Relation of infant diet to childhood health: seven year follow up of cohort of children in Dundee infant feeding study

Determinants of infants and young children feeding practices among mothers living in Saudi Arabia: a cross-sectional study

BACKGROUND

The WHO sets evidence-based guidelines for infant feeding. Adhering to the WHO guidelines ensures that infants receive the proper nutrition and thus is associated with healthy growth and development.

AIM

To describe breastfeeding and complementary feeding practices (CFPs) for infants and young children and identify determinants of appropriate feeding practices.

METHODS

This cross-sectional study was performed via structured interviews with mothers living in Saudi Arabia's Eastern Province who had children aged 6-24 months. To evaluate their adherence to the recommended WHO practices, a scoring method was applied (0-9).

RESULTS

395 mothers were interviewed. The rate of breastfeeding within the first hour, and exclusively breastfeeding for six months was both 25%. Multivariate analysis showed that exclusive breastfeeding for at least six months was less likely in middle-income mothers were less likely to exclusively breastfeed for six months than high-income mothers (OR = 0.32; 95% CI: 0.18-0.57; p < 0.001). Mothers without domestic help were also less likely to exclusively breastfeed (OR = 3.0; p < 0.001), as were those not living with their husbands (OR = 2.1; p = 0.007). Multiparous mothers and those with higher education were more likely to breastfeed than high school graduates (OR = 2.3, p = 0.02; OR = 4.4, p = 0.015, respectively). Timely breastfeeding initiation within the first hour was more common in term infants than preterm infants (OR = 5.3; p = 0.033), and infants born through normal delivery were four times more likely to initiate breastfeeding early (OR = 4.0; p < 0.001). For CFPs, 42% of participants introduced solid food at six months. 55% of mothers reported poor CFPs, primarily due to inappropriate timing of solid food introduction, choking hazards, and delayed introduction of family meals. Good CFPs were positively associated with higher maternal education, increased income, and living with a husband.

CONCLUSION

Partial compliance with WHO CFP standards need improvement. Interventions should raise awareness of factors leading to poor compliance and support early breastfeeding initiation and continuation. Low-income and less educated families appear to be most in need of support.

Impact of Gestational Diabetes Detection Thresholds on Infant Growth and Body Composition: A Prospective Cohort Study Within a Randomized Trial

OBJECTIVE

Gestational diabetes mellitus (GDM) is associated with offspring metabolic disease, including childhood obesity, but causal mediators remain to be established. We assessed the impact of lower versus higher thresholds for detection and treatment of GDM on infant risk factors for obesity, including body composition, growth, nutrition, and appetite.

RESEARCH DESIGN AND METHODS

In this prospective cohort study within the Gestational Diabetes Mellitus Trial of Diagnostic Detection Thresholds (GEMS), pregnant women were randomly allocated to detection of GDM using the lower criteria of the International Association of Diabetes and Pregnancy Study Groups or higher New Zealand criteria (ACTRN12615000290594). Randomly selected control infants of women without GDM were compared with infants exposed to A) GDM by lower but not higher criteria, with usual treatment for diabetes in pregnancy; B) GDM by lower but not higher criteria, untreated; or C) GDM by higher criteria, treated. The primary outcome was whole-body fat mass at 5-6 months.

RESULTS

There were 760 infants enrolled, and 432 were assessed for the primary outcome. Fat mass was not significantly different between control infants (2.05 kg) and exposure groups: A) GDM by lower but not higher criteria, treated (1.96 kg), adjusted mean difference (aMD) -0.09 (95% CI -0.29, 0.10); B) GDM by lower but not higher criteria, untreated (1.94 kg), aMD -0.15 (95% CI -0.35, 0.06); and C) GDM detected and treated using higher thresholds (1.87 kg), aMD -0.17 (95% CI -0.37, 0.03).

CONCLUSIONS

GDM detected using lower but not higher criteria, was not associated with increased infant fat mass at 5-6 months, regardless of maternal treatment. GDM detected and treated using higher thresholds was also not associated with increased fat mass at 5-6 months.

Optimal timing of introduction of complementary feeding: a systematic review and meta-analysis

CONTEXT

The timing of introducing complementary feeding (CF) is crucial because premature or delayed CF can be associated with adverse health outcomes in childhood and adulthood.

OBJECTIVE

This systematic review aims to evaluate the impact of the timing of CF introduction on health, nutrition, and developmental outcomes among normal-term infants.

DATA SOURCES

Electronic databases and trial registries were searched, along with the reference lists of the included studies and relevant systematic reviews.

DATA EXTRACTION

Two investigators independently extracted data from the included studies on a standardized data-extraction form.

DATA ANALYSIS

Data were meta-analyzed separately for randomized controlled trials (RCTs) and observational studies on the basis of early introduction of CF (< 3 months, < 4 months, < 6 months of age) or late introduction of CF (> 6 months, > 8 months of age). Evidence was summarized according to GRADE criteria. In total, 268 documents were included in the review, of which 7 were RCTs (from 24 articles) and 217 were observational studies (from 244 articles). Evidence from RCTs did not suggest an impact of early introduction, while low-certainty evidence from observational studies suggested that early introduction of CF (< 6 months) might increase body mass index (BMI) z score and overweight/obesity. Early introduction at < 3 months might increase BMI and odds of lower respiratory tract infection (LRTI), and early introduction at < 4 months might increase height, LRTI, and systolic and diastolic blood pressure (BP). For late introduction of CF, there was a lack of evidence from RCTs, but low-certainty evidence from observational studies suggests that late introduction of CF (> 6 months) might decrease height, BMI, and systolic and diastolic BP and might increase odds of intestinal helminth infection, while late introduction of CF (> 8 months) might increase height-for-age z score.

CONCLUSION

Insufficient evidence does suggest increased adiposity with early introduction of CF. Hence, the current recommendation of introduction of CF should stand, though more robust studies, especially from low- and middle-income settings, are needed.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration number CRD42020218517.

Timing of introduction to solid food, eczema and wheezing in later childhood: a longitudinal cohort study

BACKGROUND

The timing of introduction to solid food has been associated with eczema and wheezing in childhood. Our aim was to determine whether differences persist within the recommended 4 to 6 month age range.

METHODS

A longitudinal cohort study with repeated measures was conducted among children from birth to 10 years of age who were participating in the TARGet Kids! practice based research network in Toronto, Canada. The primary exposure was the timing of introduction to infant cereal as the first solid food. The primary outcome was eczema and the secondary outcome was wheezing collected by parent report using the validated International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Multinomial generalized estimating equations were used and effect modification by family history of asthma and breastfeeding duration were explored.

RESULTS

Of the 7843 children included, the mean (standard deviation) age of introduction to infant cereal was 5.7 (1.9) months. There was evidence for family history of asthma and breastfeeding duration to be effect modifiers in the eczema (P = 0.04) and wheezing (P = 0.05) models. Introduction to infant cereal at 4 vs. 6 months of age was associated with higher odds of eczema (OR 1.62; 95% CI: 1.12, 2.35; P = 0.01) among children without a family history of asthma who were not breastfeeding when solid foods were introduced. Introduction to infant cereal at 4 vs. 6 months of age was associated with a higher odds of wheezing (OR 1.31; 95% CI: 1.13, 1.52; P < .001) among children without a family history of asthma who were breastfeeding when solid foods were introduced. There was little evidence of an association among the remaining strata for either outcome.

CONCLUSION

The findings of this study support recommendations to introduce solid food around 6 months of age.

The influence of bystander presence on evaluations of public breastfeeding among adults in the United States

BACKGROUND

In general, people tend to support private breastfeeding more than public breastfeeding, and discomfort surrounding public breastfeeding may contribute to sub-optimal rates of breastfeeding in the United States. Few studies have systematically examined situational factors that contribute to (negative) reactions to public breastfeeding. It is unclear whether the physical location or the presence of others is more influential in shaping people's evaluations of public breastfeeding. This study aimed to experimentally investigate the influence of location, bystander presence, bystander gender, and the breastfeeding woman's use of a cover on people's evaluations of breastfeeding images.

METHOD

A sample of adults residing in the United States was randomly assigned to view an image of a breastfeeding woman in an experimental study that examined four independent variables: breastfeeding location (public vs. private), bystander presence (present vs. not present), gender of bystander (male vs. female), and use of a cover (cover vs. no cover). Participants then reported their emotional reactions to, perceptions of, and behavioral intentions toward the breastfeeding woman. In addition, participants completed measures of sexism, traditional gender role endorsement, sexual comfort, body gaze, and breastfeeding knowledge and experience.

RESULTS

Hierarchical regressions revealed no differences between private and public breastfeeding images. Perceptions of the breastfeeding woman were more favorable when she was alone than with others, and when she was covered than when she was not covered. Evaluations tended to be more favorable among participants who scored lower on hostile sexism, higher on benevolent sexism, higher on sexual comfort, and higher on breastfeeding knowledge.

CONCLUSION

The presence of bystanders may be more consequential than the physical location in shaping reactions to public breastfeeding. These findings can be applied to improve support for public breastfeeding, which may contribute to higher breastfeeding rates and the associated public health benefits.

Infant Feeding Pattern Clusters Are Associated with Childhood Health Outcomes

(1) Background: Feeding behavior habits have a pattern with a certain tendency during infancy. We aimed to identify the associations between feeding patterns in infancy and the subsequent 10-year childhood disease burden. (2) Methods: Data from 236,372 infants were obtained from the national health insurance and screening program records in South Korea. Parent-administered questionnaires during infancy provided details on the feeding type and types/frequency of complementary food for analyzing feeding patterns. The outcomes were all-cause hospitalization and the development of 15 representative childhood diseases until the age of 10 years. Anthropometric measurements obtained at 6 years of age were analyzed. To estimate outcome risks while considering multiple risk factors, we employed a Cox proportional hazard and modified Poisson regression. (3) Results: Three clusters were identified: high prevalence of breastfeeding with regular exposure to a variety of solid foods (n = 116,372, cluster 1), similar prevalence of breastfeeding and formula feeding with less exposure to solid foods (n = 108,189, cluster 2), and similar prevalence of breastfeeding and formula feeding with the least exposure to solid foods in infancy (n = 11,811, cluster 3). Compared with cluster 1, children in clusters 2 and 3 had increased risks of all-cause hospitalization (hazard ratio (HR), (95% confidence interval (CI)), 1.04 (1.03-1.06) and 1.08 (1.05-1.11), respectively). Children in clusters 2 and 3 had an increased risk of upper respiratory infection, pneumonia, and gastroenteritis, as well as neurobehavioral diseases. Overweight/obesity at the age of 6 years was associated with clusters 2 and 3. (4) Conclusions: Feeding patterns in infancy were associated with an increased risk of childhood disease burden.

Nutrition Profile for Countries of the Eastern Mediterranean Region with Different Income Levels: An Analytical Review

The World Health Organization's (WHO) Eastern Mediterranean Region (EMR) is suffering from a double burden of malnutrition in which undernutrition coexists with rising rates of overweight and obesity. Although the countries of the EMR vary greatly in terms of income level, living conditions and health challenges, the nutrition status is often discussed only by using either regional or country-specific estimates. This analytical review studies the nutrition situation of the EMR during the past 20 years by dividing the region into four groups based on their income level-the low-income group (Afghanistan, Somalia, Sudan, Syria, and Yemen), the lower-middle-income group (Djibouti, Egypt, Iran, Morocco, Pakistan, Palestine, and Tunisia), the upper-middle-income group (Iraq, Jordan, Lebanon, and Libya) and the high-income group (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and United Arab Emirates)-and by comparing and describing the estimates of the most important nutrition indicators, including stunting, wasting, overweight, obesity, anaemia, and early initiation and exclusive breastfeeding. The findings reveal that the trends of stunting and wasting were decreasing in all EMR income groups, while the percentages of overweight and obesity predominantly increased in all age groups across the income groups, with the only exception in the low-income group where a decreasing trend among children under five years existed. The income level was directly associated with the prevalence rates of overweight and obesity among other age groups except children under five, while an inverse association was observed regarding stunting and anaemia. Upper-middle-income country group showed the highest prevalence rate of overweight among children under five. Most countries of the EMR revealed below-desired rates of early initiation and exclusive breastfeeding. Changes in dietary patterns, nutrition transition, global and local crises, and nutrition policies are among the major explanatory factors for the findings. The scarcity of updated data remains a challenge in the region. Countries need support in filling the data gaps and implementing recommended policies and programmes to address the double burden of malnutrition.

Mothers' feeding practices among infants (4-12 months) and associated factors: a cross-sectional study in Saudi Arabia

A global target of increasing exclusive breast-feeding (EBF) to at least 50 % by the year 2025 was set by the WHO for infants under 6 months. The lowest prevalence in the world was found in the Eastern Mediterranean region in 2010-18 and little is known about the status of mothers' feeding practices in Saudi Arabia. The present study aimed to assess mothers' actual feeding and weaning practices used with their infants by the mothers' different age groups. The present study was conducted among 247 mothers of infants aged 4-12 months who were attending public well-baby clinics. Quantitative data were obtained by nutritionists using an electronic semi-structured questionnaire about mothers' feeding practices. Only 5·3 % of mothers engaged in EBF, 44·9 % breast-fed their infants after an hour of birth, while 92·7 % of infants had ever been breast-fed. The average intent/plan to continue breast-feeding was 4·9(±3·1) months. Younger mothers introduced weaning food around 4 weeks earlier than older mothers (mean differences were -0·4, 95 % CI -0·71, -0·13; P = 0·031). A total of 64·3 % of infants received complementary feeding before completing 17 weeks. Maternal age group and delivery mode were the only factors associated with the early introduction of complementary feeding. A total of 69·2 % of the mothers believed that 'it is a good time' and 61·1 % felt that 'infants are hungry and need other sources of food'. Online sources and family advice were the top sources of information on mothers' feeding practices. Provision of professional advice about EBF and optimal weaning practices are significant areas for improvement in terms of compliance with recommended infant feeding practices.

Total Usual Nutrient Intakes and Nutritional Status of United Arab Emirates Children (<4 Years): Findings from the Feeding Infants and Toddlers Study (FITS) 2021

Background

The transition from a predominantly milk-based diet to a diverse family diet is a window of opportunity for optimal child growth and development.

Objectives

The study aims to examine the nutritional status and food-consumption patterns of children under 4 y of age in the United Arab Emirates (UAE) and their adherence to nutrient and dietary recommendations.

Methods

A population-based cross-sectional survey of 525 children aged 0-47.9 mo was conducted in 3 major emirates: Abu Dhabi, Dubai, and Sharjah. Anthropometric measurements were obtained, and dietary assessment was conducted using the 24-h dietary recall approach. Usual intakes of energy, macronutrient, and micronutrients, including from supplements, were assessed using PC-SIDE software. Adherence to food-group recommendations was evaluated based on the American Heart Association/American Academy of Pediatrics dietary guidelines.

Results

Among 0-4-y-old children, 10% were stunted, 6% were wasted, 17% were at risk of overweight, 5% were overweight, and 3% were obese. The contribution of sweets and sugar sweetened beverages to energy intake increased from 5% in 6-11.9-mo-old children to 17% in 36-47.9-mo-old children. Compared with dietary guidelines, the lowest adherence was for fruit (13-18%) and vegetables (7-12%), while protein was within the recommendations, and 92% and 89% of children (aged 24 to 35.9 mo and 36 to 47.9 mo, respectively) had high intakes of saturated fat. Almost all toddlers failed to meet the Adequate Intake for fiber. The proportions of children exceeding the free-sugar upper limit increased from 10.6% in infants (0-5.9 mo) to 56.7% in toddlers (12- 23.9 mo). Micronutrient inadequacies were observed, particularly for calcium, zinc, folate, and vitamins A and D.

Conclusions

This study suggests a triple burden of malnutrition among infants and young children in the UAE. Results call for national nutrition intervention strategies aimed at improving dietary quality in the pediatric population.

Neonatal Birthweight, Infant Feeding, and Childhood Metabolic Markers

OBJECTIVE

Antenatal and early neonatal nutritional environment may influence later metabolic health. Infants of mothers with gestational diabetes mellitus (GDM) have higher risk for childhood obesity and metabolic syndrome (MetS). Leptin and adiponectin are known biomarkers for MetS and may guide interventions to reduce later obesity. We sought to examine the relationship between birthweight, early infancy feeding practices, and biomarkers for MetS in offspring of women with mild GDM.

STUDY DESIGN

Secondary analysis of a prospective observational follow-up study on the offspring of women who participated in a multicenter randomized treatment trial on mild GDM. Children were evaluated by research coordinators and biospecimens collected at the age of 5 to 10. Plasma concentrations of leptin and adiponectin were compared between large for gestational age (LGA) and average birthweight (AGA) infants, and according to whether solid foods were introduced early (<6 months of age) or at the recommended age (≥6 months of age). Multivariable analysis adjusted for fetal sex, race/ethnicity, and maternal body mass index.

RESULTS

Leptin and adiponectin were measured in 336 plasma samples. In bivariate analysis, compared with AGA children, LGA children had lower leptin (5.0 ng/mL [3.6-6.0] vs. 5.8 ng/mL [4.5 = 6.6], p = 0.01) and similar adiponectin (6.3 µg/mL [5.1-7.9] vs. 6.4 µg/mL [5.3-8.6], p = 0.49) concentrations. Maternal/child characteristics were similar between the early/delayed solid feeding groups. Leptin and adiponectin concentrations were similar in the early fed and delayed feeding groups (5.8 ng/mL [4.6-6.7] vs. 5.6 ng/mL [4.2-6.6], p = 0.50 and 6.4 µg/mL [5.4-8.1] vs. 6.4 µg/mL [5.1-8.8], p = 0.85, respectively). After controlling for covariates, children who were LGA and AGA at birth had similar leptin concentrations.

CONCLUSION

Birthweight and early infancy feeding practice are not associated with alterations in leptin and adiponectin in children of women with mild GDM.

KEY POINTS

· Adipocytokines are markers of metabolic status.. · Children of women with mild GDM may be at risk for MetS.. · Biomarkers similar in LGA and AGA groups.. · Biomarkers similar in early and delayed solid-fed groups.. · Nonhuman milk does not modify effect of feeding practice..

Infant infections, respiratory symptoms, and allergy in relation to timing of rice cereal introduction in a United States cohort

Rice products marketed in the USA, including baby rice cereal, contain inorganic arsenic, a putative immunotoxin. We sought to determine whether the timing of introduction of rice cereal in the first year of life influences occurrence of infections, respiratory symptoms, and allergy. Among 572 infants from the New Hampshire Birth Cohort Study, we used generalized estimating equation, adjusted for maternal smoking during pregnancy, marital status, education attainment, pre-pregnancy body mass index, maternal age at enrollment, infant birth weight, and breastfeeding history. Among 572 infants, each month earlier of introduction to rice cereal was associated with increased risks of subsequent upper respiratory tract infections (relative risk, RR = 1.04; 95% CI: 1.00-1.09); lower respiratory tract infections (RR = 1.19; 95% CI: 1.02-1.39); acute respiratory symptoms including wheeze, difficulty breathing, and cough (RR = 1.10; 95% CI: 1.00-1.22); fever requiring a prescription medicine (RR = 1.22; 95% CI: 1.02-1.45) and allergy diagnosed by a physician (RR = 1.20; 95% CI: 1.06-1.36). No clear associations were observed with gastrointestinal symptoms. Our findings suggest that introduction of rice cereal earlier may influence infants' susceptibility to respiratory infections and allergy.

Nutritional status and adequacy of feeding Practices in Infants and Toddlers 0-23.9 months living in the United Arab Emirates (UAE): findings from the feeding Infants and Toddlers Study (FITS) 2020

BACKGROUND

Infant and young child feeding practices (IYCF) impact the early and later health status of the population. Limited data is available regarding IYCF in the United Arab Emirates (UAE). This study aimed to evaluate the nutritional status and adequacy of feeding practices, energy, food, and nutrient intakes of UAE infants and toddlers ages 0-23.9 months.

METHODS

This study is a population-based cross-sectional survey of 276 infants and toddlers aged 0-23.9 months of which 180 were nationals and 96 were Arab non-nationals living in the UAE. Data were collected from the three major emirates: Abu Dhabi, Dubai, and Sharjah. Anthropometry was collected and assessed using WHO Anthro-Survey Analyzer, and a multicomponent age-specific questionnaire was used to evaluate IYCF and sociodemographic characteristics. Usual intake of energy, micronutrients, and macronutrients, including supplements, were collected using multiple-pass 24-h dietary recall and analyzed using the PC-side software. IYCF practices were assessed using the WHO indicators.

RESULTS

Overall, 4% of children were malnourished, 8% wasted, 15% stunted, 18% at risk of overweight, and 7% overweight and obese. 95% of infants were ever breastfed and 37% exclusively breastfed at 6 months. Around 98% of infants had a timely introduction of complementary food. Macronutrient intake exceeded AMDR for fat, carbohydrates, and protein for 27%, 8% and 2% of toddlers respectively. As for the percentage of those exceeding the ESPGHAN cut-off for free sugars set at 5% of energy intake, 28.6% had excessive intakes overall, 10% in 0-5.9, 21.9% in 6-11.9 and 56.7% in 12-23.9 month. Usual iron intake was below the Estimated Average Requirement (EAR) in 47% of infants 6-11.9 months. Above 12 months, the usual intake of iron and vitamin D were below EAR in 11% and 49% of toddlers respectively. Usual intake exceeded the tolerable upper intake levels (UL) for vitamin A (14 to 18%) and zinc (11 to 22%) across all ages. Approximately 93% of toddlers ages 12-23.9 months did not meet food groups' recommendations for vegetables, 87% for fruits, 48% for milk/dairy, 54% for lean meat and beans, and 33% for grains.

CONCLUSIONS

This study revealed that a high percentage of infants and toddlers aged 0-23.9 m suffer from a double burden of malnutrition, which is the coexistence of both undernutrition, and overweight and obesity in the same population. In addition to suboptimal feeding practices and inadequate/overconsumption of various nutrients. The findings highlight the need for the development of culturally specific programs aiming to improve the nutritional status of infants and toddlers in the UAE.

Can breastfeeding affect the rest of our life?

The breastfeeding period is one of the most important critical windows in our development, since milk, our first food after birth, contains several compounds, such as macronutrients, micronutrients, antibodies, growth factors and hormones that benefit human health. Indeed, nutritional, and environmental alterations during lactation, change the composition of breast milk and induce alterations in the child's development, such as obesity, leading to the metabolic dysfunctions, cardiovascular diseases and neurobehavioral disorders. This review is based on experimental animal models, most of them in rodents, and summarizes the impact of an adequate breast milk supply in view of the developmental origins of health and disease (DOHaD) concept, which has been proposed by researchers in the areas of epidemiology and basic science from around the world. Here, experimental advances in understanding the programming during breastfeeding were compiled with the purpose of generating knowledge about the genesis of chronic noncommunicable diseases and to guide the development of public policies to deal with and prevent the problems arising from this phenomenon. This review article is part of the special issue on "Cross talk between periphery and brain".

Complementary Feeding and Growth in Infants Born Preterm: A 12 Months Follow-Up Study

Evidences demonstrated that timing of weaning influences long-term growth in full term infants. However, studies on preterm infants are still lacking, and the international guidelines are focused only on healthy full-term newborn, without consensus for preterms. We aimed at evaluating, in a cohort study, the consequences of different timing of weaning on auxological outcomes up to 12 months of corrected age in a population of neonates born with gestational age < 32 weeks or birth weight < 1500 g. We divided the enrolled neonates in two cohorts according to the timing of weaning: (i) Early Weaning: introduction of complementary food before 6 months of corrected age; (ii) Late Weaning: complementary food introduced after 6 months of corrected age. Growth parameters (weight, length, body mass index, and ponderal index) were measured at 12 months of life. The two groups were statistically comparable for baseline clinical characteristics, and differences on growth parameters were not reported between the two study groups. These results were confirmed in linear and binary logistic regression multivariate models. Timing of weaning is not related to growth of preterm newborns in the first 12 months of corrected age. Studies are needed to reach consensus for the appropriate nutritional approach for preterm babies after discharge.

Sodium found in processed cow milk and estimated intake by infants

OBJECTIVE

To determine the sodium concentration in cow milk available for sale and to estimate its consumption by infants up to 6 months of age.

METHODS

Sodium level was determined by flame emission spectrophotometry in eight different lots of five brands of liquid ultra-high temperature milk and three brands of powdered milk. To estimate sodium consumption via cow milk, orientations for exceptional situations when neither breastfeeding nor infant formula is possible were considered. Inferential statistics were performed and results were compared with critical parameters at a 5% significance level.

RESULTS

The mean sodium content per portion found in liquid milk (162.5±16.2) mg/200mL was higher than that in powdered milk (116.8±3.0) mg/26g. Estimated sodium consumption by infants through powdered milk varied from 149.8 to 224.7% of adequate intake, and via liquid milk can be more than 500% of the adequate intake, reaching 812.4% of it if dilution is not applied. Seven of the eight brands of milk studied had declared, on their labels, that the sodium content was 13-30% lower than that found in chemical analysis.

CONCLUSION

Liquid and powdered whole cow milk have high sodium content, and the content per portion is higher in liquid milk than in powdered milk. The estimated consumption of sodium through these products can far exceed the adequate intake for infants from 0 to 6 months old, even when the recommended dilution and maximum daily volumes are followed.

Does breastfeeding protect children from COVID-19? An observational study from pediatric services in Majorca, Spain

BACKGROUND

It has been demonstrated that children who had been breastfed remain better protected against various infections, and notably respiratory tract infections, well beyond infancy. Since the role of breastfeeding to explain why children are less affected by COVID-19 has not been studied until now, the aim of this study was to determine whether any history of breastfeeding reduces the incidence rate of COVID-19 in children.

METHODS

This was a secondary analysis of an observational study on clinical and epidemiological characteristics of pediatric COVID-19 in Majorca. A total of 691 children were recruited during the 5 months of August-December 2020. Eligible participants were children under 14 who were tested for SARS-CoV-2 in pediatric emergency services. The independent explanatory variable was any breastfeeding. Bivariate analyses were conducted through the Chi-square test, the Fisher's Exact test or the Student's T test. All children had the same demographic, epidemiological and clinical data collected through a study team member interview and via the participants medical records.

RESULTS

Within the sample of children who visited emergency services with symptoms of potential COVID-19, we found higher prevalence of positive SARS-CoV-2 RT-PCR test results among those who were exclusively formula fed compared with those who were ever breastfed (OR 2.48; 95% CI 1.45, 3.51; P = 0.036).

CONCLUSIONS

The present study suggests that ever breastfeeding reduces the risk of COVID-19 among children, as documented for other infections.

Breastfeeding and risk of childhood asthma: a systematic review and meta-analysis

OBJECTIVE

To investigate the relationship between breastfeeding and the development of paediatric asthma.

METHODS

A systematic review and meta-analysis was conducted with MEDLINE, Embase, CINAHL and ProQuest Nursing and Allied Health source databases. Retrospective/prospective cohorts in children aged <18 years with breastfeeding exposure reported were included. The primary outcome was a diagnosis of asthma by a physician or using a guideline-based criterion. A secondary outcome was asthma severity.

RESULTS

42 studies met inclusion criteria. 37 studies reported the primary outcome of physician-/guideline-diagnosed asthma, and five studies reported effects on asthma severity. Children with longer duration/more breastfeeding compared to shorter duration/less breastfeeding have a lower risk of asthma (OR 0.84, 95% CI 0.75-0.93; I2 = 62.4%). Similarly, a lower risk of asthma was found in children who had more exclusive breastfeeding versus less exclusive breastfeeding (OR 0.81, 95% CI 0.72-0.91; I2=44%). Further stratified analysis of different age groups demonstrated a lower risk of asthma in the 0-2-years age group (OR 0.73, 95% CI 0.63-0.83) and the 3-6-years age group (OR 0.69, 95% CI 0.55-0.87); there was no statistically significant effect on the ≥7-years age group.

CONCLUSION

The findings suggest that the duration and exclusivity of breastfeeding are associated with a lower risk of asthma in children aged <7 years.

Dietary intake and nutritional status of Korean children and adolescents: a review of national survey data

In Korea, several national cross-sectional surveys monitor the diet, nutritional status, and health status of children. This continual dedicated national surveillance system contributes to the identification of nutritional and health issues, establishment of public health policies, and development of nutrition recommendations. This paper provides recent information about the Korea National Health and Nutrition Examination Survey and the Korean Youth Risk Behavior Web-based Survey and describes key nationwide survey findings published in the last 5 years on infant feeding practices and the dietary intake and nutritional status of Korean infants, children, and adolescents. There have been increasing trends in children, and teenagers who skip breakfast, eat fast food, consume sugary drinks, have vitamin D deficiency, and are obese. This review will inform pediatricians, nutritionists, and other health care practitioners who track children's growth and development. It may also help researchers and policymakers identify diet-related policies and strategies for chronic disease prevention in Korean infants, children, and adolescents.

Complementary feeding practices and their association with adiposity indicators at 12 months of age

Nutrition during the first 1000 days of life represents a window of opportunity to reduce the risk of metabolic dysfunctions later in life. Exclusive breastfeeding (EBF) and adequate introduction of solid foods are essential to promote metabolic and nutritional benefits. We evaluated the association of infant feeding practices from birth to 6 months (M) with adiposity indicators at 12 M. We performed a secondary analysis of 106 healthy term infants born from a cohort of healthy pregnant women. Type of breastfeeding (exclusive or nonexclusive), the start of complementary feeding (CF) (before (<4 M) or after (≥4 M)), and adiposity (body mass index - BMI, body mass index-for-age - BMI/A, waist circumference - WC, and waist circumference-length ratio - WLR) were evaluated at 12 M using descriptive statistics, mean differences, X2, and linear regression models. During the first 6 M, 28.3% (n = 30) of the infants received EBF. Early CF (<4 M) was present in 26.4% (n = 28) of the infants. Children who started CF < 4 M were less breastfed, received added sugars as the most frequently introduced food category, and showed higher BMI, BMI/A, WC, and WLR; those who consumed added sugars early (<4 M) had a higher WC. Starting CF < 4 M was the main factor associated with a higher WC at 12 M. Unhealthy infant feeding practices, such as lack of EBF, early CF, and early introduction of sugars, may be associated with higher adiposity at 12 M.

Parents' experiences of complementary feeding among a United Kingdom culturally diverse and deprived community

Complementary feeding practices and adherence to health recommendations are influenced by a range of different and often interrelating factors such as socio‐economic and cultural factors. However, the factors underlying these associations are often complex with less awareness of how complementary feeding approaches vary across the UK’s diverse population. This paper describes a qualitative investigation undertaken in a deprived and culturally diverse community in the UK which aimed to explore parents’ knowledge, beliefs and practices of complementary feeding. One hundred and ten mothers and fathers, self‐identified as being White British, Pakistani, Bangladeshi, Black African/Caribbean or Polish took part in twenty‐four focus group discussions, organised by age group, sex and ethnicity.

The findings revealed that most parents initiated complementary feeding before the World Health Organisation (WHO) recommendation of 6 months. Early initiation was strongly influenced by breast feeding practices alongside the extent to which parents believed that their usual milk; that is, breastmilk or formula was fulfilling their infants' nutritional needs. The composition of diet and parents' approach to complementary feeding was closely aligned to traditional cultural practices; however, some contradictions were noted. The findings also acknowledge the pertinent role of the father in influencing the dietary practices of the wider household. Learning about both the common and unique cultural feeding attitudes and practices held by parents may help us to tailor healthy complementary feeding advice in the context of increasing diversity in the United Kingdom.

Timing of Complementary Feeding Introduction and Adiposity Throughout Childhood

OBJECTIVES

To examine associations of the timing of complementary feeding (CF) introduction with adiposity throughout childhood.

METHODS

We studied 1013 children from Project Viva. Our exposure was CF introduction, categorized as <4 months (19%), 4 to <6 months (68%; reference group), and ≥6 months of age (14%). Our outcomes included adiposity measures in midchildhood (mean: 7.9 years; SD 0.8; n = 896) and early adolescence (mean: 13.2 years; SD 0.9; n = 850). We used linear regression models adjusted for potential confounders and ran separate models for infants who were breastfed at least partly for ≥4 months (categorized as breastfed; 69%) and infants who were never breastfed or stopped breastfeeding at <4 months (categorized as formula fed; 31%).

RESULTS

CF initiated at <4 months was associated with higher adiposity in midchildhood in breastfed children; associations persisted into adolescence for waist circumference, truncal fat mass, and the sum of subscapular and triceps skinfolds (eg, waist circumference: confounder-adjusted β 2.97 [95% confidence interval (CI) 0.47 to 5.47] cm). The effect estimates were larger in formula-fed children, with more associations persisting into adolescence (eg, waist circumference: adjusted β 3.42 [95% CI 0.12 to 6.71] cm). CF initiated at ≥6 months was associated with a higher subscapular/triceps skinfold ratio in midchildhood and adolescence (adjusted β 0.13 [95% CI 0.02 to 0.25]) in formula-fed children.

CONCLUSIONS

We found associations of early CF introduction with higher adiposity measurements in breastfed and formula-fed children and associations of late introduction of CF with higher adiposity in formula-fed children.

Appropriate age range for introduction of complementary feeding into an infant's diet

Following a request from the European Commission, the Panel on Nutrition, Novel Foods and Food Allergens (NDA) revised its 2009 Opinion on the appropriate age for introduction of complementary feeding of infants. This age has been evaluated considering the effects on health outcomes, nutritional aspects and infant development, and depends on the individual's characteristics and development. As long as foods have an age-appropriate texture, are nutritionally appropriate and prepared following good hygiene practices, there is no convincing evidence that at any age investigated in the included studies (< 1 to < 6 months), the introduction of complementary foods (CFs) is associated with adverse health effects or benefits (except for infants at risk of iron depletion). For nutritional reasons, the majority of infants need CFs from around 6 months of age. Infants at risk of iron depletion (exclusively breastfed infants born to mothers with low iron status, or with early umbilical cord clamping (< 1 min after birth), or born preterm, or born small-for-gestational age or with high growth velocity) may benefit from earlier introduction of CFs that are a source of iron. The earliest developmental skills relevant for consuming pureed CFs can be observed between 3 and 4 months of age. Skills for consuming finger foods can be observed in some infants at 4 months, but more commonly at 5-7 months. The fact that an infant may be ready from a neurodevelopmental perspective to progress to a more diversified diet before 6 months of age does not imply that there is a need to introduce CFs. There is no reason to postpone the introduction of potentially allergenic foods (egg, cereals, fish and peanut) to a later age than that of other CFs as far as the risk of developing atopic diseases is concerned. Regarding the risk of coeliac disease, gluten can be introduced with other CFs.

Early Eating Patterns and Overweight and Obesity in a Sample of Preschool Children in South-East Poland

The aim of this study was to assess the impact of a child's diet in the first year of life (breastfeeding duration, introduction of solid meals to the diet, the time of starting nutrition consistent with an adult diet) on the prevalence of overweight and obesity in preschool age. Three-hundred children aged 4-6 were included in the analysis. The children's height and body weight were assessed and their body mass category was determined based on the BMI (Body Mass Index) percentile. Parents provided a photocopy of the child's health book (with information concerning breastfeeding period, start of eating the same meals as the rest of the family, etc.). Obese children were breastfed for the shortest time, cow's milk was introduced to their diets the earliest, they started eating the same food as the rest of the family the earliest, and they received vegetables, fruits, cereals, and meat products in their diet the latest. The results of this study suggest that extending the breastfeeding period beyond 6 months, starting to feed the child the same meals as the rest of the family after 12 months of age, and later introduction of cow's milk to the diet would reduce the risk of the occurrence of excessive body weight in preschool children.

Infant milk-feeding practices and food allergies, allergic rhinitis, atopic dermatitis, and asthma throughout the life span: a systematic review

BACKGROUND

During the Pregnancy and Birth to 24 Months Project, the USDA and Department of Health and Human Services initiated a review of evidence on diet and health in these populations.

OBJECTIVES

The aim of these systematic reviews was to examine the relation of 1) never versus ever feeding human milk, 2) shorter versus longer durations of any human milk feeding, 3) shorter versus longer durations of exclusive human milk feeding prior to infant formula introduction, 4) feeding a lower versus higher intensity of human milk to mixed-fed infants, and 5) feeding a higher intensity of human milk by bottle versus breast with food allergies, allergic rhinitis, atopic dermatitis, and asthma.

METHODS

The Nutrition Evidence Systematic Review team conducted systematic reviews with external experts. We searched CINAHL, Cochrane, Embase, and PubMed for articles published between January 1980 and March 2016, dual-screened the results according to predetermined criteria, extracted data from and assessed the risk of bias for each included study, qualitatively synthesized the evidence, developed conclusion statements, and graded the strength of the evidence.

RESULTS

The systematic reviews numbered 1-5 above included 44, 35, 1, 0, and 0 articles, respectively. Moderate, mostly observational, evidence suggests that 1) never versus ever being fed human milk is associated with higher risk of childhood asthma, and 2) among children and adolescents who were fed human milk as infants, shorter versus longer durations of any human milk feeding are associated with higher risk of asthma. Limited evidence does not suggest associations between 1) never versus ever being fed human milk and atopic dermatitis in childhood or 2) the duration of any human milk feeding and allergic rhinitis and atopic dermatitis in childhood.

CONCLUSIONS

Moderate evidence suggests that feeding human milk for short durations or not at all is associated with higher childhood asthma risk. Evidence on food allergies, allergic rhinitis, and atopic dermatitis is limited.

Complementary feeding and food allergy, atopic dermatitis/eczema, asthma, and allergic rhinitis: a systematic review

BACKGROUND

Nutrition during infancy and toddlerhood may influence health and disease prevention across the life span. Complementary feeding (CF) starts when human milk or infant formula is complemented by other foods and beverages, beginning during infancy and continuing to age 24 mo.

OBJECTIVES

The aim of this study was to describe systematic reviews conducted for the USDA and the Department of Health and Human Services Pregnancy and Birth to 24 Months Project to answer the following question: What is the relationship between the timing of the introduction of complementary foods and beverages (CFBs), or types and amounts of CFBs consumed, and the development of food allergy, atopic dermatitis/eczema, asthma, and allergic rhinitis?

METHODS

The literature was searched using 4 databases (CINAHL, Cochrane, Embase, PubMed) to identify articles published from January 1980 to February 2017 that met predetermined inclusion criteria. For each study, data were extracted and risk of bias was assessed. The evidence was qualitatively synthesized to develop a conclusion statement, and the strength of the evidence was graded.

RESULTS

Thirty-one included articles addressed the timing of CFB introduction, and 47 articles addressed the types and amounts of CFBs consumed.

CONCLUSIONS

Moderate evidence suggests that there is no relationship between the age at which CF first begins and the risk of developing food allergy, atopic dermatitis/eczema, or childhood asthma. Limited to strong evidence, depending on the specific food, suggests that introducing allergenic foods in the first year of life (after 4 mo) does not increase the risk of food allergy and atopic dermatitis/eczema but may prevent peanut and egg allergy. There is not enough evidence to determine a relationship between diet diversity or dietary patterns and atopic disease. Research is needed to address gaps and limitations in the evidence on CF and atopic disease, including research that uses valid and reliable diagnostic measures and accounts for key confounders and potential reverse causality.

Timing of introduction of complementary foods and beverages and growth, size, and body composition: a systematic review

BACKGROUND

The systematic review described in this article was conducted as part of the USDA and Department of Health and Human Services Pregnancy and Birth to 24 Months Project.

OBJECTIVES

The aim was to describe the relationship between timing of introduction of complementary foods and beverages (CFBs) and growth, size, and body-composition outcomes across the life span.

METHODS

The literature was searched and selected using predetermined criteria. Data were extracted and risk of bias assessed for each included study. Evidence was qualitatively synthesized, conclusion statements were developed, and the strength of the evidence was graded.

RESULTS

Eighty-one articles were included in this systematic review that addressed timing of CFB introduction relative to growth, size, and body-composition outcomes from infancy through adulthood. Moderate evidence suggests that introduction of CFBs between the ages of 4 and 5 mo compared with ∼6 mo is not associated with weight status, body composition, body circumferences, weight, or length among generally healthy, full-term infants. Limited evidence suggests that introduction of CFBs before age 4 mo may be associated with higher odds of overweight/obesity. Insufficient evidence exists regarding introduction at age ≥7 mo.

CONCLUSIONS

Although several conclusions were drawn in this systematic review, additional research is needed to address gaps and limitations in the evidence on timing of introduction of CFBs and growth, size, and body composition, such as randomized controlled trials that examine multiple outcomes and/or CFB introduction between the ages of 4 and 6 mo, and research that accounts for potential confounders such as feeding practices and baseline growth status and considers issues of reverse causality.

Infant milk-feeding practices and cardiovascular disease outcomes in offspring: a systematic review

BACKGROUND

During the Pregnancy and Birth to 24 Months Project, the US Departments of Agriculture and Health and Human Services initiated a review of evidence on diet and health in these populations.

OBJECTIVES

The aim of these systematic reviews was to examine the relation of 1) never versus ever feeding human milk, 2) shorter versus longer durations of any human milk feeding, 3) shorter versus longer durations of exclusive human milk feeding, and 4) lower versus higher intensities of human milk fed to mixed-fed infants with intermediate and endpoint cardiovascular disease (CVD) outcomes in offspring.

METHODS

The Nutrition Evidence Systematic Review team conducted systematic reviews with external experts. We searched CINAHL, Cochrane, Embase, and PubMed for articles published January 1980-March 2016, dual-screened the results using predetermined criteria, extracted data from and assessed the risk of bias for each included study, qualitatively synthesized the evidence, developed conclusion statements, and graded the strength of the evidence.

RESULTS

The 4 systematic reviews included 13, 24, 6, and 0 articles, respectively. The evidence was insufficient to draw conclusions about endpoint CVD outcomes across all 4 systematic reviews. Limited evidence suggests that never versus ever being fed human milk is associated with higher blood pressure within a normal range at 6-7 y of age. Moderate evidence suggests there is no association between the duration of any human milk feeding and childhood blood pressure. Limited evidence suggests there is no association between the duration of exclusive human milk feeding and blood pressure or metabolic syndrome in childhood. Additional evidence about intermediate outcomes for the 4 systematic reviews was scant or inconclusive.

CONCLUSIONS

There is insufficient evidence to draw conclusions about the relationships between infant milk-feeding practices and endpoint CVD outcomes; however, some evidence suggests that feeding less or no human milk is not associated with childhood hypertension.

Education of family members to support weaning to solids and nutrition in infants born preterm

BACKGROUND

Weaning refers to the period of introduction of solid food to complement breast milk or formula milk. Preterm infants are known to acquire extrauterine growth restriction by the time of discharge from neonatal units. Hence, the postdischarge and weaning period are crucial for optimal growth. Optimisation of nutrition during weaning may have long-term impacts on outcomes in preterm infants. Family members of preterm infants may require nutrition education to promote ideal nutrition practices surrounding weaning in preterm infants who are at high risk of nutritional deficit.

OBJECTIVES

To investigate the role of nutrition education of family members in supporting weaning in preterm infants with respect to their growth and neurodevelopment compared with conventional management.

SEARCH METHODS

We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL 2018, Issue 5), MEDLINE via PubMed (1966 to 26 June 2018), Embase (1980 to 26 June 2018), and CINAHL (1982 to 26 June 2018). We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials (RCTs) and quasi-RCTs.

SELECTION CRITERIA

RCTs and quasi-RCTs were eligible for inclusion if they examined the effects of nutrition education of family members as compared to conventional management for weaning of preterm infants up to one year of corrected gestational age. We defined prematurity as less than 37 completed weeks of gestation.

DATA COLLECTION AND ANALYSIS

At least two review authors independently screened potential studies for inclusion and planned to identify, extract data, and assess the quality of eligible studies. We resolved any differences in opinion through discussion with a third review author and consensus among all three review authors.

MAIN RESULTS

No eligible trials looking at the impact of nutrition education of family members in weaning of preterm infants fulfilled the inclusion criteria of this systematic review. Two studies investigating the ideal timing for weaning in premature infants reported conflicting results, AUTHORS' CONCLUSIONS: We were unable to assess the impact of nutrition education of family members in weaning of preterm infants as there were no eligible studies. This may be due to the lack of evidence to determine the ideal weaning strategies for preterm infants with regards to the time of initiating weaning and type of solids to introduce. Trials are needed to assess the many aspects of infant weaning in preterm infants. Long-term neurodevelopment and metabolic outcomes should also be assessed in addition to growth parameters.

Characterization and comparison of whey N-glycoproteomes from human and bovine colostrum and mature milk

Milk glycoproteins are crucial nutrients with a variety of functions. However, whey N-glycoproteomes in human and bovine milks have not been characterized during lactation. Herein, using lectin enrichment and liquid chromatography tandem mass spectrometry, 68, 58, 100, and 98 N-glycoproteins were identified in human colostrum and mature milk as well as bovine colostrum and mature milk whey. Gene Ontology and KEGG pathway analyses were used to elucidate the biological functions of whey N-glycoproteins in human and bovine colostrum and mature milks. Whey N-glycoproteomes differed dramatically between human and bovine milks and across lactation stages. The conserved and specific whey N-glycoproteins in all four sample types were also determined. Our results improve understanding of the properties and biological functions of whey N-glycoproteins in human and bovine milk and colostra, and provide insight into the potential application of some N-glycoproteins in infant formulae at different stages of development.

Weaning Time in Preterm Infants: An Audit of Italian Primary Care Paediatricians

INTRODUCTION

According to the 2016 Italian National Institute of Statistics (Istat) data in Italy, about 6.7% of all newborns are born prematurely. Due to the lack of data on current complementary feeding in preterm infants in Italy, the aim of the survey was to evaluate individual attitudes of primary care paediatricians, concerning the introduction of complementary foods in preterm infants.

METHODS

An internet-based survey was conducted among primary care paediatricians, working in Italy, regarding (1) timing of the introduction of complementary foods to preterm newborns; (2) type of complementary foods introduced; (3) vitamin D and iron supplementations.

RESULTS

A total of 347 primary care Italian paediatricians answered the questionnaire; 44% of responders based the timing of the introduction of solid food exclusively on an infant's age, 18% on an infant's neurodevelopmental status and 4% on the body weight; the remaining 34% based the timing on two or more of these aspects. The type of complementary foods did not comply with an evidence-based sequence; 98% of participants promoted vitamin D supplementation and 89% promoted iron supplementation with great diversity in timing and doses.

CONCLUSIONS

Due to limited evidence, there is a great heterogeneity in the attitudes of primary care paediatricians concerning the introduction of complementary foods to preterm newborns. Further research is needed to provide evidence-based guidelines regarding weaning preterm newborns.

Early introduction of complementary foods and childhood overweight in breastfed and formula-fed infants in the Netherlands: the PIAMA birth cohort study

Purpose

To investigate whether early introduction of complementary foods (CF) is associated with an increased risk of overweight during childhood, and whether this association differs between formula-fed and breastfed infants.

Methods

We included 2611 participants that were born at term from a Dutch population-based birth cohort (n = 3963) designed to investigate the development of asthma and allergies. Parents kept records of their infant’s age when CF were first introduced. Weight and height were parent reported yearly from age 1 to 8 years, and at ages 11, 14 and 17 years. We used multivariate generalized estimating equations analysis to investigate the association between timing of CF introduction (before 4 months vs at or after 4 months of age) and overweight at ages 1–17 years.

Results

Children with CF introduction before 4 months had higher odds of being overweight during childhood than children with CF introduction at or after 4 months (OR 1.32, 95% CI 1.19, 1.47). This association was observed in formula-fed infants (OR 1.51, 95% CI 1.17, 1.94) and breastfed infants (OR 1.32, 95% CI 1.19, 1.47). The duration of breastfeeding modified the association between CF introduction and overweight: children breastfed for shorter than 4 months, but not children breastfed for 4 months or longer with CF introduction before 4 months had higher odds of being overweight (OR 1.37, 95% CI 1.19, 1.57 and 1.07, 95% CI 0.87, 1.32, respectively), compared to those with CF introduction at or after 4 months.

Conclusions

In children born at term, formula-fed infants and infants who were breastfed for shorter than 4 months, but not infants who were breastfed for 4 months or longer, had a higher risk of being overweight during childhood when being introduced to CF before 4 months of age.

Electronic supplementary material

The online version of this article (10.1007/s00394-018-1639-8) contains supplementary material, which is available to authorized users.

Effects of infant formula composition on long-term metabolic health

Early nutrition may have long-lasting metabolic impacts in adulthood. Even though breast milk is the gold standard, most infants are at least partly formula-fed. Despite obvious improvements, infant formulas remain perfectible to reduce the gap between breastfed and formula-fed infants. Improvements such as reducing the protein content, modulating the lipid matrix and adding prebiotics, probiotics and synbiotics, are discussed regarding metabolic health. Numerous questions remain to be answered on how impacting the infant formula composition may modulate the host metabolism and exert long-term benefits. Interactions between early nutrition (composition of human milk and infant formula) and the gut microbiota profile, as well as mechanisms connecting gut microbiota to metabolic health, are highlighted. Gut microbiota stands as a key actor in the nutritional programming but additional well-designed longitudinal human studies are needed.

Influence of infant feeding patterns over the first year of life on growth from birth to 5 years

OBJECTIVES

As early-life feeding experiences may influence later health, we aimed to examine relations between feeding patterns over the first year of life and child's growth in the first 5 years of life.

METHODS

Our analysis included 1022 children from the EDEN mother-child cohort. Three feeding patterns were previously identified, i.e. 'Later dairy products introduction and use of ready-prepared baby foods' (pattern-1), 'Long breastfeeding, later main meal food introduction and use of home-made foods' (pattern-2) and 'Use of ready-prepared adult foods' (pattern-3). Associations between the feeding patterns and growth [weight, height and body mass index {BMI}] were analysed by multivariable linear regressions. Anthropometric changes were assessed by the final value adjusted for the initial value.

RESULTS

Even though infant feeding patterns were not related to anthropometric measurements at 1, 3 and 5 years, high scores on pattern-1 were associated with higher 1-3 years weight and height changes. High scores on pattern-2 were related to lower 0-1 year weight and height changes, higher 1-5 years weight and height changes but not to BMI changes, after controlling for a wide range of potential confounding variables including parental BMI. Scores on pattern-3 were not significantly related to growth. Additional adjustment for breastfeeding duration reduced the strength of the associations between pattern-2 and growth but not those between pattern-1 and height growth.

CONCLUSION

Our findings emphasize the relevance of considering infant feeding patterns including breastfeeding duration, age of complementary foods introduction as well as type of foods used when examining effects of early infant feeding practices on later health. © 2017 World Obesity Federation.

Does the early introduction of solids promote obesity?

Childhood obesity is a major public health challenge across the developed world, and it is vital to understand the modifiable factors that contribute to it. The influence of early-life nutrition on predisposition to later obesity and metabolic disease is now well established. Much research has concentrated on the preventative effects of breastfeeding in relation to childhood obesity risk, but the optimal timing of introducing solid foods has received far less attention. This remains a much-debated and contentious issue, and differing guidelines from international bodies have caused confusion among parents. There is no conclusive evidence from current research that introducing solids before six months of age is associated with an increased risk of obesity in infancy or childhood. Current studies suggest that the most clearly established risk factor for childhood obesity is maternal body mass index. There is a need for continued research in this area.

Associations of Infant Feeding and Timing of Weight Gain and Linear Growth during Early Life with Childhood Blood Pressure: Findings from a Prospective Population Based Cohort Study

Objective

Small birth size and rapid postnatal growth have been associated with higher future blood pressure. The timing of these effects, the relative importance of weight gain and linear growth and the role of infant feeding need to be clarified.

Methods

We assessed how blood pressure relates to birth weight, infant and childhood growth and infant feeding (duration of exclusive breastfeeding and timing of introduction of complementary feeding) in 2227 children aged 5 years from a prospective cohort study (Amsterdam Born Children and their Development). Postnatal growth was represented by statistically independent measures of relative weight gain (weight gain independent of height) and linear growth in four age periods during infancy (0–1 month; 1–3 months; 3–6 months; 6–12 months) and from 12 months to 5 years.

Results

Lower birth weight was associated with higher childhood diastolic blood pressure (-0.38 mm Hg.SD^-1; P = 0.007). Faster relative weight gain and linear growth after 1 month were positively associated with systolic and diastolic blood pressure. Associations of linear growth with systolic blood pressure ranged from 0.47 to 1.49 mm Hg.SD^-1; P<0.01 for all. Coefficients were similar for different periods of infancy and also for relative weight gain and linear growth. Compared to breastfeeding <1 month, breastfeeding >1 month was associated with lower blood pressure (e.g. >6 months -1.56 mm Hg systolic blood pressure; P<0.001). Compared to >6 months, introduction of complementary feeding <6 months was associated with higher blood pressure (e.g. 4–6 months 0.91 mm Hg systolic blood pressure; P = 0.004).

Conclusions

After the age of one month faster growth in either weight or height is associated with higher childhood blood pressure. It is unknown whether faster weight gain and linear growth carry the same risk for adult hypertension and cardiovascular morbidity. Longer breastfeeding and delayed introduction of complementary feeding may be associated with lower adult blood pressure.

Is breast best? Is early solid feeding harmful?

The health benefits of breastfeeding for babies and mothers have long been recognised and it is now globally recommended that it be continued exclusively for six months. Although there are few controlled trials to support this recommendation, the most important advantage is less morbidity from gastrointestinal infection in developing countries. There is also evidence that respiratory tract infections and atopic dermatitis is reduced, and the maternal risk of breast cancer decreases, particularly with a longer duration of breastfeeding and a high parity. There is little to suggest that exclusive breastfeeding for six months adversely affects infant growth, nutritional status or infant feeding skills, but more studies are needed. Equally, there is no evidence that introduction of solids from 17 weeks is harmful in developed countries. However, in the UK breastfeeding prevalence is low and solids are introduced early for the majority of infants and much can be done to positively encourage and support all mothers to continue breastfeeding for a longer period.

Homage to the ‘H’ in developmental origins of health and disease

Abundant evidence exists linking maternal and paternal environments from pericopconception through the postnatal period to later risk to offspring diseases. This concept was first articulated by the late Sir David Barker and as such coined the Barker Hypothesis. The term was then mutated to Fetal Origins of Adult Disease and finally broadened to developmental origins of adult health and disease (DOHaD) in recognition that the perinatal environment can shape both health and disease in resulting offspring. Developmental exposure to various factors, including stress, obesity, caloric-rich diets and environmental chemicals can lead to detrimental offspring health outcomes. However, less attention has been paid to date on measures that parents can take to promote the long-term health of their offspring. In essence, have we neglected to consider the ‘H’ in DOHaD? It is the ‘H’ component that should be of primary concern to expecting mothers and fathers and those seeking to have children. While it may not be possible to eliminate exposure to all pernicious factors, prevention/remediation strategies may tip the scale to health rather than disease. By understanding disruptive DOHaD mechanisms, it may also illuminate behavioral modifications that parents can adapt before fertilization and throughout the neonatal period to promote the lifelong health of their male and female offspring. Three possibilities will be explored in the current review: parental exercise, probiotic supplementation and breastfeeding in the case of mothers. The ‘H’ paradigm should be the focus going forward as a healthy start can indeed last a lifetime.

Early additional food and fluids for healthy breastfed full-term infants

BACKGROUND

Health organisations recommend exclusive breastfeeding for six months. However, the addition of other fluids or foods before six months is common in many countries. Recently, research has suggested that introducing solid food at around four months of age while the baby continues to breastfeed is more protective against developing food allergies compared to exclusive breastfeeding for six months. Other studies have shown that the risks associated with non-exclusive breastfeeding are dependent on the type of additional food or fluid given. Given this background we felt it was important to update the previous version of this review to incorporate the latest findings from studies examining exclusive compared to non-exclusive breastfeeding.

OBJECTIVES

To assess the benefits and harms of additional food or fluid for full-term healthy breastfeeding infants and to examine the timing and type of additional food or fluid.

SEARCH METHODS

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (1 March 2016) and reference lists of all relevant retrieved papers.

SELECTION CRITERIA

Randomised or quasi-randomised controlled trials in infants under six months of age comparing exclusive breastfeeding versus breastfeeding with any additional food or fluids.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. Two review authors assessed the quality of the evidence using the GRADE approach.

MAIN RESULTS

We included 11 trials (2542 randomised infants/mothers). Nine trials (2226 analysed) provided data on outcomes of interest to this review. The variation in outcome measures and time points made it difficult to pool results from trials. Data could only be combined in a meta-analysis for one primary (breastfeeding duration) and one secondary (weight change) outcome. None of the trials reported on physiological jaundice. Infant mortality was only reported in one trial.For the majority of older trials, the description of study methods was inadequate to assess the risk of bias. Most studies that we could assess showed a high risk of other biases and over half were at high risk of selection bias.Providing breastfeeding infants with artifical milk, compared to exclusive breastfeeding, did not affect rates of breastfeeding at hospital discharge (risk ratio (RR) 1.02, 95% confidence interval (CI) 0.97 to 1.08; one trial, 100 infants; low-quality evidence). At three months, breastfeeding infants who were provided with artificial milk had higher rates of any breastfeeding compared to exclusively breastfeeding infants (RR 1.21, 95% CI 1.05 to 1.41; two trials, 137 infants; low-quality evidence). Infants who were given artifical milk in the first few days after birth before breastfeeding, had less "obvious or probable symptoms" of allergy compared to exclusively breastfeeding infants (RR 0.56, 95% CI 0.35 to 0.91; one trial, 207 infants; very low-quality evidence). No difference was found in maternal confidence when comparing non-exclusive breastfeeding infants who were provided with artificial milk with exclusive breastfeeding infants (mean difference (MD) 0.10, 95% CI -0.34 to 0.54; one study, 39 infants; low-quality evidence). Rates of breastfeeding were lower in the non-exclusive breastfeeding group compared to the exclusive breastfeeding group at four, eight, 12 (RR 0.68, 95% CI 0.53 to 0.87; one trial, 170 infants; low-quality evidence), 16 and 20 weeks.The addition of glucose water resulted in fewer episodes of hypoglycaemia (below 2.2 mmol/L) compared to the exclusive breastfeeding group, reported at 12 hours (RR 0.07, 95% CI 0.00 to 1.20; one trial, 170 infants; very low-quality evidence), but no significant difference at 24 hours (RR 1.57, 95% CI 0.27 to 9.17; one trial, 170 infants; very low-quality evidence). Weight loss was lower for infants who received additional glucose water (one trial, 170 infants) at six, 12, 24 and 48 hours of life (MD -32.50 g, 95% CI -52.09 to -12.91; low-quality evidence) compared to the exclusively breastfeeding infants but no difference between groups was observed at 72 hours of life (MD 3.00 g, 95% CI -20.83 to 26.83; very low-quality evidence). In another trial with the water and glucose water arms combined (one trial, 47 infants), we found no significant difference in weight loss between the additional fluid group and the exclusively breastfeeding group on either day three or day five (MD -1.03%, 95% CI -2.24 to 0.18; very low-quality evidence) and (MD -0.20%, 95% CI -0.86 to 0.46; very low-quality evidence).Infant mortality was reported in one trial with no deaths occurring in either group (1162 infants). The early introduction of potentially allergenic foods, compared to exclusively breastfeeding, did not reduce the risk of "food allergy" to one or more of these foods between one to three years of age (RR 0.80, 95% CI 0.51 to 1.25; 1162 children), visible eczema at 12 months stratified by visible eczema at enrolment (RR 0.86, 95% CI 0.51 to 1.44; 284 children), or food protein-induced enterocolitis syndrome reactions (RR 2.00, 95% CI 0.18 to 22.04; 1303 children) (all moderate-quality evidence). Breastfeeding infants receiving additional foods from four months showed no difference in infant weight gain (g) from 16 to 26 weeks compared to exclusive breastfeeding to six months (MD -39.48, 95% CI -128.43 to 49.48; two trials, 260 children; low-quality evidence) or weight z-scores (MD -0.01, 95% CI -0.15 to 0.13; one trial, 100 children; moderate-quality evidence).

AUTHORS' CONCLUSIONS

We found no evidence of benefit to newborn infants on the duration of breastfeeding from the brief use of additional water or glucose water. The quality of the evidence on formula supplementation was insufficient to suggest a change in practice away from exclusive breastfeeding. For infants at four to six months, we found no evidence of benefit from additional foods nor any risks related to morbidity or weight change. The majority of studies showed high risk of other bias and most outcomes were based on low-quality evidence which meant that we were unable to fully assess the benefits or harms of supplementation or to determine the impact from timing and type of supplementation. We found no evidence to disagree with the current international recommendation that healthy infants exclusively breastfeed for the first six months.

Inappropriate Feeding Behavior: One of the Important Causes of Malnutrition in 6- to 36-Month-Old Children in Myanmar

The complementary feeding period is an important time for children's growth and development. This study was conducted to 1) determine the feeding behaviors of 6- to 36-month-old children in Myanmar, 2) explore health effects of feeding behaviors, and 3) determine factors associated with feeding behaviors. A total of 807 children and their mothers (N = 642) were recruited from nine villages in Kachin, Shan, and Kokang, Myanmar. Feeding behaviors and sociodemographic characteristics were investigated using a validated questionnaire. Hemoglobin and anthropometric indicators were measured during the fieldwork. In our sample, 18.6%, 72.7%, and 9.8% of children were introduced to complementary foods (CFs) earlier than 4 months of age, between 4 and 8 months of age, and later than 8 months of age, respectively. For different types of CFs, up to the age of 24.1-36 months, there were still 6.5% and 4.1% of the children who had never been introduced to eggs and meat. Introduction of CFs earlier than 4 months of age was a risk factor for being underweight (age-adjusted odds ratio (ORadjust-age) = 1.7, 95% confidence interval (CI) = 1.2-2.5) and for stunting (ORadjust-age = 1.6, 95% CI = 1.1-2.3), whereas introduction of CFs later than 8 months of age was a risk factor for anemia (ORadjust-age = 3.5, 95% CI = 1.7-7.2). Mothers who had anemia (OR = 3.7, 95% CI = 2.0-6.9) tended toward early introduction of CFs. Women with a lower family income tended toward later introduction of CFs (OR = 2.0, 95% CI = 1.3-3.3). This study demonstrated that inappropriate feeding behavior was one of the important causes of malnutrition.

Maternal and infant factors associated with reasons for introducing solid foods

The current UK Department of Health advice is to introduce solid foods to infants at around 6 months of age, when the infant is showing signs of developmental readiness for solid foods. However, many mothers introduce solid foods before this time, and for a wide variety of reasons, some of which may not promote healthy outcomes. The aim of the current study was to examine infant and maternal characteristics associated with different reasons for introducing solid foods. Seven hundred fifty-six mothers with an infant aged 6-12 months old completed a questionnaire describing their main reason for introducing solid foods alongside demographic questions, infant weight, gender, breast/formula feeding and timing of introduction to solid foods. The majority of mothers introduced solid foods for reasons explicitly stated in the Department of Health advice as not signs of readiness for solid foods. These reasons centred on perceived infant lack of sleep, hunger or unsettled behaviour. Maternal age, education and parity, infant weight and gender and breast/formula feeding choices were all associated with reasons for introduction. A particular association was found between breastfeeding and perceiving the infant to be hungrier or needing more than milk could offer. Male infants were perceived as hungry and needing more energy than female infants. Notably, signs of readiness may be misinterpreted with some stating this reason for infants weaned prior to 16 weeks. The findings are important for those working to support and educate new parents with the introduction of solid foods in understanding the factors that might influence them.

Introduction of complementary feeding before 4months of age increases the risk of childhood overweight or obesity: a meta-analysis of prospective cohort studies

The association between the age at introduction of complementary feeding and the risk of overweight or obesity during childhood has been hotly debated, but the result remains uncertain. This meta-analysis of prospective cohort studies attempted to evaluate this association, as well as provide evidence for infant feeding recommendations. The PubMed, Embase, and Cochrane databases were systematically searched for relevant original articles published prior to March 1, 2015 that met predefined inclusion criteria. The pooled relative risks (RRs) and corresponding 95% confidence intervals (CIs) were calculated using fix-effect or random-effect models, which were chosen based on heterogeneity among studies. Ten articles consisting of 13 studies, where 8 measured being overweight as an outcome and 5 measured being obese, were included in this meta-analysis. There were a total of 63,605 participants and 11,900 incident cases in the overweight studies, and 56,136 individuals and 3246 incident cases in the obese studies. The pooled results revealed that introducing complementary foods before 4months of age compared to at 4 to 6months was associated with an increased risk of being overweight (RR, 1.18; 95% CI, 1.06-1.31) or obese (RR, 1.33; 95% CI, 1.07-1.64) during childhood. No significant relationship was observed between delaying introduction of complementary foods after 6months of age, and being overweight (RR, 1.01; 95% CI, 0.90-1.13) or obese (RR, 1.02; 95% CI, 0.91-1.14) during childhood. The results of this study suggest that the introduction of complementary foods to infants before 4months of age should be avoided to protect against childhood obesity.

Exclusive breastfeeding after home versus hospital birth in primary midwifery care in the Netherlands

Background

Breastfeeding has short-term and long-term health benefits for mother and child. We evaluated in what way birthplace was associated with the rate of exclusive breastfeeding among low risk women who gave birth in midwife-led care and who had expressed the intention to breastfeed.

Methods

We used data from the DELIVER study, which includes pregnant women from twenty midwifery practices across the Netherlands between September 2009 and April 2011. We used data from two questionnaires: one in the third trimester (after 34 weeks) and one after the birth (median 39 days postpartum). Only women who indicated an intention to breastfeed were included in the analyses. Multivariable logistic regression analysis was used to assess the association between birthplace and exclusive breastfeeding, adjusted for relevant confounders.

Results

The exclusive breastfeeding rate was 75.0 % for the 547 women who gave birth at home, and 68.5 % for the 165 women who gave birth in midwife-led care in hospital. The adjusted odds ratio for exclusive breastfeeding after a hospital birth compared to a home birth was 0.79 (95 % CI 0.53–1.18). The most frequently reported reason for not breastfeeding at the time of completing the postpartum questionnaire was ‘my baby was not drinking enough’ (47 %).

Conclusions

In the Netherlands, among low risk women who intended to breastfeed their baby, the breastfeeding success rate did not differ significantly between home and midwife-led hospital births. As breastfeeding has short-term and long-term health benefits for mother and child, women should receive adequate lactation support by healthcare workers during the critical postpartum period, regardless of the place where they give birth.

Age of introduction of first complementary feeding for infants: a systematic review

Background

Despite a World Health Organization recommendation for exclusive breastfeeding of all full-term infants to 6 months of age, it is not clear what the health implications may be. Breast milk alone may not meet the nutrition needs for all growing infants, leaving them at risk for deficiencies. The objective of this study was to investigate the relationship between moderate (4 months) versus late (6 months) introduction of complementary foods to the full-term breastfed infant on iron status and growth.

Methods

An electronic search of peer-reviewed and gray-literature was conducted for randomized control trials (RCTs) and observational studies related to the timing of introduction of complementary foods. Iron status and growth data from the relevant RCTs were analyzed using RevMan 5.2.11.

Results

Three RCTs and one observational study met the inclusion criteria. Meta-analysis showed significantly higher hemoglobin levels in infants fed solids at 4 months versus those fed solids at 6 months in developing countries [mean difference [MD]: 5.0 g/L; 95 % CI: 1.5, 8.5 g/L; P = 0.005]. Meta-anaysis also showed higher serum ferritin levels in the 4-month group in both developed and developing countries [MD: 26.0 μg/L; 95 % CI: -0.1, 52.1 μg/L, P = 0.050], [MD: 18.9 μg/L; 95 % CI: 0.7, 37.1 μg/L, P = 0.040]. Short follow-up periods and small sample sizes of the included studies were the major limitations.

Conclusions

RCT evidence suggests the rate of iron deficiency anemia in breastfed infants could be positively altered by introduction of solids at 4 months.

Electronic supplementary material

The online version of this article (doi:10.1186/s12887-015-0409-5) contains supplementary material, which is available to authorized users.

Breastfeeding and language outcomes: A review of the literature

Many researchers have investigated the potential impact of breastfeeding in infancy on a child's subsequent development, but only a small subset of these studies considers language development and impairment. This paper reviews that literature, discussing postnatal neurodevelopment, potential mechanisms for dietary influences on communication outcomes, studies of typically developing children, and studies of children with communication concerns. For population based studies of language development, a modest but statistically robust relationship is seen across large samples that account for breastfeeding exclusivity. A similar protective relationship is seen in studies that evaluate the relationship between breastfeeding and language disorders; effect sizes are typically larger in these papers. Implications for researchers and service providers are reviewed.

LEARNING OUTCOMES

Readers will be able to describe possible mechanisms by which early diet might influence neurodevelopment. They will be able to describe the relationships observed between diet in infancy and language outcomes in large population-based studies, as well as the trends observed in studies of the relationship between infant diet and communication impairment.

The Effect of a Pro-Breastfeeding and Healthy Complementary Feeding Intervention Targeting Adolescent Mothers and Grandmothers on Growth and Prevalence of Overweight of Preschool Children

Introduction

The pattern and duration of breastfeeding (BF) and the age at onset of complementary feeding, as well as its quality, have been associated with the prevalence of overweight in childhood.

Objective

To assess the effect of a pro-BF and healthy complementary feeding intervention, targeted to adolescent mothers and maternal grandmothers, on growth and prevalence of overweight and obesity in children at preschool age. This intervention had a positive impact on duration of BF and timing of onset of complementary feeding.

Methods

This randomized clinical trial involved 323 adolescent mothers, their infants, and the infants’ maternal grandmothers, when they cohabited. Mothers and grandmothers in the intervention group received counseling sessions on BF and healthy complementary feeding at the maternity ward and at home (7, 15, 30, 60, and 120 days after delivery). When children were aged 4 to 7 years, they underwent anthropometric assessment and collection of data on dietary habits. Multivariable Poisson regression with robust estimation was used for analysis.

Results

BMI-for-age and height-for-age were similar in the intervention and control groups, as was the prevalence of overweight (39% vs. 31% respectively; p=0.318). There were no significant between-group differences in dietary habits.

Conclusion

Although the intervention prolonged the duration of exclusive BF and delayed the onset of complementary feeding, it had no impact on growth or prevalence of overweight at age 4 to 7 years.

Trial Registration

ClinicalTrials.gov NCT00910377