The role of taste in food acceptance at the beginning of complementary feeding

Developmental Feeding Stages and Their Impact on Child Feeding Behavior

OBJECTIVES

Previous research has shown that critical periods of feeding skills development exist and feeding problems can arise in children due to delays in attaining feeding developmental milestones. This study aims to delineate the transitional process of feeding development in healthy children and children with gastrointestinal diseases (GIDs) and to examine the relationship between feeding milestones and the appearance of later feeding problems.

METHODS

A cross-sectional case-control study among 711 healthy Greek children and 119 children with GID, aged 2-7 years. Parents completed the Greek version of the Behavioral Pediatrics Feeding Assessment Scale and "self-reported" questionnaires assessing child's feeding history.

RESULTS

Differences in feeding behavior of preschoolers between the 2 groups were found concerning the time of introduction of complementary (pureed), lumpy, and table foods as well as finger feeding and regular cup-drinking. Age-specific milestones as proposed by guidelines were not reached. Late introduction of complementary and lumpy foods (>6 months and >9 months, respectively) as well as finger feeding (>9 months) were predictive of more problematic feeding behaviors later on.

CONCLUSIONS

The trajectory of feeding development, including less studied feeding milestones, both in healthy children and children with GIDs, indicates that there are discrepancies between current feeding practices and infant feeding guidelines, and a tendency to delay the acquisition of all assessed feeding milestones.

Contribution of home garden vegetables on reducing stunting among 6- to 23-month-old children in South Tigray, northern Ethiopia

The study was conducted to analyze the contribution of home garden vegetables in reducing stunting among 6- to 23-month-old children from South Tigray, Northern Ethiopia. The quasi-experimental study design was used. Multistage sampling technique was used to select the districts and study communities. A total of 94 purposively selected vegetable producer (intervention) households and 260 randomly selected non-producer (control) households were included in the study (1:3 ratio). The recumbent length of children was measured using horizontal wooden board to the nearest 0.1 cm. The length-for-age Z-scores were computed using WHO-Anthro 2006 software. Propensity score-matching and difference-in-difference (DID) estimates were used to analyze data using STATA software version 12. Prevalence of child stunting was 19.8 (12.7-29.4) and 21.1 (16.4-26.7)% (baseline) and 43.5 (33.5-54.1) and 46.5 (45.7-47.2)% (end line) among intervention and control groups, respectively. Child stunting was higher for boys and older children from both intervention and control households. DID estimation revealed that there was no significant difference in child stunting between intervention and control households (DID = 1.7, p = .604). However, there was an intervention effect of -0.5, 2.5, and 1.7% in the prevalence of child stunting among females, males, and both sexes, respectively. Vegetable production as an intervention strategy reduced the prevalence of stunting in children aged 6-23 months. However, vegetable production needs to be well integrated with other nutrition-sensitive interventions to realize the objective of reducing child stunting.

Socio-cultural influences on children's feeding habits and feeding frequencies in Ouagadougou, Burkina Faso: a retrospective survey

BACKGROUND

From 6 months of age, children need, in addition to breast milk, a complementary food whose nutritional composition meets their needs. However, low consumption of child-specific foods in favor of adult foods has been documented. Thus, the lack of adaptation of children to family feeding conditions has been the source of frequent malnutrition in some low-income countries. In Burkina Faso, little data is available on family-type food consumption by children. The objective was to describe the socio-cultural influences on feeding habits and food consumption frequencies of infants aged 6-23 months in Ouagadougou.

METHODS

The study was conducted from March to June 2022 using a structured questionnaire. A reminder of the previous 24 h' meals was used to assess 618 children's food consumption. Mother-child pairs were selected using the simple random sampling method, and data collection was done by the interview method. Sphinx V5, IBM SPSS Statistics 20.0 and XLSTAT 2016 software were used to process data.

RESULTS

Influences between the consumption of certain foods and the mother's social status were observed. The most consumed foods are simple porridges (67.48%), Tô/rice (65.70%), cookies and cakes (62.94%), juices and sweetened drinks (62.94%). Cowpeas (17.31%), improved porridge (13.92%) and eggs (6.63%) are the least consumed. The most meals frequency was three meals daily (33.98%), and children with the minimum daily meal frequency were 86.41%. Principal component analysis showed that the mother's social status influenced the consumption of imported infant flours, fish soups, fruits, juices and sweetened drinks, cookies and cakes, simple porridge, and tô/rice. Concerning the consumption of local infant porridges, 55.72% of the children who consumed them appreciated positively. However, for 57.75% of the parents, the lack of information limits the consumption rate of this type of flour.

CONCLUSION

High consumption of family-type meals was observed and was influenced by parental social status. In addition, the rate of acceptable meal frequencies was generally high.

Micronutrient Profile and Carbohydrate Microstructure of Commercially Prepared and Home Prepared Infant Fruit and Vegetable Purees

Large variability exists in ingredient selection and preparation of home prepared infant purees and there is a lack of data on nutritional quality in comparison to commercially prepared purees. This work had two aims. Study 1 compared the nutritional value of commercially prepared and home prepared infant purees. Food profiles from national food composition databases were used as a proxy for home prepared puree and served as the benchmark for the commercially prepared infant purees. Study 2 focused on a subset of produce that underwent molecular weight analysis to determine differences in carbohydrate profiles. Eighty-eight percent of the measurable micronutrients fell within or above the home prepared norm range with micronutrients falling below the range explained by differences in soil and growing conditions. Physicochemical characterization showed similar carbohydrate profiles with >90% of the carbohydrate fraction in the water extract constituted by low molecular weight sugars for purees produced with home preparation and commercial preparation. The estimated glycemic load (eGL) showed comparable potential impact on blood sugar levels with all purees having a low eGL (<10 glucose equivalent). In conclusion, these data suggest that both preparations provide similar micronutrient density and carbohydrate profiles.

Early Feeding Factors and Eating Behaviors among Children Aged 1–3: A Cross-Sectional Study

Early nutrition plays a crucial role not only in providing essential nutrients for proper child development, but may also be an important step in creating desirable eating behaviors, which can be transmitted into adulthood. The aim of this study was to assess possible links between early feeding factors, such as breastfeeding, complementary feeding (timing and method) as well as types of complementary foods and mealtime environment during the first three months of complementary feeding and eating behaviors in children aged 1–3 years old. This cross-sectional, online survey involved 467 mothers of toddlers aged 1–3 years old from the whole of Poland. The questionnaire consisted of questions about early feeding and the Children’s Eating Behavior Questionnaire (CEBQ). The adjusted linear regression model revealed that longer duration of any breastfeeding was negatively related to enjoyment of food (EF), desire to drink (DD) and positively related to satiety responsiveness (SR) and slowness in eating (SE) subscales. Moreover, offering homemade complementary foods more often than commercial may be related to higher SR. Eating meals during distraction seems to be negatively associated with EF, and positively with DD and SE subscales. Our study highlights possible links between early feeding factors and toddlers’ eating behaviors, so further investigation, also including dietary factors, is needed.

Less Sugar and More Whole Grains in Infant Cereals: A Sensory Acceptability Experiment With Infants and Their Parents

There is an urgent need to reduce sugar intake in early childhood. Commercial infant cereals are among the first solid foods introduced to infants at the beginning of the complementary feeding period in most countries. The aim of this study was to examine infants' overall acceptability of low-sugar complementary cereals. To do so, a between-subjects experimental study with 165 parents and their infants aged 6-24 months was conducted where one group tested a high-sugar refined cereal (21 g/100 g), and the other a low-sugar cereal (<1 g/100 g) with 50% of whole grain, which represented a 95.2% decrease in sugar content. We found no significant differences between the two groups in terms of infants' overall acceptability (infant's reaction, estimated intake and relative intake). Importantly, infants' reactions to high- and low-sugar cereals were not influenced by the time that infants had been consuming sweet cereals (15-25% sugar) before the experiment took place. In addition, parent's overall liking and sensory evaluation (sweetness, color, taste, texture, and aroma) was positive and very similar in both groups. Overall, our findings show that it is feasible to reduce sugar content in infant cereals without sacrificing its sensory acceptability by infants and their parents. This represents a good opportunity for the infant food industry to adhere to current healthy and sustainable demands of lowering the sugar intake leading to important benefits in infants' health, without compromising competitiveness in the market.

Investigating New Sensory Methods Related to Taste Sensitivity, Preferences and Diet of Mother-Infant Pairs and its Relationship to Body Composition and Biomarkers: Protocol for an Explorative Study (Preprint)

Background

Early experiences with different flavors play an important role in infant development, including food and taste acceptance. Flavors are already perceived in utero with the development of the taste and olfactory system and are passed on to the child through breast and bottle feeding. Therefore, the first 1000 days of life are considered a critical window for infant developmental programming.

Objective

The objective of our study is to investigate, both in the prenatal and postnatal period, taste sensitivity, preferences, and dietary diversity of mother-infant pairs. The explorative study design will also report on the impact of these variables on body composition (BC) and biomarkers. In contrast to conventional methods, this study involves long-term follow-up data collection from mother-infant pairs; moreover, the integration of audiovisual tools for recording infants' expressions pertaining to taste stimuli is a novelty of this study. Considering these new methodological approaches, the study aims to assess taste-related data in conjunction with BC parameters like fat-free mass or fat mass, biomarkers, and nutritional intake in infants and children.

Methods

Healthy pregnant women aged between 18 and 50 years (BMI≥18.5 kg/m² to ≤30 kg/m²; <28 weeks of gestation) were recruited from January 2014 to October 2014. The explorative design implies 2 center visits during pregnancy (24-28 weeks of gestation and 32-34 weeks of gestation) and 2 center visits after delivery (6-8 weeks postpartum and 14-16 weeks postpartum) as well as follow-up visits at 1, 3-3.5, and 6 years after delivery. Data collection encompasses anthropometric and biochemical measurements as well as BC analyses with air displacement plethysmography, taste perception assessments, and multicomponent questionnaires on demographics, feeding practices, and nutritional and lifestyle behaviors. Audiovisual data from infants’ reactions to sensory stimuli are collected and coded by trained staff using Baby Facial Action Coding and the Body Action Posture System. Birth outcomes and weight development are obtained from medical records, and additional qualitative data are gathered from 24 semistructured interviews.

Results

Our cohort represents a homogenous group of healthy women with stringent exclusion criteria. A total of 54 women met the eligibility criteria, whereas 47 mother-child pairs completed data collection at 4 center visits during and after pregnancy. Follow-up phases, data analyses, and dissemination of the findings are scheduled for the end of 2023. The study was approved by the ethics committee of the Medical University of Graz (EC No 26–066 ex 13/14), and all participants provided informed consent.

Conclusions

The results of this study could be useful for elucidating the connections between maternal and infant statuses regarding diet, taste, biomarkers, and prenatal and postnatal weight development. This study may also be relevant to the establishment of further diagnostic and interventional strategies targeting childhood obesity and early body fat development.

International Registered Report Identifier (IRRID)

DERR1-10.2196/37279

Sugar Content and Sources in Commercial Infant Cereals in Spain

Instant infant cereals reconstituted with infant formula are the first complementary food for most Spanish infants. The main aim is to provide information on sugars in the formulation of infant cereals. Product information was collected from department stores, supermarkets, and pharmacies and completed with data from brand websites. A portion of the samples was selected for total sugars determination using the HPLC and Luff-Schoorl methods. The information regarding a total of 120 milk-free instant infant cereals marketed in Spain from 12 companies was summarized. The mean of total sugars was 23 ± 9 g/100 g (25–42%), providing 24% of the calories. Most of porridges are prepared with partially hydrolyzed flours providing free sugars (glucose and maltose). The most commonly added sugar is sucrose. A total of 43.3% of products contain added sucrose, and 16.7% contain fruits. Infant cereals analyzed with added sugars can have a sugar content similar to that found in products without added sugars. Consistent differences were found in sugars content between assayed methods and this label information. Although the European legislation of infant cereals establishes values for added sugars, the labeling reflects the content of total sugars, but not that of added sugars.

Does Responsiveness to Basic Tastes Influence Preadolescents' Food Liking? Investigating Taste Responsiveness Segment on Bitter-Sour-Sweet and Salty-Umami Model Food Samples

The objective of this study was to investigate the relationships between taste responsiveness and food liking in preadolescents. Model food samples of grapefruit juice (GF) and vegetable broth (VB) modified with four additions of sucrose and sodium chloride, respectively, were employed. Intensity perception for sweetness, sourness, and bitterness were measured in GF while saltiness and umami were measured in VB. The children (N = 148) also completed food choice, familiarity, stated liking and neophobia questionnaires. The test was conducted at school, with instructions provided remotely via video call. Four segments were defined differing in basic taste responsiveness. Segments and sucrose concentrations significantly affected liking for GF, while no significant effect of segments and sodium chloride concentrations occurred on liking for VB. An increasing sucrose concentration was positively associated with liking for GF only in the segment with low responsiveness to bitter and sour tastes. No significant differences across segments were found for food choice, familiarity, stated liking, and neophobia. Conclusively, relationships between taste responsiveness and liking are product and basic taste-dependent in addition to being subject-dependent. Strategies to improve acceptance by using sucrose as a suppressor for warning sensations of bitterness and sourness can be more or less effective depending on individual responsiveness to the basic tastes.

Utilising an integrated approach to developing liking for and consumption of vegetables in children

Children eat too few vegetables and this is attributed to disliked flavours and texture as well as low energy density. Vegetables confer selective health benefits over other foods and so children are encouraged to eat them. Parents and caregivers face a challenge in incorporating vegetables into their child's habitual diet. However, liking and intake may be increased through different forms of learning. Children learn about vegetables across development from exposure to some vegetable flavours in utero, through breastmilk, complementary feeding and transitioning to family diets. Infants aged between 5 and 7 m are most amenable to accepting vegetables. However, a range of biological, social, environmental and individual factors may act independently and in tandem to reduce the appeal of eating vegetables. By applying aspects of learning theory, including social learning, liking and intake of vegetables can be increased. We propose taking an integrated and individualised approach to child feeding in order to achieve optimal learning in the early years. Simple techniques such as repeated exposure, modelling, social praise and creating social norms for eating vegetables can contribute to positive feeding experiences which in turn, contributes to increased acceptance of vegetables. However, there is a mismatch between experimental studies and the ways that children eat vegetables in real world settings. Therefore, current knowledge of the best strategies to increase vegetable liking and intake gained from experimental studies must be adapted and integrated for application to home and care settings, while responding to individual differences.

Supporting strategies for enhancing vegetable liking in the early years of life: an umbrella review of systematic reviews

BACKGROUND

Many children worldwide do not eat recommended amounts of vegetables. Disliking vegetables is a key factor associated with low intake.

OBJECTIVE

This umbrella review synthesized systematic reviews to determine the effectiveness of sensory and behavioral strategies to facilitate liking of vegetables (primary outcome) in young children up to 5 y of age, as key predictors of vegetable intake (secondary outcome).

METHODS

Nine databases were searched up to May 2019 (updated in September 2020). Two reviewers independently conducted study screening and selection, data extraction, and assessment of methodological quality using AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews). Eleven reviews (n = 1 rated strong quality, n = 4 moderate quality, n = 6 low/critically low quality) examining 85 primary studies met the review criteria: systematic reviews and meta-analyses of primary studies (any quantitative design) that examined sensory or behavioral strategies on vegetable liking or intake (outcomes reported separately for children ≤5 y). Strategy effectiveness was synthesized into 3 categories based on evidence strength: 1) promising (large and consistent body of moderate quality evidence), 2) emerging (small to moderate body of mixed consistency and quality evidence), and 3) limited (small body of limited consistency and quality evidence).

RESULTS

Promising evidence was identified for repeated exposure to a single or a variety of vegetables. Emerging evidence was identified for several strategies that increase familiarity with vegetable flavors (e.g., via exposure in utero and through breast milk, and a "vegetable first" approach to complementary feeding) and/or willingness to try vegetables (e.g., via parental role modeling, nonfood rewards, and vegetable-based story books).

CONCLUSIONS

Current evidence supports incorporation of tailored advice into guideline documents for parents and carers to repeatedly expose their children to a variety of vegetables to increase vegetable intake. Ongoing robust research on strategies to facilitate children's liking of vegetables is warranted to strengthen the evidence base underpinning advice for parents and health professionals.

Are Homemade and Commercial Infant Foods Different? A Nutritional Profile and Food Variety Analysis in Spain

Complementary feeding (CF) is an important determinant of early and later life nutrition with great implications for the health status and the development of an adequate growth. Parents can choose between homemade foods (HMFs) and/or commercial infant foods (CIFs). There is no consistent evidence as to whether HMFs provide a better nutritional profile and variety over CIFs. The aim of this study was to compare the nutritional profiles and food variety of HMFs versus CIFs in the Spanish market targeted for infants (6-11 months) and young children (12-18 months). Thirty mothers with their children aged 6 to 18 months were included in this cross-sectional study, following a 3-day weighed food diary of which HMFs were collected and chemically analyzed. HMFs meals for infant provided significantly lower energy, higher protein and higher fiber, for young children provided significantly higher protein and fiber than CIFs meals. HMFs fruit purees for infant shown significantly higher fiber and for young children provided higher energy than CIFs. HMFs meals contained a significantly greater number of different vegetables than CIFs meals (3.7 vs. 3.3), with carrot as the most frequently used in both. However, in CIFs fruit purees shown higher different fruits than HMFs, in both the banana was the fruit most frequently used. There was a predominance of meat and lack of oily fish and legumes in both HMFs and CIFs meals. HMFs and CIFs were equally characterized by a soft texture and yellow-orange colours. Importantly, our findings emphasize the need for clear guidelines for the preparation of HMFs as well as the promotion of food variety (taste and textures) in both HMFs and CIFs to suit infants' and young children's nutritional and developmental needs.

Acceptance of a Nordic, Protein-Reduced Diet for Young Children during Complementary Feeding-A Randomized Controlled Trial

Early life is critical for developing healthy eating patterns. This study aimed to investigate the effects of a Nordic, protein-reduced complementary diet (ND) compared to a diet following the current Swedish dietary guidelines on eating patterns and food acceptance. At 4-6 months (mo) of age infants were randomized to a Nordic group (NG, n = 41) or a Conventional group (CG, n = 40), and followed until 18 mo of age. Daily intake of fruits and vegetables (mean ± sd) at 12 mo was significantly higher in the NG compared to the CG: 341 ± 108 g/day vs. 220 ± 76 g/day (p < 0.001), respectively. From 12 to 18 mo, fruit and vegetable intake decreased, but the NG still consumed 32% more compared to the CG: 254 ± 99 g/day vs. 193 ± 67 g/day (p = 0.004). To assess food acceptance, both groups were tested with home exposure meals at 12 and 18 mo. No group differences in acceptance were found. We find that a ND with parental education initiates healthy eating patterns during infancy, but that the exposure meal used in the present study was insufficient to detect major differences in food acceptance. This is most likely explained by the preparation of the meal. Nordic produce offers high environmental sustainability and favorable taste composition to establish healthy food preferences during this sensitive period of early life.

Are Sugar-Reduced and Whole Grain Infant Cereals Sensorially Accepted at Weaning? A Randomized Controlled Cross-Over Trial

The way infants are fed during the complementary period can have a significant impact on infants' health and development. Infant cereals play an important role in complementary feeding in many countries. In spite of well documented benefits of a low sugar and high whole grain diet, commercial infant cereals are often refined and contain a high amount of sugars. The aim of the present study was to compare the sensory acceptability, gastrointestinal tolerance and bowel habits of two commercially available infant cereals in Spain with varying sugar and whole grain contents in infants at weaning. Forty-six healthy infants (mean age = 5.2 ± 0.4 months) received one of the two infant cereals containing either 0% whole grain flour and a high sugar content produced by starch hydrolysis (24 g/100 g) (Cereal A) or 50% whole grain flour and a medium-sugar content produced by hydrolysis (12 g/100 g) (Cereal B) in a randomized, triple blind, cross-over controlled trial. Both types of infant cereals were consumed for seven weeks. The cross-over was carried out after seven weeks. Sensory acceptability, anthropometry, gastrointestinal tolerance and adverse events were measured, and results evaluated using a linear regression model. No significant differences were observed between groups in any of the main variables analyzed. Importantly, the long-term health implications of our findings represent a wake-up call for the food industry to reduce or even eliminate simple sugars in infant cereals and for regulatory bodies and professional organizations to recommend whole grain infant cereals.

Exploring cultural beliefs and practices associated with weaning of children aged 0-12 months by mothers attending services at Maternal Child Health Clinic Kalisizo Hospital, Uganda

Introduction

Despite the fact that mothers know the exact age to wean their infants, majority of the mothers do not practice exclusive breastfeeding due to cultural beliefs and practices. The purpose of the study was to explore cultural beliefs and practices associated with weaning children at the Maternal Child Health Clinic Kalisizo Hospital.

Methods

This was a simple qualitative study. Seven in-depth-interviews were conducted among 7 mothers of children within the ages 0-12 months attending post-natal care services using self-generated semi-structured key informant's guide. This took place at the Maternal Child Health Clinic Kalisizo Hospital. Purposive sampling method was used to select mothers for the study. Three themes were generated namely: identification of the different cultural beliefs and practices associated with weaning, how the different cultural beliefs are practiced and the impacts of these cultural beliefs and practices. Data were analysed using thematic analysis.

Results

Although a majority of the mothers knew the recommended age to wean their infants, they did not ignore the ill-informed cultural beliefs, taboos and practices from their elders such as peer pressure, advice and counselling from mother-in laws and teachings from older women who are seen as role models.

Conclusion

Adherence to cultural beliefs, taboos and practices, have a powerful influence on weaning, hence hindering exclusive breast feeding.

Maternal diet during lactation and breast-feeding practices have synergistic association with child diet at 6 years

OBJECTIVE

Children breast-fed during infancy consume more fruits and vegetables than formula-fed children. This pattern is likely due, in part, to infant learning from flavours of the mother's diet transmitted through breast milk, but more research is needed to understand associations between early flavour exposures and later dietary patterns. We examined whether breast-feeding and maternal fruit and vegetable consumption during nursing were synergistically associated with higher child fruit and vegetable consumption.

DESIGN

Prospective cohort study of breast-feeding duration, maternal diet postpartum and child diet. Complete breast-feeding and maternal diet data were available for 1396 mother-child dyads; multiple imputation was used for missing data in other variables. In separate multivariable logistic regression models, we estimated the adjusted odds of high child fruit or vegetable consumption at 12 months or 6 years as a function of breast-feeding duration, maternal fruit or vegetable consumption during nursing, and their interaction.

SETTING

The Infant Feeding Practices Study II and Year 6 Follow-Up.

PARTICIPANTS

Mother-child dyads followed from birth to 6 years during 2005-2012 in the USA.

RESULTS

Longer breast-feeding duration was associated with high child fruit and vegetable consumption at 12 months. At 6 years, the interaction between breast-feeding duration and maternal vegetable consumption was associated with high child vegetable consumption.

CONCLUSIONS

Higher maternal vegetable consumption and longer breast-feeding duration were synergistically associated with high child vegetable consumption at 6 years, independent of sociodemographic characteristics and fruit and vegetable availability. Exposures to vegetable flavours through breast milk may promote later child vegetable consumption.

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

Background

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

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

Results

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

Conclusions

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

Frequency of Use of Added Sugar, Salt, and Fat in Infant Foods up to 10 Months in the Nationwide ELFE Cohort Study: Associated Infant Feeding and Caregiving Practices

The consumption of sugar, salt, and fat in infancy may influence later health. The objective of this study was to describe the frequency of use of added sugar, salt, and fat during the complementary feeding period and the associated infant caregiving practices. Data were obtained from a monthly questionnaire filled by parents for 10,907 infants from the French Etude Longitudinale Française depuis l'Enfance (ELFE) cohort. A score of frequency of use (SU) for added sugar, salt, and fat (oil, margarine, butter, and/or cream) was calculated from the age at complementary feeding introduction (CFI) to the 10th month. Associations between the SU of each added ingredient with infant feeding and caregiving practices were studied with multivariable linear regressions adjusted for familial characteristics. Only 28% of the parents followed the recommendation of adding fat and simultaneously not adding sugar or salt. Breastfeeding mothers were more prone to add sugar, salt, and fat than non-breastfeeding mothers. CFI before four months was positively associated with the SU of added sugar and salt and negatively associated with the SU of added fat. The use of commercial baby food was negatively related to the SU of added salt and fat. The use of these added ingredients was mainly related to breastfeeding, age at CFI, and use of commercial food, and it was independent of the household socioeconomic characteristics.

Differences in parental feeding styles and practices and toddler eating behaviour across complementary feeding methods: Managing expectations through consideration of effect size

Nutritional experiences during infancy and toddlerhood influence the development of healthy eating habits later in life. Interest into solid food introduction practices has experienced resurgence due to the popularization of the baby-led weaning (BLW) approach as an alternative to more traditional parent-led weaning (PLW) practices. Although the literature shows beneficial effects of BLW on eating behaviours, the magnitude of those effects is unknown making parental expectation management challenging. This study provides an estimation of the size of the difference between the solid feeding practices groups for a variety of practices consistent with the development of healthy food preferences and behaviours. 565 participants with infants between 12 and 36 months old completed a survey concerning their preferred parental feeding styles, parental feeding practices, sources of information on feeding and toddler's eating behaviour. Participants were categorised to one of four groups reflecting the level of infant self-feeding level a month after the introduction of solid food (Strict PLW, Predominant PLW, Predominant BLW and Strict BLW). Estimated effect sizes of the observed significant differences showed that the magnitude of effects was modest to minimal. Moderate effect sizes were observed in comparisons regarding breastfeeding duration, maternal feeding practices, sources of information and types of first food given to the infants at the beginning of solid feeding introduction. When it comes to toddlers' eating behaviour and the family food environment, although some differences were statistically significant, the effect sizes were very small. Considering the long-lasting impact of food preferences developed at this stage along with the stress surrounding infant feeding decisions, it is crucial that the complementary feeding advice parents receive reflects realistic expectations of the outcomes regarding the effects on eating behaviour.

An update on complementary feeding

Complementary feeding is an important developmental milestone in children and occurs at a formative time for the development of healthy eating habits that can continue into later childhood and beyond. The timing of weaning has been a controversial subject and recommendations in the UK differ from those in Europe. In the UK and New Zealand, baby-led weaning is becoming increasingly popular. The importance of responsive feeding is highlighted to make parents aware of a baby's cues indicating hunger or fullness. There have also been advances in the science of immunology that deem the early introduction of allergens to be a preventive strategy for food allergies. This article discusses the nutritional requirements for infants and reviews the foods that should be introduced and avoided. Guidelines are changing all the time, so nurses must keep up to date with current research to be able to offer advice to parents of infants.

Patterns and predictors of food texture introduction in French children aged 4–36 months

The aims of this study were to describe which and when food textures are offered to children between 4 and 36 months in France and to identify the associated factors. An online cross-sectional survey was designed, including questions about 188 food texture combinations representing three texture levels: purées (T1), soft small pieces (T2) and hard/large pieces and double textures (T3). Mothers indicated which combinations they already offered to their child. A food texture exposure score (TextExp) was calculated for all of the texture levels combined and for each texture level separately. Associations between TextExp and maternal and child characteristics and feeding practices were explored by multiple linear regressions, per age class. Answers from 2999 mothers living in France, mostly educated and primiparous, were analysed. Over the first year, children were mainly exposed to purées. Soft and small pieces were slowly introduced between 6 and 22 months, whereas hard/large pieces were mainly introduced from 13 months onwards. TextExp was positively associated with children’s number of teeth and ability to eat alone with their finger or a fork. For almost all age classes, TextExp was higher in children introduced to complementary feeding earlier, lower for children who were offered only commercial baby foods and higher for those who were offered only home-made/non-specific foods during the second year. Our study shows that until 12 months of age the majority of French children were exposed to pieces to a small extent. It provides new insights to further understand the development of texture acceptance during a key period for the development of eating habits.

The development of basic taste sensitivity and preferences in children

This study aims at understanding how preference and sensitivity to the basic tastes develop in the preschool years, and how the two relate to each other. To expand on the existing literature regarding taste preferences conducted in cross-sectional studies, a longitudinal design was applied with children from age four to six years old. During the springs of 2015, 2016, and 2017, 131 children born in 2011 were tested in their kindergartens. To investigate preferences for sweet, sour and bitter tastes, the children performed ranking-by-elimination procedures on fruit-flavored beverages and chocolates with three taste intensity levels. The beverages varied in either sucrose, citric acid, or the bitter component isolone. The chocolates varied in the bitter component theobromine from cocoa and sucrose content. Each year, the children also performed paired-comparison tasks opposing plain water to tastant dilutions at four concentrations. The stimuli consisted of the five basic tastes: sweet (sucrose) sour (citric acid monohydrate) umami (monosodium glutamate), salty (sodium chloride), and bitter (quinine hydrochloride dihydrate). Preference for sweetness levels increased with age, while preference for bitterness and sourness levels were stable. Concerning taste sensitivity, the children showed an increase in sensitivity for sourness and saltiness, a decrease for sweetness, and stability for umami and bitterness. A negative association was found between sweetness sensitivity and preference for sweetness. The study highlights different trajectories of sensitivity and preferences across tastes. On average, a reduction in sweetness sensitivity combined with an increase in preference for higher sweetness was observed from the age of four to six. The weak relationship between taste sensitivity and taste preference in our data suggests that taste preference development is shaped by a multitude of factors in addition to taste sensitivity.

Many Infants and Young Children Are Not Compliant with Mexican and International Complementary Feeding Recommendations for Milk and Other Beverages

Mexican and international authorities provide guidelines for milk and beverage consumption for young children. This study classifies beverages as appropriate or inappropriate by age (0-5.9, 6-11.9, and 12-23.9 months) and details consumption patterns, amounts consumed, and the associated socio-demographic characteristics. Analysis of the Mexican National Nutrition and Health Survey (ENSANUT 2012) was conducted (n = 949). Among 0-5.9 month olds, 66.7% consumed either breast milk, infant formula, or a combination with no other beverages, whereas 29.3% consumed breast milk and/or infant formula with water (mean = 58 g/day) and/or other beverages (mean = 115 g/day), such as 100% fruit juice, milk, and sugar-sweetened beverages (SSBs). For infants 6-11.9 months, appropriate beverages include breast milk, infant formula, and water; only 40.2% met these recommendations. Many 6-11.9 month olds consumed age-inappropriate beverages, including milk (31%) and SSBs (35%). After 12 months of age, appropriate beverages include water, milk, and a limited amount of 100% fruit juice and SSBs; 32.4% complied fully, 18.3% consumed appropriate and inappropriate beverages, and 49.3% consumed only inappropriate beverages. Among 12-23.9 month olds, 58% consumed milk, 18% juice, and 42% water while 63% consumed SSBs. Many infants and young children are not compliant with Mexican and international breastfeeding and complementary feeding guidelines for beverages. Communication and guidance about age-appropriate beverages should be improved.

Promoting healthy food preferences from the start: a narrative review of food preference learning from the prenatal period through early childhood

The palatable, energy-dense foods that characterize modern environments can promote unhealthy eating habits, along with humans' predispositions to accept sweet tastes and reject those that are sour or bitter. Yet food preferences are malleable, and examining food preference learning during early life can highlight ways to promote acceptance of healthier foods. This narrative review describes research from the past 10 years focused on food preference learning from the prenatal period through early childhood (ages 2-5 years). Exposure to a variety of healthy foods from the start, including during the prenatal period, early milk-feeding and the introduction to complementary foods and beverages, can support subsequent acceptance of those foods. Yet development is plastic, and healthier food preferences can still be promoted after infancy. In early childhood, research supports starting with the simplest strategies, such as repeated exposure and modelling, reserving other strategies for use when needed to motivate the initial tasting necessary for repeated exposure effects to begin. This review can help caregivers and practitioners to promote the development of healthy food preferences early in life. Specific implementation recommendations, the role of individual differences and next steps for research in this area are also discussed.

Development of a new in-home testing method to assess infant food liking

The objective of this study was to develop a new elaborate method to evaluate infants' liking of foods that could be applied at home and to compare the results of this elaborate method with those of a basic method. Mothers of infants aged 4 to 7 (n = 44) and 12-15 months (n = 46) participated in this study. For the basic method, mothers were asked to assess their infant's global liking at the end of a meal. Then, for the elaborate method, mothers received detailed instructions on how to feed their infant, how infants might express like/dislike and when to stop the meal. During the first nine spoons, they were asked to report the presence/absence of positive and negative behaviours after each spoon, and the infant's initial liking was reported after each triplet of spoons. They also assessed their infant's global liking at the end of the meal. Both methods were applied using three commercial familiar baby foods adapted to each age range. In 4-7-month-olds, the elaborate method showed a significant difference across products for liking, whereas the basic method did not show any difference. In 12-15-month-olds, the elaborate method showed more differences across products for liking than the basic method. In both age groups, negative behaviours, despite being less frequently reported, provided better liking discrimination than positive behaviours. In conclusion, the elaborate method produced better product liking discrimination than the basic method by focusing maternal attention on infants' eating behaviours since the first spoons.

Early Taste Experiences and Later Food Choices

Background. Nutrition in early life is increasingly considered to be an important factor influencing later health. Food preferences are formed in infancy, are tracked into childhood and beyond, and complementary feeding practices are crucial to prevent obesity later in life. Methods. Through a literature search strategy, we have investigated the role of breastfeeding, of complementary feeding, and the parental and sociocultural factors which contribute to set food preferences early in life. Results. Children are predisposed to prefer high-energy, -sugar, and -salt foods, and in pre-school age to reject new foods (food neophobia). While genetically determined individual differences exist, repeated offering of foods can modify innate preferences. Conclusions. Starting in the prenatal period, a varied exposure through amniotic fluid and repeated experiences with novel flavors during breastfeeding and complementary feeding increase children’s willingness to try new foods within a positive social environment.

Sensory Acceptability of Infant Cereals with Whole Grain in Infants and Young Children

In many countries, infant cereals are one of the first foods introduced during the complementary feeding stage. These cereals are usually made with refined cereal flours, even though several health benefits have been linked to the intake of whole grain cereals. Prior evidence suggests that food preferences are developed at early stages of life, and may persist in later childhood and adulthood. Our aim was to test whether an infant cereal with 30% of whole grain was similarly accepted both by parents and infants in comparison to a similar cereal made from refined flour. A total of 81 infants between 4 and 24 months old were included in the study. Parent-infant pairs participated in an 8-day experimental study. Acceptance was rated on hedonic scales (4-points for infants and 7-points for parents). Other attributes like color, smell, and taste were evaluated by the parents. Acceptability for infant cereals with whole grain and refined cereals was very similar both for infants (2.30 ± 0.12 and 2.32 ± 0.11, p = 0.606) and parents (6.1 ± 0.8 and 6.0 ± 0.9, p = 0.494). Therefore, our findings show that there is an opportunity to introduce whole grain cereals to infants, including those who are already used to consuming refined infant cereals, thereby accelerating the exposure of whole grain in early life.

Complementary Feeding Strategies to Facilitate Acceptance of Fruits and Vegetables: A Narrative Review of the Literature

Complementary feeding (CF), which should begin after exclusive breastfeeding for six months, according to the World Health Organization (WHO), or after four months and before six months according to the European Society for Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN), is a period when the infant implicitly learns what, when, how, and how much to eat. At the onset of CF, the brain and the gut are still developing and maturing, and food experiences contribute to shaping brain connections involved in food hedonics and in the control of food intake. These learning processes are likely to have a long-term impact. Children’s consumption of fruit and vegetables (FV) is below recommendations in many countries. Thus, it is crucial to establish preferences for FV early, when infants are learning to eat. The development of food preferences mainly starts when infants discover their first solid foods. This narrative review summarizes the factors that influence FV acceptance at the start of the CF period: previous milk feeding experience; timing of onset of CF; repeated exposures to the food; variety of foods offered as of the start of the CF period; quality and sensory properties of the complementary foods; quality of the meal time context; and parental responsive feeding.

Association between tactile over-responsivity and vegetable consumption early in the introduction of solid foods and its variation with age

The main aim of the current study was to test the hypothesis that early reactions to a vegetable in infants may be associated with sensory processing, in particular, tactile over-responsivity. A secondary aim was to see whether the relationship between sensory over-responsivity and vegetable consumption would be moderated by the age of the infant. A sample of 61 infants was recruited from children's centres and playgroups in South Birmingham, UK. Infant's acceptance of carrot was measured in grams during the first week of complementary feeding in one testing situation. Mothers filled in self-report measures of infant sensory processing, as well as their own fruit and vegetable consumption. Infant carrot consumption in the first week of solid food consumption was negatively associated with total sensory over-responsivity across different sensory domains (P < 0.01). Across the sensory domains only tactile over-responsivity predicted carrot consumption, accounting for 10.7% of the variance in consumption scores. Across the sample as a whole, the relationship between carrot consumption and tactile over-responsivity varied according to the age of introduction to solid foods. In particular, those who were weaned later and had high tactile over-responsivity ate less carrot (P < 0.001). Infants who were weaned early ate a similar amount of carrot, regardless of their tactile responsivity (P > 0.05). This study constitutes some of the first evidence to suggest that sensory processing styles be associated with early vegetable acceptance; however, more research is needed to evaluate the best strategies to use when feeding infants who are sensitive to tactile information.

Stability of food neophobia from infancy through early childhood

The purpose of the present study was to examine whether rejection of novel foods during infancy predicted child behavioral and parent-reported neophobia at 4.5 years of age. Data for the present study were drawn from a longitudinal study following individuals (n = 82) from infancy through early childhood. At 6 and 12 months of age, the infants tasted a novel food (green beans, hummus, or cottage cheese) and their reactions were coded for rejection of the food (i.e. crying, force outs, or refusals). The children returned to the laboratory at 4.5 years of age and participated in a behavioral neophobia task where they were offered three novel foods (lychee, nori, and haw jelly) and the number of novel foods they tasted was recorded. Mothers also reported their own and their children's levels of food neophobia. Regression analyses revealed that rejection of novel foods at 6 months interacted with maternal neophobia to predict parent-rated child neophobia. Infants who exhibited low levels of rejection at 6 months showed higher levels of parent-rated neophobia when their mothers also showed high compared to low levels of neophobia. At 12 months of age, however, infants who exhibited high levels of rejection tended to have high levels of parent-rated neophobia regardless of their mothers' levels of neophobia. These results provide preliminary evidence that rejection of novel foods during infancy does predict neophobia during early childhood, but the results vary depending on when rejection of new foods is measured.

[Nutritional counseling for children under two years of age: opportunities and obstacles as strategic challenges]

This article sought to conduct a critical analysis of the state of the art of the scientific production in counseling practices in nutrition for infants under two years of age, discussing the opportunities and obstacles in terms of strategic challenges for implementing healthy nutrition practices. It is a bibliographic study, with the core interest being counseling on infant nutrition. The majority (58.1 %) of the articles analyzed was published between 2008 and 2011. The educative actions of counseling on infant feeding were directed at health professionals and caregivers to children under two years of age. As opportunities in the practice of nutritional counseling the following stand out: an improvement in the performance of health professionals, the adoption of healthy eating practices by caregivers, and an improvement in the nutritional status of the children. As obstacles, the following stand out: a lack of training of caregivers and professionals regarding complementary healthy feeding and difficulties regarding the practice of counseling by a health care professional. This evidence reaffirms the importance of incorporating counseling guidance on infant feeding, as permanent practices in policies for child health care.

A step-by-step introduction to vegetables at the beginning of complementary feeding. The effects of early and repeated exposure

Breastfeeding (BF) is associated with willingness to accept vegetables. This may be due to the variety of flavours delivered via breast milk. Some mothers add vegetables to milk during complementary feeding (CF) to enhance acceptance. The present study tested a step-by-step exposure to vegetables in milk then rice during CF, on intake and liking of vegetables. Just before CF, enrolled mothers were randomised to an intervention (IG, n = 18; 6 BF) or control group (CG, n = 18; 6 BF). IG infants received 12 daily exposures to vegetable puree added to milk (days 1-12), then 12 × 2 daily exposures to vegetable puree added to rice at home (days 13-24). Plain milk and rice were given to CG. Then both received 11 daily exposures to vegetable puree. Intake was weighed and liking rated on days 25-26 and 33-35 after the start of CF in the laboratory, supplemented by the same data recorded at home. Vegetables were rotated daily (carrots, green beans, spinach, broccoli). Intake, liking and pace of eating were greater for IG than CG infants. Intake and liking of carrots were greater than green beans. However, at 6m then 18m follow up, vegetable (carrot > green beans) but not group differences were observed. Mothers reported appreciation of the structure and guidance of this systematic approach. Early exposure to vegetables in a step-by-step method could be included in CF guidelines and longer term benefits assessed by extending the exposure period.

'Just a pinch of salt'. An experimental comparison of the effect of repeated exposure and flavor-flavor learning with salt or spice on vegetable acceptance in toddlers

Children's vegetable intake is below the recommended amounts. No studies to date have tested the relevance of using salt or spices to increase children's vegetable acceptance. Our objective was to compare the effect of repeated exposure (RE) and of flavor-flavor learning (FFL) on toddlers' acceptance of a non-familiar vegetable. Two unconditioned stimuli were used: salt and a salt-associated spice. Toddlers attending six nurseries were assigned to 3 groups in a between subject design. Groups were exposed 8 times to a basic salsify puree (0.2% salt w/w; RE group; n = 47), a salty salsify puree (0.5% salt w/w; FFL-Salt group; n = 54) or a spiced salsify puree (0.2% salt and 0.02% nutmeg w/w; FFL-Nutmeg group; n = 50). Acceptance (intake and liking) of the target vegetable (basic salsify puree) and of a control vegetable (carrot puree) was evaluated at pre-exposure, at each exposure of the learning period, at post-exposure, and at 1, 3 and 6 months after exposure. In all groups, intake of the target vegetable increased from pre- to post-exposure. This increase was significantly higher in the RE group (64 ± 11 g) than in the FFL-Salt group (23 ± 11 g) and marginally higher than in the FFL-Nutmeg group (36 ± 11 g). No difference between groups was observed on the increase in liking of the target vegetable from pre- to post-exposure. The increase of the target vegetable intake was still observed after 6 months for all groups. Thus, repeated exposure appears to be the simplest choice to increase vegetable intake on the short and long term in toddlers.

Salivary protein profiles are linked to bitter taste acceptance in infants

Based on recent studies in adult subjects, saliva composition is increasingly considered as a physiological factor contributing to taste sensitivity or acceptance. In order to evaluate a possible link between salivary protein composition and taste acceptance in infants, 73 infants participated longitudinally in taste acceptance tests and donated saliva at the age at 3 and 6 months. Intake ratios, reflecting acceptance of a taste solution relative to water were calculated for the five basic tastes. Salivary proteins were separated by one-dimensional electrophoresis and bands were semi-quantified by image analysis. Partial least square (PLS) regression analyses were performed for each taste at both ages to explain intake ratios by band intensities. Bitterness acceptance in the younger infants was unique in the sense that salivary protein profiles could partly predict bitter taste acceptance. At that age, infants were on average indifferent to the 0.18-M urea solution, but great variability in acceptance was observed. The six bands considered as the best predictors for bitterness acceptance were identified by MALDI-TOF mass spectrometry. Higher abundance of bands containing secretory component, zinc-α-2-glycoprotein and carbonic anhydrase 6 was associated to a lower bitterness acceptance, while higher abundance of bands containing lactoperoxidase, prolactin-inducible protein and S-type cystatins was associated to a higher bitterness acceptance. In a second stage, S-type cystatin abundance was measured by Western blotting in order to tentatively confirm this particular finding in an independent group of 22 infants. Although not reaching statistical significance, probably due to a relatively small sample size, it was again observed that cystatin abundance was higher in infants accepting more readily the bitter solution over water.

CONCLUSION

saliva protein composition may contribute to bitter taste acceptance in the younger infants.