Effect of Fortified Formula on Growth and Nutritional Status in Young Children: A Systematic Review and Meta-Analysis

Previous reviews of the effect of young child formulas on health outcomes in infants and toddlers have been inconclusive. In this study, we undertook a contemporary synthesis of studies investigating the effects of consuming fortified milk beverages (compared to cow’s milk or unfortified comparator formula) on growth and/or nutritional status in children 1−3 years of age. Five electronic databases were searched (PubMed, Web of Science, Scopus, ProQuest, and Cochrane Library) for randomised controlled trials comparing fortified milk against control milk in young children (9−48 months), published between January 1990 and June 2022. Outcomes were growth, body composition, biochemical markers, and/or nutritional status. Mean differences (MD) were pooled using random-effects meta-analysis where there were ≥3 studies. The risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool. Nineteen articles (12 studies; n = 4795) met the inclusion criteria. Heterogeneity was substantial, likely attributable to considerable variation in study characteristics. Fortified milk was associated with increased weight gain (MD = 0.14 kg [95% CI 0.06, 021], p = 0.0003) compared with control milk. Subgroup analyses demonstrated increases in weight in lower-income countries, and in studies with intervention periods > 6 months. There were no effects of fortified milks on other anthropometric measures. Haemoglobin (MD = 3.76 g/L [95% CI 0.17, 7.34], p = 0.04) and ferritin (MD = 0.01 nmol/L [95% CI 0.00, 0.02], p = 0.02) concentrations were increased in infants consuming fortified milks. Fortified milk beverages appear to offer a safe and acceptable source of complementary nutrition as a short-term strategy for addressing nutritional deficits and may modestly promote weight gain in vulnerable populations when provided for periods > 6 months. This study was prospectively registered with PROSPERO (CRD42022339920) and funded by the Infant Nutrition Council.

Towards healthier and more sustainable diets in the Australian context: comparison of current diets with the Australian Dietary Guidelines and the EAT-Lancet Planetary Health Diet

BACKGROUND

There is increasing focus on moving populations towards healthier and more environmentally sustainable dietary patterns. The Australian Dietary Guidelines provide dietary patterns that promote health and wellbeing. It is unclear how these guidelines align with the more recently published global recommendations of the EAT-Lancet Planetary Health Reference Diet, and how Australian diets compare to both sets of recommendations.

METHODS

Data from one 24-h recall collected for the 2011-13 National Nutrition and Physical Activity Survey were analysed for 5,920 adults aged 19-50 years. Subgroups of this population were identified by diet quality and lower or higher consumption of foods often considered to be environmentally intensive (higher animal meat and dairy foods) or associated with healthiness (higher vegetables and lower discretionary choices). Food group and nutrient composition of Australian diets were compared to diets modelled on the Australian Dietary Guidelines and Planetary Health Reference Diet. The environmental impacts of diets were estimated using an index of combined metrics.

RESULTS

Compared with the Planetary Health Reference Diet, the Australian Dietary Guidelines contained more servings of the vegetable, dairy and alternatives, fruit, and discretionary choices. The amount of meat and alternatives was higher in the Planetary Health Reference Diet than Australian Dietary Guidelines due to the inclusion of more plant-based meat alternatives. The average Australian diet contained two to almost four times the Australian Dietary Guidelines and Planetary Health Reference Diet maximum recommended intake of discretionary choices, and provided inadequate amounts of the vegetables, cereals, unsaturated fats and meats and alternatives food groups, primarily due to lower intakes of plant-based alternatives. The average Australian diet also contained less dairy and alternatives than the Australian Dietary Guidelines. In the average Australian diet, red meat and poultry contributed 73% to the total servings of meat and alternatives compared to 33% and 10% for the Australian Dietary Guidelines and Planetary Health Reference Diet respectively. The modelled Australian Dietary Guidelines diet met the relevant nutrient reference value for all 22 nutrients examined, whereas the Planetary Health Reference Diet contained an inadequate amount of calcium. The environmental impact scores of the Planetary Health Reference Diet and Australian Dietary Guidelines were 31% and 46% lower than the average Australian diet.

CONCLUSIONS

Significant changes are required for Australians' dietary intake to align more closely with national and global dietary recommendations for health and environmental sustainability.

Beverage Intake and Associated Nutrient Contribution for Aboriginal and Torres Strait Islander Australians: Secondary Analysis of a National Dietary Survey 2012–2013

Beverages contribute significantly to dietary intake. Research exploring the impact of beverage types on nutrient intake for Australian Aboriginal and Torres Strait Islander people is limited. A secondary analysis of the Australian Aboriginal and Torres Strait Islander Health Survey 2012–2013 (n = 4109) was undertaken. The daily intake, percentage of consumers, and contribution to total nutrient intake was estimated for 12 beverage categories. Beverage intake contributed to 17.4% of total energy, 27.0% of total calcium, 26.3% of total vitamin C, and 46.6% of total sugar intake. The most frequently consumed beverage categories for children (aged 2 to 18 years) were water, fruit juice/drinks, soft drinks, and cordial; and for adults, water, tea, coffee and soft drinks. The primary sources of beverages with added sugar were fruit juice/drinks (for children), tea (for people living remotely), coffee (for adults in metropolitan/regional areas) and soft drinks (for everyone). Actions to modify beverage intake to improve health should maintain the positive nutrient attributes of beverage intake. This analysis of a large-scale national dietary survey provides benchmarking of beverage intake to support program and policy development to modify intake where this is determined as a priority by the community.

Sensory swap: Modelling the impact of swapping discretionary choices for similar tasting core foods on the energy, nutrients and sensory properties of Australian diets

Food choice is strongly driven by the sensory characteristics of foods with sweet, salty and fatty mouthfeel considered highly palatable and rewarding. Attempts to improve diet quality have not addressed sensory characteristics of diets before. This report describes a data modelling exercise that could underpin a dietary strategy to help support consumption of higher quality diets without compromising sensory preferences. This study used the Australian National Nutrition and Physical Activity Survey data (in 9341 adults) and the CSIRO sensory-diet database. A method was developed to find core food swaps which had a similar sensory profile as discretionary foods. This study investigated the impact of such swaps on energy and nutrient intake and the impact of the swaps on servings of food groups. The modelling resulted in a similar sensory profile of core foods to that of discretionary foods with hardness, sweetness and fatty mouthfeel all within 1-3% but the saltiness approached a 4% change. There was a small (3.6%) increase in energy intake. This swap strategy decreased the intake of risk nutrients such as saturated fat and added sugars, but not sodium, while increasing the intake of beneficial nutrients like calcium, zinc and vitamin C. Results also show that there was an increase in the intake of servings of core food groups such as fruits, grains, and dairy products but little change in vegetables. In conclusion, similar sensory swaps are possible and could underpin a diet strategy, that could be further refined through food appropriateness, to improve quality.

Sensory characteristics of vegetables consumed by Australian children

OBJECTIVES

Consumption is driven by children's sensory acceptance, but little is known about the sensory characteristics of vegetables that children commonly eat. A greater understanding could help design more effective interventions to help raise intakes, thus realising beneficial health effects. This study sought to: (1) Understand the vegetable consumption patterns in children, with and without potatoes, using the Australian and WHO definitions. (2) Describe the sensory characteristics of vegetables consumed by children by age group, level of intake and variety. (3) Determine the vegetable preferences of children, by age group, level of intake and variety.

DESIGN

Analysis of National Nutrition Survey data, combining reported vegetable intake with sensory characteristics described by a trained panel.

SETTING

Australia.

PARTICIPANTS

A nationally representative sample of Australian children and adolescents aged 2-17·9 years (n 2812).

RESULTS

While consumption increased in older age groups, variety remained constant. Greater variety, however, was associated with higher vegetable consumption. Potato intake increased with consumption, contributing over one-third of total vegetable intake for highest vegetable consumption and for older age groups. Children favoured relatively sweet vegetables and reported lower consumption of bitter vegetables. There were no differences in the sensory properties of vegetables consumed by children in different age groups. After potatoes, carrots, sweetcorn, mixtures, fruiting and cruciferous types were preferred vegetables.

CONCLUSION

Children tend to prefer vegetables with sensory characteristics consistent with innate taste preferences (sweet and low bitterness). Increasing exposure to a variety of vegetables may help increase the persistently low vegetable consumption patterns of children.

Adjustment Factors Can Improve Estimates of Food Group Intake Assessed Using a Short Dietary Assessment Instrument

BACKGROUND

Methods to address misreporting associated with short dietary assessment instruments are needed.

OBJECTIVE

Our objective was to develop and evaluate the direct and indirect validity of adjustment factors applied to a short dietary assessment instrument to improve estimates of usual consumption of core and discretionary food and beverage intake.

DESIGN

Validation of the Short Food Survey relative to 24-hour recalls was performed. The Short Food Survey requires individuals to report their usual intake of fruit, vegetables, grains, meat, dairy, and discretionary choices in multiples of standard servings. Adjustment factors were developed based on a ratio (usual portion size estimated from national data to standard serving size). The estimates of food group intakes (unadjusted and adjusted) were compared to 24-hour recalls.

PARTICIPANTS/SETTING

Three population samples were used in this study. The direct validation used data from 61 Australian adults (collected 2013-2014). The indirect validation compared data from the 2011-2013 Australian National Nutrition and Physical Activity Survey (n=9,435) to a sample of 145,975 who completed the Short Food Survey in a format that is freely available online (2015-2016).

MAIN OUTCOME MEASURES

Food group intake (in servings) was measured.

STATISTICAL ANALYSES PERFORMED

Descriptive and inferential statistical analyses were conducted.

RESULTS

Direct validation showed the adjustment factors improved the survey-derived estimates of intake for all food groups except grain foods. For grains, the mean difference went from -0.6 servings to +1.2 to 1.5 servings. The absolute difference in food group intake between the adjusted Short Food Survey and recalls remained statistically significant for fruit, meat, dairy, and grains, but was not different for vegetables and discretionary foods. The indirect validation showed that the adjusted estimates of intake from the online Short Food Survey were closer to the population estimates reported by 24-hour recall for all food groups except meat.

CONCLUSIONS

Adjustment factors can improve estimates of food group intake assessed using a short dietary assessment instrument for some but not all food groups.