ArticleLiterature Review

Complementary feeding: A commentary by the ESPGHAN Committee on Nutrition

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Abstract

This position paper on complementary feeding summarizes evidence for health effects of complementary foods. It focuses on healthy infants in Europe. After reviewing current knowledge and practices, we have formulated these conclusions: Exclusive or full breast-feeding for about 6 months is a desirable goal. Complementary feeding (ie, solid foods and liquids other than breast milk or infant formula and follow-on formula) should not be introduced before 17 weeks and not later than 26 weeks. There is no convincing scientific evidence that avoidance or delayed introduction of potentially allergenic foods, such as fish and eggs, reduces allergies, either in infants considered at increased risk for the development of allergy or in those not considered to be at increased risk. During the complementary feeding period, >90% of the iron requirements of a breast-fed infant must be met by complementary foods, which should provide sufficient bioavailable iron. Cow's milk is a poor source of iron and should not be used as the main drink before 12 months, although small volumes may be added to complementary foods. It is prudent to avoid both early (<4 months) and late (>or=7 months) introduction of gluten, and to introduce gluten gradually while the infant is still breast-fed, inasmuch as this may reduce the risk of celiac disease, type 1 diabetes mellitus, and wheat allergy. Infants and young children receiving a vegetarian diet should receive a sufficient amount ( approximately 500 mL) of breast milk or formula and dairy products. Infants and young children should not be fed a vegan diet.

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... Sin embargo, considerando aspectos de maduración renal, inmunológica, gastrointestinal y neurológica, asociaciones como las Sociedades Europea y Norteamericana de Gastroenterología, Hepatología y Nutrición Pediátrica (ESPGHAN, NASPGHAN) y la Academia Europea de Alergia e Inmunología Clínica (EAACI) recomiendan iniciar la introducción de alimentos complementarios entre las 17 y 26 semanas de vida 8 . ...
... Introducción temprana de alimentos complementarios. Se considera introducción temprana de alimentos complementarios cuando se inicia antes de la semana 17 de vida 4,8 . ...
... Introducción tardía de la alimentación complementaria. Se considera tardía la introducción de la AC después de la semana 26 de vida 4,8 ; puede tener efectos negativos, como: desaceleración del crecimiento y desnutrición debido a que la lactancia materna exclusiva no satisface los requerimientos de energía y proteínas después de los 6 meses de edad; deficiencia de hierro, anemia y deficiencia de zinc, debido a la introducción tardía de alimentos fuente de estos minerales como las carnes rojas y cereales fortificados 8,65 ; trastornos de la conducta alimentaria de lactantes, como rechazo a sólidos, vómitos por aversión a los alimentos y atragantamiento aparente 66,67 . ...
... According to the WHO, the American Academy of Pediatrics, and the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN), breastfeeding is the optimal way of feeding infants and young children. It is also good for mothers, families, and society at large, with a number of specific health, environmental, and economic benefits [1][2][3]. Compared to formula feeding, breastfeeding reduces infant perinatal mortality and prevents a number of both childhood and adult diseases. Increased use of breastfeeding could prevent the deaths of 823,000 children under 5 and 20,000 breast cancer deaths annually [4]. ...
... It comprises 17 statements rated on a 5-item Likert scale, from 1 (strongly disagree) to 5 (strongly agree). Points in questions: 1,2,4,6,8,10,11,14,17 should be reversed (i.e., 1 = 5, 2 = 4, 4 = 2, 5 = 1), and the scores for each item then summed together. Nine items have wording favorable to breastfeeding, and the remaining ones favorable to formula feeding. ...
Article
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Background: The Iowa Infant Feeding Attitude Scale (IIFAS), which is used for the assessment of attitudes towards breastfeeding, has been found to be reliable and valid in a number of countries, but has not yet been psychometrically tested in Polish women. The purpose of the study was to report on the cultural adaptation of the IIFAS to Polish settings and on its validation, to evaluate the breastfeeding attitudes in Polish women who recently gave birth, and to identify the determinants of these attitudes. Methods: The study was performed in a group of 401 women in their first postpartum days. Results: Cronbach's α for the scale was 0.725. Discriminative power coefficients of all questionnaire items were higher than 0.2. Subscales were strongly correlated with the total score, with a correlation coefficient of 0.803 for the "favorable toward breastfeeding" subscale (p < 0.001), and 0.803 for the "favorable toward formula feeding" subscale (p < 0.05). For the item "A mother who occasionally drinks alcohol should not breastfeed her baby", the factor loading did not reach the criterion value, and so the item was not included in further analyses. The mean IIFAS score was 63.12 (±7.34). Conclusions: The Polish version of the IIFAS is a reliable and appropriate measure of women's attitudes towards infant feeding in Polish settings, with acceptable psychometric properties and construct validity.
... Despite the potential nutritional benefits of animal-source foods, it has been reported that children, particularly those in LMICs, communities, populations, and lowincome households are hardly given foods such as meat, eggs, fish, and milk [15]. It should be noted though that previous studies from high-income countries advise against the introduction of cow's milk in the main drinks of infants before 12-months of age due to it being a poor source of iron, however, it was suggested that it can be added to complementary foods in small quantity [17]. Hence, there is the need for high-quality studies that seeks to investigate the suitability of animal-based foods during complementary feeding on the growth, macro-and micronutrient status of children from high-income countries and resource-rich environment who may not have access to supplementation, fortified foods and/or drinks as well as well-planned vegan diet diets due to an increasing prevalence of the practice of vegetarian diets among caregivers [18][19][20][21][22]. Against this background, previous and recent literature have shown that infants and young children, especially those from LMICs, communities, populations, and low-income households are at high risk of growth faltering, macro-and micronutrient deficiencies due to inadequate consumption of animal-based protein-rich foods , [17,[23][24][25]. ...
... It should be noted though that previous studies from high-income countries advise against the introduction of cow's milk in the main drinks of infants before 12-months of age due to it being a poor source of iron, however, it was suggested that it can be added to complementary foods in small quantity [17]. Hence, there is the need for high-quality studies that seeks to investigate the suitability of animal-based foods during complementary feeding on the growth, macro-and micronutrient status of children from high-income countries and resource-rich environment who may not have access to supplementation, fortified foods and/or drinks as well as well-planned vegan diet diets due to an increasing prevalence of the practice of vegetarian diets among caregivers [18][19][20][21][22]. Against this background, previous and recent literature have shown that infants and young children, especially those from LMICs, communities, populations, and low-income households are at high risk of growth faltering, macro-and micronutrient deficiencies due to inadequate consumption of animal-based protein-rich foods , [17,[23][24][25]. ...
Article
Although animal-source foods are suitable complementary food for child growth in low- and middle-income countries (LMICs), their efficacy is still under discussion. This systematic review and meta-analysis was therefore done to investigate the suitability of animal-source foods intake on child physical growth in LMICs. A systematic literature search was done using electronic databases and scanning the reference list of included studies, previous meta-analysis, and systematic reviews. Paper selection was based on the PICO (ST) criteria. Papers were selected if based on 6 to 24-months-old children, if they were randomised controlled trials evaluating the effect of complementary animal-based food supplementation of any natural origin, if reporting at least a measure of body size and published after 2000. The PRISMA guidelines for reporting systematic review was followed in the paper selection. Fourteen papers were included in the systematic review and eight were considered for the meta-analysis. Animal-based food supplementation resulted in a higher length-for-age Z-score (LAZ) and weight-for-age Z-score (WAZ) compared to the control group, with random effect sizes estimates of 0.15 (95% CI = 0.02, 0.27) and 0.20 (95% CI = 0.03, 0.36). Results were confirmed after influence analyses, and publication bias resulted as negligible. We observed an increased effect on LAZ and WAZ when the food supplementation was based on egg (effect size = 0.31 (95% CI = −0.03, 0.64) and 0.36 (95% CI = −0.03, 0.75) for LAZ and WAZ, respectively). Animal-source foods are a suitable complementary food to improve growth in 6 to 24-month-old children in LMICs.
... The early introduction of complementary feeding was defined in this study as the introduction of any food before the infant reaches 17 weeks. This was defined based on the European Society's guidance, that infants younger than 17 weeks should not be given any complementary foods (32) , and has been used in many Western (33,34) and Arab countries (10,35) in studies with related objectives (10) . Complementary food was defined in this study based on the definition used by the Saudi Food and Drug Authority (36) , which is in line with the European Food Safety Authority (EFSA) (37) . ...
... Although there is consensus on the WHO recommendations and other organisations such as the European Society for Paediatric Gastroenterology Hepatology and Nutrition (32,50) agree that the earliest introduction of complementary feeding should not be done before 4 months or 17 weeks, 64 % of our sample introduced complementary feeding when the infant was <17 weeks and this was influenced significantly by the mother's age, with 45 % of younger mothers more likely to wean their infants at <17 weeks than older mothers. Higher rates (62·5 %) of early weaning practice have also been found in Tabouk city in SA and similar findings have been made in other Middle East countries. ...
Article
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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.
... According to the World Health Organization (WHO), the adequate nutrition of infants is essential to ensure the growth and optimal development of children and achieve better health throughout life, including prevention of overweight, obesity, and diet-related non-communicable diseases [1]. The WHO and the Nutrition Committee for the European Society for Paediatric, Gastroenterology, Hepatology, and Nutrition (ESPGHAN) recommend exclusive breastfeeding for the first six months of life [2]. ...
... The transition period from exclusive breastfeeding to family foods is referred to as complementary feeding and usually covers the period from 6 to 18-24 months of age. The ESPGHAN recommends that the complementary feeding (i.e., solid foods and liquids other than breast milk or infant formula and follow-on formula) should not be introduced before 17 weeks and not later than 26 weeks [2], and this recommendation is supported by the European Food Safety Authority (EFSA) which concludes that four to six months is a safe period [3]. ...
Article
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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.
... IFs formulated from cow milk are produced at low-costs and widely marketed, and processed to adjust macro and micronutrient contents to obtain nutritional characteristics as similar as possible to human breast milk, which is safer for neonates or infants under one year old [10]. Cow milk processing aims to reduce protein content to avoid overloading the newborn immature renal tubular systems, mainly through the reduction of casein content and consequent improvement of whey protein: casein ratios in order to enrich IFs with high biological-activity proteins aiming to supply essential amino acids and facilitate milk digestion [1]. ...
... Most essential amino acids were detected in all IFs, although at lower concentrations compared to established guidelines, probably due to reduced concentration of α-La and Lf whey proteins, the best source of essential amino acids, as indicated by the HPLC analysis (Tables 1 and 2). Essential IFs amino acid contents were lower than the reference values and exhibited tryptophan as the first limiting amino acid, corroborating other studies [10,69]. Essential amino acids were significantly different among IFs brands and batches, reflecting protein fraction variability (Table 3), with the relative concentration of each amino acid also depending on CM composition [26,71]. ...
Article
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Infant formulas, designed to provide similar nutritional composition and performance to human milk, are recommended when breastfeeding is not enough to provide for the nutritional needs of children under 12 months of age. In this context, the present study aimed to assess the protein quality and essential amino acid content of both starting (phase 1) and follow-up (phase 2) formulas from different manufacturers. The chemical amino acid score and protein digestibility corrected by the amino acid score were calculated. The determined protein contents in most formulas were above the maximum limit recommended by FAO and WHO guidelines and at odds with the protein contents declared in the label. All infant formulas contained lactoferrin (0.06 to 0.44 g·100 g−1) and α-lactalbumin (0.02 to 1.34 g·100 g−1) below recommended concentrations, whereas ĸ-casein (8.28 to 12.91 g·100 g−1), α-casein (0.70 to 2.28 g·100 g−1) and β-lactoglobulin (1.32 to 4.19 g·100 g−1) were detected above recommended concentrations. Essential amino acid quantification indicated that threonine, leucine and phenylalanine were the most abundant amino acids found in the investigated infant formulas. In conclusion, infant formulas are still unconforming to nutritional breast milk quality and must be improved in order to follow current global health authority guidelines.
... 임신 기간 중 엄마나 출생 후 신생아에게 비타민 D를 섭취 하게 하여 알레르기질환을 예방하였는지에 관한 중재 연구 들 결과를 보면 많은 연구들에서 비타민 D의 알레르기질환 의 예방 효과가 있음을 입증하였지만(Camargo et al., 2007; 방할 수 있는지에 대해 살펴본 17개 연구들을 2016년 코크 란 리뷰를 통해서 분석했을 때 불행히도 예방 효과는 보이지 고형식을 늦게 먹이는 방법으로 이유식을 6개월 이후 에 시도하는 방법은 아직도 많은 사람들이 실천하고 있다. 그러나 미국이나 유럽의 소아영양과 알레르기 전문가그룹(Agostoni et al., 2008;Greer et al., 2008;Host et al., 2008)은 임신 기간이나 수유 중 모체의 식이제한이 알레 르기질환의 발생을 줄이지 못해서 권고하지 않는다고 하 였다. 그리고 2012년 코크란 리뷰(Kramer & Kakuma, 2012)에 따르면 알레르기질환 발생 위험이 높은 아기를 임신한 산모의 식이제한이 알레르기질환의 발생을 예방하 는 것보다 재태 체중 증가가 잘 안되거나, 미숙아 출산과 관 련됨을 보고하였다. ...
Article
The increasing prevalence of allergic diseases in the past decades has been caused by environmental rather than genetic factors. Recent research has focused on the relationship between the mother’s environmental exposure, especially during pregnancy, and allergic outcomes in the offspring. Intervention studies to prevent allergic diseases have also been conducted. Environmental factors, such as diet induce changes in the mother's intestinal flora, and the signals generated have a permanent effect on the fetal immune development through an epigenetic mechanism, which may be involved in disease development. This review outlines whether dietary patterns in mothers are related to allergic diseases, and it summarizes whether supplementation with micronutrients, such as omega-3 unsaturated fatty acids, vitamin D, and folic acid can prevent allergic diseases. Studies have found that a westernized diet is associated with an increase in the prevalence of allergic diseases; however, intervention studies conducted with micronutrients or probiotics do not provide clear results regarding its preventive effect. A mother’s diet during pregnancy or lactation may affect the health of the child. Well-designed intervention studies are warranted to attempt to prevent allergic diseases. Consequently, good dietary patterns based on high-quality evidence are recommended for pregnant and lactating mothers.
... Along with breast and formula feeding, this period further includes the weaning process and the introduction of solids. In full-term infants, the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) [2,3] recommends a stepwise introduction of complementary food between the 17th and 26th week of life. In preterm infants, guidelines on the optimal time for starting solids and the ideal composition of complementary food meeting their special requirements are missing [4,5]. ...
Article
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In term infants it is recommended to introduce solids between the 17th and 26th week of life, whereas data for preterm infants are missing. In a prospective, two-arm interventional study we investigated longitudinal growth of VLBW infants after early (10–12th) or late (16–18th) week of life, corrected for term, introduction of standardized complementary food. Primary endpoint was height at one year of age, corrected for term, and secondary endpoints were other anthropometric parameters such as weight, head circumference, BMI, and z-scores. Among 177 infants who underwent randomization, the primary outcome could be assessed in 83 (93%) assigned to the early and 83 (94%) to the late group. Mean birthweight was 941 (SD ± 253) g in the early and 932 (SD ± 256) g in the late group, mean gestational age at birth was 27 + 1/7 weeks in both groups. Height was 74.7 (mean; SD ± 2.7) cm in the early and 74.4 cm (mean; SD ± 2.8; n.s.) cm in the late group at one year of age, corrected for term. There were no differences in anthropometric parameters between the study groups except for a transient effect on weight z-score at 6 months. In preterm infants, starting solids should rather be related to neurological ability than to considerations of nutritional intake and growth.
... The complementary feeding represents a crucial stage in which a balance must be reached in order to guarantee the energetic and nutritional requirements of the child, allowing him/her to have adequate development according to age and considering their limited digestive capacity. In this regard, the European Society for Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) defines exclusive breastfeeding for around six months and establishes that the introduction of complementary foods should not occur before 17 weeks but should not be delayed beyond 26 weeks [35]. ...
Article
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The first years of life represent a window of opportunity to establish proper dietary patterns and to maintain them over time. Our aim was to describe the diet of a cohort of Spanish children, from 2 to 36 months, and to identify the components that could influence the quality of the diet at 24 and 36 months of age. This was a longitudinal prospective study analyzing information from administered questionnaires about general characteristics and food frequency consumption in 97 full-term babies. At 2–3 months of age, only 53.6% of infants were observed to be breastfed. The intake of animal foodstuffs from 12 to 36 months was higher than national recommendations, and the contrary was true for fruits and vegetables. The intake of vitamin D was below European Food Safety Authority recommendations. Moreover, energy intake at 6 months was inversely associated with Mediterranean Diet Score (MDS) at 24 months, whereas vegetables intake was positively associated with MDS at 36 months. These results could be useful in the creation of future guidelines focused on the promotion of breastfeeding and healthy early-life food habits.
... Full-term and preterm infants should start the complementary foods at 6 months of life. Ironrich complementary foods include meat, baby cereals, and some vegetables 21,22) . The higher prevalence of iron deficiency anemia among babies from 12-18 months may due to supplemented adequate and high rick added food, another study on the relation of iron deficiency anemia and the type of food given is indicated in this city. ...
Article
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about the prevalence of iron deficiency anemia among exclusive breastfed babies in Ramadi city
... Infants in poorer families tend to be breastfed for longer [51,54]. For children older than 12 months with a better supply of complementary food in high-income countries, additional breast milk may increase fat intake since the primary nutrient in breast milk after 12 months for infant is fat [55]. These facts may be significant reasons for the higher risk of MHO and MUO in longer periods (≥12 months) of breastfeeding. ...
Article
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Background: Additional metabolic indicators ought to be combined as outcome variables when exploring the impact of breastfeeding on obesity risk. Given the role of a healthy lifestyle in reducing obesity, we aimed to assess the effect of breastfeeding duration on different obesity phenotypes according to metabolic status in children and adolescents, and to explore the offsetting effect of healthy lifestyle factors on the associations between breastfeeding duration and obesity phenotypes. Methods: A total of 8208 eligible children and adolescents aged 7–18 years were recruited from a Chinese national cross-sectional study conducted in 2013. Anthropometric indicators were measured in the survey sites, metabolic indicators were tested from fasting blood samples, and breastfeeding duration and sociodemographic factors were collected by questionnaires. According to anthropometric and metabolic indicators, obesity phenotypes were divided into metabolic healthy normal weight (MHNW), metabolic unhealthy normal weight (MUNW), metabolic healthy obesity (MHO), and metabolic unhealthy obesity (MUO). Four common obesity risk factors (dietary consumption, physical activity, screen time, and sleep duration) were used to construct a healthy lifestyle score. Scores on the lifestyle index ranged from 0 to 4 and were further divided into unfavorable lifestyles (zero or one healthy lifestyle factor), intermediate lifestyles (two healthy lifestyle factors), and favorable lifestyle (three or four healthy lifestyle factors). Multinomial logistic regression was used to estimate the odds ratio (OR) and 95% confidence interval (95% CI) for the associations between breastfeeding duration and obesity phenotypes. Furthermore, the interaction terms of breastfeeding duration and each healthy lifestyle category were tested to explore the offsetting effect of lifestyle factors. Results: The prevalence of obesity among Chinese children and adolescents aged 7–18 years was 11.0%. Among the children and adolescents with obesity, the prevalence of MHO and MUO was 41.0% and 59.0%, respectively. Compared to the children and adolescents who were breastfed for 6–11 months, prolonged breastfeeding (≥12 months) increased the risks of MUNW (OR = 1.35, 95% CI: 1.19–1.52), MHO (OR = 1.61, 95% CI: 1.27–2.05), and MUO (OR = 1.46, 95% CI: 1.20–1.76). When stratified by healthy lifestyle category, there was a typical dose–response relationship between duration of breastfeeding over 12 months and MUNW, MHO, and MUO, with an increased risk of a favorable lifestyle moved to an unfavorable lifestyle. Conclusions: Prolonged breastfeeding (≥12 months) may be associated with increased risks of MUNW, MHO, and MUO, and the benefits of breastfeeding among children and adolescents may begin to wane around the age of 12 months. The increased risks may be largely offset by a favorable lifestyle.
... birth, yet the first few months of life are a "sensitive" period during which these preferences can be modified to promote acceptance of nutrient-dense foods (6,8). Complementary feeding (CF), or introduction of solid foods and liquids other than breast milk or formula (9), is arguably the most important opportunity to override innate preferences and shape children's future dietary habits. Repeated exposure to new foods has consistently been shown to increase acceptance, and particularly vegetables (6,(10)(11)(12). ...
Article
Background Complementary feeding (CF) provides an opportunity to shape children's future dietary habits, setting the foundation for good nutrition and health. Objective We estimated effects of 3 CF behaviors on early childhood diet quality using inverse probability (IP) weighting of marginal structural models (MSMs). Methods Among 1,041 children from the Boston-area Project Viva cohort, we estimated effects on the mean Youth Healthy Eating Index (YHEI) score in early childhood of: 1) delayed (≥12mo, vs. early [<12mo]) introduction of sweets and fruit juice; 2) continued (vs. ceased) offering of initially refused foods; and 3) early (<12mo, vs. late [≥12mo]) introduction of flavor/texture variety. Mothers reported CF behaviors at 1y and completed food frequency questionnaires for children in early childhood (median age 3.1y). We estimated average treatment effects (ATEs) using IP weighting of MSMs to adjust for both confounding and selection bias due to censored outcomes and examined effect modification by child sex and breastfeeding (BF) vs. formula feeding (FF) at 6mo. Results Twelve percent of mothers delayed introducing sweets/fruit juice, 93% continued offering initially refused foods, and 32% introduced flavor/texture variety early. The mean±SD YHEI score was 52.8±9.2 points. In adjusted models, we estimated a higher mean YHEI score with delayed (vs. early) sweets and fruit juice among BF children (ATE 4.5 points, 95% CI: 1.0, 7.4), as well as with continued (vs. ceased) offering of refused foods among females (ATE 5.4 points, 95% CI: 0.8, 9.1). The ATE for early (vs. late) flavor/texture variety was 1.7 points (95% CI: 0.3, 3.2) overall and stronger (2.8 points, 95% CI: 0.7, 5.1) among the FF group. Conclusions Delayed introduction of sweets/juice, continued offering of refused foods, and early flavor/texture variety may all result in higher childhood diet quality. Effects may depend on child sex and infant breastfeeding status. Clinical Trial Registry information: Project Viva is registered at clinicaltrials.gov as NCT02820402.
... This is because cereals are good sources of energy, fiber, minerals, phytochemicals, carbohydrates, and proteins (Akanbi et al., 2019a;Shehu et al., 2019). In addition, they are sufficient to cover the nutritional requirements of babies (Agostoni et al., 2008) and are an optimal vehicle for iron fortification when the baby's iron stores are depleting (Domellöf et al., 2014;Klerks et al., 2019). The major cereals for producing this type of product are wheat, sorghum, oats, millet, or rice because they can be added to fruit and vegetable purees and can be used to make porridge (Akanbi et al., 2019b). ...
Chapter
Enzymes play major roles in baby food manufacturing, ranging from enhancing the flavor, solubility, and digestibility of nutrients in baby foods. Enzymes have also been used to produce some functional ingredients that are added to baby foods. For instance, proteases are used for the in vitro digestion of milk protein for use in infant formulas. Lipases are used to produce pure concentrates of functional lipids such as omega-3 docosahexaenoic acid (DHA) to fortify baby foods. Pure DHA concentrates are often added to infant formulas because they have unique roles in infants' brain and eye development. In addition, several enzymes have also been used to produce lactose-free foods for babies with lactose intolerance. Therefore, this chapter focuses on the use of enzymes to enhance the quality, safety, and nutritional properties of baby foods during production.
... the child's digestive tract and motors skills are sufficiently developed (oral motor skills allow the swallowing of foods other than milk (76)), and there is a low risk for allergies development (77). Different recommendations exist that are debating the proper date of starting CoF. ...
Thesis
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The first thousand days of life from conception onwards are crucial, among other aspects, for the development of healthy eating habits and food preferences in children. Parental feeding practices significantly influence infants' food consumption and choices during this period, therefore parents must be properly informed and guided through the early feeding process. Renewed guidelines, covering this theme, have been released in France in June 2019. Considering the frequent interactions that healthcare professionals, such as pediatricians, have with parents during the early feeding, their role can be considered fundamental for the transmission of updated information. This thesis aims at contributing to the development of a paper brochure to disseminate these public health recommendations to the lay public. It consists of four studies aiming at: informing a new public health communication strategy considering the needs of parents and healthcare professionals on child feeding communication; assessing whether the material developed (paper brochure) has a short-term effect on parental knowledge; and finally, if it is positively evaluated by healthcare professionals. The results, reported in four articles in this doctoral thesis, highlighted that healthcare professionals are the most used and influent source of information for parents. Some differences existed regarding the communication needs of parents and the perceptions of pediatricians regarding those needs. In particular, diverging from pediatricians’ opinion, parents often ask for meaningful advice to their personal network and are in demand for practical tips. The paper brochure contributed to increase parental knowledge on child feeding independently from parental socio-demographical characteristics. Professionals evaluated the brochure as a good tool to support their discourse during consultations. These results contribute to the evidence for public health stakeholders when updating and providing resources for the dissemination of child feeding guidelines, with the ultimate aim of building a strategy accounting for the needs of all the users, to facilitate the circulation of official and updated information.
... The European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) currently recommends low-dose gluten introduction between 4 and 12 months with no comment on relation to breastfeeding, 24 a reversal of earlier recommendations to introduce gluten between 4 and 6 months. 25 Recognising that early feeding recommendations must balance the risks of CD and IgE-mediated wheat allergy, we recommend when feeding gluten to give, but not gorge. ...
Article
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Classically considered a disease of early childhood characterised by malabsorption and failure to thrive, coeliac disease is now recognised to arise in genetically susceptible individuals at any age. Although permissive HLA genotypes are the strongest predictor of coeliac disease, they are not sufficient. Several prospective cohort studies enrolling genetically at‐risk infants have investigated the role of potential triggers of coeliac disease autoimmunity, such as timing of gluten introduction, viral infections and dietary patterns. Much less is known about triggers of coeliac disease in adulthood. Better understanding of factors leading to coeliac disease may be helpful in the management of those with potential coeliac disease (elevated serum celiac antibodies without villous atrophy in the small intestine), many of whom initiate a gluten‐free diet without demonstration of villous atrophy. There are a range of clinical presentations of celiac disease in childhood and patterns of coeliac serology, including fluctuation and spontaneous reversion on a gluten‐containing diet, vary. There is a current debate over best strategies to manage adults and children with potential coeliac disease to avoid over‐treatment and under‐treatment. Childhood and adolescence carry unique issues pertaining to the diagnosis and management of coeliac disease, and include nutrition and growth, rescreening, repeat biopsy, dietary adherence concerns and transition to adult care. In conclusion, while coeliac disease has similar pathogenesis and general clinical manifestations in paediatric and adult populations, diagnostic and management approaches need to adapt to the developmental stages.
... 1. развитию функциональных расстройств ЖКТ; 2. увеличению числа детей с аллергическими реакциями; 3. снижению иммунологической защиты детского организма с повышенным риском развития инфекционной патологии; 4. служить фактором риска развития целиакии [10,11]. ...
Article
The article presents data characterizing the features and timing of the introduction of complementary foods to children of the first year of life living in the Belgorod region. The purpose of the study was to study the features of feeding children in the first year of life living in the Belgorod region, and to evaluate the success of the implementation of the “National Program for Optimizing the Feeding of Children in the First Year of Life” in pediatric practice. Methods. Subject to the principles of voluntariness and confidentiality, interviews were conducted with 348 women with young children (the first two years of life) born at 38-41 weeks of gestation with an Apgar score of at least 8 points. To conduct the study, a questionnaire was developed that allows retrospectively assessing the duration of breastfeeding and the timing of the introduction of complementary foods. Results. When assessing the nutrition of children in the first year of life, the following problems were identified: early termination of breastfeeding (before the child reaches the age of 3 months) - in 29.8% of cases, violation of the timing of the introduction of complementary foods (earlier than 4 months and later than 6 months - 22% children), the rules for the introduction of complementary foods (52.7%) and the range of selected products. The main source of information for young parents about complementary foods, the timing and methods of its introduction were: in 60.1% - medical workers, in 12.9% - the opinion and advice of relatives, friends and acquaintances, in 3.2% - the exchange of information with other parents with children of the same age, in 18.1% - information contained on the Internet. Research results. The results of the study show the need for further work on the active implementation of the existing recommendations in the practice of pediatricians, aimed at implementing the principles of breastfeeding support to increase the duration of lactation, on the timeliness of the introduction of complementary foods, the implementation of the rules for the introduction and selection of the range of introduced food products.
... The timely introduction of complementary food in childhood and their dietary adequacy are cornerstones for lifelong health that also influence the risk for malnutrition [8]. According to the WHO, timely introduction of complementary food is at 6 months of age where breastmilk is no longer sufficient to meet the energy and nutrient needs of the growing infant [53]. It was evident, in the current study, that the timely introduction of solid food was 'very good' according to the WHO IYCF rating [45]. ...
Article
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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.
... While early life nutrition influences the development of food preferences and dietary habits later on (Nicklaus, Boggio, Chabanet and Issanchou 2004), the first two years of life are also nutritionally vulnerable as this period is linked to both short term health outcomes and long term disease risks (Robinson and Fall 2012;Schwarzenberg and Georgieff 2018). Complementary feeding is the phase where solid foods are introduced, generally between 4 and 6 months of age, alongside continued milk intake (Agostoni et al. 2008). The New Zealand Ministry of Health Food and Nutrition Guidelines for infants and toddlers inform the evidence-based practice of many health professionals including Well Child providers (e.g. ...
Article
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This study sought to explore infant complementary feeding practices among Māori whānau and the extent to which they may be informed by traditional and culturally specific practices, knowledge, personal beliefs and values. This study also endeavoured to explore how these practices, values and beliefs may have changed across time and between generations. Māori-centred qualitative methods were used within a theoretical framework of Kaupapa Māori and socioecological theories. Semi-structured interviews were conducted and analysed using Braun & Clarke’s method of thematic analysis to uncover key themes and a new theory for understanding infant feeding among Māori whānau. The themes and theories identified through this project suggest that infant complementary feeding is believed to be a natural and instinctive process for Māori whānau, one that is undergoing a process of decolonisation across generations. These theories indicate that Te Ao Māori centred living, grounded in mātauranga Māori is integral to infant feeding values and practices within Māori whānau. It is also clear that many Māori parents desire more culturally relevant infant nutrition information and support. Our findings should inform future updates to infant complementary feeding guidelines within Aotearoa New Zealand, as well as developments in infant nutrition information and support.
... Thereafter, complementary feeding provides benefits to the infant including supporting energy and nutrient intakes needed for growth, and exposure to increased sensory variety to promote ac-ceptance of a diverse range of food textures and flavours and the adoption of a healthy diet (Blossfeld, Collins, Kiely, & Delahunty, 2007;Forestell & Mennella, 2007;Simione et al., 2018). However, early introduction to complementary feeding has been associated with increased risk of food allergies, childhood obesity, and rapid weight gain during early childhood, (Agostoni et al., 2008;Aris et al., 2018;Fogel et al., 2020;Grimshaw et al., 2013;Pluymen et al., 2018). ...
Article
Complementary foods provide many nutritional benefits to infants as they transition from a milk-based to solid-food diet. The appropriate introduction of solid and semi-solid foods exposes infants to a variety of tastes and textures, aids the development of oral processing skills and promotes acceptance of a diverse diet in later childhood. While commercially available infant complementary foods serve as a convenient option for parents and caregivers, their appropriateness for different ages has been called into question. We sought to assess the consistency of the sensory properties of commercially available complementary foods designed for different ages and explore whether sensory intensity changes with front-of-pack age recommendations in Singapore. First, we used a sensory panel to characterise perceptual differences across a range of commercially available infant and toddler complementary foods (n=25) from three categories (biscuit/wafer, rice extruded snack, and puree/porridge/ready-to-eat meal) and establish the relationship between perceived sensory differences and the manufacturer’s age-recommendations (5 to 16 months). Separately, mothers’ (n=121) perception of a similar range of infant complementary foods was evaluated to explore their expected sensory properties in response to labelled age-recommendations for each category. Results suggested that there were significant differences in the sensory perceptions of different infant complementary foods within each category (p ≤ 0.05). However, there was no distinct relationships between the taste and texture profiles and age recommendations for biscuit/wafer and rice extruded snack infant foods, whereas there was uniform alignment between increased intensity of sensory properties and increasing age recommendations for puree/porridge/ready-to-eat meals. By contrast, mothers’ expected sensory perceptions of infant complementary foods were guided by product age recommendations across all categories, with intensity for expected taste and texture characteristics increasing with recommended age. Taken together, the findings suggest the need for closer alignment between product’s sensory properties and their recommended age for specific stages of infant and toddler development, as communicated to parents through front-of-pack labels.
... The elimination diet is not recommended for pregnant women with a family history of atopy (6). Early inclusion of the most common allergenic products in the diet, such as wheat, peanuts, or fish, contributes to the decreased risk of developing allergies (7); however, gluten inclusion earlier than four months of age, or later than seven months, increases the risk of allergy (8). ...
Article
The number of hospitalizations due to an anaphylactic reaction to food is continuously increasing. Therefore, there is an urgent need to seek effective therapy. Currently, the only way to treat food allergies is to avoid allergens and to administer intramuscular epinephrine if an accidental allergen intake occurs. The only causal therapeutic strategy is specific oral immunotherapy. An increasing amount of data confirms this therapy's effectiveness and safety, but the results remain inconclusive due to the lack of long-term follow-up. In this state-of-the-art review, we briefly summarize the latest placebo-controlled randomized-controlled trials on oral immunotherapy to treat food allergy. During the paper's review, we asked the following questions: does the therapy permanently increase the amount of allergen consumed without symptoms? Does it significantly increase or decrease the occurrence of severe systemic reactions - requiring the administration of epinephrine or hospitalization? Many authors describe outcomes such as an increase in the amount of allergen that can be safely ingested; however, significant clinical benefits such as decreased hospitalizations or anaphylaxis incidence are rarely included in the results. To date, there is no unified protocol of therapy, which makes comparisons between studies difficult because of significant differences in types, doses, and routes of administration of the allergen, timeline for up-dosing and maintenance, duration of the therapy, and primary outcomes of OIT.
... Before the weaning method is tried again, there should be a brief period without any attempts. Children over the age of two may be more open to persuasion by talking; thus, weaning can be done more quickly if the mothers wait until the child reaches the appropriate age (25,26). This study has some limitations. ...
... It is only after this point that the infant becomes dependent on external dietary iron sources, as evidenced by the considerable increase in recommended intakes from 7 months onwards. Failure to incorporate sufficient iron-rich complementary foods into the diet and the early introduction and/or excessive intake of unmodified cow's milk are significant risk factors for iron deficiency in 6-24-month olds (17)(18)(19) . Unfortunately, inadequate iron intakes are widely reported amongst infants and young children in Ireland (18,20) , the UK (21) and across Europe (9) . ...
Article
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Iron is essential for the functioning of all cells and organs, most critically for the developing brain in the fundamental neuronal processes of myelination, energy and neurotransmitter metabolism. Iron deficiency, especially in the first 1,000 days of life, can result in long-lasting, irreversible deficits in cognition, motor function and behaviour. Pregnant women, infants and young children are most vulnerable to iron deficiency, due to their high requirements to support growth and development, coupled with a frequently inadequate dietary supply. An unrecognised problem is that even if iron intake is adequate, common pregnancy-related and lifestyle factors can affect maternal-fetal iron supply in utero, resulting in an increased risk of deficiency for the mother and her fetus. While preterm birth, gestational diabetes mellitus and intrauterine growth restriction are known risk factors, more recent evidence suggests that maternal obesity and delivery by Caesarean section further increase the risk of iron deficiency in the newborn infant, which can persist into early childhood. Despite the considerable threat that early-life iron deficiency poses to long-term neurological development, life chances and a country's overall social and economic progress, strategies to tackle the issue are non-existent, too limited or totally inappropriate. Prevention strategies, focused on improving the health and nutritional status of women of reproductive age are required. Delayed cord clamping should be considered a priority. Better screening strategies to enable the early detection of iron deficiency during pregnancy and early-life should be prioritised, with intervention strategies to protect maternal health and the developing brain.
... Pe baza dovezilor disponibile obținute exclusiv din studii observaționale, ESPGHAN CoN a concluzionat că este prudent să se evite atât introducerea timpurie (< 4 luni), cât și cea târzie (> 7 luni) și introducerea glutenului în timp ce sugarul este încă alăptat, deoarece acest lucru poate reduce nu numai riscul de boală celiacă (CD), ci și diabetul zaharat de tip 1 și alergia la grâu (18). Cu toate acestea, două studii recente au examinat corelația dintre vârsta la care are loc introducerea glutenului și riscul de a dezvolta autoimunitate pentru CD sau CD în timpul copilăriei la copiii cu risc genetic pentru CD. ...
Article
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From the moment of birth, the diet must aim an optimal development of the full-term, healthy newborn, and the best known option until now is the breast milk. Studies have consistently highlighted the benefits of natural nutrition, emphasizing its nutritional qualities but also its role in developing immunity for the newborn. A curent challenge is the moment of initiating food diversification, with recommendations indicating ages between 4 and 6 months. Therefore, an analysis of existing recommendations should be linked to studies on the onset of food allergies with the initiation of diversification. There are also cases in which the natural diet cannot be achieved, in these situations the administration of milk formulas is required. Infant mill formulas have evolved a lot in terms of quality and composition, approaching the breast milk, but they can not be considered equal to it.
... Very few infants were fed solid foods before four months, which is encouraging as the early introduction of complementary foods may increase the risk of obesity, gastrointestinal disorders, and food allergy [7,10]. Likewise, delayed introduction to complementary foods is associated with feeding difficulties, growth faltering, and micronutrient deficiencies [7]. ...
Article
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The 2021 Australian Feeding Infants and Toddlers Study (OzFITS 2021) is the first nationwide survey of the feeding practices of children under 2 years. Key Findings: Nearly half of the infants were exclusively breastfed to 4 months, and breastfeeding duration was long, with 68% of infants breastfed to 6 months and 44% breastfed into their second year. Infants were introduced to complementary foods at the appropriate time, between 4 and 6 months. We found a mismatch between the number of recommended servings from each food group in the Australian Dietary Guidelines and the dietary intake of toddlers in our study. Toddlers consumed twice as many fruit servings as recommended, and nearly all consumed discretionary foods despite no allowance for these foods. While most toddlers consumed the recommended dairy serves, they consumed half the recommended servings for other food groups—meats and alternatives, grains, and vegetables. The modeling that informed the Australian Dietary Guidelines did not include an allowance for breastmilk; this needs to be addressed, as a quarter of toddlers in OzFITS 2021 received 30% or more energy from breastmilk. Infants and toddlers met their requirements for most nutrients. One exception was iron, where 90% of older infants and 25% of toddlers had inadequate intakes. Excessive sodium intake was also of concern, with 1 in 3 toddlers exceeding the upper limit of 1000 mg/day. Here, we discuss additional findings, study limitations, gaps in the evidence base, and future directions.
... Some studies have shown an increased concentration of bifidobacteria and decreased in Bacteroides in breastfed infants' gut compared to those receiving starter formulas (Fallani et al., 2011;Lind, Larnkjaer, Mølgaard, & Michaelsen, 2018), which is consistent with the bifidogenic effect described for HMOs (van Esch et al., 2020). Thereafter, complementary feeding (the introduction of solid food between 17 and 26 weeks of age) (Agostoni et al., 2008) also influences on the infant's microbiota although its effects on microbiota development are not yet fully understood (Koenig et al., 2011). Recent research has revealed the existence of crucial time points at which the introduction of certain foods had a substantial impact on microbiota composition (Koenig et al., 2011). ...
Article
Extensive work has established the importance of the gut microbiota during the first years of life. However, there are few longitudinal studies describing the role of infants' diet on the evolution of the fecal microbiota and their metabolic activity during this stage. The aim of this work was to explore the impact of diet on the composition of the major intestinal microorganisms and their main microbial metabolites from birth to 12 months. This is a longitudinal prospective study of diet and fecal microbiota. Bacterial groups levels were determined by qPCR and short-chain fatty acids (SCFAs) concentrations by gas chromatography. Information from self-administered questionnaires about general characteristics and food frequency were obtained from a cohort of 83, Spanish and full-term, infants at 15, 90, 180 and 365 days of age. Results revealed that Enterobacteriaceae decrease in weaning period contrary to Bacteroides group and Clostridium cluster IV. Conclusion our study supports weaning period as a key step for gut microbiota transition and suggests the importance of the consumption of dietary fiber with the increase of certain bacterial groups as Clostridium cluster IV, which could be beneficial for the host. Finally, studies specially designed to analyze the production and the excretion of SCFAs in children are needed to understand how diet could influence in this process.
... The introduction of solid, semi-solid or soft foods before 6 months, according to the WHO, is the introduction of any food other than breast milk, with the exception of drinking water, oral rehydration solutions, vitamin, and mineral supplements [5]. This complementary feeding may be tolerated if initiated in a child between 17 weeks and 26 weeks of age [22]. We observed a rate of introduction of solid, semi-solid or soft foods before 6 months of 74.04%. ...
Article
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Purpose: In the Democratic Republic of the Congo (DRC), malnutrition remains a public health problem despite interventions to improve the nutritional status of children. The objective of this study is to determine the degree of association between dietary practices and malnutrition among infants aged 12 to 23 months in Lubumbashi (DRC). Methods: We conducted a community-based cross-sectional study of 574 infants between 12 and 23 months of age from urban and semi-urban areas. Door to door survey was done to collect data. Nutritional status was assessed and compared with feeding practices. A multivariate analysis was conducted to evaluate the association between dietary practices and malnutrition in these children. Results: Bottle feeding before 6 months (adjusted odds ratio [aOR] = 1.8 [1.2-2.8]; p = 0.006), introduction of solid, semi-solid or soft foods before 6 months (aOR = 2.1 [1.0-4.3]; p = 0.042), and insufficient minimum dietary diversity (aOR = 2.3 [1.6-3.5]; p < 0.0001) were independently associated with stunting. Late breastfeeding initiation (aOR = 2.4 [1.1-5.0]; p = 0.023) increases the risk of wasting. Conclusion: Infant malnutrition is sometimes a reflection of inappropriate eating practices from the early stages of a child's life. Adherence to sufficient nutritional recommendations at birth can reduce this burden in developing countries.
... Ayrıca komite hem erken (<4 ay) hem de geç (≥7 ay) dönemde gluten alımının, bebeklerde buğday alerjisi riskini artırabileceğini ifade etmektedir. Anne sütü alan bebeklerde, gluten içeren besinlerin kademeli olarak verilmesi önerilmektedir (Agostoni vd., 2008). Öte yandan en alerjik besinlerin (yumurta, balık, yer fıstığı, buğday vb.) tamamlayıcı besin olarak başlanmasını geciktirmek için bir neden bulunmamaktadır (Pham-Thi ve Bidat, 2014). ...
Conference Paper
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Objective: Gluten-free packaged snack products are generally low in protein and fiber, and high in sugar and fat. Considering the nutritional requirements of celiac patients; it is aimed to produce healthy bar with Izabella grapes, arrowroot flour, buckwheat popped, date syrup, bee pollen and grape seeds. Materials and Methods: Fifteen samples were produced from mustrad from Isabella grapes (100 g), date syrup (10%, 20%, 30%) and arrowroot flour (5 g, 7.5 g, 10 g) by using Box Behnken optimization method and sensory analysis was performed in the samples. The formula of the inner core of the bar was acquired according to the overall acceptance score. Buckwheat popped (5 g, 7.5 g, 10 g), grape seed (5 g, 7.5 g, 10 g) and pollen (1 g, 2 g, 3 g) that the quantities of which were determined by using the Box Behnken optimization method, and sensory analysis was applied. Results: It was determined that the samples with 5 g arrowroot flour got the highest scores in all parameters. On the overall acceptability parameter; arrowroot flour (p=0.016), time (p=0.019), buckwheat popped (p=0.026) and grape seed (p=0.022) were found to be effective separately. 100 g of the bar; It contains 31 g carbohydrates, 2 g protein, 1.2 g fat, 7.5 g fiber, 43.4 mg calcium, 21.4 mg magnesium, 0.4 mg zinc and 0.8 mg iron and gluten content < 5 ppm determined. Conclusion: Produced product; it is a healthy product for individuals with celiac, with its feature of meeting 30% of the daily fiber, 6% of both calcium and magnesium needs, 4% of protein needs according to the reference intake values.
Article
The prevalence of food allergy (FA) is increasing in some areas of the globe, highlighting the need for better strategies for prevention, diagnosis, and therapy. In the last few decades, we have made great strides in understanding the causes and mechanisms underlying FAs, prompting guideline updates. Earlier guidelines recommended avoidance of common food allergens during pregnancy and lactation and delaying the introduction of allergenic foods in children aged between 1 and 3 years. Recent guidelines for allergy prevention recommend consumption of a healthy and diverse diet without eliminating or increasing the consumption of allergenic foods during pregnancy or breast-feeding. Early introduction of allergenic foods is recommended by most guidelines for allergy prevention after a period of exclusive breast-feedng (6 months [World Health Organization] or 4 months [European Academy of Allergy and Clinical Immunology]). New diagnostics for FA have been developed with varied availability of these tests in different countries. Finally, the first oral immunotherapy drug for FA was approved by the US Food and Drug Administration and European Medicines Agency in 2020. In this review, we will address the global prevalence of FA, our current understanding of the causes of FA, and the latest guidelines for preventing, diagnosing, and treating FA. We will also discuss similarities and differences between FA guidelines.
Preprint
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Extensive work has established the importance of the gut microbiota during the first years of life. However, there are few longitudinal studies describing the role of infants´ diet on the evolution of the fecal microbiota and their metabolic activity during this stage. The aim of this work was to explore the impact of diet on the composition of the major intestinal microorganisms and their main microbial metabolites from birth to 12 months. This is a longitudinal prospective study analyzing fecal microbiota, bacterial groups levels were determined by qPCR and short-chain fatty acids (SCFAs) levels by gas chromatography, as well as information from self-administered questionnaires about general characteristics and food frequency from a cohort of 83, Spanish and full-term, infants at 15, 90, 180 and 365 days of age. Results revealed that Enterobacteriaceae and Bifidobacterium decrease in weaning period contrary to Bacteroides group and Clostridium cluster IV. Furthermore, a clustering based on fecal bacterial groups, SCFAs and type of delivery and feeding, gender and living area suggested that the excretion of SCFAs is strongly related to the type of lactation. Conclusion: our study supports weaning period as a key step for gut microbiota transition and suggests the importance of the consumption of dietary fiber with the increase of certain bacterial groups as Clostridium cluster IV, which could be beneficial for the host. Finally, studies specially designed to analyze the production and the excretion of SCFAs in children are needed to understand how diet could influence in this process.
Article
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Introduction : Recommended by the World Health Organization as the optimal way of infant feeding, maternal breast milk represents the best nourishment for the newborn baby during its first six months. The purpose of this study was to evaluate some of the Romanian mothers’ characteristics that can influence their attitude towards breastfeeding and food diversification. Methods : A questionnaire about 32 questions, including demographics items and breastfeeding attitudes, was sent online (socializing platforms) in 2020 to mothers from all Romania districts. Our sample included at the end 1768 subjects, who fully completed the questionnaire. Statistical analysis was carried out using the GraphPad statistical software. Results : The prevalence of breastfeeding for more than six months was only 32.18% in our group, and most of them were educated mothers who lives in urban areas (OR=2.76), were married (OR=1.98), had over 30 years old (OR=1.43) and have more than one child (OR=1.74). Conclusions : We underline the importance of tackling in our future community interventions some of the socio-demographic characteristics of pregnant women (like groups education, good and accessible information about breastfeeding, young age, first pregnancy, or mothers from rural areas as well) in developing good habits of breastfeeding or complementary feeding, in order to improve their children health status and proper development.
Article
Optimal complementary feeding practices play a vital role in the nutritional status of young children. In Kenya, significantly higher rates of acute malnutrition have been reported among pastoralist communities, particularly among children aged 6-23months. There is inadequate complementary feeding data on pastoralist communities despite their vulnerability. The objective of the study was to establish the determinants of complementary feeding practices and nutritional status of children 6-23 months among pastoralist communities of Isiolo County, Kenya. A cross-sectional analytical study using two-stage cluster sampling methodology was applied to select a sample of 288 children aged 6-23 months from pastoralist communities. Data on the socio-demographic characteristics of the study population, complementary feeding practices and anthropometric measurements of the children aged 6-23 months was collected and analysed. Overall, the prevalence of stunting, underweight and wasting was 19.1%, 7.3% and 5.2% respectively. A variation in malnutrition prevalence was observed with age of children, with the 18-23month age group showing a higher prevalence of all forms of undernutrition. Male children had significantly higher proportions of underweight and stunting (p ≤ 0.05). Complementary feeding practices were sub-optimal - minimum meal frequency (60.4%), minimum dietary diversity (35.4%) and minimum acceptable diet (25.3%). Child age, child sex, caregiver’s age, and caregiver education level were significant determinants for complementary feeding practices and nutritional status of children 6-23months (p ≤ 0.05). We recommend that community based approaches targeting pastoralist communities should address the basic cause of child malnutrition through nutrition education and women empowerment initiatives.
Chapter
Complementary feeding, from 6 to 24 months of age, is a critical period for nutrient adequacy as children transition from an exclusively milk based diet to one in which nutrient requirements are met from all food groups. Therefore, evidence-based food-based dietary guidelines (FBDG) are critical to promote optimal nutrition and health in early development. We review the main considerations in establishing quantitative FBDG for infants and toddlers. We also conducted a descriptive analysis evaluating the extent to which existing quantitative FBDG from developed countries align with nutrient reference values (NRVs). Quantitative FBDG from five countries were identified using pre-defined criteria. Seven-day menus were constructed using each FBDG and the nutrient content was compared to global and country-specific NRV. The FBDG could be translated to provide menus adequate in energy and macronutrients. Some of the FBDG translated menus were below NRV for key nutrients (potassium, calcium, zinc, iron, and vitamin D). FBDG developed using linear programming tended to best approximate micronutrient targets. In conclusion, quantitative FBDG for complementary feeding in several countries are not fully aligned with key nutrient requirements. Analytic approaches, such as linear programming, are helpful to guide the development of FBDG, particularly for difficult to reach nutrients.
Article
Aim/objective: The optimal time of starting complementary foods (CFs) in infants remains a subject of debate. This population-based longitudinal cohort study evaluated the association between early CF introduction and body mass index (BMI) in children aged 5-7 years. Methods: This study included 917,707 children born in Korea during 2008-2009. Initial timing of CF introduction was obtained by questionnaires administered between 4-6 months and 9-12 months of age. The cohort consisted of 154,565 eligible individuals who properly completed the screening program, including structured questionnaires, anthropometric measurements, and physical examinations. To balance baseline characteristics, children were subjected to propensity score matching based on 95 covariates, including indicators of baseline health such as perinatal condition, birth weight, economic status, clinical disease and drug exposure. Exposure was defined as introduction to CF at age <4 months, and outcomes were overweight (BMI z-score > 85th percentile) and obesity (BMI z-score > 95th percentile) at ages 5-7 years. Results: Of the 154,565 eligible children in the observed cohort, 10,499 (6.8%) were introduced to CF at age <4 months and 144,066 (93.2%) at age ≥4 months. Propensity score matching yielded 9,680 children introduced to CF at age <4 months and 35,396 at age ≥4 months. The risk for being overweight or obese at age 5-7 years was slightly higher among those who started CF at age <4 months than at age ≥4 months (adjusted relative risk [aRR] 1.06; 95% confidence interval [CI], 1.02-1.09). A similar but stronger association was observed for being obese at age 5-7 years (aRR 1.12; 95% CI, 1.05-1.19). Conclusion: Early CF introduction before age 4 months was associated with increased BMI at age 5-7 years. This article is protected by copyright. All rights reserved.
Article
Objective to assess the dietary inflammatory index (DII) and its association with maternal factors and excess body weight in Brazilian children under two years old in complementary feeding. Methods This is a cross-sectional study (2016-2019), conducted with 231 mothers and children aged from six to 24 months. The food consumption of the mother-child dyad was obtained through the mean of three 24-hour recalls, as well as information on the consumption of breast milk. The DII was used to verify the quality of the diet. The children's weight and length were measured and the weight/height index was calculated. Path analysis was used to assess the interrelationships between variables. Multiple linear regression was conducted to identify the components of the C-DII that contributed the most to explaining its variation. Results The children had an anti-inflammatory diet (C-DII = -0.37 ± 0.91) while the mothers had a pro-inflammatory diet (M-DII +0.24 ± 0.86). The fiber was the nutrient which contributed most to the variations in the C-DII. Approximately 28% of children were excess body weight. In the pathway analysis, we verified a direct negative effect of education on excess body weight (SC= -0.180; p=0.034) and C-DII (SC= -0.167; p= 0.002); negative direct effect of breastfeeding on the C-DII (SC= -0.294; p<0.001); and positive direct effect of M-DII on C-DII (SC= 0.119; p: 0.021). Conclusion The child's pro-inflammatory of the child's diet during the period of complementary feeding was associated with maternal pro-inflammatory diets, lower education and absence of breastfeeding practice.
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Healthy eating in childhood and adolescence is important for proper growth and development and to establish a healthy foundation for future dietary habits. This paper aims to describe the elaboration of dietary plans for pediatric ages highlighting critical points related to the application of the Italian nutrient recommendations. National databases on food composition data were used to compile the dietary plans. Starting from the definition of serving size for adults, the suggested portion size for pediatric ages was shaped to produce appropriate dietary plans according to the different classes of age. Items from “cereals and derivatives,” “milk,” “fruit,” “vegetables,” “olive oil,” and “water” groups were included daily. Pizza was included once a week. Sweets and snacks were gradually introduced, once a week in infants and up to five times a week in adolescents. Legumes were provided three times a week, as a source of vegetable and sustainable proteins. The main critical aspect of the dietary plans was related to the monotony, especially for snacks and breakfasts. This work demonstrated the limits of the translation of Italian nutrient recommendations into dietary plans for pediatric age groups. Keeping the protein intake in the recommended range of 8–12% of daily energy resulted in inadequate provision of calcium and iron. Other critical points were the reference values for body weight and physical activity. The proposed dietary plans are adequate with regard to food composition, the intake of energy and several nutrients, and in terms of food selection. However, their implementations require action, information, and advocacy.
Chapter
The continuing increase in atopic diseases over the past 30 years is carrying an immense individual and societal cost and burden. Research investigating specific atopic diseases but also the broader context in which these diseases develop and their implications on health is being conducted worldwide. As the onset of atopic diseases is often seen in early infancy with implications for health long into adulthood, specific focus has been on modifiable environmental factors. Allergen/immunogen exposure in humans starts in utero and continues postnatally. Nutrition accounts for a significant segment of exposure which also has undergone extensive changes and modification throughout human history and across cultures. Other environmental exposures exerting epigenetic effects over and in addition to genetic predisposition have been described and are being studied. Stark differences are being noted between prevalence of atopic diseases in the so-called westernized countries and other parts of the world. Investigation of contributing factors to allow for primary prevention and develop targeted interventions to halt the progression of atopic diseases is ongoing.
Chapter
Celiac disease is a systemic immune-mediated disorder caused by the ingestion of gluten in genetically susceptible persons. It is one of the most common lifelong disorders, affecting 1%–2% of the population worldwide. The prevalence of celiac disease has increased in some countries over recent decades, pointing to the role of one or more possible environmental triggers, other than gluten, that could be involved in its pathogenesis. It has been hypothesized that early nutrition may have a role in the switches of the tolerance–intolerance immune balance. However, both breastfeeding and age at gluten introduction were deemed less important or perhaps even irrelevant by two randomized clinical trials that failed to find an effect on the risk of celiac disease. Since then attention has shifted, and some evidence emerged on the possible role of the quantity of gluten on the risk of celiac disease. The idea that nutrition in the first years of life is not the only factor for the development of the disease is gaining ground in the recent years, but it may concur with other risk factors (in particular infections in the first years of life, and the composition of intestinal microbiota) to the development of celiac disease.
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After 6 months of age, it becomes increasingly difficult for breastfed infants to meet their nutritional needs (energy, iron, zinc, protein, and some fat-soluble vitamins) from breast milk alone. Therefore, complementary foods should have adequate energy density and contain good sources of iron, zinc, and protein. The introduction of complementary foods (CF) is an important process in infancy that most likely plays a major role in the child’s future development and health. The introduction of CF helps infants to adopt their family’s feeding model finally and gradually. The variation in the age at which an infant reaches new developmental stages is a major reason why population-based guidelines recommend a time period for the introduction of CF as well as for the transition to the family diet. We show that dietary reference values for energy and nutrients can be met using the example of a modular concept, namely the German Dietary Scheme for the First Year of Life.
Chapter
Infancy is the time to form the basis of long-life healthy eating patterns. Eating behavior including food preferences, acceptance and intake, evolves dramatically during the first years of life as a consequence of physiological, functional, and cognitive processes. Progressing from a milk-based diet to complementary foods and to family foods, infants and toddlers learn how to eat through sensory experiences, achievement of oral-motor abilities and observation. Alongside nutritional aspects of breastfeeding and timely complementary feeding, type and style of caregiver-child feeding interaction is fundamental to promote child’s healthy potential. Hence, to set up healthy eating behaviors in their child, parents, and caregivers must be encouraged, educated and guided in adopting adequate feeding practices such as being responsive to infant/toddler’s needs, skills and characteristics to promote self-regulation as well as exposing repeatedly him/her to a variety of novel foods in a positive manner to improve his/her acceptance of nutritious foods. Interventions promoting responsive-parenting-behaviors may be useful in averting detrimental feeding practices and child’s obesity as well. Lastly, feeding guidelines need be improved based on current evidence, while further research is required to establish more conclusive evidence regarding the long-lasting health effects of the different nutritional exposures early-in-life.
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Infants experience rapid growth and development during their first year of life. The objective of the study was to investigate the early dietary habits of Latvian infants and their relation to iron metabolism. The study was composed of Study A “Research on eating habits of infants living in Latvia” (n = 344) and Study B “Research on the association between eating habits of infants living in Latvia and iron metabolism” (n = 73). 89% of infants (n = 18) were breastfed (BF) in the first month, and 21% (n =15) were exclusively BF for the first six months. The average age for introducing complementary food was five months. Iron intake was on average 7.4 mg. Iron deficiency (ID) was in 9.6% (n = 7) and iron deficiency anemia (IDA) in 4.1% (n = 3) of infants. The blood iron level was lower in 30% (n = 8) of infants fed with cow’s milk. For infants who obtained iron predominantly from non-animal products, serum ferritin (SF) was within normal range. SF was within the normal range for 93% (n = 26) of infants who did not consume legumes. Dietary habits of infants in Latvia partly correspond to the guidelines. 63% of infants did not consume enough iron from food and ID was observed in 9.6% of infants and IDA in 4.1%. A lower iron level in blood occurred in breastfed infants and in infants for whom cow’s milk was introduced at an early stage; a lower mean corpuscular volume level was observed in infants whose exclusive breast-feeding continued for at least the first four months; lower SF occurred in breastfed infants, in at least the first four months for exclusively breastfed infants, and in infants for whom whose legumes had been introduced in diet. A higher level of soluble transferrin receptors was observed in infants who were not first-born.
Chapter
Exclusive breastfeeding is the best way to feed all infants. According to literature, 25 up to 50% of infants develop functional gastrointestinal disorders (FGIDs), and half of them present with a combination of different FGIDs. Although considered as benign transient conditions, FGIDs in infants do have negative short- and long-term health consequences, with a major impact on quality of life of the infant and its family. GI microbiota has been shown to be involved in infantile colic (strong), constipation (moderate), and gastroesophageal reflux (weak evidence). Besides reassurance and anticipatory guidance, nutritional interventions restoring a balanced gastrointestinal microbiota appear to be an effective and safe approach to management in specific scenarios. In those infants that cannot be breastfed, the use of partially hydrolyzed whey proteins, reduced lactose, probiotics, and prebiotics, including human milk oligosaccharides, high levels of magnesium and palm-oil free formulas have been shown to be effective in varying degrees in the prevention and management of specific FGIDs. Dietary interventions can improve the quality of life in FGIDs, particularly in infants. Limited data are available in toddlers. Many toddlers have imbalances in dietary intake, and excess dietary protein may play a role. Recurrent abdominal pain or irritable bowel syndrome is frequent in this age group, with few studies suggesting that interventions with an impact on the gastrointestinal microbiota composition might be beneficial. More data are needed in this age group.
Article
Introduction: Vitamin D deficiency is now being recognized as an epidemic worldwide. Recent accumulating data on the vitamin D status of Egyptians indicate a resurgence of its deficiency among otherwise healthy members. Methods: a cross sectional study including 300 children of preschool age, with no rachitic manifestations, recruited from Aboulrich Children Hospital, Cairo University. 25 hydroxyvitamin D was measured by ELISA based technique, levels < 10ng/ml were considered deficient, levels of 10-19.9ng/ml were considered insufficient and levels ≥ 20 ng/ml were considered sufficient. Results:15% of children had sufficient levels of vitamin D, 27.3% had insufficient levels and 57.7% had deficient levels. The mean level of 25 hydroxyvitamin D in our study was 11.9 ng/ml ± 10.19 SD, ranging from 4.6-75.5 ng/ml.Vitamin D levels were significantly higher in children coming from rural areas (P < 0.001), levels were also much higher in children living in sunny areas (P = 0.005). Vitamin D deficiency was more common in the children who didn't receive vitamin D supplementation (P < 0.001). Conclusion:Vitamin D deficiency is a common problem in Egyptian preschool children. Adequate sun exposure and vitamin D supplement are necessary in our community.
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After exclusive breastfeeding periods (6 months), complementary food becomes critical for infant health. To identify the preference and food variety in homemade complementary food, and correlate it with family characteristics and anemia in infant, we conducted a cross-sectional studies. Participants were 51 pairs of infants (6-10 months old) and their mothers in Magelang regency, Central Java, Indonesia. Questionnaires on family characteristics and complimentary food were used. Infant Haemoglobin (Hb) levels measured. This study showed, most mothers selected homemade (64.7%). Almost all infant had anemia (93.9%) and low variation in homemade complementary food (87.9%). The food ingredients used were dominated by rice (72.7%) and vegetables (84.8%). Tubers (3%), nuts (3%), and animal protein sources (15.5%) were least selected. Parental characteristics were not related to the instant or homemade preference (p> 0.05). Higher maternal age (r=0.38; p<0.05) and more food ingredients in homemade complementary food (r=0.92; p<0.05) related to higher Hb level. Since more food ingredients related to lower risk of anemia, enhancing complementary food variation in 6-12 months infant is urgently required. Education for families to assure nutritional sufficiency on 6-12 months infant complementary foods should be easy to access and relevant to the availability of local food ingredients
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This study was designed to examine the knowledge, attitude and practice of Exclusive Breast feeding among women attending postnatal care in Comprehensive Health Centre, Saminaka, Lere L.G.A, Kaduna State. It was a hospital-based descriptive study involving women of childbearing age. One hundred and ten respondents were selected by convenience and data concerning their knowledge, attitude and practice of Exclusive breastfeeding (EBF) was obtained using a set of thirty items structured,self-designed questionnaire. The data was analysed using simple frequency, percentages, mean and Chi-square. The result shows that most of the respondents(28.2%) were in the age category of 21-25 years, with the mean age of 28.5.Majority of the respondents(32.7%) and (39.1%) have attained the level ofprimary and secondary education respectively. The study revealed a high level of awareness (100%) of EBF, however, only few of the respondents have adequate knowledge. Majority of the respondents (55.5%) had positive attitude towards EBF method, however most of the respondents (56.4%) practice complementary feeding, attributable to their culture. P-value = 0.05 significance. Although, breastfeeding is a common practice in this locality, adequate knowledge and practice of EBF is relatively low. Therefore, it is recommended thatrelevant stakeholders, such as the government, donor agencies, health care personnel, as well as Community leaders, should intensify efforts aimed at improving the knowledge and practice of EBF by nursing mothers, towards achieving the sustainable development goal number two and three respectively. Method: Descriptive survey was adopted for this study;the questionnaire was administered to the respondents with the help of trained research assistants. An informed consent from both the authority of the health facility and the respondents were obtained prior to carrying out the process of data collection.
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This study was designed to examine the knowledge, attitude and practice of Exclusive Breast feeding among women attending postnatal care in Comprehensive Health Centre, Saminaka, Lere L.G.A, Kaduna State. It was a hospital-based descriptive study involving women of childbearing age. One hundred and ten respondents were selected by convenience and data concerning their knowledge, attitude and practice of Exclusive breastfeeding (EBF) was obtained using a set of thirty items structured,self-designed questionnaire. The data was analysed using simple frequency, percentages, mean and Chi-square. The result shows that most of the respondents(28.2%) were in the age category of 21-25 years, with the mean age of 28.5.Majority of the respondents(32.7%) and (39.1%) have attained the level ofprimary and secondary education respectively. The study revealed a high level of awareness (100%) of EBF, however, only few of the respondents have adequate knowledge. Majority of the respondents (55.5%) had positive attitude towards EBF method, however most of the respondents (56.4%) practice complementary feeding, attributable to their culture. P-value = 0.05 significance. Although, breastfeeding is a common practice in this locality, adequate knowledge and practice of EBF is relatively low. Therefore, it is recommended thatrelevant stakeholders, such as the government, donor agencies, health care personnel, as well as Community leaders, should intensify efforts aimed at improving the knowledge and practice of EBF by nursing mothers, towards achieving the sustainable development goal number two and three respectively. Method: Descriptive survey was adopted for this study;the questionnaire was administered to the respondents with the help of trained research assistants. An informed consent from both the authority of the health facility and the respondents were obtained prior to carrying out the process of data collection.
Article
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Preface and Acknowledgements This is the first text book that is prepared as a joint work between four Arab countries including Egypt, Jordan, Lebanon and Syria (in alphabetical order) which seeks to present and integrate relevant information related to the field of infant and young child feeding. It is prepared for individuals who wish to specialize in the field of lactation management for promoting, supporting and protecting breastfeeding and continued support of infant feeding in the first five years of life. It is intended for use by countries in different regions of the world with a focus of developing countries and countries where breastfeeding is mandatory for saving lives and achieving the Sustainable Development Goals. This book was prepared in three phases, the first phase was done between the main authors, in the second phase a team from Egypt and a team from Lebanon reviewed and edited the chapters, in the third phase the book was again reviewed and finalized by the main authors. It is divided into 22 chapters that cover the academic, clinical, nutritional and critical management procedures necessary for nutritionists, physicians, health providers to support mothers at different levels of care and in different chronological periods of child development from conception to five years of age and is centered around the needs of both the mother, the baby and the family and community at large for promoting, supporting and protecting breastfeeding. It is tailored to the needs of specialists globally, but especially for those from the developing countries. This book would not have been made possible without the bulk of authentic and growing literature updates and research work, from all over the world, that was accessed online. We are sincerely grateful to the Nutrition Unit in the Eastern Mediterranean Region (EMRO) for its support in the editing and finalization RI�the book to reach its current state. We sincerely appreciate the team in Lebanon led by Dr. Maha Hoteit and included: Lactation Specialist Rim El Hajj Sleiman; Ms. Carla Ibrahim, Holy Spirit University of Kaslik (USEK); Ms. Hala Mohsen, Lebanese University, and Ms. Nour Yazbeck, Lebanese University, who dedicated much time and effort in this work. We are also grateful to the team who assisted Dr. Azza Abul-Fadl from Egypt who included Professor Salah Ali Ismail Ali, Sohag University; Dr. Ahmed Alsaed Younes, Head of EPA and ESBMF; the team from Benha Univeristy including Professor AlRawhaa Abuamer and Dr. Ranya Abdelatty from Benha Faculty of Medicine, and the team from Alexandria University; Professor Nadia Farghaly, Faculty of Medicine, Dr. Ahlam Mahmoud and Dr. Eman Kaluibi, Faculty of Nursing and the team from MCFC including Dr. Shorouk Haithamy and Dr. Samaah Zohair and Organizational psychologist Ms. Iman Sarhan from Newcastle University. This has been an intense and invigorating experience especially with the feedback received from Syria by Dr. Mahmoud Bozo who participated in the activity despite the difficult circumstances in Syria. We are grateful to Dr. Moataz Saleh, Nutrition Specialist and Dr. Naglaa Arafa, Nutrition officer from UNICEF, Cairo office for their technical support. Indeed this work would not have been made possible without the coordinating efforts of Dr Ms. Nashwa Nasr from WHO-EMRO. We received support from the administrators, designers and information technologists and many other experts who supported this work and to whom we are also very grateful. Last but not least we owe this work to the spiritual support of mothers struggling to breastfeed their babies who have inspired us throughout this work and we hope our efforts will reach out to them and to all those who are encouraging, guiding and supporting them in their exceptionally unique motherhood experience. We commend and applaud the many scientists, research workers and authors of books in this field and are grateful to those who delivered libraries to our homes by the internet. We sincerely hope that this material as a publication or an e-book will be a match of their work and meet the needs of a large spectrum of readers, learners and scientists who wish to expand their knowledge in this field. We look forward to expanding this work and making it available in different languages and welcome those who can assist us to accomplish this
Article
Objective This study aimed to characterize the availability, the nutritional composition, and the processing degree of industrial foods for 0-36-month-old children according to the neighborhoods affluence. Design A cross-sectional exploratory study. Setting All food products available in retail stores for children aged 0 to 36 months were analyzed. Data collection took place in two neighborhoods, comparing two different sociodemographic districts (high versus low per capita income), Campanhã and Foz do Douro in Porto,Portugal. Participants A total of 431commercially food products for children aged 0 to 36-month-old children sold in 23 retail stores were identified. Food products were classified according to their processing degree using NOVA. Results For NOVA analysis, 244 food products were included being 82 (33.6%) minimally processed, 25 (10.2%) of processed and 137 (56.1%) were ultra-processed. No food product was classified as culinary ingredient.The products included mostly cereals, yogurts, prevailed in high-income neighborhoods, in 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/minimilly processed products. Conclusions The high availability of UPF offered for 0-36-month-old children should be considered when designing interventions to promote healthy diet in infancy.
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The critical period during which the dietary supply of long-chain polyunsaturated fatty acids (LCPs) may influence the maturation of cortical function in term infants is unknown. The aim of the present study was to determine the relative importance for maturation of the visual cortex of the dietary supply of LCPs during the first 6 wk of life compared with that during weeks 7-52. A randomized controlled clinical trial of LCP supplementation in 65 healthy term infants who were weaned from breast-feeding at 6 wk of age was conducted to determine whether the dietary supply of LCPs after weaning influenced the maturation of visual acuity and stereoacuity. Despite a dietary supply of LCPs from breast milk during the first 6 wk of life, infants who were weaned to formula that did not provide LCPs had significantly poorer visual acuity at 17, 26, and 52 wk of age and significantly poorer stereoacuity at 17 wk of age than did infants who were weaned to LCP-supplemented formula. Better acuity and stereoacuity at 17 wk was correlated with higher concentrations of docosahexaenoic acid in plasma. Better acuity at 52 wk was correlated with higher concentrations of docosahexaenoic acid in plasma and red blood cells. No significant effects of diet on growth were found. The results suggest that the critical period during which the dietary supply of LCPs can influence the maturation of cortical function extends beyond 6 wk of age.
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This review of the developmental readiness of normal, full-term infants to progress from exclusive breastfeeding to the introduction of complementary foods is the result of the international debate regarding the best age to introduce complementary foods into the diet of the breastfed human infant. After a list of definitions, four papers focus on: "Immune System Development in Relation to the Duration of Exclusive Breastfeeding" (Armond S. Goldman); "Gastrointestinal Development in Relation to the Duration of Exclusive Breastfeeding" (W. Allan Walker); "Infant Oral Motor Development in Relation to the Duration of Exclusive Breastfeeding" (Audrey J. Naylor, Sarah Danner, and Sandra Lang); and "Maternal Reproductive and Lactational Physiology in Relation to the Duration of Exclusive Breastfeeding" (Alan S. McNeilly). (SM)
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a2 Unité 342 INSERM, Hôpital Saint Vincent de Paul, 75014 Paris, France
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The growing prevalence of childhood overweight and obesity has renewed interest in determining the influence of the maternal and infant diet on the risk of developing excess fat mass later in life. Review of available human and animal data reporting the effects of dietary fat and fat types early in life on adipose development. Rodent studies tend to show that maternal high-fat feeding during pregnancy and lactation results in increased adiposity of the offspring. Nevertheless, today there is a lack of population-based studies investigating this potential detrimental effect of maternal high-fat intake. Most epidemiological studies, performed so far, do not find any association between the level of dietary fat intake of infants and children and body weight and/or fatness. Regarding fat types exposure to high levels of dietary n-6 fatty acids during gestation and post-natal life, has been shown to promote obesity in mice. Nevertheless, other rodent studies do not demonstrate such an effect. There is no evidence supporting a restriction of fat intake during the first two post-natal years but the potential detrimental effects of maternal high-fat intake during gestation should be further investigated. The role of dietary fat types as early determinants of childhood obesity has so far been poorly studied. Robust evidence to support the adipogenic effects of n-6 fatty acids enriched-diets is currently lacking but this hypothesis is of importance and should be further evaluated in different animal models as well as in longitudinal human studies.
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Using a desalivated rat model, the authors found that several commonly used infant formulas had significant cariogenic potential. Sucrose was by far the most cariogenic and cows' milk the least cariogenic of all the products examined. The data show that dental practitioners and other health care professionals should discourage the use of sugar in baby bottles and provide information on which formulas are least likely to induce caries when continuous bottle feeding is unavoidable.
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To investigate the relation of infant feeding practice to childhood respiratory illness, growth, body composition, and blood pressure. Follow up study of a cohort of children (mean age 7.3 years) who had detailed infant feeding and demographic data collected prospectively during the first two years of life. Dundee. 674 infants, of whom 545 (81%) were available for study. Data on respiratory illness were available for 545 children (mean age 7.3 (range 6.1-9.9) years); height for 410 children; weight and body mass index for 412 children; body composition for 405 children; blood pressure for 301 children (mean age 7.2 (range 6.9-10.0) years). Respiratory illness, weight, height, body mass index, percentage body fat, and blood pressure in relation to duration of breast feeding and timing of introduction of solids. After adjustment for the significant confounding variables the estimated probability of ever having respiratory illness in children who received breast milk exclusively for at least 15 weeks was consistently lower (17.0% (95% confidence interval 15.9% to 18.1%) for exclusive breast feeding, 31.0% (26.8% to 35.2%) for partial breast feeding, and 32.2% (30.7% to 33.7%) for bottle feeding. Solid feeding before 15 weeks was associated with an increased probability of wheeze during childhood (21.0% (19.9% to 22.1%) v 9.7% (8.6% to 10.8%)). It was also associated with increased percentage body fat and weight in childhood (mean body fat 18.5% (18.2% to 18.8%) v 16.5% (16.0% to 17.0%); weight standard deviation score 0.02 (-0.02 to 0.06) v -0.09 (-0.16 to 0.02). Systolic blood pressure was raised significantly in children who were exclusively bottle fed compared with children who received breast milk (mean 94.2 (93.5 to 94.9) mm Hg v 90.7 (89.9 to 91.7) mm Hg). The probability of respiratory illness occurring at any time during childhood is significantly reduced if the child is fed exclusively breast milk for 15 weeks and no solid foods are introduced during this time. Breast feeding and the late introduction of solids may have a beneficial effect on childhood health and subsequent adult disease.
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To evaluate the effect of introducing complementary foods before 6 mo of age, we randomly assigned 164 infants who had been exclusively breast-fed for 4 mo to continue being exclusively breast-fed until 6 mo (EBF group) or to receive iron-fortified foods in addition to breast milk from 4 to 6 mo (BF+SF group). At 6 mo, the BF+SF group had higher mean iron intake (4 mg/d compared with 0.2 mg/d in EBF infants) and higher hemoglobin, hematocrit, and ferritin values than the EBF group (P < 0.05). The percentage with low hemoglobin (< 103 g/L) did not differ significantly between groups, but fewer infants in the BF+SF group had a low hematocrit (< 0.33; 21.4% compared with 32.0%, respectively; P < 0.05). The percentage of infants with ferritin concentrations < 12 microg/L at 6 mo was lower than the percentage with low hemoglobin or hematocrit, raising questions about the validity of the cutoffs at this age. Infants at greatest risk for anemia and low ferritin were those with birth weights < 2500 g; no infant with a birth weight > 3000 g had a low ferritin value at 6 mo. We conclude that the risk of iron deficiency is low among infants with birth weights > 3000 g who are exclusively breast-fed for 6 mo. Iron drops are recommended for low-birth-weight infants; for breast-fed infants with birth weights between 2500 and 3000 g, further research is needed to determine whether iron drops are more effective than complementary foods for preventing iron deficiency before 6 mo.
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The maximum and minimum fat intakes that are physiologically tolerable by healthy infants and young children are not well defined. The maximum tolerable fat intake appears to be limited by the minimum requirements of protein, carbohydrates and micronutrients. It is unresolved whether or not there is a minimum metabolic requirement of dietary fat, beyond the requirements of essential fatty acids and lipid soluble vitamins and the effects on energy density and an adequate total energy intake. The first postnatal months of the human infant are characterized by a rapid weight gain and extensive fat deposition. Body fat deposition equals 25% of the total energy intake during the first 2 and 16% during the third and fourth months, respectively. The provision of dietary lipids in amounts at least matching the needs for tissue storage and fat oxidation appears to be of advantage for energy balance and physiological growth. Some reports have associated low fat diets with less than 30% of energy as fat with adverse effects on child growth beyond infancy, but it remains unresolved whether these effects were caused by an associated effect on dietary energy density and total intake of energy and other nutrients. Closely supervised, healthy infants from an affluent population grew normally with a diet providing about 30% of the energy as fat from the seventh month of life onwards, but it is not known to what extent adaptive mechanisms such as a reduction of physical activity may have been required. It is not known whether infants and young children stressed by frequent occurrence of diarrhea and infections may adapt to a 30% fat diet as well or not. No evidence is available for a health benefit of a low total fat intake in infancy. In view of the limited available information, further research is required to define optimal fat intakes in early childhood since this question is of major importance for child health.
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TREATMENT OF ALLERGIC REACTIONS TO FOOD PROTEINS: Infants with confirmed food protein allergy should be treated by complete exclusion of the causal protein - In exclusively breast fed infants, a strict elimination of the causal protein from the diet of the lactating mother should be tried - Infants with cows' milk protein allergy who are not breast fed should receive a dietary product with highly reduced allergenicity based on 'extensively' hydrolysed protein or, in selected cases, a product based on an amino acid mixture - In infants with adverse reactions to food proteins and malabsorptive enteropathy, the use of a formula with highly reduced allergenicity (extensively hydrolysed formula or amino acid mixture) without lactose and with medium chain triglycerides might be useful until normal absorptive function of the mucosa is regained - For the treatment of most infants with food allergy whose digestive and absorptive functions show no major disturbances, products with highly reduced allergenicity based on extensively hydrolysed protein or amino acid mixtures, but whose other compositional characteristics meet the European union criteria for infant formulas, is recommended - Diets based on unmodified proteins of other species' milk (for example, goats' or sheep's milk), or so called 'partially' hydrolysed formulas should not be used for the treatment of cows' milk protein allergy. - PREVENTION OF ADVERSE REACTIONS TO FOOD PROTEINS: Exclusive breast feeding during the first 4-6 months of life might greatly reduce the incidence of allergic manifestations and is strongly recommended - Supplementary foods should not be introduced before the 5th month of life - In bottle fed infants with a documented hereditary atopy risk (affected parent or sibling), the exclusive feeding of a formula with a confirmed reduced allergenicity is recommended because it can reduce the incidence of adverse reactions to food, especially to cows' milk protein - More studies comparing the preventive effects of formulas that have highly reduced allergenicity with formulas that have moderately reduced allergenicity are needed - Dietary products used for preventive purposes in infancy need to be evaluated carefully with respect to their preventive and nutritional effects in appropriate clinical studies - There is no conclusive evidence to support the use of formulas with reduced allergenicity for preventive purposes in healthy infants without a family history of allergic disease.
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The hypothesis that preweaning nutrition influences adult fat cell number and adiposity was tested in baboons. Newborn baboons were fed Similac formulas with caloric densities of 40.5 kcal (underfed), 67.5 kcal (fed normally), and 94.5 kcal (overfed) per 100 g formula. From weaning (16 wk) until necropsy at 5 yr of age all baboons were fed the same diet. At necropsy, fat cell number and fat cell size in 10 fat depots were measured. Female baboons overfed as infants had markedly greater fat depot mass, primarily because of fat cell hypertrophy, than normally fed or underfed females. Overfed male baboons had a greater fat mass in 4 of 10 depots compared with males underfed or fed normally as infants. Underfeeding did not affect body weight, nor adipose mass of either sex. The results show that infant food intake does not have a major influence on the fat cell number of young adult baboons.
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Taste preferences for sucrose solutions and water were studied in 199 human infants at birth and 140 of the same infants at 6 months of age. Taste preferences were determined by allowing ad libitum ingestion of sucrose solutions and water during brief presentations. At 6 months, 7-day dietary records for the infants were obtained from the mothers. According to the dietary records, many infants (27%) were fed sweetened water (water plus table sugar, honey or Karo syrup) by their mothers. Compared with infants not fed sweetened water, the infants fed sweetened water ingested more sucrose solution but not more water during the brief taste tests conducted at 6 months of age. Those infants not fed sweetened water exhibited a diminished intake of sucrose solution relative to water at 6 months of age. In contrast, infants fed sweetened water at 6 months maintained the same level of intake of sucrose solution relative to water as existed at birth. The data obtained also revealed relationships between intake of taste solutions and whether the infant was breast or bottle fed, whether the infant was black or white, and birth weight of the infant. None of these factors interacted with the sweet water feeding history variable. These data suggest that the experience of consuming sweetened water maintains the preference for sucrose solutions whereas an absence of this experience results in a depression of preference. Experimental studies are needed to investigate this phenomenon further.
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Coronary heart disease is a major cause of morbidity and mortality in Europe, particularly northern, central, and eastern Europe. Several strategies have been recommended for children and adolescents to promote a healthy lifestyle and thereby reduce the risk of coronary heart disease in later life. The European Society of Pediatric Gastroenterology and Nutrition (ESPGAN) Committee on Nutrition reviewed some of these strategies, and our conclusions and recommendations are reported herein.
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In vivo and in vitro experiments strongly support the view that marked increases in the levels of mRNA and in the activities of lipogenic enzymes that occur in liver and white adipose tissue of the rat after weaning to a high-carbohydrate diet are dependent on an increase in plasma glucose and insulin concentrations. An increased glucose metabolism is necessary for the expression of insulin effects on fatty acid synthase (FAS) and acetyl-CoA carboxylase (ACC) mRNA accumulation in white adipose tissue, as insulin is ineffective in vitro in the absence of glucose. It is suggested that intracellular glucose-6-phosphate could play an important role in the effect of insulin on lipogenic enzyme gene expression in white adipose tissue. Other hormones and substrates could also play a role in the surge of lipogenesis after weaning. The fall in plasma glucagon after weaning to a high-carbohydrate diet could reinforce the insulin-induced accumulation of FAS and ACC mRNA, as this hormone inhibits the accumulation of lipogenic enzyme mRNA in liver and white adipose tissue. The decrease in the dietary supply of fat after weaning to a high-carbohydrate diet could also potentiate the accumulation of FAS and ACC mRNA in liver because long-chain poly-unsaturated fatty acids are potent inhibitors of the expression of the genes encoding liver lipogenic enzymes. A direct effect of fatty acids on a cis-acting element of the lipogenic enzyme genes could be involved, as the regulatory region of FAS gene contains a polyunsaturated fatty acid response element that shares some similarity with the peroxisome proliferator-activated receptor recently described.
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A population-based study on the nutritional status of children consuming macrobiotic diets was carried out in The Netherlands. Participants followed a macrobiotic diet based mainly on whole-grain cereals, pulses, and vegetables. Studies in children aged 0-10 y suggested that growth was retarded mainly between 6 and 18 mo. This was confirmed in a subsequent mixed-longitudinal study (including data on diet, anthropometry, blood chemistry, and pediatric examination) in 4-18 mo-old macrobiotic infants and a matched omnivorous control group. Ubiquitous deficiencies of energy, protein, vitamin B-12, vitamin D, calcium, and riboflavin were detected in macrobiotic infants, leading to retarded growth, fat and muscle wasting, and slower psychomotor development. Breast milk from macrobiotic mothers contained less vitamin B-12, calcium, and magnesium. Supplementation of the macrobiotic diet with fat (minimum 20-25 g/d), fatty fish (minimum 100-150 g/wk), and dairy products (minimum 150-250 g/d) is recommended.
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To assess the relations between early introduction of solid food and infant weight, gastrointestinal illness, and allergic illnesses during the first two years of life. Prospective observational study of infants followed up for 24 months after birth. Community setting in Dundee. 671 newborn infants, of whom 455 were still available for study at 2 years of age. Infants' diet, weight, and incidence of gastrointestinal illness, respiratory illness, napkin dermatitis, and eczema at 2 weeks and 2, 3, 4, 6, 9, 12, 15, 18, 21, and 24 months of age. The infants given solid food at an early age (at < 8 weeks or 8-12 weeks) were heavier than those introduced to solids later (after 12 weeks) at 4, 8, 13, and 26 weeks of age (p < 0.01) but not at 52 and 104 weeks. At their first solid feed those given solids early were heavier than infants of similar age who had not yet received solids. The incidence of gastrointestinal illness, wheeze, and nappy dermatitis was not related to early introduction of solids. There was a significant but less than twofold increase in respiratory illness at 14-26 weeks of age and persistent cough at 14-26 and 27-39 weeks of age among the infants given solids early. The incidence of eczema was increased in the infants who received solids at 8-12 weeks of age. Early introduction of solid food to infants is less harmful than was previously reported. Longer follow up is needed, but, meanwhile, a more relaxed approach to early feeding with solids should be considered.