ethnicity compared to White (OR 1.45-2.48, I²= 44.8%, P = 0.16).

CONCLUSIONS

Among mothers breastfeeding at 1 week, those who were younger, White or had fewer years of full-time education were at greatest risk of discontinuing before 6 weeks. This risk persisted over time and was independent of their high risk of not initiating breastfeeding.

Maternal characteristics influence infant feeding styles in Caribbean women

OBJECTIVE

To examine associations between maternal characteristics and feeding styles in Caribbean mothers.

DESIGN

Participants were mother-child pairs enrolled in a cluster randomised trial of a parenting intervention in three Caribbean islands. Maternal characteristics were obtained by questionnaires when infants were 6-8 weeks old. Items adapted from the Toddler Feeding Behaviour Questionnaire were used to assess infant feeding styles at the age of 1 year. Feeding styles were identified using factor analysis and associations with maternal characteristics assessed using multilevel linear regression.

SETTING

Health clinics in St. Lucia (n 9), Antigua (n 10) and Jamaica (n 20).

PARTICIPANTS

A total of 405 mother-child pairs from the larger trial.

RESULTS

Maternal depressive symptoms were associated with uninvolved (β = 0·38, 95 % CI (0·14, 0·62)), restrictive (β = 0·44, 95 % CI (0·19, 0·69)) and forceful (β = 0·31, 95 % CI (0·06, 0·57)) feeding and inversely associated with responsive feeding (β = -0·30, 95 % CI (-0·56, -0·05)). Maternal vocabulary was inversely associated with uninvolved (β = -0·31, 95 % CI (-0·57, -0·06)), restrictive (β = -0·30, 95 % CI (-0·56, -0·04)), indulgent (β = -0·47, 95 % CI (-0·73, -0·21)) and forceful (β = -0·54, 95 % CI (-0·81, -0·28)) feeding. Indulgent feeding was negatively associated with socio-economic status (β = -0·27, 95 % CI (-0·53, -0·00)) and was lower among mothers ≥35 years (β = -0·32, 95 % CI (-0·62, -0·02)). Breast-feeding at 1 year was associated with forceful feeding (β = 0·41, 95 % CI (0·21, 0·61)). No significant associations were found between maternal education, BMI, occupation and feeding styles.

CONCLUSION

Services to identify and assist mothers with depressive symptoms may benefit infant feeding style. Interventions to promote responsive feeding may be important for less educated, younger and socio-economically disadvantaged mothers.

Predictors of Age at Juice Introduction and Associations with Subsequent Beverage Intake in Early and Middle Childhood

BACKGROUND

The American Academy of Pediatrics recommends that if parents choose to introduce juice, they wait until ≥12 months, citing concerns of obesity and dental caries.

OBJECTIVES

We sought to identify correlates of early juice introduction (<6 months) and determine whether early introduction establishes a pattern of sugary beverage intake in childhood.

METHODS

Upstate KIDS is a prospective birth cohort study with follow-up through 7 years (n = 4989). The age of juice introduction was assessed from responses on periodic questionnaires from 4-18 months and categorized as <6,  6 to <12, and ≥12 months. Sociodemographic information was reported using vital records or maternal questionnaires. At 24, 30, and 36 months and 7 years, mothers reported their child's regular juice, soda, water, and milk intakes. The analysis was restricted to singletons and 1 randomly selected twin from each pair with information on juice introduction (n = 4067). We assessed associations of sociodemographic correlates with juice introduction using Cox proportional hazard models. The relations of juice introduction with beverage intake were evaluated using Poisson or logistic regression for adjusted risk ratios (aRR) or ORs, adjusting for sociodemographic covariates and total beverage intake.

RESULTS

Of the mothers, 25% and 74% introduced juice prior to 6 and 12 months, respectively. Younger maternal age; black or Hispanic race/ethnicity; lower educational attainment; Special Supplemental Nutrition Program for Women, Infants, and Children participation (yes); smoking during pregnancy; a higher pre-pregnancy BMI; a lower household income; and living in a townhouse/condominium or mobile home were associated with earlier juice introduction. Earlier juice introduction was related to a higher childhood juice intake, any soda intake, and lower water intake, holding total beverage intake constant [aRR, 1.5 (95% CI: 1.3-1.7; P-trend < 0.0001); adjusted OR 1.6 (95% CI: 1.0-2.4; P-trend = 0.01); aRR 0.9 (95% CI: 0.8-0.9; P-trend < 0.0001), respectively].

CONCLUSIONS

Markers of lower socioeconomic status are strongly associated with earlier juice introduction, which, in turn, relates to sugary beverage intake in childhood, potentially replacing water.

A prenatal group based phone counseling intervention to improve breastfeeding rates and complementary feeding: a randomized, controlled pilot and feasibility trial

Background

Despite numerous benefits for both mom and baby, few infants are exclusively breastfed for the recommended first six months. Additionally, infants are given solids too early. Prenatal education increases rates of breastfeeding initiation and we hypothesize it can also improve exclusive breastfeeding rates and prevent the early introduction of solids. We conducted a randomized controlled pilot and feasibility trial to understand the feasibility and maternal acceptance of a prenatal behavioral lifestyle intervention (PBLI) delivered via group based phone counseling (GBPC) and its effectiveness on rates of exclusive breastfeeding up to six months postpartum. Secondary aims included rates of any breastfeeding up to six months, rates of early introduction of solids, and infant feeding progression.

Methods

Forty-one pregnant women were recruited from a Kansas City Metropolitan Obstetrics and Gynecology office and randomly assigned to a usual care group or a PBLI. Women in the PBLI participated in six GBPC sessions where they learned about breastfeeding and introducing solids. Feeding questionnaires to assess breastfeeding and introduction of solids were sent at two weeks, two months, four months, and six months postpartum. Structured interviews were also conducted after the intervention and at six months postpartum to assess maternal acceptance and intervention feasibility.

Results

Participants overwhelmingly found the intervention acceptable and beneficial.

Rates of exclusive breastfeeding and any breastfeeding did not differ between groups at any time point. No between group differences were found for early introduction of solids or infant feeding progression.

Conclusions

Mothers discontinue breastfeeding earlier than recommended despite high rates of initiation. A PBLI delivered via GBP is feasible, acceptable to participants, and showed positive impacts such as maternal empowerment for both breastfeeding and introducing solids. Future interventions should incorporate both prenatal and postpartum components.

Trial registration

Study protocols were approved by the University of Kansas Medical Center’s Human Subjects Committee (STUDY00140506) and registered at ClinicalTrials.gov on 02/22/2018 (NCT03442517, retrospectively registered). All participants gave written informed consent prior to data collection.

Timing of Introduction of Complementary Foods and Beverages to Infants of Low-Income Women

Background: Although rates of complementary food and beverage (CFB) consumption among infants under 4 to 6 months of age have been declining, they remain well above the American Academy of Pediatrics (AAPs) recommendations. It is unclear if women with low income in the United States are more likely than other women to introduce CFBs early. We examined timing of introduction of CFBs to infants of mothers with low income to further illuminate infant feeding practices in this potentially vulnerable population. Materials and Methods: We analyzed infant feeding data collected prospectively from 443 mother-infant dyads. Data were obtained by interview at 1, 3, and 6 months postpartum. We used Kaplan-Meier curves to show time to introduction of CFBs overall and by type of CFB, and log-rank tests to compare timing by demographic and clinical characteristics. Results: Participants were mostly non-Hispanic black or white, with a high school education or less. By month 3, 48% of infants were fed at least one CFB, increasing to over 83% by month 5. Women who did not work outside the home introduced CFBs significantly earlier than those who worked, as did women who smoked compared with those who did not. Timing did not differ by other participant characteristics. Conclusions: Introduction of CFBs before 4-6 months was common. Clinical guidance and intervention programs should support mothers toward the goal of improving infant diets in this at-risk population.

Feeding Problems in Typically Developing Young Children, a Population-Based Study

Feeding problems have been estimated to occur in approximately 25-45% of normally developing children. The aim of this study was to investigate the prevalence of feeding problems in typically developing young children in Greece. Child feeding behavior, parents' feelings about their child's feeding patterns, and parental feeding practices were also explored. Parents completed the Greek version of the Behavioral Pediatrics Feeding Assessment Scale (BPFAS). Data on 742 healthy, typically developing children aged two to seven years are presented. Overall, the majority of children in the sample showed high frequency of desirable mealtime behaviors and low frequency of undesirable mealtime behaviors. However, a significant proportion of the cohort presented with food neophobia and low consumption of vegetables. When applying test cut-off scores, it was found that 8.2% of the sample had abnormal Total Frequency Score (TFS) and 26.6% had abnormal Total Problem Score (TPS). The study showed that parent-reported feeding problems are quite common in children of typical development in Greece. Moreover, while the majority of the sample displayed a high frequency of favorable behaviors, specific child feeding behaviors are amenable to improvement.

Determinants of fruits, vegetables, and ultra-processed foods consumption among infants

The objective was to evaluate the influence of individual and contextual determinants on infant's consumption of fruits and vegetables (FV), and ultra-processed foods (UPF). The data was obtained from the Survey of Prevalence of Breastfeeding in Brazilian Municipalities, 2008. A representative sample of 14,326 infants 6-11.9 months old, from seventy-five municipalities of São Paulo state was evaluated. The influence of determinants on FV and UPF consumption was analyzed using Poisson multilevel regression. Mother's educational level and maternal age had positive dose-response effect for the consumption of FV (p trend < 0.001) and negative for UPF (p trend < 0.001). Infants of multiparous women and those who received outpatient care in public medical system showed lower prevalence of FV (p < 0.001 for both) and higher prevalence of UPF (respectively, p < 0.001 and p = 0.001). Moreover, the contextual variable related to population size indicated that the prevalence of consumption of FV decreased (p < 0.001) and UPF increased (p = 0.081) with decreased population size. Therefore, infants born to women with low education levels, who received outpatient care in the public health network, and who reside in small municipalities should be prioritized for educational programs related to feeding practices.

Introducing Juice and Sugar-Sweetened Beverages in Early Infancy: Parental Knowledge and Intended Behaviors

OBJECTIVE

Assess caregivers' knowledge about juice and sugar-sweetened beverages (SSBs) and identify factors that contribute to their early introduction.

METHODS

One hundred forty-four parents of young infants completed a 45-item questionnaire focused on infant nutrition.

RESULTS

Seventy-two percent of parents plan to give juice to their babies starting in the first year of life; only 16% plan to introduce SSBs. Parents with some college education or more were significantly less likely to report an intention to introduce juice (P < .0001) and SSBs (P < .001) in their children's diets. Education level was significantly associated with knowledge about juice and SSBs (P < .001). Parents with higher knowledge were significantly less likely to plan on introducing juice (P < .001) and SSBs (P < .001).

CONCLUSION

Parents of young infants lack enough knowledge about the detrimental effects of juice and sugary drinks. These knowledge gaps give pediatric providers a unique opportunity to provide anticipatory guidance starting in early infancy on the adverse health effects of juice and SSBs.

Assessing Diet Quality in a Racially and Ethnically Diverse Cohort of Low-income Toddlers

BACKGROUND

Low-income racially and ethnically diverse children are at higher risk for obesity compared with their counterparts; yet, few studies have assessed their diet quality.

OBJECTIVE

The aim of the study was to evaluate the diet quality of a racially and ethnically diverse cohort of 2-year-olds using the Healthy Eating Index (HEI)-2010.

METHODS

We used 24-hour dietary recall data from caregivers of toddlers (24-34 months) at 4 pediatric resident clinics that participated in the Greenlight Study to calculate compliance with the Dietary Guidelines for Americans (DGA) using total HEI score (range 0-100) and 12 component scores.

RESULTS

Participants (n = 231) were mostly Hispanic (57%) or non-Hispanic black (27%) and from low-income families. Mean HEI-2010 score was 62.8 (standard deviation [SD] 10.5). Though not significant, Hispanics had the highest HEI score. Toddlers of caregivers without obesity, older than 35 years and born outside the United States had higher HEI scores. Most had high HEI component scores for dairy, fruit, and protein foods, but few achieved maximum scores, particularly for whole grains (13%), vegetables (10%), and fatty acid ratio (7%).

CONCLUSIONS

Despite scores reflective of DGA recommendations for fruit, dairy and protein foods, toddlers in this diverse sample had low quality diets as measured by the HEI, driven largely by low component scores for whole grains, vegetables, and ratio of unsaturated to saturated fatty acids.

Early Weight Gain Forecasts Accelerated Eruption of Deciduous Teeth and Later Overweight Status during the First Year

OBJECTIVES

To determine whether early diet and weight gain velocity have independent or interactive effects on deciduous teeth emergence and overweight status during the first year.

STUDY DESIGN

Monthly measures of anthropometry and teeth eruption were collected during a 1-year trial (0.5-12.5 months) on formula-fed infants in which the type of randomized infant formula (cow milk or extensively hydrolyzed protein) diet significantly affected early (0.5-4.5 months) weight gain velocity. Generalized linear mixed models determined whether early diet and weight gain velocity had independent or interactive effects on timing and pattern of teeth eruption. Data from a trial on breastfed infants were used to explore effects of breast milk vs infant formula diets on teeth eruption and overweight status at 10.5 months.

RESULTS

Independent of infant formula diet, velocities of weight gain had direct effects on the age of first deciduous tooth (P < .04) and number of erupted teeth over time (P < .002). Greater velocity of weight gain from 0.5 to 4.5 months caused earlier and more frequent eruption of deciduous teeth from 4.5 to 12.5 months. Exploratory follow-up analyses on the breastfed and formula-fed diet groups found early weight gain velocity (P = .001), but not diet or its interaction, had significant effects. Infants in the upper quartile for weight gain velocity had more primary teeth (P = .002), and a greater proportion of them were overweight (P < .001) at 10.5 months.

CONCLUSIONS

Faster weight gain accretion forecasted accelerated primary teeth eruption and increased percentage of children who were overweight-risk factors for dental caries and obesity.

TRIAL REGISTRATION

ClinicalTrials.govNCT01700205 [2012-2015] and NCT01667549 [2012-2015].

The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) Responsive Parenting Intervention for Firstborns Affects Dietary Intake of Secondborn Infants

BACKGROUND

Although previous work has shown that children with older siblings tend to have poorer diet quality, no study has directly compared diets of infant siblings.

OBJECTIVE

The goals of this analysis were to examine birth-order differences in dietary intake between firstborn (FB) and secondborn (SB) siblings, and to determine whether a responsive parenting (RP) intervention modified birth-order effects on diet.

METHODS

The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) study randomly assigned first-time mothers to an RP intervention, which included guidance on feeding, sleep, soothing, and interactive play, or control. INSIGHT mothers who delivered a second child enrolled in an observation-only study of their SB infant (SIBSIGHT). Mothers completed FFQs for both children at ages 6 (n = 97 sibling pairs) and 12 (n = 100) mo. FB compared with SB intake of food groups of interest were compared, and the moderating effect of the RP intervention on birth-order differences was tested using generalized linear mixed models.

RESULTS

Though FBs and SBs had similar diets, more FBs than SBs consumed 100% fruit juice at both 6 (13.8 compared with 3.2%, P = 0.006) and 12 mo (46.0 compared with 32.0%, P = 0.01). SBs consumed fruit more frequently (FB 2.8 compared with SB 3.2 times/d, P = 0.01), and were more likely to consume fried potatoes (FB 38.4 compared with SB 57.6%, P = 0.0009) and processed meats (FB 43.0 compared with SB 58.0%, P = 0.02) than FBs at 12 mo. There were no differences by birth order in intake of sweets, snacks, or sugar-sweetened beverages at 12 mo. At 12 mo, RP-group SBs ate vegetables more times per day (3.2) than control SBs (2.2, P = 0.01). RP-SBs also consumed a greater variety of vegetables (10.2) than control-SBs (7.9, P = 0.01).

CONCLUSIONS

Birth order is not consistently associated with healthy or unhealthy infant dietary intake. However, an RP intervention delivered to first-time mothers may benefit subsequent infants' vegetable intake. This trial was registered at clinicaltrials.gov as NCT01167270.

Fatores associados aos tipos de dificuldades alimentares em crianças entre 0 e 10 anos de idade: um estudo retrospectivo em um centro de referência brasileiro

Objetivo: identificar fatores associados à prevalência dos diferentes tipos de dificuldades alimentares em crianças com idade entre 0 e 10 anos.Métodos: trata-se de um estudo observacional retrospectivo com dados de crianças de 0 a 10 anos diagnosticadas com alguma dificuldade alimentar, atendidas em um centro de referência localizado no município de São Paulo, SP, Brasil. A presença da dificuldade alimentar foi analisada de acordo com o diagnóstico multidisciplinar, o aparecimento da queixa, os dados sobre a gestação e a amamentação, o estilo parental, a presença de causas orgânicas e as complicações associadas. Os dados foram tabulados no programa Microsoft Excel e as análises estatísticas foram realizadas no programa IBM SPSS Statistics 21 através de frequências absolutas e relativas, média, desvio padrão, teste do qui-quadrado e Kruskall-Wallis com o teste de post-hoc de Dunn.Resultados: foram avaliados 166 pacientes com um predomínio do sexo masculino, em idade pré-escolar e nascidos a termo. O diagnóstico mais prevalente foi de seletividade alimentar, sem doenças orgânicas ou reações associadas. Os diagnósticos de dificuldade alimentar apresentaram associação estatisticamente significativa com idade, idade gestacional de nascimento, idade e fase da alimentação de aparecimento da queixa.Conclusões: os fatores que apresentaram associação com os diferentes tipos de dificuldade alimentar foram a idade, a idade gestacional de nascimento e a idade e fase da alimentação de aparecimento da queixa. O presente estudo permite iniciar um direcionamento mais específico de ações de orientação e de prevenção de dificuldade alimentar. Dessa forma, destaca-se a importância da realização de estudos desse cunho.

Developmental assessments during the first 5 years of life in infants fed breast milk, cow's milk formula, or soy formula

OBJECTIVE

To investigate the effects of infant feeding mode on childhood cognition and language as the differential effects of infant feeding on development remain understudied.

METHODS

Breastfed [BF, 174], cow's milk-based formula-fed [MF, 169], or soy protein-based formula-fed [SF, 161] children were longitudinally tested from age 3 to 60 months for neurodevelopment. Data were analyzed using mixed models while adjusting for multiple covariates. Sex differences were also assessed.

RESULTS

Standard scores were within established norms for all groups. There were no differences in mental development to age 24 months, yet BF children had significantly higher motor development scores at age 3 months than SF children (99.1 versus. 97.2). BF children had significantly higher composite intelligence scores at 48 months than MF and SF children (113.4 versus. 109.6 and 108.4, respectively) and higher verbal intelligence scores than SF children at 48 (105.6 versus. 100.7) and 60 months (109.8 versus. 105.9). Greater total language scores at ages 36 and 48 months were found in BF children compared with children fed MF or SF (p < .001), with differences between sexes for auditory comprehension. Higher total language scores at age 60 months were found between BF and SF (105.0 versus. 100.1).

CONCLUSION

Breastfeeding was associated with small, statistically significant, differences between children ages 3 and 5 years in verbal intelligence, expressive communication, and auditory comprehension with the latter having potential sexual dimorphic effects. Yet, these differences remain small and may not be of clinical relevance. Overall, MF and SF did not significantly differ.

Associations of sugar intake with anthropometrics in children from ages 2 until 8 years in the EU Childhood Obesity Project

PURPOSE

We determined the association of total sugar intake with body weight and fat mass in children on an energy-equivalent basis and potential changes in the association from 2 to 8 years of age.

METHODS

Data were available from the Childhood Obesity Project Trial initiated in 2002. Sugar intake was measured by 3-day weighed food protocols at 2, 3, 4, 5, 6, and 8 years of age. Body mass index (BMI) and fat mass index (FMI) were available at the same time points. To investigate the association of sugar intake with anthropometrics over time, linear mixed models were applied. Odds ratios for having a high BMI or FMI (above one standard deviation) were estimated by logistic random-effects models. To control for total energy intake, the residual method was chosen and models were additionally adjusted for total energy intake.

RESULTS

Data were available for 809 children with in total 2846 observations. In an isocaloric model, an increase of 100 kcal from sugar per day was significantly associated with lower zBMI (- 0.033; 95% CI -0.061, - 0.005) and zFMI (- 0.050; 95% CI - 0.089, - 0.011). In addition, a 100 kcal higher sugar intake was related to lower odds of having a high zBMI (OR 0.743; 95% CI 0.611, 0.903).

CONCLUSION

This study provides no indication that increased total sugar intake positively affects BMI on an energy-equivalent basis. Whether the negative association of sugar is due to physiological effects or points more to macronutrient preferences or a reporting bias (lower sugar intake) in children with higher BMI can be debated.

CLINICAL TRIAL REGISTRY

ClinicalTrials.gov Identifier: NCT00338689; Registered: June 19, 2006. URL: http://clinicaltrials.gov/ct2/show/NCT00338689?term=NCT00338689&rank=1 .

Food neophobia and pickiness among children and associations with socioenvironmental and cognitive factors

Food neophobia and picky eating are common behaviors exhibited among children that may impact their nutritional health. Due to the limited data available regarding food neophobia and pickiness in Saudi Arabia, this study aimed to estimate the prevalence of picky eating and food neophobia among Saudi children and to examine the association of socioenvironmental and cognitive factors with food neophobia and pickiness. The study included 216 healthy children with no known allergy, aged 3-7 years old, recruited from six schools in Jeddah, Saudi Arabia. A questionnaire was utilized to collect sociodemographic information from parents. Food neophobia and pickiness were evaluated using 2 separate scales. Socioenvironmental factors that may contribute to the development of food neophobia and pickiness were evaluated, such as breastfeeding duration and weaning practices, parental strategies, peer modeling, and social facilitation. Sensory sensitivity and disgust were also evaluated to assess the association with cognitive factors. Linear regression analysis with 95% confidence intervals was used to test the associations with the selected socioenvironmental and cognitive factors. The majority of children showed moderate to severe food neophobia and pickiness (98.6% and 89.8%, respectively). The socioenvironmental factors of peer modeling and selected parental strategies were found to have a significant association with food neophobia and pickiness. Assessed cognitive factors were found to be associated with food neophobia and pickiness. Future studies investigating causes of food neophobia and food pickiness among children are warranted.

Maternal predictors of infant beverage consumption: results from the Nurture cohort study

OBJECTIVE

The goal of the present study was to estimate prevalence and maternal risk factors for infant beverage consumption.

DESIGN

Observational birth cohort.

SETTING

Central North Carolina, USA.

PARTICIPANTS

Mothers 20-36 weeks pregnant were surveyed every 3 months through their infant's first year (n 666) on their sociodemographics and infant's consumption frequency of 100 % fruit and vegetable juices and sugar-sweetened-beverages (SSB). Repeated-measure models, using a compound symmetry covariance structure, were used to assess the association of sociodemographic and maternal predictors with introducing juice and SSB separately and explored interaction terms with time to determine how the effects of the predictors change over time.

RESULTS

On average, mothers were 28 years old, 72 % were non-Hispanic Black and 59 % were low-income. We found time by race, income, education, maternal age and breast-feeding duration interactions for both juice and SSB consumption. At approximately 6-7 months of age through 12 months of age, being Black, having a lower income (≤$US 20 000 v. >$US 20 000 per year) and education (less than high-school degree v. high-school degree or higher), being younger (<26 years v. ≥26 years) and breast-feeding for fewer than 26 weeks were each associated with introduction of both juice and SSB consumption.

CONCLUSIONS

Future efforts are needed to raise awareness on the importance of national recommendations of limiting juice and SSB for infants, together with decreasing disparities in unhealthy beverage intake early in life.

Factors associated with early introduction of complementary feeding and consumption of non-recommended foods among Dutch infants: the BeeBOFT study

BACKGROUND

Timing and types of complementary feeding in infancy affect nutritional status and health later in life. The present study aimed to investigate the factors associated with early introduction of complementary feeding (i.e., before age 4 months), and factors associated with infants consumption of non-recommended foods, including sweet beverages and snack foods.

METHODS

This study used cross-sectional data from the BeeBOFT study (n = 2157). Data on complementary feeding practices and potential determinants were obtained by questionnaire at infant's age of 6 months. Logistic regression models were used to investigate factors associated with early introduction of complementary feeding and infants' consumption of non-recommended foods.

RESULTS

21.4% of infants had received complementary feeding before 4 months of age. At the age of 6 months, 20.2% of all infants were consuming sweet beverages daily and 16.5% were consuming snack foods daily. Younger maternal age, lower maternal educational level, absence or shorter duration of breastfeeding, parental conviction that "my child always wants to eat when he/she sees someone eating" and not attending day-care were independently associated with both early introduction of complementary feeding and the consumption of non-recommended foods. Higher maternal pre-pregnancy BMI and infant postnatal weight gain were associated only with early introduction of complementary feeding.

CONCLUSIONS

We identified several demographical, biological, behavioral, psychosocial, and social factors associated with inappropriate complementary feeding practices. These findings are relevant for designing intervention programs aimed at educating parents.

TRIAL REGISTRATION

The trail is registered at Netherlands Trial Register, trail registration number: NTR1831 . Retrospectively registered on May 29, 2009.

The Early Introduction of Complementary (Solid) Foods: A Prospective Cohort Study of Infants in Chengdu, China

The objective of this study was to document the types of foods introduced to infants before six months of age and identify factors associated with their early introduction. A prospective cohort study of infant feeding for the first six months after birth was undertaken in the city of Chengdu, PR China. The participants were 845 mothers who delivered their infants in hospitals in Chengdu. Mothers were interviewed within 15 days of giving birth and were followed up with for six months. The outcome measures were the introduction of complementary foods to infants within four and six months postpartum. Complementary foods are defined as any food, whether manufactured or locally prepared, used as a complement to breast milk or infant formula. In this study the emphasis was on solids and not liquid foods. More than 94% of the infants were given complementary foods (semi-solid or solid foods) before the age of six months and 10% by four months. The most commonly introduced food was infant cereal, which was given to three quarters of the infants by six months. Multivariate analysis showed that maternal education level was a significant factor affecting the introduction of complementary foods before four months, adjusted odds ratio 2.983 (1.232–7.219), with the more educated mothers introducing complementary foods earlier. More antenatal and postnatal health promotion efforts are required to highlight the benefits of introducing solid foods later than is the current practice in Chengdu, at or close to six months of age. Further education is also required for training health professionals including pediatricians, midwives, and community health staff.

Knowledge and attitudes towards breastfeeding practices: A cross-sectional survey of postnatal mothers in China

OBJECTIVE

To examine the mothers' knowledge and attitudes toward breastfeeding and highlight barriers to exclusive breastfeeding in Chinese postpartum mothers.

DESIGN

Cross sectional survey SETTING: Maternity wards of two large, multi-service teaching hospitals, Wuhan, China.

PARTICIPANTS

324 postnatal mothers completed a structured questionnaire during their stay at hospital from October 2016 to January 2017.

MEASUREMENTS AND FINDINGS

Descriptive and inferential statistics revealed that most mothers showed neutral attitude on breastfeeding and neutral knowledge level as well. The average score for the total Iowa Infant Feeding Attitude Scale (IIFAS) was 56.55±4.77 M±SD, and 10.83±2.77, M±SD for the knowledge section. The mothers who had poor knowledge were less likely to initiate breastfeeding within an hour after birth.

CONCLUSIONS

The results of this study are applicable to nurses and nurse midwives to assist in identification of women who may be at-risk to not initiate breastfeeding. Maternal positive attitude and good knowledge play key roles in the process of breastfeeding. Thus, it is important to provide antenatal and early postpartum education and periodical breastfeeding counselling, especially for new mothers, to improve maternal attitudes and knowledge toward breastfeeding practices.

Parental intuitive eating behaviors and their association with infant feeding styles among low-income families

INTRODUCTION

Feeding styles, the attitudes and behaviors parents use to direct their child's eating, shape a child's ability to self-regulate food intake and affects their future risk of obesity. This study examined how parental intuitive eating, where parents follow their own hunger and satiety cues, relates to infant feeding styles in a low-income, predominately Black population.

METHODS

Parents of healthy infants aged 5.5-12.5 months were recruited during well-child visits at two urban primary care clinics. Parent's intuitive eating behaviors and infant feeding styles were measured using the Intuitive Eating Scale-2 (IES-2) and the Infant Feeding Style Questionnaire (IFSQ), respectively. Multivariable regression analysis, controlling for maternal and child demographic variables, was conducted to determine the relationship between parent intuitive eating behaviors and five infant feeding styles: restrictive, pressuring, indulgent, laissez-faire, and responsive.

RESULTS

201 parents completed the study, 90% were mothers and 69% were Black. Average infant age was 8.8 ± 2.0 months. Parents who reported relying on their own hunger and satiety cues when eating were more likely to feed their infant in a responsive style (β 0.10 ± 0.04, p < 0.05). Parents who reported eating unconditionally, not labeling foods as forbidden, were more likely to feed their infant in a laissez-faire (β 0.16 ± 0.06, p < 0.05) and indulgent (β 0.09 ± 0.03, p < 0.05) feeding style.

CONCLUSIONS

Parental intuitive eating behaviors are associated with both responsive and non-responsive infant feeding styles. Future studies should examine how parental intuitive eating and infant feeding styles affect infant growth trajectories.

Mother's Infant and Young Child Feeding (IYCF) knowledge improved timely initiation of complementary feeding of children aged 6-24 months in the rural population of northwest Ethiopia

Objectives

Appropriate complementary feeding is vital to reduce young child morbidity and mortality. However, it continues as sub-optimal in Ethiopia, and literatures are also scarce. Therefore, this study aimed to determine timely initiation of complementary feeding and associated factors among mothers with children aged 6–24 months in the rural population of northwest Ethiopia. In the community based cross-sectional study, data on child feeding practices, individual and household characteristics were collected in Dabat Demographic Surveillance System site, Dabat District, northwest Ethiopia from 01 May to 29 June 2015. The bivariate and backward stepwise multivariable statistical methods were carried out to identify factors associated with timely initiation of complementary feeding.

Results

About 53.8% [95% CI 45.9, 61.7] and 4.6% [95% CI 1.3, 7.9] of children were found with timely initiation of complementary feeding and had minimum dietary diversity, respectively. The odds of timely initiation of complementary feeding was higher among mothers with medium [AOR = 2.34, 95% CI 1.54, 3.81] and high [AOR = 2.10, 95% CI 1.41, 3.87] mother’s IYCF knowledge. In Dabat district, complementary feeding practice is lower. Thus, efforts should be strengthened to boost mother’s IYCF knowledge.

Breastfeeding to 12 mo and beyond: nutrition outcomes at 3 to 5 y of age

Background

Little is known about nutrition outcomes in preschoolers associated with breastfeeding duration beyond 12 mo of age.

Objective

The aim was to examine the association between total breastfeeding duration and nutrition outcomes at 3 to 5 y of age.

Design

A cross-sectional study in healthy children, ages 3-5 y, recruited from 9 primary care practices in Toronto was conducted through the TARGet Kids! (The Applied Research Group for Kids) research network. Parents completed standardized surveys, including the Nutrition Screening for Every Preschooler (NutriSTEP) used to assess nutrition risk.

Results

A total of 2987 children were included. Ninety-two percent of children were breastfed, and the mean ± SD breastfeeding duration was 11.4 ± 8.4 mo. The prevalence of nutrition risk (score >20) was 17.0%. We examined breastfeeding duration as a continuous variable. With the use of restricted cubic spline modeling, we confirmed a nonlinear relation between breastfeeding duration and NutriSTEP score, dietary intake and eating behavior subscores, and sugar-sweetened beverage and sweet-savory snack consumption. Segmented linear regression was used to examine this nonlinear relation in a piecewise approach. We found a decreasing trend in NutriSTEP score for children who were breastfed for 0-6 mo (β = -0.14; 95% CI: -0.29, 0.004), a significant decrease in NutriSTEP score for children breastfed for 6-12 mo (β = -0.20; 95% CI: -0.33, -0.07), and no significant change after 12 mo (β = 0.09; 95% CI: -0.07, 0.24) and beyond. The mean ± SD NutriSTEP scores were 17.1 ± 7.4 for no breastfeeding, 15.9 ± 6.5 for breastfeeding >0-6 mo, 13.9 ± 6.2 for >6-12 mo, 13.7 ± 6.3 for >12-18 mo, 14.6 ± 6.7 for >18-24 mo, and 14.3 ± 6.8 for >24-36 mo.

Conclusions

Breastfeeding for ≤12 mo was associated with decreased nutrition risk and healthier eating behaviors and dietary intake at 3-5 y of age. We found insufficient evidence of additional benefit for breastfeeding beyond 12 mo of age. The TARGet Kids! practice-based research network is registered at www.clinicaltrials.gov as NCT01869530.

Using Ethnography to Identify Barriers and Facilitators to Optimal Infant and Young Child Feeding in Rural Ghana: Implications for Programs

BACKGROUND

Understanding the context of infant and young child feeding (IYCF) is recognized as essential for designing appropriate complementary feeding interventions.

OBJECTIVE

Our objective was to study household IYCF behaviors in 2 districts in southern and northern Ghana to identify opportunities to improve existing nutrition programs.

METHODS

We interviewed 80 caregivers of children aged 6 to 23 months using ethnographic methods, including free listing, guided discussions and cognitive mapping techniques, and 24-hour dietary recall. Descriptive statistics and thematic content analysis were used to analyze quantitative and qualitative data.

RESULTS

In both settings, children's diets were predominantly maize based. Fish, the main animal source food, was consumed daily but in very small quantities. Milk was consumed by only a few children, in tea and porridge. Fruits were seldom consumed. Household food production did not meet requirements, and the markets were heavily relied on for staples and other key ingredients. Most caregivers demonstrated basic knowledge and understanding of key health and nutrition concepts. Barriers to optimal child feeding identified were lack of money to purchase the nutritious foods recommended for children, seasonal food insecurity, and some caregiver beliefs, practices, and nutrition knowledge gaps. Positive contextual features include caregiver recognition of the dietary needs of young children and commitment to provide foods to meet these needs.

CONCLUSION

Our findings suggest that complementary feeding in these rural settings can be improved through reinforcement or modification of strategic components of local health and nutrition education in light of existing barriers and enablers to optimal IYCF.

Parental Knowledge of AAP Juice Guidelines Is Associated With Parent and Children's Consumption of Juice and Sugar-Sweetened Beverages in an Underserved Population

This study tested whether parental knowledge of the American Academy of Pediatrics' (AAP) recommendations on juice limits for children is associated with decreased consumption of juice and sugar-sweetened beverages (SSBs) among parents and children. Fifty-two parents with children 2 to 12 years old in a resident continuity clinic in East Harlem, New York, completed a survey asking about children's and parent's practice and quantitative consumption of juice and SSBs as well as parental knowledge of the AAP recommendations on juice limits. Parent's total daily consumption of juice and SSBs ( P < .01), parent's score on the test of AAP guidelines ( P = .04), and parent's post-high school education ( P = .01) were associated with children's juice and SSB consumption in a multivariable linear regression model. Children's consumption of juice and SSBs is positively associated with parental consumption of juice and SSBs and negatively associated with parental formal education and knowledge of the AAP recommendations on juice limits.

INFLUENCE OF BREASTFEEDING ON CONSUMPTION OF SWEETENED BEVERAGES OR FOODS

Objective:

To verify whether breastfeeding is associated with lower prevalence of consumption of sweetened beverages or foods in infants.

Methods:

This is a cross-sectional study with data collected from the Survey on Prevalence of Breastfeeding conducted in Brazilian municipalities in 2008. A representative sample of 14,326 infants aged 6 to 11.9 months of age, residents of 75 municipalities in the State of São Paulo, Southeastern Brazil, was studied. The influence of breastfeeding on the consumption of sweetened beverages or food products was analyzed by multilevel Poisson regression. Variables with p<0.20 in the crude analysis were included in the multilevel analysis.

Results:

Most infants were on breastfeeding (56.1%). The prevalence of sweetened drinks or foods consumption was 53.3%. The consumption of sweetened products was shown to be less prevalent among breastfed infants after adjustment for confounding factors (PR 0.87; 95%CI 0.83-0.91).

Conclusions:

Breastfeeding was associated with lower consumption of sweetened beverages or foods. As an additional effect of actions aimed at promoting breastfeeding, a decrease in intake of sweetened products is expected among infants.

Consumption of obesogenic foods in non-Hispanic black mother-infant dyads

Obesity continues to be a problem in the United States. Of particular concern is the epidemic of early childhood obesity. A significant predictor of child diet is maternal diet, but little is known about this relationship during infancy. This study examined the association between maternal and infant consumption of key food groups from 6 to 18 months using data from the Infant Care, Feeding, and Risk of Obesity Study, a prospective cohort of 217 non-Hispanic black, low-income, first-time mothers. Using data from 24-hr dietary recalls collected during in-home visits at 6, 9, 12, and 18 months, we assessed longitudinal associations between mother and child intake of both energy-dense, nutrient-poor (obesogenic) food groups and fibre-, nutrient-rich food groups using random intercept logistic regression. Both mothers and their infants had high intake of sugar-sweetened beverages, desserts, and sweets and low intake of vegetables and whole grains. Infant consumption of key food groups was strongly associated with maternal consumption, suggesting the need for focused interventions to target maternal diet as a pathway to decreasing risk for the establishment of poor dietary patterns early in life.

The concurrent and longitudinal associations of temperament and nutritional risk factors in early childhood

BACKGROUND

Early childhood temperament is increasingly recognized as an important attribute that may impact screen time use, outdoor play and childhood obesity. The relationship between temperament and nutrition in preschool children is less clear.

OBJECTIVE

The objective of the study is to investigate if temperament dimensions (negative affectivity, effortful control and surgency) in early childhood are associated with nutritional risk factors.

METHODS

Six hundred seventy-eight children were followed (mean age at baseline visit 3.1 years; mean time to follow-up 16.5 months). Parents reported on child temperament and nutritional risk factors during regularly scheduled well-child clinic visits.

RESULTS

A mixed effect model demonstrated a significant association between higher negative affectivity (1.03; 95% CI 0.69 to 1.37) and higher effortful control (-0.88; 95% CI -1.27 to -0.49) on concurrent nutritional risk, independent of covariates. Multivariate linear regression analysis identified that higher effortful control, and not negative affectivity, was significantly associated with a decrease in nutritional risk (-0.67; 95% CI -1.10 to -0.24) over time, independent of covariates. There was no relationship identified between surgency and nutritional risk.

CONCLUSION

Three-year-old children with higher effortful control had reduced nutritional risk at 5 years of age. Future nutritional risk prevention strategies may benefit from interventions to increase effortful control in early childhood.

Feeding and nutritional profiles of children at 12 months of age living in the western region of the city of São Paulo: The Procriar Project

ABSTRACT Objective To analyze the feeding profiles, nutritional statuses and influences of maternal characteristics on food consumption of infants at the end of the first year of life. Methods This is a cross-sectional study nested within a cohort of pregnant women that evaluated children with a mean age of 12.1 months. The weights and lengths were measured, and the body mass index was calculated. Food consumption was obtained through 24-hour recall and was assessed qualitatively. The outcomes studied dichotomously (yes/no) were overweight (body mass index ≥+2 Z-scores), consumption of foods considered unhealthy (i.e., sugar, petit suisse cheese, sandwich crackers, and soft drinks), consumption of fruits, legumes and vegetables and a minimum acceptable diet composed of minimum dietary diversity and minimum meal frequency. Logistic regression models were constructed to evaluate the association between maternal variables and the outcomes studied. Results A total of 254 infants were evaluated, of whom 10.7% were overweight. The majority of the infants did not receive a minimum acceptable diet (58.7%), 28.0% consumed petit suisse cheese and 42.0% received added sugar in their preparations. Mothers less than 20 years old or with more schooling were more likely to offer unhealthy foods to their children (.=0.03). Fruits, legumes and vegetables (consumption was higher among children of mothers over 20 years old (.=0.04). Conclusion The study revealed a high prevalence of overweight and an inadequacy of food consumption among children. The finding that adolescent mothers and/or mothers with more schooling tend to offer inadequate food to children may favor the definition of specific educational strategies.

Factors associated with the introduction of complementary feeding in the French ELFE cohort study

The objectives of this study were to estimate the age of complementary feeding introduction (CFI) and investigate the related health, demographic, and socio-economic factors. Analyses were based on 10,931 infants from the French national birth cohort ELFE, born in 2011. Health, demographic, and socio-economic data concerning infants and parents were collected at birth (face-to-face interviews and medical records) and 2 months (telephone interviews). Data on milk feeding and CFI practices were collected at birth and 2 months then monthly from 3 to 10 months using online or paper questionnaires. The associations between both health and social factors and CFI age were tested by multivariable multinomial logistic regressions. The mean CFI age was 5.2 ± 1.2 months; 26% of the infants started complementary feeding before 4 months of age (CF < 4 months), 62% between 4 and 6 months of age, and 12% after 6 months of age (CF > 6 months). CF < 4 months was more likely when mothers smoked, were overweight/obese, younger (<29 years), and used their personal experience as an information source in child caregiving and when both parents were not born in France. CF < 4 months was less likely when the infant was a girl, second-born, when the mother breastfed longer, and had attended at least one birth preparation class. Mothers of second-born infants and who breastfed their child longer were more likely to introduce CF > 6 months. Couples in which fathers were born in France and mothers were not born in France were less likely to introduce CF > 6 months. CF < 4 months occurred in more than 25% of the cases. It is important to continue promoting clear CFI recommendations, especially in smoking, overweight, young, not born in France, and nonbreastfeeding mothers.

The role of cognitive stimulation at home in low-income preschoolers' nutrition, physical activity and body mass index

BACKGROUND

Early childhood obesity disproportionately affects children of low socioeconomic status. Children attending Head Start are reported to have an obesity rate of 17.9%.This longitudinal study aimed to understand the relationship between cognitive stimulation at home and intake of junk food, physical activity and body size, for a nationally representative sample of 3- and 4-year old children entering Head Start.

METHODS

We used The Family and Child Experiences Survey 2006. Cognitive stimulation at home was measured for 1905 children at preschool entry using items from the Home Observation Measurement of the Environment Short Form. Junk food consumption and physical activity were obtained from parent interviews at kindergarten entry. BMI z scores were based on CDC national standards. We analyzed the association between early cognitive stimulation and junk food consumption, physical activity and BMI, using multinomial and binary logistic regression on a weighted sample.

RESULTS

Children who received moderate levels of cognitive stimulation at home had a 1.5 increase in the likelihood of consuming low amounts of junk food compared to children from low cognitive stimulation environments. Children who received moderate and high levels of cognitive stimulation were two and three times, respectively, more likely to be physically active than those in low cognitive stimulation homes. No direct relationship was identified between cognitive stimulation and BMI.

CONCLUSION

Prevention and treatment efforts to address early childhood obesity may consider strategies that support parents in providing cognitively stimulating home environments. Existing evidence-based programs can guide intervention in pediatric primary care.

Consumption of key food groups during the postpartum period in low-income, non-Hispanic black mothers

The postpartum period can impact diet quality and subsequently place women at greater risk for overweight or obesity. This study examined consumption of key food groups during the first 2 years postpartum among low income, non-Hispanic black, first-time mothers. Data were from the Infant Care, Feeding and Risk of Obesity Study, a cohort of 217 mother-infant dyads, followed from 3 to 18 months postpartum, collected from 2003 to 2007. At each study visit (3, 6, 9, 12, and 18 months) 24-h dietary recalls were collected. Consumption levels were compared to those recommended from the 2010 Dietary Guidelines for Americans (DGAs) for each of the following food groups: fruits, vegetables, grains, whole grains, protein foods and dairy, as well as an estimated upper limit for sugar-sweetened beverage (SSB) consumption. At each time point, mothers met recommended intake levels for grains and protein foods only. In random-intercept logistic regression models, no demographic or household characteristics were associated with a likelihood of consuming recommended levels for any of the food groups according to the DGAs. Given the low intake of fruits, vegetables, whole grains and lean protein foods and high intake of SSBs and refined grains, interventions targeting women's diet during the postpartum period are warranted.

Beyond Food Access: The Impact of Parent-, Home-, and Neighborhood-Level Factors on Children's Diets

Despite the growth in empirical research on neighborhood environmental characteristics and their influence on children’s diets, physical activity, and obesity, much remains to be learned, as few have examined the relationship between neighborhood food availability on dietary behavior in children, specifically. This analysis utilized data from a community-based, cross-sectional sample of children (n = 199) that was collected in New Orleans, Louisiana, in 2010. This dataset was linked to food environment data to assess the impact of neighborhood food access as well as household and parent factors on children’s diets. We observed a negligible impact of the neighborhood food environment on children’s diets, except with respect to fast food, with children who had access to fast food within 500 m around their home significantly less likely (OR = 0.35, 95% CI: 0.1, 0.8) to consume vegetables. Key parental and household factors did play a role in diet, including receipt of public assistance and cooking meals at home. Children receiving public assistance were 2.5 times (95% CI: 1.1, 5.4) more likely to consume fruit more than twice per day compared with children not receiving public assistance. Children whose family cooked dinner at home more than 5 times per week had significantly more consumption of fruit (64% vs. 58%) and vegetables (55% vs. 39%), but less soda (27% vs. 43%). Findings highlight the need for future research that focuses on the dynamic and complex relationships between built and social factors in the communities and homes of children that impact their diet in order to develop multilevel prevention approaches that address childhood obesity.

Positive feelings during pregnancy, early feeding practices, and infant health

BACKGROUND

Early parenting practices, such as infant feeding, can affect children's physical health. Additionally, negative prenatal maternal affect can influence feeding choices, such as breast-feeding, and can have a detrimental effect on children's health. Little is known, however, about the contribution of positive maternal affect during pregnancy on feeding practices and children's health.

METHODS

This study explored whether positive prenatal feelings influenced children's health during the first 18 months, and whether early feeding practices mediated the relationship between these two variables. Low-income, ethnically diverse, primiparous women (n = 114) reported their feelings of pregnancy uplifts and hassles during their third trimester. These women were interviewed again at 2, 4, 6, 9, 12, and 18 months post-partum about their feeding practices. A retrospective audit of their infants' medical charts was completed from birth to 18 months.

RESULTS

Using structural equation modeling, having more uplifts than hassles during pregnancy was associated with longer breast-feeding duration and greater adherence to recommended schedules for introducing fruits and vegetables, solids, and baby cereal. These feeding practices were linked to better child health outcomes, including reduced risk of upper respiratory tract infections, conjunctivitis, otitis media, and thrush.

CONCLUSIONS

Positive maternal feelings during pregnancy were associated with better feeding practices, and these better feeding practices were associated with fewer common childhood illnesses. Helping expectant women focus on the positive aspects of their pregnancy may lead to postnatal care methods that are fiscally advantageous, preventive of detrimental postnatal choices, and medically beneficial for children.

Maternal Attitudes, Normative Beliefs, and Subjective Norms of Mothers of 2- and 3-Year-Old Children

INTRODUCTION

This exploratory study examined maternal attitudes, normative beliefs, subjective norms, and meal selection behaviors of mothers of 2- and 3-year-old children.

METHODS

Guided by the Theory of Reasoned Action, we had mothers complete three surveys, two interviews, and a feeding simulation exercise. Data were analyzed using descriptive and bivariate statistics and multivariate linear regression.

RESULTS

A total of 31 mothers (50% Latino, 34% Black, 46.9% ≤ high school education, 31.3% poor health literacy) of 32 children (37.5% overweight/obese) participated in this study. Maternal normative beliefs (knowledge of U.S. Department of Agriculture recommendations) did not reflect actual U.S. Department of Agriculture recommendations. Collectively, regression models explained 13% (dairy) to 51% (vegetables) of the variance in behavioral intent, with normative belief an independent predictor in all models except grain and dairy.

DISCUSSION

Meal selection behaviors, on average, were predicted by poor knowledge of U.S. Department of Agriculture recommendations. Dietary guidance appropriate to health literacy level should be incorporated into well-child visits.

INSIGHT responsive parenting intervention is associated with healthier patterns of dietary exposures in infants

OBJECTIVE

To determine whether a responsive parenting (RP) intervention affects infant dietary patterns.

METHODS

Primiparous mother-newborn dyads (n = 291) were randomized to the Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) RP intervention or control. Curricula were delivered at nurse home visits at ages 3, 16, 28, and 40 weeks. RP group feeding guidance advised responsive feeding, delayed introduction of solids, repeated exposure to novel foods, and age-appropriate portion sizes. Latent class analysis identified patterns of dietary exposure at 9 months. Class membership at 9 months was used to predict BMI percentile at 2 years.

RESULTS

Five dietary patterns were identified: "Breastfed, Fruits and Vegetables," "Breastfed, Low Variety," "Formula, Fruits and Vegetables," "Formula, Low Variety," and "Formula, High Energy Density." Over 60% of infants had patterns low in fruits and vegetables or high in energy-dense foods. RP group infants were less likely than control to be in the "Formula, Low Variety" class (OR = 0.40, 95% CI 0.23-0.71) or "Formula, High Energy Density" class (OR = 0.28, 95% CI 0.12-0.61) relative to the "Formula, Fruits and Vegetables" class. Dietary pattern at 9 months was significantly associated with BMI percentile at 2 years.

CONCLUSIONS

While a majority of infants consumed diets low in fruits and vegetables, the INSIGHT RP intervention was associated with healthier dietary patterns.

Factors associated with sugar intake and sugar sources in European children from 1 to 8 years of age

BACKGROUND/OBJECTIVES

The World Health Organization recommends to limit intake of free sugars to 5% of total energy per day because of the great impact of high sugar intake on body fat deposition, adiposity and dental caries. However, little data exist about total intake and sources of sugar in European children. Therefore, this paper aims to describe sugar intake and dietary sugar sources and associated factors.

SUBJECTS/METHODS

Three-day weighed dietary records were obtained at eight time points from children 1 to 8 years of age (n=995) in five European countries. Food items were classified into subgroups according to food composition. Linear mixed models were used to examine associated factors.

RESULTS

Total sugar intake increased from 65 g/day (30.0% of energy intake (E%)) at 12 months of age to 83 g/day (20.9 E%) at 96 months of age. Around 80% of children's sugar intake was derived from the following sources: milk and dairy products, fruits and fruit products, confectionary and sugar sweetened beverages (SSB). Total sugar intake and dietary sugar sources varied significantly by country of residence. Boys had a significantly (P=0.003) higher total sugar consumption than girls.SSB consumption was significantly higher in children from young mothers while sugar intake from fruit products was lower in children from mothers with lower educational status and those with higher birth order.

CONCLUSIONS

Sugar intake in our population was lower than in other studies. Total sugar intake was associated with country of residence and gender, while dietary sugar sources varied by country of residence, maternal age, education and birth order.