Parent-reported offering of allergen foods to infants during complementary feeding: An observational study of New Zealand infants.

The prevalence of food allergies in New Zealand infants is uncertain but is believed to be similar to Australia, exceeding 10%. Current recommendations for reducing food allergy risk are to offer all major food allergens to infants from as early as six months of age (start of complementary feeding), and before 12 months of age. However, little is known regarding parental practices around introducing major food allergens. This study aimed to explore parental offering of major food allergens to infants during complementary feeding, and parent-reported food allergies. The cross-sectional study is a secondary analysis of the multi-centre (Auckland and Dunedin) First Foods New Zealand study of 625 parent-infant dyads. Participants were recruited in 2020-2022 when infants were 7-10 months of age. Questionnaires assessed sociodemographic characteristics, complementary feeding approach, infant pouch use and parental responses to five food allergy questions. All major food allergens had been offered to only 17% of infants by 9-10 months of age. Having offered egg, peanut, tree nuts, sesame, soy and seafood was more commonly associated with using a baby-led complementary feeding approach than a parent-led approach (p < 0.001). Frequent baby food pouch use was associated with a lower likelihood of offering egg and peanut (both p < 0.001). Overall, 12.6% of infants had a reported food allergy, with symptomatic response after exposure being the most common diagnostic tool. Most infants are not offered all major food allergens during early complementary feeding, with some parents actively avoiding major food allergens in the first year of life. These results provide up-to-date knowledge of parental practices, highlighting the need for more targeted advice and strategies to improve parental engagement with allergy prevention and diagnosis.

Household food insecurity and novel complementary feeding methods in New Zealand families.

Optimal nutrition during infancy is critical given its influence on lifelong health and wellbeing. Two novel methods of infant complementary feeding, commercial baby food pouch use and baby-led weaning (BLW), are becoming increasingly popular worldwide. Household food insecurity may influence complementary feeding practices adopted by families, but no studies have investigated the use of BLW and baby food pouches in families experiencing food insecurity. The First Foods New Zealand study was a multicentre, observational study in infants 7.0-9.9 months of age. Households (n = 604) were classified into one of three categories of food insecurity (severely food insecure, moderately food insecure, and food secure). The use of complementary feeding practices was assessed via a self-administered questionnaire, both at the current age (mean 8.4 months) and retrospectively at 6 months. Mothers experiencing severe food insecurity had 5.70 times the odds of currently using commercial baby food pouches frequently (≥5 times/week) compared to food secure mothers (95% CI [1.54, 21.01]), reporting that pouches were 'easy to use' (89%) and made it 'easy to get fruits and vegetables in' (64%). In contrast, no evidence of a difference in the prevalence of current BLW was observed among mothers experiencing moderate food insecurity (adjusted OR; 1.28, 95% CI [0.73, 2.24]) or severe food insecurity (adjusted OR; 1.03, 95% CI [0.44, 2.43]) compared to food secure mothers. The high prevalence of frequent commercial baby food pouch use in food insecure households underscores the need for research to determine whether frequent pouch use impacts infant health.

Frequent Use of Baby Food Pouches in Infants and Young Children and Associations with Energy Intake and BMI: An Observational Study.

OBJECTIVE: Most wet commercial infant foods are now sold in squeezable 'pouches'. While multiple expert groups have expressed concern about their use, it is not known how commonly they are consumed and whether they impact energy intake or body mass index (BMI). The objectives were to describe pouch use, and determine associations with energy intake and BMI, in infants and young children. METHODS: In this observational cross-sectional study of 933 young New Zealand children (6.0 months-3.9 years), pouch use was assessed by a questionnaire ('frequent' use was consuming food from a baby food pouch ≥5 times/week in the past month), usual energy intake using two 24-h recalls, and BMI z-score calculated using World Health Organization standards. RESULTS: The sample broadly represented the wider population (27.1% high socioeconomic deprivation, 22.5% Maori). Frequent pouch use declined with age (infants 27%, toddlers 16%, preschoolers 8%). Few children were both frequent pouch users and regularly used the nozzle (infants 5%, toddlers 13%, preschoolers 8%). Preschoolers who were frequent pouch users consumed significantly less energy than non-users (-580 kJ [-1094, -67]), but infants (115 [-35, 265]) and toddlers (-206 [-789, 378]) did not appear to have a different energy intake than non-users. There were no statistically significant differences in the BMI z-score by pouch use. CONCLUSIONS: These results do not support the strong concerns expressed about their use, particularly given the lack of evidence for higher energy intake or BMI.

Equations to estimate human milk intake in infants aged 7 to 10 months: prediction models from a cross-sectional study.

BACKGROUND: Obtaining valid estimates of nutrient intake in infants is currently limited by the difficulties of accurately measuring human milk intake. Current methods are either unsuitable for large-scale studies (i.e., the gold standard dose-to-mother stable isotope technique) or use set amounts, regardless of known variability in individual intake. OBJECTIVES: This cross-sectional study aimed to develop equations to predict human milk intake using simple measures and to carry out external validation of existing methods against the gold standard technique. METHODS: Data on human milk intake were obtained using the dose-to-mother stable isotope technique in 157 infants aged 7-10 mo and their mothers. Predictive equations were developed using questionnaire and anthropometric data (Model 1) and additional dietary data (Model 2) using lasso regression. Bland-Altman plots and intraclass correlation coefficients (ICC) also assessed the validity of existing methods (FITS and ALSPAC studies). RESULTS: The strongest univariate predictors of human milk intake in infants of 8.3 mo on average (46% female) were infant age, infant body mass index (BMI), number of breastfeeds a day, infant formula consumption, and energy from complementary food intake. Mean [95% confidence interval (CI)] differences in predicted versus measured human milk intake [mean (SD): 762 (257) mL/day] were 0.0 mL/day (-26, 26) for Model 1 (ICC 0.74) and 0.5 mL/day (-21, 22) for Model 2 (ICC 0.83). Corresponding differences were -197 mL/day (-233, -161; ICC 0.32) and -175 mL/day (-216, -134; ICC 0.41) for the methods used by FITS and ALSPAC, respectively. CONCLUSIONS: The Human Milk Intake Level Calculation provides substantial improvements on existing methods to estimate human milk intake in infants aged 7-10 mo, while utilizing data commonly collected in nutrition surveys. Although further validation in an external sample is recommended, these equations can be used to estimate human milk intake at this age with some confidence. This clinical trial was registered at http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379436) as ACTRN12620000459921.

Baby Food Pouches, Baby-Led Weaning, and Iron Status in New Zealand Infants: An Observational Study.

Iron deficiency in infants can impact development, and there are concerns that the use of baby food pouches and baby-led weaning may impair iron status. First Foods New Zealand (FFNZ) was an observational study of 625 New Zealand infants aged 6.9 to 10.1 months. Feeding methods were defined based on parental reports of infant feeding at "around 6 months of age": "frequent" baby food pouch use (five+ times per week) and "full baby-led weaning" (the infant primarily self-feeds). Iron status was assessed using a venepuncture blood sample. The estimated prevalence of suboptimal iron status was 23%, but neither feeding method significantly predicted body iron concentrations nor the odds of iron sufficiency after controlling for potential confounding factors including infant formula intake. Adjusted ORs for iron sufficiency were 1.50 (95% CI: 0.67-3.39) for frequent pouch users compared to non-pouch users and 0.91 (95% CI: 0.45-1.87) for baby-led weaning compared to traditional spoon-feeding. Contrary to concerns, there was no evidence that baby food pouch use or baby-led weaning, as currently practiced in New Zealand, were associated with poorer iron status in this age group. However, notable levels of suboptimal iron status, regardless of the feeding method, emphasise the ongoing need for paying attention to infant iron nutrition.

Contribution of Infant Food Pouches and Other Commercial Infant Foods to the Diets of Infants: A Cross-sectional Study.

BACKGROUND: Although considerable concern has been expressed about the nutritional implications of infant food pouches, how they impact infant diet has not been examined. OBJECTIVES: The objective of this study was to determine the contribution of infant food pouches specifically, and commercial infant foods generally, to nutrient intake from complementary foods in infants. METHODS: Two multiple-pass 24-h diet recall data were collected from 645 infants (6.0-11.9 mo) in the First Foods and Young Foods New Zealand studies. Detailed information was obtained on commercial infant food use, including pouches, and nutrient composition was calculated through recipe modeling. RESULTS: The diverse sample (46.1% female; 21.1% Maori, 14.1% Asian, and 54.6% European) was aged (SD) 8.4 (0.9) mo. More than one-quarter of households had high socioeconomic deprivation. Almost half (45.3%) of infants consumed an infant food pouch on ≥1 recall day [mean (SD), 1.3 (0.9) times/d], obtaining 218 (124) kJ of energy on each eating occasion. Comparable numbers for all commercial infant and toddler foods (CITFs) were 78.0%, contributing 2.2 (1.6) and 140 (118) kJ of energy. Infant food pouches provided 25.5% of the total energy from complementary foods in those infants who consumed pouches on the recall days but just 11% in all infants. Median percentage contribution of infant food pouches to nutrient intake from complementary foods in consumers ranged from <1% (added sugars and retinol) to >30% (carbohydrate, total sugars, fiber, vitamin A, and vitamin C). CITF contributed 21.4% of energy from complementary foods for infant consumers, with median percentage contribution ranging from 0.1% (retinol) to 40.3% (iron). CONCLUSIONS: Infant food pouches make relatively small contributions to energy intake in infants but are important sources of carbohydrates, fiber, and vitamins A, C, and B-6. Almost half of the total sugars consumed from complementary foods is provided by these pouches. This trial was registered at the Australian New Zealand Clinical Trials Registry as ACTRN12620000459921.

Baby food pouches and Baby-Led Weaning: Associations with energy intake, eating behaviour and infant weight status.

Although concern is frequently expressed regarding the potential impact of baby food pouch use and Baby-Led Weaning (BLW) on infant health, research is scarce. Data on pouch use, BLW, energy intake, eating behaviour and body mass index (BMI) were obtained for 625 infants aged 7-10 months in the First Foods New Zealand study. Frequent pouch use was defined as ≥5 times/week during the past month. Traditional spoon-feeding (TSF), "partial" BLW and "full" BLW referred to the relative proportions of spoon-feeding versus infant self-feeding, assessed at 6 months (retrospectively) and current age. Daily energy intake was determined using two 24-h dietary recalls, and caregivers reported on a variety of eating behaviours. Researchers measured infant length and weight, and BMI z-scores were calculated (World Health Organization Child Growth Standards). In total, 28% of infants consumed food from pouches frequently. Frequent pouch use was not significantly related to BMI z-score (mean difference, 0.09; 95% CI -0.09, 0.27) or energy intake (92 kJ/day; -19, 202), but was associated with greater food responsiveness (standardised mean difference, 0.3; 95% CI 0.1, 0.4), food fussiness (0.3; 0.1, 0.4) and selective/restrictive eating (0.3; 0.2, 0.5). Compared to TSF, full BLW was associated with greater daily energy intake (BLW at 6 months: mean difference 150 kJ/day; 95% CI 4, 297; BLW at current age: 180 kJ/day; 62, 299) and with a range of eating behaviours, including greater satiety responsiveness, but not BMI z-score (6 months: 0.06 (-0.18, 0.30); current age: 0.06 (-0.13, 0.26)). In conclusion, neither feeding approach was associated with weight in infants, despite BLW being associated with greater energy intake compared with TSF. However, infants who consumed pouches frequently displayed higher food fussiness and more selective eating.

Micronutrient status of New Zealand adolescent women consuming vegetarian and non-vegetarian diets.

BACKGROUND AND OBJECTIVES: Globally, there appears to be an ever-increasing interest in adopting a vegetarian diet. However, there are concerns that avoiding meat may increase the risk of anaemia and micronutrient deficiencies, especially for vulnerable populations, such as adolescent women. The objective of this study was to compare the micronutrient status of vegetarian and non-vegetarian adolescent women in New Zealand. METHODS AND STUDY DESIGN: Adolescent women aged 15-18 y were recruited from eight locations across New Zealand. Blood samples were analysed for: haemoglobin, serum ferritin, soluble transferrin receptor, zinc, selenium, retinol binding protein, folate, vitamin B-12, vitamin D and parathyroid hormone. RESULTS: Of the 182 participants who provided a blood sample, 15% self-identified as vegetarian (n=27). On average, vegetarians had 3.1% (95% CI -5.8 to -0.4, p=0.025) lower haemoglobin, and 8.3% (95%CI -14.1 to -2.1, p=0.004) lower selenium. In contrast, serum folate was 80.5% (95% CI 45.7 to 123.7, p<0.001) higher. The prevalence of zinc and selenium deficiency was higher among vegetarians (50% and 12%, respectively) than non-vegetarians (21%, and 2%, respectively). CONCLUSIONS: Adolescent vegetarian women may be at increased risk of deficiency of micronutrients commonly found in animal products, including zinc and selenium, and may benefit from following dietary practices that enhance micronutrient intake and absorption.

Adherence to Infant Feeding Guidelines in the First Foods New Zealand Study.

Infant feeding guidelines provide evidence-based recommendations to support optimal infant health, growth, and development, and exploring adherence to guidelines is a useful way of assessing diet quality. The aim of this study was to determine adherence to the recently updated Ministry of Health "Healthy Eating Guidelines for New Zealand Babies and Toddlers (0-2 years old)". Data were obtained from First Foods New Zealand, a multicentre observational study of 625 infants aged 7.0-10.0 months. Caregivers completed two 24-h diet recalls and a demographic and feeding questionnaire. Nearly all caregivers (97.9%) initiated breastfeeding, 37.8% exclusively breastfed to around six months of age, and 66.2% were currently breastfeeding (mean age 8.4 months). Most caregivers met recommendations for solid food introduction, including appropriate age (75.4%), iron-rich foods (88.3%), puréed textures (80.3%), and spoon-feeding (74.1%). Infants consumed vegetables (63.2%) and fruit (53.9%) more frequently than grain foods (49.5%), milk and milk products (38.6%), and meat and protein-rich foods (31.8%). Most caregivers avoided inappropriate beverages (93.9%) and adding salt (76.5%) and sugar (90.6%). Our findings indicated that while most infants met the recommendations for the introduction of appropriate solid foods, the prevalence of exclusive breastfeeding could be improved, indicating that New Zealand families may need more support.

Rapid infant weight gain or point-in-time weight status: Which is the best predictor of later obesity and body composition?

OBJECTIVE: The aim of this study was to determine which growth indicator (weight, weight-for-length, BMI) and time frame (6- or 12-month intervals between 0 and 24 months) of rapid infant weight gain (RIWG) best predicted obesity risk and body composition at 11 years of age. METHODS: RIWG (increase ≥0.67 z scores between two time points) was calculated from weight and length/height at birth, 0.5, 1, 1.5, and 2 years. The predictive value of each measure and time frame was calculated in relation to obesity (BMI ≥95th percentile) and body fat (fat mass index [FMI], dual-energy X-ray absorptiometry scan) at 11 years. RESULTS: The sensitivity (1.5% to 62.1%) and positive predictive value (12.5% to 33.3%) of RIWG to predict obesity varied considerably. Having obesity at any time point appeared a stronger risk factor than any indicator of RIWG for obesity at 11 years. Obesity at any age during infancy consistently predicted a greater FMI of around 1.1 to 1.5 kg/m2 at 11 years, whereas differences for RIWG were inconsistent. CONCLUSIONS: A simple measure of obesity status at a single time point between 6 and 24 months of age appeared a stronger risk factor for later obesity and FMI than RIWG assessed by any indicator, over any time frame.

A Qualitative Study of Parental Perceptions of Baby Food Pouches: A Netnographic Analysis.

Globally, a recent phenomenon in complementary feeding is the use of squeezable baby food pouches. However, some health agencies have raised concerns about their possible long-term health effects. The aim of this study was to describe parental perceptions of the use of baby food pouches during complementary feeding (i.e., the transition from an entirely milk-based diet to solid foods) using a netnographic analysis of discussions on publicly available forums. In this study, the community was parents of young children. Six parenting forums were identified through a Google search using defined selection criteria. Discussion threads relating to baby food pouches were collected and imported into NVivo12 for thematic analysis via inductive reasoning. Perceptions of baby food pouches fell within two broad categories-benefits and concerns. The most commonly reported themes related to benefits were: convenience, health, baby enjoys, variety, and cost; whereas the most common concerns reported were: health, cost, lack of dietary exposure, dependence, and waste. Many parents reported both benefits and concerns. Once research has determined the long-term effect of using pouches on infants' health regarding eating habits, nutritional status, growth, and development, the findings of this study can inform educational strategies to either encourage or discourage their use.

Selenium intakes and plasma selenium of New Zealand toddlers: secondary analysis of a randomised controlled trial.

Little is known about Se intakes and status in very young New Zealand children. However, Se intakes below recommendations and lower Se status compared with international studies have been reported in New Zealand (particularly South Island) adults. The Baby-Led Introduction to SolidS (BLISS) randomised controlled trial compared a modified version of baby-led weaning (infants feed themselves rather than being spoon-fed), with traditional spoon-feeding (Control). Weighed 3-d diet records were collected and plasma Se concentration measured using inductively coupled plasma mass spectrometry (ICP-MS). In total, 101 (BLISS n 50, Control n 51) 12-month-old toddlers provided complete data. The OR of Se intakes below the estimated average requirement (EAR) was no different between BLISS and Control (OR: 0·89; 95 % CI 0·39, 2·03), and there was no difference in mean plasma Se concentration between groups (0·04 µmol/l; 95 % CI -0·03, 0·11). In an adjusted model, consuming breast milk was associated with lower plasma Se concentrations (-0·12 µmol/l; 95 % CI -0·19, -0·04). Of the food groups other than infant milk (breast milk or infant formula), 'breads and cereals' contributed the most to Se intakes (12 % of intake). In conclusion, Se intakes and plasma Se concentrations of 12-month-old New Zealand toddlers were no different between those who had followed a baby-led approach to complementary feeding and those who followed traditional spoon-feeding. However, more than half of toddlers had Se intakes below the EAR.

Investigating the moderators and mediators of an effective sleep intervention in the Prevention of Overweight in Infancy (POI) randomized controlled trial: Exploratory analyses.

The Prevention of Overweight in Infancy (POI) sleep intervention halved obesity risk at 2 years of age. However, the intervention mechanisms are unclear. Consequently, the objective of the current work was to use exploratory analyses to investigate potential moderators and mediators of the sleep intervention on obesity outcomes at age 2 years. Data were collected between 2009 and 2012. The effect of demographic and study design variables on body mass index z-score (BMI z-score) and obesity was compared in moderator subgroups at 2 years of age (n = 683, 85%). Mediating effects of child and parent-household variables assessed whether the sleep intervention resulted in meaningful changes in the mediating variable (defined as changes which were statistically significant [p < .05] or where the effect size was ≥0.15 SD), followed by assessing relationships with obesity outcomes. The sleep intervention appeared most effective in children in higher deprivation areas (effect on BMI z-score -0.25 [-0.53, 0.04], effect on obesity odds ratio [OR] 0.43 [0.16, 1.13]), and with mothers of non-European, non-Maori ethnicity (effect on BMI z-score -0.27 [-0.73, 0.20], effect on obesity OR 0.13 [95% confidence interval 0.01, 1.11]). This suggested moderation by deprivation and ethnicity. Aspects of sleep improved meaningfully in children after intervention but did not significantly relate to obesity outcomes, and other outcomes were not meaningfully affected by the sleep intervention. Thus, mediation was not indicated. Overall, the POI sleep intervention improved obesity outcomes at 2 years, and the current work identified some potential moderators, but no mediators.

Relative Validity and Reproducibility of a Semi-Quantitative Food Frequency Questionnaire for Determining Nutrient Intake in Older Adults in New Zealand: The REACH Study.

Dietary intake is an important predictor of health and disease outcomes. This cross-sectional study evaluated the relative validity and reproducibility of a semi-quantitative food frequency questionnaire (FFQ) for assessing energy and nutrient intake in older adults. Dietary data were collected 2018-2019 in Auckland, New Zealand from a convenience sample of community-dwelling adults (65-74 years, n = 294, 37% male) using a 109-item self-administered FFQ at baseline (FFQ1) and four weeks later to assess reproducibility. FFQ1 was compared to a four-day food record to determine relative validity. Agreement between dietary assessment tools was assessed for both raw and energy-adjusted nutrient intakes using paired t-tests, correlation coefficients, weighted kappa statistic, Bland-Altman plots, and linear regression analysis. Energy adjustments moderately improved the relative validity and reproducibility for most nutrients. For energy and energy-adjusted nutrient intakes, the mean correlation coefficients were 0.38 (validity) and 0.65 (reproducibility); the mean weighted kappa statistics were 0.27 (validity) and 0.51 (reproducibility). A significant slope of bias was present in 54% (validity) and 25% (reproducibility) of Bland-Altman plots. The Researching Eating, Activity, and Cognitive Health (REACH) FFQ has acceptable relative validity and good reproducibility for ranking nutrient intakes in older New Zealand adults, but is less suitable for assessing absolute nutrient intakes.

Dietary patterns and cognitive function in older New Zealand adults: the REACH study.

PURPOSE: The global population is ageing. Evidence show dietary patterns may be associated with cognitive status in older adults. This cross-sectional study investigated associations between dietary patterns and cognitive function in older adults in New Zealand. METHODS: The REACH study (Researching Eating, Activity, and Cognitive Health) included 371 participants (65-74 years, 36% male) living independently in Auckland, New Zealand. Valid and reproducible dietary patterns were derived, using principal component analysis, from dietary data collected by a 109-item validated food frequency questionnaire. Six cognitive domains (global cognition, attention and vigilance, executive function, episodic memory, working memory, and spatial memory) were tested using COMPASS (Computerised Mental Performance Assessment System). Associations between dietary patterns and cognitive scores, adjusted for age, sex, education, physical activity, energy, and Apolipoprotein E-ε4 status were analysed using multiple linear regression analysis. RESULTS: Three dietary patterns explained 18% of dietary intake variation-'Mediterranean style' (comprising: salad vegetables, leafy cruciferous vegetables, other vegetables, avocados and olives, alliums, nuts and seeds, white fish and shellfish, oily fish, and berries); 'Western' (comprising: processed meats, sauces and condiments, cakes, biscuits and puddings, meat pies and chips, and processed fish); and 'Prudent' (comprising: dried legumes, soy-based foods, fresh and frozen legumes, whole grains, and carrots). No associations between any cognitive domain and dietary pattern scores were observed. Global cognitive function was associated with being younger and having a university education. CONCLUSION: In this cohort of community-dwelling, older adults in New Zealand, current dietary patterns were not associated with cognitive function.

Associations between dietary patterns and the metabolic syndrome in older adults in New Zealand: the REACH study.

The metabolic syndrome is common in older adults and may be modified by the diet. The aim of this study was to examine associations between a posteriori dietary patterns and the metabolic syndrome in an older New Zealand population. The REACH study (Researching Eating, Activity, and Cognitive Health) included 366 participants (aged 65-74 years, 36 % male) living independently in Auckland, New Zealand. Dietary data were collected using a 109-item FFQ with demonstrated validity and reproducibility for assessing dietary patterns using principal component analysis. The metabolic syndrome was defined by the National Cholesterol Education Program Adult Treatment Panel III. Associations between dietary patterns and the metabolic syndrome, adjusted for age, sex, index of multiple deprivation, physical activity, and energy intake were analysed using logistic regression analysis. Three dietary patterns explained 18 % of dietary intake variation - 'Mediterranean style' (salad/leafy cruciferous/other vegetables, avocados/olives, alliums, nuts/seeds, shellfish and white/oily fish, berries), 'prudent' (dried/fresh/frozen legumes, soya-based foods, whole grains and carrots) and 'Western' (processed meat/fish, sauces/condiments, cakes/biscuits/puddings and meat pies/hot chips). No associations were seen between 'Mediterranean style' (OR = 0·75 (95 % CI 0·53, 1·06), P = 0·11) or 'prudent' (OR = 1·17 (95 % CI 0·83, 1·59), P = 0·35) patterns and the metabolic syndrome after co-variate adjustment. The 'Western' pattern was positively associated with the metabolic syndrome (OR = 1·67 (95 % CI 1·08, 2·63), P = 0·02). There was also a small association between an index of multiple deprivation (OR = 1·04 (95 % CI 1·02, 1·06), P < 0·001) and the metabolic syndrome. This cross-sectional study provides further support for a Western dietary pattern being a risk factor for the metabolic syndrome in an older population.

Relative Validity and Reproducibility of a Food Frequency Questionnaire for Assessing Dietary Patterns and Food Group Intake in Older New Zealand Adults: The Researching Eating, Activity, and Cognitive Health Study.

BACKGROUND: Dietary pattern analysis considers the overall dietary intake and combinations of foods eaten. Valid and reproducible tools for determining dietary patterns are necessary to assess diet-disease relationships. OBJECTIVE: This study evaluated the relative validity and reproducibility of the Researching Eating, Activity, and Cognitive Health (REACH) Study food frequency questionnaire (FFQ) specifically designed to identify dietary patterns in older adults. DESIGN: A subset of participants from the REACH study completed two identical 109-item FFQs 1 month apart (FFQ1 and FFQ2) to assess reproducibility and a 4-day food record between FFQ administrations to assess relative validity. Foods from each dietary assessment tool were assigned to 57 food groups. Principal component analysis was applied to the food group consumption reported in each dietary assessment tool to derive dietary patterns. PARTICIPANTS AND SETTING: Dietary data were collected (2018 and 2019) from a subset of the REACH study (n = 294, 37% men) aged 65 to 74 years, living in Auckland, New Zealand. MAIN OUTCOME MEASURES: Daily intakes of 57 food groups and dietary patterns of older adults participating in REACH living in New Zealand. STATISTICAL ANALYSIS: Agreement of dietary pattern loadings were assessed using Tucker's congruence coefficient. Agreement of dietary pattern scores and food group intakes were assessed using Spearman correlation coefficients (acceptable correlation rho = 0.20 to 0.49), weighted kappa statistic (acceptable statistic κw = 0.20 to 0.60), and Bland-Altman analysis, including mean difference, limits of agreement, plots, and slope of bias. RESULTS: Three similar dietary patterns were identified from each dietary assessment tool: Mediterranean style, Western, and prudent. Congruence coefficients between factor loadings ranged from 0.54 to 0.80. Correlations of dietary pattern scores ranged from 0.47 to 0.59 (reproducibility) and 0.33 to 0.43 (validity) (all P values < 0.001); weighted kappa scores from 0.40 to 0.48 (reproducibility) and 0.27 to 0.37 (validity); limits of agreement from ± 1.79 to ± 2.09 (reproducibility) and ± 2.09 to ± 2.27 (validity); a negative slope of bias was seen in the prudent pattern for reproducibility and validity (P < 0.001). CONCLUSIONS: The REACH FFQ generated dietary patterns with acceptable reproducibility and relative validity and therefore can be used to examine associations between dietary patterns and health outcomes in older New Zealand adults.

Nutritional Implications of Baby-Led Weaning and Baby Food Pouches as Novel Methods of Infant Feeding: Protocol for an Observational Study.

BACKGROUND: The complementary feeding period is a time of unparalleled dietary change for every human, during which the diet changes from one that is 100% milk to one that resembles the usual diet of the wider family in less than a year. Despite this major dietary shift, we know relatively little about food and nutrient intake in infants worldwide and virtually nothing about the impact of baby food "pouches" and "baby-led weaning" (BLW), which are infant feeding approaches that are becoming increasingly popular. Pouches are squeezable containers with a plastic spout that have great appeal for parents, as evidenced by their extraordinary market share worldwide. BLW is an alternative approach to introducing solids that promotes infant self-feeding of whole foods rather than being fed purées, and is popular and widely advocated on social media. The nutritional and health impacts of these novel methods of infant feeding have not yet been determined. OBJECTIVE: The aim of the First Foods New Zealand study is to determine the iron status, growth, food and nutrient intakes, breast milk intake, eating and feeding behaviors, dental health, oral motor skills, and choking risk of New Zealand infants in general and those who are using pouches or BLW compared with those who are not. METHODS: Dietary intake (two 24-hour recalls supplemented with food photographs), iron status (hemoglobin, plasma ferritin, and soluble transferrin receptor), weight status (BMI), food pouch use and extent of BLW (questionnaire), breast milk intake (deuterium oxide "dose-to-mother" technique), eating and feeding behaviors (questionnaires and video recording of an evening meal), dental health (photographs of upper and lower teeth for counting of caries and developmental defects of enamel), oral motor skills (questionnaires), and choking risk (questionnaire) will be assessed in 625 infants aged 7.0 to 9.9 months. Propensity score matching will be used to address bias caused by differences in demographics between groups so that the results more closely represent a potential causal effect. RESULTS: This observational study has full ethical approval from the Health and Disability Ethics Committees New Zealand (19/STH/151) and was funded in May 2019 by the Health Research Council (HRC) of New Zealand (grant 19/172). Data collection commenced in July 2020, and the first results are expected to be submitted for publication in 2022. CONCLUSIONS: This large study will provide much needed data on the implications for nutritional intake and health with the use of baby food pouches and BLW in infancy. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12620000459921; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379436. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/29048.

Energy, Sugars, Iron, and Vitamin B12 Content of Commercial Infant Food Pouches and Other Commercial Infant Foods on the New Zealand Market.

There has been an important shift in the New Zealand infant food market over the past decade, with the majority of complementary foods now sold in "pouches". Along with the increasing market share of commercial infant food pouches internationally, there have been growing concerns about their nutritional quality. However, research examining the nutritional quality of these pouches compared to other forms of commercial infant foods in New Zealand has not been undertaken. Nor have any studies reported the free sugars or added sugars content of these foods. To address this knowledge gap, a cross-sectional survey of infant foods sold in New Zealand supermarkets was conducted in 2019-2020. Recipes and nutrient lines were developed for the 266 foods identified (133 food pouches). The energy, iron, vitamin B12, total sugars, free sugars, and added sugars content of infant food pouches and other forms of commercial infant foods per 100 g were compared, both within food groups and by age group. Infant food pouches contained similar median amounts of energy, iron, and vitamin B12 to other forms of commercial infant foods but contained considerably more total sugars (8.4 g/100 g vs. 2.3 g/100 g). However, median free sugars and added sugars content was very low across all food groups except for "dairy" and "sweet snacks". All "dry cereals" were fortified with iron whereas none of the infant food pouches were. Therefore, consuming food pouches to the exclusion of other commercial infant foods may place infants at risk of iron deficiency if they do not receive sufficient iron from other sources.

Validation and calibration of the Eating Assessment in Toddlers FFQ (EAT FFQ) for children, used in the Growing Up Milk - Lite (GUMLi) randomised controlled trial.

The Eating Assessment in Toddlers FFQ (EAT FFQ) has been shown to have good reliability and comparative validity for ranking nutrient intakes in young children. With the addition of food items (n 4), we aimed to re-assess the validity of the EAT FFQ and estimate calibration factors in a sub-sample of children (n 97) participating in the Growing Up Milk - Lite (GUMLi) randomised control trial (2015-2017). Participants completed the ninety-nine-item GUMLi EAT FFQ and record-assisted 24-h recalls (24HR) on two occasions. Energy and nutrient intakes were assessed at months 9 and 12 post-randomisation and calibration factors calculated to determine predicted estimates from the GUMLi EAT FFQ. Validity was assessed using Pearson correlation coefficients, weighted kappa (κ) and exact quartile categorisation. Calibration was calculated using linear regression models on 24HR, adjusted for sex and treatment group. Nutrient intakes were significantly correlated between the GUMLi EAT FFQ and 24HR at both time points. Energy-adjusted, de-attenuated Pearson correlations ranged from 0·3 (fibre) to 0·8 (Fe) at 9 months and from 0·3 (Ca) to 0·7 (Fe) at 12 months. Weighted κ for the quartiles ranged from 0·2 (Zn) to 0·6 (Fe) at 9 months and from 0·1 (total fat) to 0·5 (Fe) at 12 months. Exact agreement ranged from 30 to 74 %. Calibration factors predicted up to 56 % of the variation in the 24HR at 9 months and 44 % at 12 months. The GUMLi EAT FFQ remained a useful tool for ranking nutrient intakes with similar estimated validity compared with other FFQ used in children under 2 years.