Breast-feeding and weaning practices in the DONALD study: age and time trends

Diet Diversity During Infancy and the Prevalence of Sensitization and Allergy in Children up to 3 Years of Age in the Kujawsko-Pomorskie Voivodeship, Poland

The study examines the influence of a diversified diet, changes in the consistency of introduced foods, and the method of meal preparation during infancy on the development of sensitization and/or allergy in toddlers. Introducing more product groups into the diet reduced the risk of allergy at 6 months of age (adjusted odds ratio [aOR] = 0.17; 95% confidence interval [CI] 0.04-0.71; P = 0.015) and at 12 months (aOR = 0.14; 95% CI 0.03-0.57; P = 0.006). Children with allergy and/or sensitization had been introduced to fewer product groups at 6 months (P = 0.003; P < 0.001; P = 0.008) and at 12 months (P = 0.001, P < 0.001; P = 0.001) compared with those without allergy and/or sensitization. Children with allergy and/or sensitization were fed ready-made, ie, purchased, products significantly more often than self-prepared foods compared with children without allergy and/or sensitization (P = 0.001; P = 0.006). Allergic and/or sensitized children tended to be switched to solids later (11 vs 10 months, P = 0.041; P = 0.037) (12 vs 10 months, P = 0.013) than children without sensitization and/or allergy. The earlier introduction of a varied diet reduced the risk of allergy and/or sensitization. Delaying the introduction of solid foods and using ready-made products instead of self-prepared ones increases the risk of allergy in toddlers.

Commercial complementary food feeding and associated factors among mothers of children aged 6-23 months old in Mettu Town, Southwest Ethiopia, 2022

BACKGROUND

Commercial complementary foods (CCF) are unhealthy products for children under 24 months, containing unhealthy fats, refined starches, sugars, salt, and additives. The consumption of CCF is linked to non-communicable diseases, making it crucial to assess intake in Ethiopia, especially in Mettu town.

OBJECTIVE

To assess the prevalence of commercial complementary food feeding and associated factors among mothers of 6-23 months old children in Mettu Town, 2022.

METHOD

A community-based cross-sectional study was conducted in Mettu town, involving 386 randomly selected mothers of children aged 6-23 months. Data was collected using a pre-tested semi-structured questionnaire and analyzed using SPSS version 25. Variables with a P-value < 0.05 in the multivariable logistic regression were declared as having a statistically significant association with CCF feeding.

RESULTS

The prevalence of CCF feeding within 24 h before the reporting period was 44.3%. In multivariable regression analysis, the age of index child 0-11months (AOR = 2.43, 95%CI: 1.53-3.85), non-exclusive breastfeeding (AOR = 2.18, 95%CI: 1.34-3.52), exposure to CCF promotions (AOR = 2.15, 95%CI: 1.32-3.50), maternal employment (AOR = 2.10, 95%CI: 1.28-3.44), and higher tertile wealth status (AOR = 2.19, 95%CI: 1.17-4.10) were significantly associated with CCF feeding.

CONCLUSION

The current study revealed that nearly half of the mothers in Mettu town were feeding their children with commercially produced complementary foods. Age of child, non-exclusive breastfeeding, CCF promotions, maternal employment, and higher wealth status were found to have a significant association with CCF feeding. Therefore, continuous health education should be given to mothers to encourage exclusive breastfeeding until 6 months of age and to improve home-made complementary food feeding.

Evaluation of Selected Antioxidant Parameters in Ready-to-Eat Food for Infants and Young Children

Infants and young children have diverse dietary needs, so conducting a detailed analysis of the food they consume in terms of antioxidant activity and the content of antioxidant elements is of utmost importance. The aim of the study was to assess the antioxidant properties and the content of Cu (copper), Se (selenium), and Zn (zinc) in baby products. A total of 398 samples of ready-to-eat food consumed by children were tested. To evaluate the antioxidant activity (338 samples, without dairy), the Folin-Ciocalteu method and the 2,2-diphenyl-1-picrylhydrazyl radical scavenging test (DPPH) were employed to determine the total phenolic content (TPC). For the determination of mineral component content (398 samples), atomic absorption spectrometry (AAS) was used to analyze the levels of Cu and Zn, while inductively coupled plasma mass spectrometry (ICP-MS) was utilized for the quantification of Se. Fruit and vegetable mousses exhibited the highest average total phenolic content (TPC) and the highest percentage of free radical scavenging in the DPPH test. In terms of mineral content, the group of dairy products recorded the highest average levels of Cu and Se, while porridges contained the highest content of Zn. Notably, only organic baby food contained significantly more Zn compared to conventional food (12.2 ± 13.9 mg/kg vs. 10.7 ± 14.4 mg/kg). Ready-to-eat products designed for consumption by children provide antioxidant properties, and the presence of Zn, Cu, and Se can contribute to supporting antioxidant processes.

Health relevance of lowering postprandial glycaemia in the paediatric population through diet': results from a multistakeholder workshop

To summarize current knowledge and gaps regarding the role of postprandial glycaemic response in the paediatric population, a workshop was organized in June 2021 by the European branch of the International Life Science Institute (ILSI). This virtual event comprised of talks given by experts followed by in-depth discussions in breakout sessions with workshop participants. The main pre-specified topics addressed by the workshop organizing committee to the invited speakers and the workshop participants were: (1) the role of glycaemic responses for paediatric health, based on mechanistic insights from animal and human data, and long-term evidence from observational and intervention studies in paediatric populations, and (2) changes in metabolism and changes in dietary needs from infancy to adolescence. Each talk as well as the discussions were summarised, including the main identified research gaps. The workshop led to the consensus on the crucial role on health of postprandial glycaemic response in paediatric population. However, a lack of scientific data has been identified regarding detailed glucose and insulin profiles in response to foods commonly consumed by paediatric populations, as well as a lack of long-term evidence including the need for suitable predictors during childhood and adolescence to anticipate health effects during adulthood.

Commercial Complementary Food in Germany: A 2020 Market Survey

As consumption of commercial complementary food (CCF) during infancy and toddlerhood is common, the aim of the present study was to describe the current (2020) German market of CCF products targeted at infants and toddlers with a special focus on ingredients, macronutrients, and the practice of nutrient fortification. Information on age declarations, ingredients, energy and nutrient contents, and nutrient fortification was obtained in a market survey by contacting the producers and searching manufacturers’ websites. Each product was assigned to 1 of 13 product categories (menus, milk−cereal−meal, fruit−cereal−meal, oil, vegetables, meat, fish, fruits, cereals, snack foods, pouches, desserts, beverages). Descriptive statistics were used. We identified 1057 CF products on the German market (infants’ CCF (<12 months): n = 829; toddlers’ CCF (>12 months): n = 228)). The highest protein content (% of energy content, %E) was found in meat products. In pouches, beverages, cereal fruit meals, and fruits, more than 50% of energy came from total sugar. The highest median salt content was found in toddlers’ menus and desserts. Around one-third of infants’ CCF products and one quarter of toddlers’ products were fortified with nutrients. Vitamin B1 (thiamin) was the most frequently fortified nutrient, followed by vitamin C, iron, calcium, and vitamin D. Apple was the type of fruit listed most often in products with fruits, whereas carrot was the most frequent vegetable among CCF with vegetables. In particular, the high total sugar content of most CCFs currently available on the German market may promote unhealthy dietary habits. Parents need to be advised about the optimal selection of products.

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.

Feeding frozen complementary foods promotes food acceptance in infants: The randomized intervention trial Baby Gourmet

Infancy may represent a sensitive window for establishing food preferences that could affect the individual's long-term potential to establish healthy eating patterns. Our study was based on the hypothesis that preserving the natural flavor of the ingredients of commercially prepared complementary foods would increase the acceptance of new foods, especially vegetables. Frozen vegetable-based meals for infants were developed to preserve the natural taste of the ingredients better than sterilization of meals in jars. In a 3-month randomized, controlled intervention study, 51 infants were fed either frozen menus (intervention group) or commercial sterilized meals in jars (control group) on at least 5 days per week. Then the acceptability of a known vegetable-based puree was tested in comparison to an unknown puree, measuring the quantities consumed and also the mother's assessment of the infants' liking. In conclusion, the results of this study clearly indicated that infants fed vegetable-based frozen meals for 3 months accepted a new vegetable better than infants fed sterilized commercial meals in jars.

Complementary Feeding Practices and Parental Pressure to Eat among Spanish Infants and Toddlers: A Cross-Sectional Study

The introduction of complementary foods is a crucial stage in the development and determination of infants’ health status in both the short and longer-term. This study describes complementary feeding practices among infants and toddlers in Spain. Also, relationships among sample characteristics (both parents and their child), feeding practices (timing, type of complementary food), and parental pressure to eat were explored. Cognitive interviewing with 18 parents was used to refine the survey questions. Responses from a national random sample of 630 parents, who were responsible for feeding their infants and toddlers aged 3–18 months, were obtained. Solids, often cereals and/or fruits first, were introduced at a median age of five months. Fish and eggs were introduced around the age of nine and ten months. Almost all children were fed with home-prepared foods at least once per week (93%), and in 36% of the cases, salt was added. Interestingly, higher levels of parental pressure to eat were found in female infants, younger parents, parents with a full-time job, the southern regions of Spain, and in infants who were not fed with home-prepared foods. Our insights underline the importance of clear feeding recommendations that can support health care professionals in promoting effective strategies to improve parental feeding practices.

Commercial complementary food use amongst European infants and children: results from the EU Childhood Obesity Project

PURPOSE

The objective of this secondary analysis is to describe the types of commercial complementary foods (CCF) consumed by infants and young children enrolled in the European Childhood Obesity Project (CHOP), to describe the contribution of CCF to dietary energy intakes and to determine factors associated with CCF use over the first 2 years of life.

METHODS

The CHOP trial is a multicenter intervention trial in Germany, Belgium, Italy, Poland and Spain that tested the effect of varying levels of protein in infant formula on the risk for childhood obesity. Infants were recruited from October 2002 to June 2004. Dietary data on CCF use for this secondary analysis were taken from weighted, 3-day dietary records from 1088 infants at 9 time points over the first 2 years of life.

RESULTS

Reported energy intakes from CCF during infancy (4-9 months) was significantly higher (p ≤ 0.002) amongst formula-fed children compared to breastfed children. Sweetened CCF intakes were significantly higher (p ≤ 0.009) amongst formula-fed infants. Female infants were fed significantly less CCF and infant age was strongly associated with daily CCF intakes, peaking at 9 months of age. Infants from families with middle- and high-level of education were fed significantly less quantities of CCF compared to infants with parents with lower education. Sweetened CCF were very common in Spain, Italy and Poland, with over 95% of infants and children fed CCF at 9 and 12 months of age consuming at least one sweetened CCF. At 24 months of age, 68% of the CHOP cohort were still fed CCF.

CONCLUSIONS

CCF comprised a substantial part of the diets of this cohort of European infants and young children. The proportion of infants being fed sweetened CCF is concerning. More studies on the quality of commercial complementary foods in Europe are warranted, including market surveys on the saturation of the Western European market with sweetened CCF products.

Release and migration of cyclic polyester oligomers from bisphenol A non-intent polyester-phenol-coatings into food simulants and infant food - a comprehensive study

Coatings for cans or closures are essential to protect the metal from corrosion and the food from migration of hazardous metal ions. Since coatings are no inert materials, they can release substances of potential health concern into food. In the present study, a comprehensive analysis is presented for a complex two-layered polyester-phenol-coating commercially used for metal closures of complementary infant food in sterilised glass jars. Focussed on the identity and migration of cyclic polyester oligomers as a kind of predictable non-intentionally added substances, polyester resin raw materials (n = 3) as well as individual coating layers (n = 3) were characterised by several analytical strategies (size exclusion chromatography, high-performance liquid chromatography mass spectrometry, diode array detection, charged aerosol detection, monomer determination after alkaline hydrolysis, overall migrate). The main polyester monomers were terephthalic acid, isophthalic acid, trimellitic acid, ethylene glycol, diethylene glycol, neopentylglycol, 2-methyl-1,3-propanediol, 1,4-butanediol and tricyclodecanedimethanol. The coatings were extracted with solvents acetonitrile and ethanol (24 h, 60°C), food simulants 50% ethanol, 20% ethanol and water (1 h, 121°C) as well as homemade and commercial baby food (1 h, 121°C). The released total polyester content determined by alkaline hydrolysis ranged from 288 µg/dm² (water, 1 h, 121°C) to 6154 µg/dm² (acetonitrile, 24 h, 60°C). However, individual cyclic oligomers, mainly dimers, were released from the coating to up to about 140 µg/dm². Migration into infant food was best represented by the food simulants water (up to 1% fat) and 20% ethanol (up to 5% fat). Cyclic polyester oligomers are classified as Cramer III substances by the threshold of toxicological concern concept associated to an exposure threshold of 1.5 µg/kg body weight per day. Exposure to cyclic polyester oligomers might be a potential concern for highly exposed infants.

Fatores relacionados com uma menor duração total do aleitamento materno

Resumo O objetivo deste artigo é identificar fatores relacionados com uma maior duração do aleitamento materno. Realizou-se um estudo caso-controle aninhado em uma coorte de mães que tiveram seus filhos nas duas maiores maternidades públicas de João Pessoa – PB quando eles tinham em torno de dois anos de idade. Os casos foram aquelas que amamentaram até o 15 mês (n = 55) e os controles as que amamentaram por mais de 15 meses (n = 48). As variáveis de exposição foram características socioeconômicas maternas, da gestação e parto e a introdução precoce de alimentação complementar. Aplicou-se o teste Qui-Quadrado para selecionar as variáveis independentes (p-valor <= 0,20) para ingressar em um modelo de regressão logística múltipla, permanecendo no modelo final somente aquelas com p-valor <= 0,05. A introdução precoce de fórmula infantil (OR = 4,71, IC95%: 1,76 – 12,63), de outros leites (OR = 3,25, IC95%: 1,27 – 8,31) e realizar menos de seis consultas pré-natal (OR = 2,73, IC95%: 1,04 – 7,07) foram fatores de risco para a menor duração do aleitamento materno. A introdução precoce de fórmulas infantis ou outros leites pode ser um indicador importante para a adoção de ações de promoção e apoio oportunas para o prolongamento da amamentação para atingir a meta da OMS de aleitamento materno por dois anos ou mais.

Contribution of commercial infant products and fortified staple foods to nutrient intake at ages 6, 12, and 18 months in a cohort of children from a low socio-economic community in South Africa

Fortification of two staple foods, maize meal and wheat flour (bread), is mandatory, and commercial infant products are widely available in South Africa. Using a 24-hr recall, we determined the contribution of these foods towards nutrient intakes at ages 6 (n = 715), 12 (n = 446), and 18 (n = 213) months in a cohort of children in a peri-urban community, North West province. On the day of recall, commercial infant products were consumed by 83% of children at 6 months, 46% at 12 months, and 15% at 18 months; fortified staples were consumed by 23%, 81%, and 96%, respectively. For consumers thereof, commercial infant products contributed 33% energy and 94% iron intakes at 6 months and 27% energy and 56% iron intakes at 12 months; nutrient densities of the complementary diet was higher than for nonconsumers for most micronutrients. For consumers of fortified staples, energy contribution thereof was 11% at 6 months versus 29% at 18 months; at 18 months, fortified staples contributed >30% of iron, zinc, vitamin A, thiamine, niacin, vitamin B6, and folate; at 12 months, nutrient densities of the complementary diet were higher for zinc, folate, and vitamin B6 but lower for calcium, iron, vitamin A, niacin, and vitamin C than nonconsumers. At ages 12 and 18 months, ~75% of children had low calcium intakes. At 12 months, 51.4% of consumers versus 25.0% (P = 0.005) of nonconsumers of fortified staples had adequate intakes (>EAR) for all eight fortificant nutrients. However, despite fortification, nutrient gaps remain.

Práticas e crenças populares associadas ao desmame precoce

Objetivo: Comprender la influencia de las prácticas y creencias populares en el destete precoz de puérperas que asistían al programa Estratégia Saúde da Família.Metodología: Estudio descriptivo con enfoque cualitativo, el cual se llevó a cabo entre abril y mayo de 2016 con 12 puérperas registradas en la unidad de Atendimento Multiprofissional Especializado (AME) Saúde da Família, a partir de entrevistas semiestructuradas. Los datos se analizaron mediante el análisis de contenido temático.Resultados: Las mujeres participantes en nuestro estudio comprendieron la importancia de la lactancia materna exclusiva. Sin embargo, factores como el retorno al trabajo o al estudio, las creencias y tabúes —como creer que la leche materna no es suficiente—, la dificultad de agarre y el temor por las alteraciones estéticas de los senos llevan al destete o a la inclusión de otros alimentos en la dieta antes de los primeros seis meses de vida del niño. La mayoría de las puérperas no recibió orientación profesional sobre la lactancia materna durante el control prenatal; aquellas que obtuvieron orientación informaron que la figura del enfermero fue un agente facilitador.Conclusión: Es necesario desmitificar la lactancia materna exclusiva y promover que esta práctica se lleve a cabo durante un tiempo determinado.

Nutritional aspects of commercially prepared infant foods in developed countries: a narrative review

Nutritional intake during infancy is a critical aspect of child development and health that is of significant public health concern. Although there is extensive research on breast-feeding and timing of solid food introduction, there is less evidence on types of solid foods fed to infants, specifically commercially prepared infant foods. The consumption of commercially prepared infant foods is very prevalent in many developed countries, exceeding the consumption of homemade foods in some situations. Although these food products may have practical advantages, there are concerns about their nutritional composition, sweet taste, bioavailability of micronutrients, diversity of ingredients and long-term health effects. The extent that the manufacturing, fortification and promotion of these products are regulated by legislation varies between countries and regions. The aim of the present narrative review is to investigate, appraise and summarise these aspects. Overall there are very few studies directly comparing homemade and commercial infant foods and a lack of longitudinal studies to draw firm conclusions on whether commercial infant foods are mostly beneficial or unfavourable to infant health.

Association between full breastfeeding, timing of complementary food introduction, and iron status in infancy in Germany: results of a secondary analysis of a randomized trial

PURPOSE

Considering the low content in breast milk breastfed infants might be at particular risk for depleted iron stores after the first months of life. This study evaluates the association of the mode of milk feeding and the timing of complementary food (CF) introduction with parameters of iron status in term healthy infants in Germany.

METHODS

In this secondary analysis of a randomized controlled trial, parents recorded all foods consumed by their infants from the age of 8 weeks onwards. Mothers were advised on the German food-based dietary guidelines for infants. Accordingly, CF was introduced between the fifth and seventh month of age. Blood samples were taken at 4 and at 10 months of age for analyses of iron status parameters. Iron depletion was defined as serum ferritin <12 ng/mL.

RESULTS

The iron intake was lower in breastfed infants (n = 50) than in formula fed (n = 23) with decreasing differences during the course of infancy. At 10 months of age, most iron parameters were not associated with the mode of milk feeding or the timing of CF introduction. At this age, the iron depletion prevalence was >34% without general differences according to the mode of milk feeding or the timing of CF introduction.

CONCLUSION

The high prevalence of depleted iron stores observed in both breastfed and formula-fed infants illustrates the need for further studies to improve our understanding of the optimal iron intake and sensitive parameters of iron status in infancy.

Commercial complementary food consumption is prospectively associated with added sugar intake in childhood

Given that commercial complementary food (CF) can contain high levels of added sugar, a high consumption may predispose to a preference for sweet taste later in life. This study examined cross-sectional associations between commercial CF consumption and added sugar intake in infancy as well as its prospective relation to added sugar intake in pre-school and primary-school age children. In all, 288 children of the Dortmund Nutritional and Anthropometric Longitudinally Designed Study with 3-d weighed dietary records at 0·5 and 0·75 (infancy), 3 and 4 (pre-school age) and 6 and 7 years of age (primary-school age) were included in this analysis. Individual commercial CF consumption as percentage of total commercial CF (%cCF) was averaged at 0·5 and 0·75 years. Individual total added sugar intake (g/d, energy percentage/d) was averaged for all three age groups. Multivariable logistic and linear regression models were used to analyse associations between %cCF and added sugar intake. In infancy, a higher %cCF was associated with odds for high added sugar intake from CF and for high total added sugar intake (>75th percentile, P<0·033). Prospectively, a higher %cCF was related to higher added sugar intake in both pre-school (P<0·041) and primary-school age children (P<0·039), although these associations were attenuated in models adjusting for added sugar intake in infancy. A higher %cCF in infancy may predispose to higher added sugar intake in later childhood by virtue of its added sugar content. Therefore, offering home-made CF or carefully chosen commercial CF without added sugar might be one strategy to reduce sugar intake in infancy and later on.

Effects of a Follow-On Formula Containing Isomaltulose (Palatinose™) on Metabolic Response, Acceptance, Tolerance and Safety in Infants: A Randomized-Controlled Trial

Effects of the dietary glycaemic load on postprandial blood glucose and insulin response might be of importance for fat deposition and risk of obesity. We aimed to investigate the metabolic effects, acceptance and tolerance of a follow-on formula containing the low glycaemic and low insulinaemic carbohydrate isomaltulose replacing high glycaemic maltodextrin. Healthy term infants aged 4 to 8 completed months (n = 50) were randomized to receive the intervention follow-on formula (IF, 2.1g isomaltulose (Palatinose™)/100mL) or an isocaloric conventional formula (CF) providing 2.1g maltodextrin/100mL for four weeks. Plasma insulinaemia 60min after start of feeding (primary outcome) was not statistically different, while glycaemia adjusted for age and time for drinking/volume of meal 60min after start of feeding was 122(105,140) mg/dL in IF (median, interquartile range) and 111(100,123) in CF (p = 0.01). Urinary c-peptide:creatinine ratio did not differ (IF:81.5(44.7, 96.0) vs. CF:56.8(37.5, 129),p = 0.43). Urinary c-peptide:creatinine ratio was correlated total intake of energy (R = 0.31,p = 0.045), protein (R = 0.42,p = 0.006) and fat (R = 0.40,p = 0.01) but not with carbohydrate intake (R = 0.22,p = 0.16). Both formulae were well accepted without differences in time of crying, flatulence, stool characteristics and the occurrence of adverse events. The expected lower postprandial plasma insulin and blood glucose level due to replacement of high glycaemic maltodextrin by low glycaemic isomaltulose were not observed in the single time-point blood analysis. In infants aged 4 to 8 completed months fed a liquid formula, peak blood glucose might be reached earlier than 60min after start of feeding. Non-invasive urinary c-peptide measurements may be a suitable marker of nutritional intake during the previous four days in infants.

Trial registration: ClinicalTrials.gov NCT01627015

Types of fruits and vegetables used in commercial baby foods and their contribution to sugar content

Fruits and vegetables (F&V) are often featured in names of commercial baby foods (CBFs). We aimed to survey all available CBFs in the UK market with F&V included in the food name in order to describe the amount and types of F&V used in CBF and their contribution to total sugar content. Food labels were used to identify F&V and total sugar content. Fruits were more common than vegetables in names of the 329 CBFs identified. The six most common F&V in the names were all relatively sweet: apple, banana, tomato, mango, carrot and sweet potato. The percentage of F&V in the foods ranged from a median of 94% for sweet-spoonable to 13% for dry-savoury products. Fruit content of sweet foods (n = 177) was higher than vegetable content of savoury foods (n = 152) with a median (IQR) of 64.0 g/100 g (33.0-100.0) vs. 46.0 g/100 g (33-56.7). Fruit juice was added to 18% of products. The proportion of F&V in CBF correlated significantly with sugar content for all the food types except dry-savoury food (sweet-spoonable r = 0.24, P = 0.006; savoury-spoonable r = 0.65, P < 0.001; sweet-dry r = 0.81, P < 0.001; savoury-dry r = 0.51, P = 0.06) and explained up to two-thirds of the variation in sugar content. The F&V content of CBFs mainly consists of fruits and relatively sweet vegetables which are unlikely to encourage preferences for bitter-tasting vegetables or other non-sweet foods. F&V contribute significantly to the total sugar content, particularly of savoury foods.

[Factors influencing the prevalence and duration of breastfeeding in Germany: results of the KiGGS study: first follow up (KiGGS Wave 1)]

Breastfeeding is the natural way of feeding infants in the first months of their lives and has been proven to have health benefits for both infants and mothers. Breastfeeding initiation and duration are affected by social, demographic and health factors. The aim of this study was to describe the current rates of breastfeeding initiation and duration in Germany, and to identify potential factors that underline these rates. Additionally, results are compared with the KiGGS basic (2003-2006; birth cohorts 1996-2002) study in order to reveal the development in the trends of breastfeeding initiation and duration in Germany. The KiGGS wave 1 (2009-2012) includes data on the breastfeeding behavior of mothers of 4410 children aged between 0 and 6 years (birth cohorts 2002-2012). Altogether, 82% (95% confidence interval 79.8-84.2 %) of children were ever breastfed, and the average breastfeeding duration was 7.5 months (7.2-7.8). There was a slight increase in the breastfeeding initiation in Germany over the last several years. Breastfeeding initiation among children aged 0-6 years increased by 4% points compared to 0- to 6-year-olds (birth cohorts 1996-2002) from the KiGGS basic study. The breastfeeding duration stayed unchanged. The breastfeeding behavior was mainly related to the age of the mother at birth, the mother's education level, smoking during pregnancy, and multiple or premature birth. Despite the overall increasing trend in breastfeeding initiation, there is still a growing need for breastfeeding promotion and support for young and less educated mothers, mothers who smoke during pregnancy, and also for mothers with premature babies or multiple births.

Age and time trends in the diet of young children: results of the DONALD study

PURPOSE

To describe age and time trends of energy and macronutrient intake during infancy and toddlerhood and to set a special focus on dietary practices with respect to milk, complementary food, and family food intake.

METHODS

Three-day dietary records (n = 2241) collected at 3, 6, 9, 12, 18, 24, and 36 months (480 subjects) between 2004 and 2013 from the ongoing open cohort DONALD (Dortmund Nutritional and Anthropometric Longitudinally Designed) study were evaluated using repeated-measures regression analyses for trend analysis.

RESULTS

Significant age trends were found for macronutrients with a decrease in fat intake (% of energy intake, %E) and an increase in carbohydrates (%E) and protein (%E). Exclusive and partial breastfeeding rates at 3 and 6 months did not differ between 2004 and 2008 and 2009 and 2013 (p > 0.05). Macronutrient pattern was virtually stable over time, whereas food group intake (% of total food intake excluding beverages, % TFI) changed significantly during the study period. Breast/bottle milk (% TFI) intake increased over time in the toddler subgroup, whereas family food (% TFI) decreased.

CONCLUSIONS

Our data demonstrate a period of stagnation in the last 10 years with respect to breastfeeding duration in infancy. Further breastfeeding promotion in Germany is needed to continue the favourable progress of the previous decades. In toddlerhood, breast/bottle milk remains a substantial part of the diet and has increased during the last 10 years. Parents should be encouraged to implement healthy eating habits during early toddlerhood and to facilitate their child's participation in appropriate family meals.