A study of commercially available complementary foods for infants and young children under 36 months

Background

Commercially available complementary foods (CACFs) have been assuming an important proportion of infants and toddlers' diets in high-income countries, despite the concerns regarding their nutritional content and potential problematic marketing strategies used to promote these products. In 2016, the WHO guidance on ending the inappropriate promotion of foods for infants and young children (IYC) was approved (1) to support countries to take action on this issue. To implement this Guidance, a draft Nutrient Profile Model (NPM) (2) was developed to drive decisions regarding the identification of foods which are inappropriate for promotion.

Aim

To support the implementation of the NPM at National Level, studying the availability, composition, and marketing of CACFs for IYC in Portugal.

Methods

Three phases were considered: 1) collect data on CACFs products targeted at IYC (0-36 months); 2) compare composition of these products with WHO guidance; 3) compare methods used to promote these products with WHO Guidance.

Results

A total of 209 products were sampled. The most common products were soft-wet spoonable, ready-to-eat foods (n = 129), dry, powdered and instant cereal/starchy foods (n = 61) and dry finger foods and snacks (n = 16). Twenty-five products (11%) were marketed as being suitable for infants under the age of 6 months. For infants between 6-8 months 78% of the products were marketed as being suitable. For the age group 12 months and over, 11% of the products were marketed as being suitable.

Conclusions

This study provides valuable insights into the CACFs at the national level and reinforces that action is needed to improve the implementation and operationalization of WHO guidance on ending the inappropriate promotion of foods for IYC.

Key messages

NPM can support countries identifying products that can/cannot be promoted for IYC. It is a key opportunity to build policy measures, ensuring children healthy growth and development.

Trends in breastfeeding rates in Portugal: results from five National Health Interview Surveys

Background

The World Health Organization advice breast milk as the perfect food for the newborn starting immediately after birth and exclusively up to at least 6 months of age. However, there are considerable differences in breastfeeding rates between countries related to their policies on breastfeeding promotion and duration of maternity leave. This study aims to describe changes in breastfeeding rates over time in Portugal as a way to inform social policies and public health initiatives on breastfeeding.

Methods

To examine the breastfeeding rates evolution we used data from five National Health Surveys. Breastfeeding was assessed based on information provided by the mothers of children born between 1982 and 2014. Birth cohorts were grouped in block of 3-year period. We estimated 3 and 6-months exclusive breastfeeding rates and 95% confidence intervals. Trends in breastfeeding rates for each outcome were assessed by linear regression weighting each cohort-specific estimate by the inverse of variance in the logit scale.

Results

We analyzed data on 9172 children; sample size by birth cohort ranged from 213 in 2012/14 to 1651 in 1994/96. Proportion of infants ever breastfed during the study period varied between 71.7% and 86.7%. The 3 months exclusive breastfeeding rate increased by 9.5% (CI95%:7.8-11.3%) per 3-year period, from 41.3% (CI95%:38.7-43.9%) in 1982/84 to 62.4% (CI95%:55.7-68.7%) in 2012/14. The 6 months exclusive breastfeeding rate raised up from 23.5% (CI 95%:21.2-25.7%) in 1982/84 to 31.9% (CI95%:26.0-38.5%) in 2012/14, corresponding to 5.6% increase per 3-year period.

Conclusions

This study shows a positive evolution in breastfeeding practices, with an increased in the prevalence of women who reported exclusively breastfeeding until the 3rd and 6th month after birth. Our results may be explained by changes in maternity leave duration. Furthermore, the results emphasize the need for further investment in breastfeeding support services and professionalś training.

Key messages

Positive evolution in breastfeeding practices in Portugal. Maternity leave duration could have a positive role.

Health Literacy in Diabetes management: A priority in health care

Background

Glycemic control and self-management of diabetes are influenced by a range of factors, including health literacy - the ability to access, understand, appraise, and use health information. This study explored associations between domains of health literacy (HL), glycemic control and perceived general health in people with diabetes.

Methodology

Cross-sectional study, with 453 people with diabetes,attending the Portuguese Diabetes Association (APDP). We collected information on HL, demographics, glycemic control and self-perception of health. HL was assessed using the Health Literacy Questionnaire. Descriptive and correlational analysis were performed.

Results

85.4% consider Feeling understood and supported by healthcare providers but only 54.1% have the Ability to actively engage with healthcare providers and 27.8% feel the Ability to find good health information,66.5% consider Having sufficient information to manage my health but only 38.7% are Understanding health information well enough to know what to do and 28.5% refer the Ability to find good health information. Higher HL scores were associated with better glycemic control and more positive perception of general health(GH) across the following domains: Having sufficient information to manage my health, Appraisal of health information, Ability to find good health information, Actively managing my health and social support for health. The domains Ability to actively engage with healthcare providers and Navigating the healthcare system were also associated with more positive perception of GH. Associations achieved either p < 0.001 or p < 0.05. Considering HL levels, a statistically significant negative association was found with the levels of HbA1c and positive association with perceived general health, even for functional HL.

Conclusions

The results emphasize the importance of improving the level of HL of people with diabetes in order to improve glycemic control and the perceive General Health

Key messages

Health literacy is critical for diabetes self-management. People with diabetes need to understand and use health information to promote well-being and diabetes control.

Baby foods available in the Portuguese marketplace and the application of nutrient profile models

Background

An investment in nutrition at the earliest possible stage, providing appropriate complementary feeding, is critical to ensure proper growth and to prevent noncommunicable diseases (NCDs). Food and drinks high in fats, free sugars and salt are being marketed for consumption by young children and represent particular concern.

Aim

This study aims to determine the compliance of complementary foods (CACFs) for infants and young children sold in the Portuguese marketplace according to WHO draft Nutrient Profile model (NPM) for infants and young children between 6 and 36 months (1).

Methods

A sample of 128 CACFs was collected. Using nutritional food label information, products were divided into four food categories: dry, powdered and instant cereals; dry finger foods and snacks; meals with chunky pieces; and soft-wet spoonable, ready-to-eat foods. Packaging information was used to determine sodium, fat and sugar content per 100 g and percentage energy from total sugar by food category.

Results

Twenty-eight products (22%) comply with all the criteria established in the NPM. All the evaluated dry, powdered, and instant cereals, dry finger foods and snacks and meals with chunky pieces (n = 55) comply with recommendations proposed for total fat (≤4.5 g/100 kcal). Analysis of energy contribution from total sugars reveals 9 % (n = 5) of dry finger foods and snacks comply with the proposed criteria < 15% total energy from total sugars. The 73 soft-wet spoonable, ready-to-eat foods assessed, 74 % (n = 54) comply with the sodium thresholds of 50 mg/100 kcal, 64 % (n = 47) had a content ≥ 60 Kcal/100 g and 74 % (n = 54) contained over 20% of energy derived from sugar.

Conclusions

CACFs available in the Portuguese marketplace are characterised by products with high proportion of calories derived from sugar, promoting an environment that encourages development of sweet-taste preferences and adverse health outcomes resultant from the overconsumption of sugar in early life.

Key messages

There is an urgent need for updated regulations to support and guide product reformulation. A nutrient profile model for CACFs will establishes compositional thresholds and provides guidance on product-labelling and promotions.

Human colostrum contains IgA antibodies reactive to enteropathogenic Escherichia coli virulence-associated proteins: intimin, BfpA, EspA, and EspB

BACKGROUND

In Brazil, enteropathogenic Escherichia coli diarrhoea is endemic among infants born into low economic levels, and it is one of the main causes of morbidity and mortality in this group. Binding of enteropathogenic E. coli to the brush border mucosa triggers a cascade of transmembrane and intracellular signals, causing cytoskeletal reorganization and formation of a specific lesion, termed the attaching and effacing lesion. Several enteropathogenic E. coli gene products have been implicated in formation of attaching and effacing lesions. Evaluation of pathogen-specific protective factors shows that breast feeding is effective against enteropathogenic E. coli infection. To investigate the nature of the protection, defatted colostrum and secretory immunoglobulin A obtained from mothers living in Sao Paulo were investigated for the ability to recognise selected enteropathogenic E. coli-associated virulence factors.

METHODS

Western blot analysis was used to investigate the IgA repertoire in pooled colostrum that is reactive with specific enteropathogenic E. coli proteins. Whole enteropathogenic E. coli bacterial cell extracts, nonpathogenic E. coli strains overexpressing specific virulence factors, and purified polypeptides were used as antigen sources in this study.

RESULTS

Reaction of the colostrum samples in Western blots of whole bacterial cell extracts and selected purified enteropathogenic E. coli proteins showed that they contained a secretory immunoglobulin A reactive with all the virulence-associated proteins studied.

CONCLUSION

These results suggest that maternal antibodies may protect infants from enteropathogenic E. coli infection by interfering with adherence processes (anti-intimin and anti-bundle-forming pili antibodies) and cell signaling (anti-enteropathogenic Escherichia coli-secreted protein A and B antibodies.

Decrease in passive cutaneous anaphylaxis reactions in rats secondary to stress

Anaphylaxis was assayed by the passive cutaneous anaphylaxis (PCA) test in male Wistar rats (250 g body weight). Three experimental groups were used: animals restrained in an electric chamber and submitted to electric shock immediately after sensitization and 24 h before anaphylaxis (31 animals), animals restrained in the electric chamber for the same time but receiving no electric shock (23 animals), and non-manipulated, home-cage control animals (24 animals). The frequency of PCA reactions was decreased in the group of animals submitted to restraint when compared with the home-cage control group. However, the group of animals submitted to both restraint and electric shock showed no decrease in the frequency of PCA reactions. It is suggested that, in rats, stress induced by restraint decreases PCA reactions and that this decrease is counteracted by a simultaneous stress induced by electric shock.

Influence of stress on IgE production

Intense acute stress, consequent to restraint, leads to a diminished production of IgE antiovalbumin antibodies in mice. The IgE content of sera from experimental or control animals was assayed by the enzyme-linked immunosorbent assay (ELISA) at days 8, 16, and 20 after immunization. The statistics revealed significant differences in the IgE level of the animals submitted to acute stress and home cage control animals on days 16 and 20 after immunization, but not on day 8.