Healthy eating for infants--mothers' attitudes

Nutrient Intakes in Early Life and Risk of Obesity

There is increasing evidence that environmental factors in early life predict later health. The early adiposity rebound recorded in most obese subjects suggests that factors promoting body fat development have operated in the first years of life. Birth weight, growth velocity and body mass index (BMI) trajectories seem to be highly sensitive to the environmental conditions present during pregnancy and in early life (“The first 1000 days”). Particularly, nutritional exposure can have a long-term effect on health in adulthood. The high protein-low fat diet often recorded in young children may have contributed to the rapid rise of childhood obesity prevalence during the last decades. Metabolic programming by early nutrition could explain the development of later obesity and adult diseases.

Investigating Mothers' Decisions to Give Their 2- to 3-Year-Old Child a Nutritionally Balanced Diet

OBJECTIVE

To identify, using the Theory of Planned Behavior, the sociocognitive factors that influence mothers' decisions toward healthy eating and limiting discretionary choices (eg, lollipops) for their children aged 2-3 years.

DESIGN

Prospective correlational design with a 1-week follow-up.

PARTICIPANTS

A total of 197 mothers completed the main survey; 161 completed the follow-up behavior measure.

VARIABLES MEASURED

Phase 1 assessed intention, attitude, subjective norm, and perceived behavioral control; and 2 additional variables of parental role construction and group norms. Phase 2 assessed follow-up behavior.

ANALYSIS

Hierarchical multiple regressions (changes in multivariate coefficient) were used to predict mothers' intentions and actions for the two target behaviors.

RESULTS

Attitude, subjective norm, and perceived behavioral control predicted intentions; and intentions and perceived behavioral control predicted behavior for healthy eating and discretionary choices. Parental role construction was a significant predictor of intentions for both target behaviors.

CONCLUSIONS AND IMPLICATIONS

Results provide support for the application of the Theory of Planned Behavior in this context, as well as the addition of parental role construction. The findings illustrate the potential importance of developing intervention programs that account for sociocognitive factors to modify mothers' child feeding practices that have implications for lifelong health outcomes.

Breastfeeding, early nutrition, and adult body fat

OBJECTIVE

To examine the association between breastfeeding and adult body fatness, adjusting for nutritional intake in early childhood.

STUDY DESIGN

Nutritional intakes of 73 healthy infants born in 1984 who participated in the 2-decade-long Longitudinal Study of Nutrition and Growth in Children (Etude Longitudinale Alimentation Nutrition Croissance des Enfants [ELANCE]) were estimated at age 10 months and again at age 2 years. Breastfeeding was defined as any breastfeeding, including partial breastfeeding, regardless of duration. At age 20 years, weight, height, subscapular skinfold thickness (SF), and fat mass (assessed via bioelectrical impedance analysis) were measured.

RESULTS

In this sample, 64% of the children had been breastfed. In linear regression models adjusted for mother's body mass index and father's profession, breastfeeding was not associated with any of the body fat measurements at 20 years (all P > .05). After adding nutritional intake variables (total energy and % energy from nutrients) to the models, breastfeeding became significantly associated with lower SF at 20 years. In particular, breastfed subjects had significantly lower % SF at 20 years after adjustment for energy and % fat intakes at 2 years of age, (β = -28.25% SF; 95% CI, -50.28% to -6.21%; P = .013) or when adjusting for energy and % carbohydrates at 2 years of age (β = -28.27% SF; 95% CI, -50.64% to -5.90%; P = .014).

CONCLUSION

Breastfeeding was not associated with adult body fatness taking into account the usual confounding factors. However, after also adjusting for nutritional intake covariates, a protective effect of breastfeeding emerged. Early nutrition needs to be taken into account when examining the long-term health effects of breastfeeding.

Do mothers understand healthy eating principles for low-birth-weight infants?

OBJECTIVES

To describe feeding patterns and mothers' perceptions of desirable feeding practices in low-birth-weight (LBW) infants after hospital discharge in England and to test for the association of inappropriate practices/perceptions with identifiable demographics.

DESIGN

Postal questionnaires from 198 mothers of LBW infants in London, Liverpool and Winchester were analysed regarding infant demographics, mothers' demographics, infant milks used, solid feeding practices and mothers' perceptions of infant feeding practices.

RESULTS

At birth, the median weight, independent of gestational age, was 1.80 kg (range 0.6-2.50 kg) and 37.1% of infants received breast milk exclusively; 83.7% were breast-fed at some stage, a practice favoured more by first-time mothers (90.2%) than multiparous mothers (73.4%) (P = 0.004) as well as by mothers of higher social groups (P = 0.019). The median age of solid food introduction was 17 postnatal weeks (range 8-36 weeks); the timing correlated strongly with infant birth weight (P < 0.001). A high-fibre diet and a low-fat diet were incorrectly considered important for their infants by 67.1% and 51.6% of mothers, respectively. Regarding a high-fibre diet as important was associated with being a multiparous mother (P = 0.006), while regarding a low-fat diet as important was associated with low social group (P = 0.018). A quarter of mothers did not consider 'plenty of calories' to be important for their infants, reflecting similar attitudes in 1990 for mothers of term infants; this incorrect attitude exhibited an association with being a first-time mother (P = 0.047).

CONCLUSIONS

Infant feeding practices were very variable, showing poor concordance with national and international recommendations for term infants. In selecting foods for their infants, many mothers appeared to be applying principles more appropriate to planning a healthy diet for adults. There is an urgent need to develop and implement evidence-based guidelines for feeding LBW infants after hospital discharge, with special attention given to multiparous mothers as well as mothers from lower social groups.

Mothers' views on feeding infants around the time of weaning

Objective

To describe women's views about aspects of infants' diets around the time of weaning, making comparisons with national guidelines.

Design

A survey of women with a 9-month-old child.

Setting

Adelaide, South Australia.

Subjects

Five hundred and five women who joined a longitudinal study during pregnancy.

Results

Sources of information varied, with written material most commonly used (37%). Cows' milk was considered suitable as the main drink for weaned infants by 14% of women. There were divergent views about the suitability of eggs, with many women concerned about allergy. The majority of women (84%) viewed fruit juice as suitable although many qualified their response, often by stating that fruit juice should be diluted. Almost all women considered the amount of sugar mattered, primarily because of tooth decay, and that salt mattered although the reason was often uncertain. It was widely believed (77%) that additives in food could cause health problems, in particular hyperactivity and allergies, and half of the women reported avoiding specific foods because of concerns about allergies. Many women thought that giving their child food that was high in fat would encourage a liking for ‘junk’ food or lead to fatness in adulthood.

Conclusions

There is considerable diversity in the views women express about aspects of infant feeding that have been the subject of guidelines. Further health promotion efforts are needed to achieve greater consistency with recommendations and to address other concerns women have. This will entail greater engagement with parents and shared development of responses.

Consumer needs regarding dietetic products for pregnant and lactating women and for baby foods

This meeting discussed the regulation, marketing and communication needs of these products from a consumer point of view. It was agreed, that clear and consistent messages are needed from health professionals, public authorities, industry and also the media. There is also a need to better understand the context in which choices of products are made. Research into these topics is reviewed in this paper, but it is obvious that more research into consumer and health professional behaviour is needed. This will allow best practices for communication of the use of dietetic foods for the important consumer group of lactating mothers and young parents.

Drinks consumed by 18-month-old children: are current recommendations being followed?

OBJECTIVE

To examine the types of drinks consumed by children at 18 months of age, determine any associations with socio-demographic characteristics and investigate the use of a bottle for providing these drinks.

DESIGN

A total of 1026 randomly chosen children from the Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC) were studied.

METHODS

As part of a dietary diary completed when their children were 18 months of age, mothers were asked to record all drinks consumed over a 24 h period and to report the containers used to give these drinks. Socio-demographic characteristics were obtained via self-completion questionnaire.

RESULTS

Dietary records were available for 1026 children at 18 months. A wide variety of drinks were given at this age. In all, 64% of children had received at least one drink in a bottle and 10% solely used a bottle. Bottle users consumed a significantly greater volume of milk drinks compared to those who used a cup or other container. The types of drinks consumed and adherence to the guidelines on weaning were associated with several socio-demographic characteristics. In particular, children with mothers of lower educational level were more likely to receive fizzy drinks and low-calorie soft drinks, more likely to drink from a bottle, and less likely to drink from a cup.

CONCLUSION

We have shown that certain groups of mothers with 18-month-old children are not following the current guidelines on weaning. Assuming these guidelines have scientific validity, it is clear that nutritional education needs to be targeted at these mothers to help them feed their children in the optimal way, to protect from nutritional deficiencies, possible later obesity and poor dental health.

SPONSORSHIP

University of Bristol.

Fat content of the diet among pre-school children in Britain; relationship with food and nutrient intakes

OBJECTIVE

To investigate the relationship between the percentage of energy from fat and food and nutrient intakes at 18 and 43 months of age.

DESIGN

Diet was assessed using a 3 day unweighed food record. The children were divided into quartiles of fat intake as a percentage of energy (QFI), and food and nutrient intakes in the different QFIs were compared.

SUBJECTS

A total of 1026 children at 18 months and 863 children at 43 months, taking part in the Avon Longitudinal Study of Pregnancy and Childhood, participated.

RESULTS

At 18 months the mean (s.d.) fat intake was 31.2 (2.8) % of energy in the lowest QFI and 43.1 (2.2) % in the highest. Energy intake increased slightly with increasing QFI. The percentage of energy derived from total sugar, and in particular non-milk extrinsic sugar fell as QFI increased, as did the ratio of polyunsaturated to saturated fatty acids. Intakes of retinol equivalents and zinc increased significantly with increasing QFI, while intakes of iron and most water soluble vitamins fell. There was a particularly marked fall in vitamin C intake as fat intake increased, from 11.8 mg/MJ in the lowest QFI, to 6.0 mg/MJ in the highest (P<0.001). Consumption of whole milk increased substantially with percentage energy from fat, from 51 g/MJ in the lowest QFI to 116 g/MJ in the highest (P<0.001), while consumption of fruit and fruit juice fell. The results obtained at 43 months were very similar.

CONCLUSIONS

The chances of a suboptimal intake of zinc and retinol were higher at lower fat intakes. However, intakes of the fat-soluble vitamins E and D were unrelated to fat intake and intakes of iron and vitamin C fell as fat intakes increased. Some suggestions for improving diet in this age group have been given.

SPONSOR

University of Bristol.

Dietary fat intakes in infants and primary school children in Germany

We report dietary fat intake data in groups of infants and children in Germany. A group of 148 healthy infants was followed prospectively from birth through the first year of life. After birth, 78.9% of infants were breast-fed; 50% were breast-fed at 3 mo and 9. 8% were breast-fed at 12 mo. Infant formula was given to 22% of infants after birth, 53% at 3 mo, and 58% at 12 mo. Complementary foods were consumed by 16% of infants at 3 mo, 97% at 6 mo, and 98-100% at 7-12 mo. In non-breast-fed infants, mean dietary fat intakes were 44.8%, 42.9%, 37.4%, and 35.7% of energy intake at the ages of 1, 4, 6, and 12 mo, respectively. Calculated energy and nutrient intakes were within recommended ranges and weight gain was normal. Therefore, we see no compelling reason to actively modify total fat intakes at this age. In 158 primary school children aged 6-11 y, 7-d checklist protocols showed 41% of energy intake as fat with approximately 50% as saturated fat. Because German children of this age are experiencing increasing rates of obesity and high serum cholesterol concentrations, a stepwise reduction of total fat and saturated fat intakes in primary school children appears desirable to improve long-term health.

Weaning practice in the Glasgow Longitudinal Infant Growth Study

AIMS

To assess compliance with Department of Health guidelines on weaning practice in a representative sample of 127 infants from Glasgow, and to identify factors influencing timing of weaning.

METHODS

Questionnaires on feeding and weaning were completed during home visits. Ninety eight mothers completed a further questionnaire on attitudes to weaning.

RESULTS

Median age at introduction of solid food was 11 weeks (range 4-35 weeks); only 7% of infants had not been weaned before age 4 months. There was no difference in timing of weaning between boys and girls. Younger mothers (< 20 years old), those of lower socioeconomic status, and those who formula fed their infants tended to introduce solids earlier. Infants who were heaviest before weaning were weaned earlier. Seventy three of 98 mothers reported that they weaned their babies because they felt that they required more food. Sources of information influencing time of weaning were previous experience (53/98), books and leaflets (43/98), advice from the health visitor (31/98), and family and friends (15/98). Sixty five of 98 mothers reported receiving formal information on weaning, in most cases (54) this was from the health visitor. Mothers who received formal information tended to wean their infants later. Two per cent of infants had been given cow's milk as a main drink by age 6 months, 17% by 9 months, and 45% by the end of the first year.

CONCLUSION

Compliance with recommendations on timing of weaning (not before 4 months), weaning foods, and cow's milk consumption in Glasgow is poor, although no poorer than in many other areas of the UK as found by Office of Population, Censuses and Surveys. Public health messages in relation to weaning may not be reaching their target audience.

Healthy eating for infants--mothers' actions

The aim of this study was to analyse the nutrient composition, with respect to energy density, protein, fat, carbohydrate, non-starch polysaccharides and certain micronutrients, of home-prepared infant foods and to compare the nutrient composition with the draft European Commission directive for baby foods, the published nutrient content of manufactured baby foods, and with breast milk. Two hundred and sixty-five samples of home-prepared weaning foods for infants aged 3-12 months were collected and chemically analysed. Many of the food samples were low in energy, protein, fat, iron, calcium and zinc and high in non-starch polysaccharides and sodium. Home-prepared weaning foods have some shortcomings in terms of nutrient composition. Advice from health care professionals needs to focus on these areas at the same time as presenting the nutritional merits of manufactured baby foods.