Infant Cereals: Current Status, Challenges, and Future Opportunities for Whole Grains

A Descriptive Study of Spanish and Ecuadorian Commercial Infant Cereals: Are They in Line with Current Recommendations?

Cereals are an important source of nutrients, especially used in complementary feeding. The objective of this study is to review the nutritional composition of cereal-based foods for infants from 4 months and toddlers that are offered in Spain and Ecuador, countries selected because of the opportunity to work in them, and due to their socio-economic differences (industrialized and developing countries, respectively). The number of these products was 105 cereals in Spain and 22 in Ecuador. The products were classified as gluten-free cereals, five cereals, eight cereals, multigrain cereals, and cookies. A 25 g serving was used to determine the percentage in which the samples analyzed can cover the Reference Nutrient Intake (RNI) for micronutrients in infants from 7 months and toddlers according to the European Food Safety Authority (EFSA). Nutritional information per 100 g of dry product was collected according to medium, minimum, and maximum units, and nutrient density was calculated. The age range in which these products are recommended is different in both countries. The nutritional composition presents some differences; Spanish cereals show a lower content of sodium, added sugars, hydrolyzed cereals, and maltodextrin than Ecuadorian cereals. Commercialized cereals could contribute to satisfying the nutritional needs of infants and toddlers; however, they can also be a source of non-recommended components.

Co-ingestion of Cereals and Legumes during Infant Complementary Feeding: Starch and Protein in vitro Digestion

This study explores the impact of co-ingesting cereals and legumes on starch and protein during simulated infant in vitro digestion. Various legumes (chickpeas, lentils, peas) were added to cereals (durum wheat, brown rice, white maize), and their effects on starch and protein hydrolysis were analyzed. Substituting 50% of cereal with legumes increased proteins, minerals, and dietary fiber. Infant food with legumes exhibited smoother pasting properties. Legumes in cereal purées led to varying starch hydrolysis trends, with the lowest values in durum wheat with chickpea and all cereal blends with peas. Resistant starch levels exceeding 50% were found in infant food samples. Digested protein hydrolysis increased with legumes in durum wheat, except for peas. Brown rice mixtures decreased significantly compared to the control with chickpeas (61%) and peas (42%), while lentil blends increased by 46%. Legumes generally did not significantly affect starch bioavailability, even with α-amylase inhibitors. Lentil-cereal purées could enhance infant food nutritional value.

Essential and Toxic Elements in Infant Cereal in Brazil: Exposure Risk Assessment

Infant cereals, one of the first solid foods introduced to infants, have been reported to pose risks to human health because they contain toxic elements and an excess of essential elements. The objective of this study was to assess the cancer and non-cancer risk of exposure to essential and toxic elements in infant cereal in Brazil. In our analyses, we included data from 18 samples of infant cereals made from different raw materials and estimated the incremental lifetime cancer risks and non-cancer hazard quotients (HQs) for their consumption. Rice cereal is particularly concerning because it is immensely popular and usually contains high levels of inorganic arsenic. In addition to arsenic, we assessed aluminum, boron, barium, cadmium, chromium, copper, lead, manganese, nickel, selenium, silver, strontium, and zinc. The cancer risk was highest for rice cereal, which was also found to have an HQ > 1 for most of the tested elements. Inorganic As was the element associated with the highest cancer risk in infant cereal. All of the infant cereals included in this research contained at least one element with an HQ > 1. The essential and non-essential elements that presented HQ > 1 more frequently were zinc and cadmium, respectively. The cancer and non-cancer risks could potentially be decreased by reducing the amount of toxic and essential elements (when in excess), and public policies could have a positive influence on risk management in this complex scenario.

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

BACKGROUND

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

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSION

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

Evaluation of maternal performance about food security in dietary diversity for children aged 12-24 months and its relationship with anthropometric measurements

BACKGROUND

Despite growing awareness of the problem of food security, some areas of Iran continue to experience food insecurity. The aim of the present study was to evaluate maternal performance about food security in dietary diversity for children aged between 12-24 months and its relationship with anthropometric measurements in Bushehr.

METHODS

A cross-sectional study was carried out using 400 mothers of children aged from 12 to 24 months in Bushehr selected via quota sampling. Data were collected using a reliable localized version of a 32-item food frequency questionnaire, consisting of six subscales, with a Cronbach's α: 0.81. The anthropometric measurements of height and weight were also calculated. Data analysis was performed using median, Mean±SD and multinomial logistic regression test, and odds ratio in SPSS, version 18.

RESULTS

According to standard servings, only 24% of the mothers fed their infants cereals, whereas 54.8%, 36.3%, 39.8%, and 20.3% of the mothers used meat, fruits, vegetables, and dairy products, respectively. The strongest associations were between attendance at educational classes and vegetable consumption (OR=2.09, CI=1.03-4.21), age at the onset of complementary feeding and the consumption of meat (OR=1.30, CI=1.02-1.66) and fruits (OR=1.44, CI=1.03-2.03), and the mothers' level of education and use of dairy products (OR=0.29, CI=0.09-0.90). No evidence of a significant association was found between consumption of any food groups and the anthropometric measurements.

CONCLUSIONS

Mothers in Bushehr performed poorly in providing their infants with the required nutrition with regard to dietary diversity and amount of food. However, their performance can be improved by enhancing their basic nutrition knowledge, holding practical classes on food preparation for them, and focusing on mothers with infants in high-risk groups, e.g. infants suffering from excessive weight gain, obesity, and malnutrition.

Nutritional Facts and Health/Nutrition Claims of Commercial Plant-Based Infant Foods: Where Do We Stand?

One of the current drivers of the infant food market is the rising demand for vegan products, and thus accurate knowledge of their nutritional composition is required to guide parents and health professionals. Thus, this study aimed to assess the nutritional composition of commercial plant-based infant foods, in addition to analyzing their health/nutrition claims. A selection of infant products launched in the global market (2017–2021) were classified into eight types and each type was divided into vegan and vegetarian products. Based on the ingredients list, cereals, seeds, pseudocereals and/or pulses were the most used ingredients in the retrieved products. The nutritional composition of six out eight types varied significantly among vegan and vegetarian products. When protein, calcium and iron contents differed significantly, vegan products had the highest protein content in all categories, compared to those that were vegetarian. When significant differences were found in sugar content, vegan products have lower amounts in all categories, compared to vegetarian products. Health and nutrition claims were found mostly used in vegetarian products. Strategies to reduce added sodium and sugar, and saturated fatty acids is required to ensure a healthy diet for infants. This study also implies the importance of a complete labelling of infants’ foods, especially vegan products to help parents making a reasonable choice.

Commercial Complementary Food in Germany: A 2020 Market Survey

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

Nutritional Composition of Infant Cereal Prototypes Can Precisely Predict Their Glycemic Index

Designing cereal-based products with appropriate metabolic responses is of high interest to the food industry in view of the potential health impact of the product. The objective of this study was to test whether a model that used the nutrient composition of breakfast cereals to predict their glycemic index (GI) and glycemic load (GL) could also accurately predict the GI and GL for complete (containing protein, reconstituted in water) infant cereal prototypes. Four independent studies measured the postprandial glucose response of 20 complete infant cereal prototypes (51−76 g/100 g glycemic carbohydrates) in healthy adults. The predictions were strongly correlated with the measured values for both the GI (r = 0.93, p-value < 0.01) and GL (r = 0.98, p-value < 0.01). The in vivo incremental area under the curve (iAUC) for glucose showed a strong linear relationship with the predicted GL (r = 0.99, p < 0.01). In summary, the model previously developed to predict the GI and GL of breakfast cereals was both accurate and precise for infant cereals and could be considered a simple tool to support nutritionally responsible product development.

Mycotoxins of Concern in Children and Infant Cereal Food at European Level: Incidence and Bioaccessibility

Cereals are of utmost importance for the nutrition of infants and children, as they provide important nutrients for their growth and development and, in addition, they are easily digestible, being the best choice for the transition from breast milk/infant formula to solid foods. It is well known that children are more susceptible than adults to toxic food contaminants, such as mycotoxins, common contaminants in cereals. Many mycotoxins are already regulated and controlled according to strict quality control standards in Europe and around the world. There are, however, some mycotoxins about which the level of knowledge is lower: the so-called emerging mycotoxins, which are not yet regulated. The current review summarizes the recent information (since 2014) published in the scientific literature on the amounts of mycotoxins in infants’ and children’s cereal-based food in Europe, as well as their behaviour during digestion (bioaccessibility). Additionally, analytical methods used for mycotoxin determination and in vitro methods used to evaluate bioaccessibility are also reported. Some studies demonstrated the co-occurrence of regulated and emerging mycotoxins in cereal products used in children’s food, which highlights the need to adopt guidelines on the simultaneous presence of more than one mycotoxin. Although very little research has been done on the bioaccessibility of mycotoxins in these food products, very interesting results correlating the fiber and lipid contents of such products with a higher or lower bioaccessibility of mycotoxins were reported. LC-MS/MS is the method of choice for the detection and quantification of mycotoxins due to its high sensibility and accuracy. In vitro static digestion models are the preferred ones for bioaccessibility evaluation due to their simplicity and accuracy.

Consumer Motives for Choosing Fruit and Cereal Bars—Differences Due to Consumer Lifestyles, Attitudes toward the Product, and Expectations

Fruit and cereal bars are the response to the changing needs of consumers seeking health-promoting and convenient products. A cross-sectional study was conducted using the CAWI (Computer-Assisted Web Interview) method, with 1034 respondents consuming products of this kind. The aims of the study were (1) to identify consumer segments based on the importance they attached to the selected attributes of fruit and cereal bars and (2) to characterize the identified segments in terms of frequency and reasons for the consumption of fruit and cereal bars, views on their impact on health, and consumer behavior related to the selected lifestyle elements. Five distinct consumer clusters were identified. Involved and Health-oriented were more likely to consume bars, perceiving them as nutritious products, with a positive impact on health. Frugal and Visual consumed fruit and cereal bars the least frequently. They paid little attention to choosing healthier products in daily diet and physical activity. The Information seekers consumed bars to reduce stress and to improve their mood.

E-1500: Survey on feeding practices in the first 1,500 days of life, recommended by healthcare professionals in Latin America

INTRODUCTION

Health-disease processes are established and programmed in the first 1500 days of life, a period in which nutrition and the microbiota play a fundamental role. Feeding practices vary, according to regional sociocultural characteristics. The Early Nutrition Group of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition (LASPGHAN) established the goal of identifying the main feeding practices in the first 1500 days that were recommended by health professionals in Latin America.

MATERIALS AND METHODS

A survey was conducted on the aspects of maternal-infant and young child nutrition during the first 1500 days of life. An open invitation was extended to Latin American healthcare professionals to anonymously answer the online survey.

RESULTS

A total of 1284 surveys from participants in 18 Latin American countries were analyzed. The mean age of the participants was 37.14 ± 11.1 years, 75.7% were women, 64.7% were physicians, and the rest were nutritionists/nutriologists. A total of 71.4% were familiar with the concept of the first 1000 days of life, 95% answered that exclusive breastfeeding should be carried out up to 6 months of age, and 34.3% responded that complementary feeding should be begun between 4 and 6 months of age. There was scant knowledge regarding nutrition in the pregnant woman. Adherence to traditional complementary feeding practices was evident.

CONCLUSIONS

In a group of Latin American healthcare professionals, knowledge about nutrition in the first 1000-1500 days of life of an individual is still incomplete and insufficient, showing the need for continued training of healthcare professionals, with respect to those themes.

Wholegrain intake, growth and metabolic markers in Danish infants and toddlers: a longitudinal study

PURPOSE

Wholegrain intake is linked to lower risk of lifestyle diseases, but little is known about its role in growth and metabolic health during the first years of life. We characterized wholegrain and dietary fibre intake in 439 Danish children at 9 and 36 months of age and explored associations with height z-scores (HAZ), body mass index z-scores (BMIZ) and metabolic markers.

METHODS

We used pooled data from two infant cohorts and estimated intakes of total wholegrain, dietary fibre and wholegrain subtypes from 7-day dietary records. Associations with HAZ, BMIZ and non-fasting plasma low-density (LDLC) and high-density-lipoprotein cholesterol, triacylglycerol, insulin and glucose were analysed in mixed models, adjusted for potential confounders.

RESULTS

Median (25th, 75th percentile) wholegrain intake was 7.5 (4.9, 10.5) and 6.5 (4.6, 9.0) g/MJ at 9 and 36 months. Neither wholegrain nor dietary fibre intake were associated with HAZ (P ≥ 0.09). At 36 months, wholegrain intake was inversely associated with LDLC (P = 0.05) and directly with glucose (P < 0.001). In secondary analyses, wholegrain rye was inversely associated with glucose at 9 months and insulin at 36 months (both P ≤ 0.03). Oat and wheat wholegrain were directly associated with glucose (both P ≤ 0.01) and wheat with BMIZ (P = 0.02) at 36 months.

CONCLUSION

Danish infants and toddlers have high intakes of wholegrain and dietary fibre, with no indication of compromised growth. In line with studies in adults, wholegrain intake was inversely associated with LDLC. The observed direct association between wholegrain intake and plasma glucose and associations with wholegrain subtypes should be investigated further.

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

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

Sugar Content and Sources in Commercial Infant Cereals in Spain

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

Iron Bioavailability from Infant Cereals Containing Whole Grains and Pulses: A Stable Isotope Study in Malawian Children

BACKGROUND

Compared with infant cereals based on refined grains, an infant cereal containing whole grains (WGs) and pulses with adequate amounts of ascorbic acid to protect against absorption inhibitors could be a healthier source of well-absorbed iron. However, iron absorption from such cereals is uncertain.

OBJECTIVE

We measured iron bioavailability from ferrous fumarate (Fefum) added to commercial infant cereals containing 1) refined wheat flour (reference meal), 2) WG wheat and lentil flour (WG-wheat-lentil), 3) WG wheat and chickpea flour (WG-wheat-chickpeas), and 4) WG oat flour (WG-oat) and from ferrous bisglycinate (FeBG) added to the same oat-based cereal (WG-oat-FeBG).

METHODS

In a prospective, single-blinded randomized crossover study, 6- to 14-mo-old Malawian children (n = 30) consumed 25-g servings of all 5 test meals containing 2.25 mg stable isotope-labeled iron and 13.5 mg ascorbic acid. Fractional iron absorption (FIA) was assessed by erythrocyte incorporation of isotopes after 14 d. Comparisons were made using linear mixed models.

RESULTS

Seventy percent of the children were anemic and 67% were iron deficient. Geometric mean FIA percentages (-SD, +SD) from the cereals were as follows: 1) refined wheat, 12.1 (4.8, 30.6); 2) WG-wheat-lentil, 15.8 (6.6, 37.6); 3) WG-wheat-chickpeas, 12.8 (5.5, 29.8); and 4) WG-oat, 9.2 (3.9, 21.5) and 7.4 (2.9, 18.9) from WG-oat-FeBG. Meal predicted FIA (P ≤ 0.001), whereas in pairwise comparisons, only WG-oat-FeBG was significantly different compared with the refined wheat meal (P = 0.02). In addition, FIAs from WG-wheat-lentil and WG-wheat-chickpeas were significantly higher than from WG-oat (P = 0.002 and P = 0.04, respectively) and WG-oat-FeBG (P < 0.001 and P = 0.004, respectively).

CONCLUSION

In Malawian children, when given with ascorbic acid at a molar ratio of 2:1, iron bioavailability from Fefum-fortified infant cereals containing WG wheat and pulses is ≈13-15%, whereas that from FeBG- and Fefum-fortified infant cereals based on WG oats is ≈7-9%.

Degree of processing and nutritional value of children's food products

OBJECTIVE

This study aimed to characterise the availability, the nutritional composition and the processing degree of industrial foods for 0-36-month-old children according to the neighbourhoods affluence.

DESIGN

A cross-sectional exploratory study.

SETTING

All food products available in retail stores for children aged 0-36 months were analysed. Data collection took place in two neighbourhoods, comparing two different sociodemographic districts (high v. low per capita income), Campanhã and Foz do Douro in Porto, Portugal.

PARTICIPANTS

A total of 431 commercially processed food products for children aged 0-36 months which are sold in 23 retail stores were identified. Food products were classified according to their processing degree using the NOVA Food Classification System.

RESULTS

For NOVA analysis, of the 244 food products that were included 82 (33·6 %) were minimally processed, 25 (10·2 %) processed and 137 (56·1 %) ultra processed. No food product was classified as a culinary ingredient. The products included mostly cereals, yogurts, prevailed in high-income neighbourhoods for the 0-6-month-old group. It was observed that some categories of ultra-processed food (UPF) presented higher amounts of energy, sugars, saturated fat and salt than unprocessed/minimally processed products.

CONCLUSIONS

The high availability of UPF offered for 0-36-month-old children should be considered when designing interventions to promote a healthy diet in infancy.

Perspective: A Legal and Nutritional Perspective on the Introduction of Quinoa-Based Infant and Follow-on Formula in the EU

Infants are vulnerable consumers and highly depend on dietary proteins for growth and development during their first months of life. Infant formula (IF) and follow-on formula (FOF) have been developed to meet these requirements, although few protein sources are currently allowed to be used. At the same time, allergies to these available protein sources are becoming more frequent. There is thus a need to explore alternative protein sources for infant nutrition. One alternative could be quinoa, which is a pseudocereal that is naturally free from gluten and has a high protein content and quality. This review assessed the composition, nutritional properties, and applicability of quinoa proteins for IF and FOF as well as the legal framework for their use in the European Union (EU). The protein quality of isolated quinoa proteins (IQPs) is relatively high compared with other plant-based proteins like rice. Besides, during the protein isolation process, unfavorable compounds are mostly removed, ensuring that the final product can comply with the maximum residue concentrations allowed. Overall, IF and FOF are strictly regulated under the Foods for Specific Groups (FSG) Regulation (EU) No 609/2013 and more research is needed before the introduction of IQP in such products is considered, but this review shows it has several promising features that warrant further investigation.

Probiotic infant cereal improves children's gut microbiota: Insights using the Simulator of Human Intestinal Microbial Ecosystem (SHIME®)

Infant́s gut microbiota can be modulated by many factors, including mode of delivery, feeding regime, maternal diet/weight and probiotic and prebiotic consumption. The gut microbiota in dysbiosis has been associated with innumerous diseases. In this sense, early childhood intestinal microbiome modulation can be a strategy for disease prevention. This study had the purpose to evaluate the effect of an infant cereal with probiotic (Bifidobacterium animalis ssp. lactis BB-12®) on infant́s intestinal microbiota using SHIME®, which simulates human gastrointestinal conditions. The ascending colon was inoculated with fecal microbiota from three children (2-3 years old). NH₄⁺, short chain fatty acids (SCFASs) and microbiota composition were determined by selective ion electrode, GC/MS and 16S sequencing, respectively. After treatment, butyric acid production increased (p < 0.05) 52% and a decrease in NH₄⁺ production was observed (p < 0.01). The treatment stimulated an increase (p < 0.01) of Lactobacillaceae families, more precisely L. gasseri and L. kefiri. L. gasseri has been associated with the prevention of allergic rhinitis in children and L. kefiri in the prevention of obesity. Thus, infant cereal with BB-12® is able to stimulate the growth of L. gasseri and L. kefiri in a beneficial way, reducing NH₄⁺ and increasing the production of SCFAs, especially butyric acid, in SHIME®.

Effects of Whole-Grain and Sugar Content in Infant Cereals on Gut Microbiota at Weaning: A Randomized Trial

The introduction of complementary foods during infancy marks an important step in the development of the infant gut microbiome. Infant cereals are popular weaning foods but consistent evidence on their effect on the intestinal microbiota, especially when differing in nutritional quality, is lacking. Fecal samples from 4–7-month-old Spanish infants who consumed infant cereals differing in whole grain and sugar content as first weaning foods were analyzed on changes in microbial composition by massively parallel sequencing of the 16S ribosomal RNA gene at baseline and after 7 weeks of intervention. Samples were obtained from a previous trial conducted in Spain demonstrating whole-grain cereal acceptability. In total, samples of 18 infants consuming 0% whole grain cereals with 24 g sugar (0-WG) and 25 infants consuming 50% whole grain cereals with 12 g sugar (50-WG) were analyzed. Microbial composition changed significantly over time (p = 0.001), per intervention group (p = 0.029) and per infant (p = 0.001). Abundance of genus Veillonella increased in both groups while Enterococcus decreased. Within the 0-WG group, phylum Actinobacteria decreased along with genus Bifidobacterium. In the 50-WG, we observed an increase in Lachnoclostridium and Bacteroides. In addition, 50-WG decreased Proteobacteria and Escherichia to levels lower than 0-WG. Although weaning itself appeared to be responsible for most changes, the increased presence of anaerobic fermenters together with inhibition of pathogenic Escherichia may indicate a supporting effect of infant cereals with 50% whole grains and a reduced sugar content over infant cereals manufactured with refined hydrolyzed flours on the infant microbiota. In fact, using a novel methodology for the identification of microbial signatures, we found two groups of microbial taxa predictive of infants consuming enriched whole-grain infant cereals with a high predictive value of about 93%.

Mycotoxin Occurrence, Exposure and Health Implications in Infants and Young Children in Sub-Saharan Africa: A Review

Infants and young children (IYC) remain the most vulnerable population group to environmental hazards worldwide, especially in economically developing regions such as sub-Saharan Africa (SSA). As a result, several governmental and non-governmental institutions including health, environmental and food safety networks and researchers have been proactive toward protecting this group. Mycotoxins, toxic secondary fungal metabolites, contribute largely to the health risks of this young population. In SSA, the scenario is worsened by socioeconomic status, poor agricultural and storage practices, and low level of awareness, as well as the non-establishment and lack of enforcement of regulatory limits in the region. Studies have revealed mycotoxin occurrence in breast milk and other weaning foods. Of concern is the early exposure of infants to mycotoxins through transplacental transfer and breast milk as a consequence of maternal exposure, which may result in adverse health effects. The current paper presents an overview of mycotoxin occurrence in foods intended for IYC in SSA. It discusses the imperative evidence of mycotoxin exposure of this population group in SSA, taking into account consumption data and the occurrence of mycotoxins in food, as well as biomonitoring approaches. Additionally, it discusses the health implications associated with IYC exposure to mycotoxins in SSA.

Nutrient Composition of Foods Marketed to Children or Adolescents Sold in the Spanish Market: Are They Any Better?

Healthy eating is essential for the growth and development of children and adolescents. Eating habits established in childhood continue into adulthood. In Spain, the frequent promotion of foods with low nutritional value is already considered a threat to the health of the population, particularly to children and adolescents. In this work, we analyse 3209 foods from the Food Database, BADALI. Foods were classified as marketed to children or adolescents according to the advertising on the packaging, television or internet. We found that 17.5% of foods in the database were marketed to this population and 97% of those were considered unhealthy following the Pan American Health Organization Nutrient Profile Model (PAHO-NPM). In the total of foods for children or adolescents, 61.5% were high in fat, 58.5% in free-sugar, 45.4% in saturated fat and 45% in sodium. Foods marketed to them presented higher amounts of carbohydrates and sugar, while lower protein and fibre content than the rest. There was also considerable variability in levels of the other nutrients found in these products, which depended largely on the food group. According to our findings, there is a tendency for products marketed to children or adolescents to be unhealthy and of a poorer nutritional quality than those not targeted at them.

Enteral Nutrition in Pediatric Short-Bowel Syndrome

Pediatric intestinal failure (IF) is the critical reduction of intestinal mass or function below the amount necessary for normal growth in children. Short-bowel syndrome (SBS) is the most common cause of IF in infants and children and is caused by intestinal resection. Enteral autonomy and freedom from parenteral nutrition is the mainstay of nutrition management in SBS. The goal is to achieve intestinal adaptation while maintaining proper growth and development. Treatment is variable, and there remains a paucity of evidence to draw well-informed conclusions for the care of individuals in this complex population. Physiological principles of enteral nutrition and practical recommendations for advancing the diet of patients with pediatric SBS are presented. Emerging trends in nutrition management, such as the growing interest in blending diets and the impact on SBS, are reviewed. Finally, the influence of the microbiome on enteral tolerance and small bowel bacterial overgrowth are considered.

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

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