Moving Complementary Feeding Forward: Report on a Workshop of the Federation of International Societies for Pediatric Gastroenterology, Hepatology and Nutrition (FISPGHAN) and the World Health Organization Regional Office for Europe

Practices for introducing complementary foods in Taiwan: A nationwide survey from 2013 to 2016

BACKGROUND/PURPOSE

Introducing complementary foods to infants is a critical stage in their healthy growth and development process. In this study, we analyzed the feeding habits and choices of caregivers in Taiwan during this essential transition period.

METHODS

Data from the 2013-2016 Nutrition and Health Survey in Taiwan were analyzed. Using a multistage stratified sampling technique, we collected data through questionnaires on the feeding practices, challenges, and information sources associated with complementary feeding. We also investigated the timing of introducing various foods. Certain feeding indicators recommended by the World Health Organization were modified and used for analysis.

RESULTS

Among 439 caregivers of infants aged 2-24 months, complementary feeding typically began at 5 months, and it primarily began with cereals and pureed foods. At 6-8 months of age, 98.29% of the infants received these foods. Only 48.39% of infants aged 6-24 months consumed eggs or flesh foods. Among the primary challenges for caregivers were concerns regarding infants' adaptation to new foods (38.2%), refusal of foods by infants (37.1%), and uncertainty regarding which foods to introduce (11.4%). The main sources of information were friends and family (46.9%), the Internet (46.5%), and baby care books (35.6%). Notably, approximately 51% of the respondents used commercial baby foods.

CONCLUSION

In Taiwan, although the majority of infants begin complementary feeding on time, the introduction of eggs and flesh foods is typically delayed. Given the growing reliance on the Internet in the modern age, accurate feeding information should be disseminated online.

Frequent Use of Baby Food Pouches in Infants and Young Children and Associations with Energy Intake and BMI: An Observational Study

OBJECTIVE

Most wet commercial infant foods are now sold in squeezable 'pouches'. While multiple expert groups have expressed concern about their use, it is not known how commonly they are consumed and whether they impact energy intake or body mass index (BMI). The objectives were to describe pouch use, and determine associations with energy intake and BMI, in infants and young children.

METHODS

In this observational cross-sectional study of 933 young New Zealand children (6.0 months-3.9 years), pouch use was assessed by a questionnaire ('frequent' use was consuming food from a baby food pouch ≥5 times/week in the past month), usual energy intake using two 24-h recalls, and BMI z-score calculated using World Health Organization standards.

RESULTS

The sample broadly represented the wider population (27.1% high socioeconomic deprivation, 22.5% Māori). Frequent pouch use declined with age (infants 27%, toddlers 16%, preschoolers 8%). Few children were both frequent pouch users and regularly used the nozzle (infants 5%, toddlers 13%, preschoolers 8%). Preschoolers who were frequent pouch users consumed significantly less energy than non-users (-580 kJ [-1094, -67]), but infants (115 [-35, 265]) and toddlers (-206 [-789, 378]) did not appear to have a different energy intake than non-users. There were no statistically significant differences in the BMI z-score by pouch use.

CONCLUSIONS

These results do not support the strong concerns expressed about their use, particularly given the lack of evidence for higher energy intake or BMI.

Consumption frequency of ultra-processed foods and beverages among 6- to 36-month-olds in Kampala, Uganda

The nutrition transition in sub-Saharan Africa has led to increased consumption of ultra-processed foods in infancy, especially sweet foods. This has heightened the risk for nutrition-related non-communicable diseases, including dental caries and overweight/obesity, and promotes poor food choices later in life. The present study used a cross-sectional design to investigate the consumption frequency of ultra-processed foods and beverages among urban 6- to 36-month-olds attending four selected health facilities in Kampala using a standardised questionnaire and 24-h diet recall record. The primary outcome was the consumption of at least one ultra-processed food or beverage (UPFB) the previous day, and frequency of UPFB consumption of the week before was the secondary outcome. Four hundred and ten caregiver-child pairs were randomly recruited, 94% of caregivers being mothers with a mean age of 30.7 (±5.3) years. Fifty-nine per cent of mothers and 73% of fathers had attained a college education. The median age of children was 18 months and 51% were female. Most children (57%) consumed at least one UPFB the previous day. In the week before, 69% had consumed UPFB frequently (4-7 days) which was significantly positively associated with maternal education (odds ratio [OR] = 2.85, 95% confidence interval [CI]: 1.02-7.96, p = 0.045) and child's age ([OR = 2.87, 95% CI: 1.62-5.08, p < 0.001], [OR = 3.68, 95% CI: 1.88-7.20, p < 0.001]). In conclusion, the dietary habits of the surveyed Ugandan population were unhealthy, characterised by the frequent consumption of UPFB with added sugar. There is an urgent need to re-enforce existing Ugandan food regulation guidelines and policies and to build strong nutritional education programmes to enhance health-promoting environments in early childhood.

Factors impacting complementary feeding advice given by paediatricians in Cyprus

BACKGROUND

Complementary feeding has long-term effects on health but there is heterogeneity in recommendations across Europe. Recommendations include responsive feeding practices and nutritional needs but there is a debate in primary paediatricians as to which one should be the main criterion for complementary feeding. This pilot study investigated (i) the factors affecting the recommendations of paediatricians in Cyprus for starting complementary feeding, (ii) whether their main criterion is the developmental readiness or the nutritional needs of the infant and (iii) how this priority influences recommendations.

METHODS

The 11-item questionnaire was completed by 73 Cypriot paediatricians.

RESULTS

Approximately 66% of paediatricians recommended starting complementary feeding between 5 and 6 months, 29% between 4 and 5 and 3% between 6 and 7 months. Predefined schemes were recommended by ∼25% of paediatricians, baby-led weaning by 14% and 58% of paediatricians recommended either modality depending on the family circumstances whilst 4% involve the mother in the decision process. Approximately 64% of paediatricians recommended the introduction of parent's diet after the first year of life. Approximately 55% of paediatricians chose developmental readiness and 45% nutritional needs of the infant as their primary criterion for starting complementary feeding. Paediatricians who prioritized developmental readiness were more likely to be younger, less likely to advice on meat quantity and less likely to follow good nutritional practice.

CONCLUSIONS

The younger the paediatrician the more likely they are to prioritize developmental readiness over nutritional needs of the infant for complementary feeding. Paediatricians who prioritized developmental readiness were also less likely to provide nutritional advice.

Baby Food Pouches, Baby-Led Weaning, and Iron Status in New Zealand Infants: An Observational Study

Iron deficiency in infants can impact development, and there are concerns that the use of baby food pouches and baby-led weaning may impair iron status. First Foods New Zealand (FFNZ) was an observational study of 625 New Zealand infants aged 6.9 to 10.1 months. Feeding methods were defined based on parental reports of infant feeding at "around 6 months of age": "frequent" baby food pouch use (five+ times per week) and "full baby-led weaning" (the infant primarily self-feeds). Iron status was assessed using a venepuncture blood sample. The estimated prevalence of suboptimal iron status was 23%, but neither feeding method significantly predicted body iron concentrations nor the odds of iron sufficiency after controlling for potential confounding factors including infant formula intake. Adjusted ORs for iron sufficiency were 1.50 (95% CI: 0.67-3.39) for frequent pouch users compared to non-pouch users and 0.91 (95% CI: 0.45-1.87) for baby-led weaning compared to traditional spoon-feeding. Contrary to concerns, there was no evidence that baby food pouch use or baby-led weaning, as currently practiced in New Zealand, were associated with poorer iron status in this age group. However, notable levels of suboptimal iron status, regardless of the feeding method, emphasise the ongoing need for paying attention to infant iron nutrition.

Contribution of Infant Food Pouches and Other Commercial Infant Foods to the Diets of Infants: A Cross-sectional Study

BACKGROUND

Although considerable concern has been expressed about the nutritional implications of infant food pouches, how they impact infant diet has not been examined.

OBJECTIVES

The objective of this study was to determine the contribution of infant food pouches specifically, and commercial infant foods generally, to nutrient intake from complementary foods in infants.

METHODS

Two multiple-pass 24-h diet recall data were collected from 645 infants (6.0-11.9 mo) in the First Foods and Young Foods New Zealand studies. Detailed information was obtained on commercial infant food use, including pouches, and nutrient composition was calculated through recipe modeling.

RESULTS

The diverse sample (46.1% female; 21.1% Māori, 14.1% Asian, and 54.6% European) was aged (SD) 8.4 (0.9) mo. More than one-quarter of households had high socioeconomic deprivation. Almost half (45.3%) of infants consumed an infant food pouch on ≥1 recall day [mean (SD), 1.3 (0.9) times/d], obtaining 218 (124) kJ of energy on each eating occasion. Comparable numbers for all commercial infant and toddler foods (CITFs) were 78.0%, contributing 2.2 (1.6) and 140 (118) kJ of energy. Infant food pouches provided 25.5% of the total energy from complementary foods in those infants who consumed pouches on the recall days but just 11% in all infants. Median percentage contribution of infant food pouches to nutrient intake from complementary foods in consumers ranged from <1% (added sugars and retinol) to >30% (carbohydrate, total sugars, fiber, vitamin A, and vitamin C). CITF contributed 21.4% of energy from complementary foods for infant consumers, with median percentage contribution ranging from 0.1% (retinol) to 40.3% (iron).

CONCLUSIONS

Infant food pouches make relatively small contributions to energy intake in infants but are important sources of carbohydrates, fiber, and vitamins A, C, and B-6. Almost half of the total sugars consumed from complementary foods is provided by these pouches. This trial was registered at the Australian New Zealand Clinical Trials Registry as ACTRN12620000459921.