Patterns of complementary feeding introduction and associated factors in a cohort of Brazilian infants.

BACKGROUND: Understanding the timing of food introduction in infants is essential for promoting optimal complementary feeding practices. However, existing studies often rely on cross-sectional data, limiting the ability to capture age-specific patterns. We aimed to describe food introduction during the first year of life by identifying patterns related to age at food introduction and associated factors in a cohort of Brazilian infants. METHODS: Data were collected through standardized questionnaires administered to mothers via face-to-face interviews during the infant's first month of life and at 3, 6, 9, and 12 months of age. Additionally, two telephone interviews were conducted at 2 and 4 months of age. Information regarding food intake was assessed using a list of 48 foods, with two key aspects recorded: whether the food was introduced (yes/no) and the age at introduction. To define food introduction patterns, we employed k-means cluster analysis. Hierarchical Poisson multiple regression was employed to examine the associations between sociodemographic, biological, and healthcare factors and patterns of food introduction. RESULTS: Three distinct patterns were identified and named according to their main characteristics: Pattern 1 - "Low Infant Formula and Timely CF Introduction"; Pattern 2 - "High Infant Formula and Early CF Introduction"; and Pattern 3 - "High Infant Formula and Later Ultra-processed Food Introduction". Breastfeeding at six months showed a positive association with Pattern 1 (PR = 1.40; 95% CI = 1.10-1.80), while bottle use at four months was negatively associated with Pattern 1 (PR = 0.68; 95% CI = 0.53-0.87). No variables studied exhibited an association with Pattern 2. For Pattern 3, higher prevalences were observed among children whose mothers were aged < 20 years (PR = 1.54; 95% CI = 1.13-2.01) or > 34 years (PR = 1.42; 95% CI = 1.04-1.93). Not receiving guidance on the recommended duration of breastfeeding and complementary feeding during prenatal care was associated with a higher prevalence of children in this pattern (PR = 1.35; 95% CI = 1.01-1.80). CONCLUSIONS: We identified three distinct patterns of age at food introduction in the study population, although none perfectly aligned with Brazilian or WHO dietary recommendations. These findings underscore the need for targeted interventions to promote timely and healthy complementary feeding practices in Brazilian infants.

Patrones de alimentación perceptiva durante la primera infancia en conglomerados urbanos. Argentina, 2018-19 / Responsive feeding patterns during early childhood in urban areas. Argentina, 2018­2019

Introducción. La calidad de la alimentación implica tanto la cantidad y calidad de los alimentos que se ofrecen como la forma en que se ofrecen, el entorno y las respuestas de quien los ofrece. El objetivo de este trabajo fue identificar patrones de comportamiento relacionados a la alimentación perceptiva en niños entre 6 y 23 meses de áreas urbanas de la Argentina en 2018-19. Población y métodos. Análisis secundario de datos de la 2da Encuesta Nacional de Nutrición y Salud 2018-19, de una muestra probabilística polietápica de localidades urbanas de 5000 habitantes y más de Argentina. Se realizó análisis descriptivo y análisis de componentes principales para identificar los patrones de alimentación perceptiva en 4379 niños y niñas de 6 a 23 meses. Resultados. Se identificaron cinco patrones de alimentación perceptiva, las dos primeras dimensiones explicaron el 71,1 % de la inercia (p = 0,013). El patrón donde prevalecía la posibilidad de experimentación, la autonomía, la interacción y la ausencia de pantallas, premios y distracciones se asoció a niños/as mayores de 12 meses, de las regiones del centro y sur (Cuyo, Pampeana, Gran Buenos Aires y Patagonia), mientras que el patrón relacionado con menor autonomía, experimentación y autorregulación correspondió a las regiones Noroeste y Noreste, y a niños/as entre 6 y 11 meses. Conclusión. Se evidencian prácticas de alimentación perceptiva que se corresponden con patrones diferenciados entre sí, asociados a diferentes etapas y a la región donde viven los niños/as.

Introduction. Dietary quality involves both the quantity and quality of food offered, the way and the setting in which it is offered, and the responses of the person offering it. The objective of this study was to identify behavioral patterns related to responsive feeding in children aged 6 to 23 months in urban areas from Argentina in 2018­2019. Population and methods. Secondary analysis based on data from the second National Survey on Nutrition and Health of 2018­2019 conducted in a multistage probability sample from urban areas of 5000 inhabitants or more in Argentina. A descriptive analysis and a principal component analysis were performed to identify responsive feeding patterns in 4379 children aged 6 to 23 months. Results. Five responsive feeding patterns were identified; the first 2 dimensions explained 71.1% of inertia (p = 0.013). The pattern with a prevailing possibility of experimentation, autonomy, interaction, and the absence of screens, rewards and distractions was associated with children older than 12 months from the central and south regions (Cuyo, Pampa, Greater Buenos Aires, and Patagonia), whereas the pattern related to a lower autonomy, experimentation, and self-regulation corresponded to children aged 6 to 11 months from the Northwest and Northeast regions. Conclusion. There is evidence of responsive feeding practices that correspond to distinguishable patterns, associated with different stages of life and with the region where the children live

Inequalities in Complementary Feeding Programs in Randomized Intervention and Nonintervention Areas after Program Implementation in Bangladesh, Ethiopia, and Vietnam.

Background: Children in the 6-23-mo age group need to consume adequate energy and nutrients for healthy growth, brain development, cognition, and future productivity. Yet, large deficits remain. Complementary feeding practices can be improved on a large scale, but whether interventions reach and benefit disadvantaged mothers is not known. Objectives: To assess inequalities in complementary feeding practices and coverage following large-scale program implementation in 3 low- and middle-income countries. Methods: We re-analyzed evaluation data from randomized controlled studies conducted in Bangladesh, Ethiopia, and Vietnam and calculated socioeconomic inequality using Erreygers index for intervention and nonintervention areas. Intervention coverage indicators were developed in each country for interpersonal communication, community mobilization, agricultural extension, and media. We compared the direction and magnitude of inequalities in intervention and nonintervention areas. Results: At the endline, coverage, and practices related to complementary feeding were better in intervention areas, but coverage and practices favored the better-off and more educated mothers. In Bangladesh, only 5, and in Vietnam, only 1 out of 16 coverage variables measured favored disadvantaged mothers or were neutral; in Ethiopia, out of 18 coverage variables measured, 11 favored disadvantaged mothers or were neutral, and in all 3 countries, only 5-6 variables out of 16 that were measured favored disadvantaged mothers or were neutral. Conclusions: Inequalities exist both in how children in the 6-23-mo age group are fed and in programs aimed at improving complementary feeding practices. Programs favor the better-off and more educated mothers. We need to better understand context-specific program barriers and tailor targeted interventions to reach disadvantaged mothers.

Consumption frequency of ultra-processed foods and beverages among 6- to 36-month-olds in Kampala, Uganda.

The nutrition transition in sub-Saharan Africa has led to increased consumption of ultra-processed foods in infancy, especially sweet foods. This has heightened the risk for nutrition-related non-communicable diseases, including dental caries and overweight/obesity, and promotes poor food choices later in life. The present study used a cross-sectional design to investigate the consumption frequency of ultra-processed foods and beverages among urban 6- to 36-month-olds attending four selected health facilities in Kampala using a standardised questionnaire and 24-h diet recall record. The primary outcome was the consumption of at least one ultra-processed food or beverage (UPFB) the previous day, and frequency of UPFB consumption of the week before was the secondary outcome. Four hundred and ten caregiver-child pairs were randomly recruited, 94% of caregivers being mothers with a mean age of 30.7 (±5.3) years. Fifty-nine per cent of mothers and 73% of fathers had attained a college education. The median age of children was 18 months and 51% were female. Most children (57%) consumed at least one UPFB the previous day. In the week before, 69% had consumed UPFB frequently (4-7 days) which was significantly positively associated with maternal education (odds ratio [OR] = 2.85, 95% confidence interval [CI]: 1.02-7.96, p = 0.045) and child's age ([OR = 2.87, 95% CI: 1.62-5.08, p < 0.001], [OR = 3.68, 95% CI: 1.88-7.20, p < 0.001]). In conclusion, the dietary habits of the surveyed Ugandan population were unhealthy, characterised by the frequent consumption of UPFB with added sugar. There is an urgent need to re-enforce existing Ugandan food regulation guidelines and policies and to build strong nutritional education programmes to enhance health-promoting environments in early childhood.

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.

Allergens weaning: what is missing from commercial baby food?

Summary: Background. Current recommendations for infant weaning suggest introducing common food allergens by the age of 12 months. While homemade meals are advisable, there is a notable demand for commercially available complementary foods (CACF). Furthermore, emerging evidence suggests a potential link between the consumption of ultra-processed products and the incidence of allergic diseases. This study aimed to examine the presence of the fourteen main food allergens in CACF ingredients through label analysis and evaluate their extent of processing. Methods. Between January and February 2024, labels of all CACF found in infant feeding sections of 10 Portuguese grocery retailers were analyzed. CACF were categorized based on the NOVA food classification system's processing levels. Milk formulas, products for children over 15 months, and those for children with food allergies or intolerances were excluded Results. Of the 492 products analysed, 132 contained wheat and 112 contained milk. 16 products included fish and 6 contained egg. Soy was listed as an ingredient in 11 products, mainly as soy lecithin. Only 2 product contained nuts, and 1 product contained peanuts. None of the products contained the remaining six allergens. The majority of milk- and wheat-containing products were classified as ultra-processed and contained added sugars and/or sweeteners. Conclusions. Despite the current guidelines, commercial baby foods often lack major allergens, namely nuts and peanuts, eggs, and shellfish. Our results underscore the need for healthy, age-appropriate, minimally processed products that incorporate rather than exclude major food allergens.

Current Evidence on Nutrient Intakes and Infant Growth: A Narrative Review of Baby-Led Weaning vs. Conventional Weaning.

Throughout infancy, changes in growth and development are observed, including changes in nutritional requirements; at approximately 6 months of age, when complementary feeding begins, breastmilk and/or formula are no longer the sole source of energy and nutrients. Little is known about the impact of complementary feeding (CF) approaches used during this time on infant nutrition and growth. Baby-led weaning (BLW) has continued to gain popularity over the last two decades, emphasizing the importance of examining the adequacy of different CF methods. This narrative review of 19 studies from January 2010 to April 2024 aims to discuss the differences between BLW and conventional weaning (CW). The definition of BLW varied across studies, and no standard definition has been established. Though no differences in energy were reported, macronutrient and micronutrient intakes were variable between approaches, including for micronutrients such as iron and zinc. Of the few studies with growth data, results comparing BLW and CW were conflicting. Differences were seen in the demographics of parents who chose to follow BLW and breastfeeding prevalence and duration prior to complementary feeding. Additional research is needed to understand the impacts of BLW and CW on nutrient intakes and growth to inform recommendations for infant complementary feeding approaches.

Nourishing the Infant Gut Microbiome to Support Immune Health: Protocol of SUN (Seeding Through Feeding) Randomized Controlled Trial.

BACKGROUND: The introduction of complementary foods during the first year of life influences the diversity of the gut microbiome. How this diversity affects immune development and health is unclear. OBJECTIVE: This study evaluates the effect of consuming kumara or kumara with added banana powder (resistant starch) compared to a reference control at 4 months post randomization on the prevalence of respiratory tract infections and the development of the gut microbiome. METHODS: This study is a double-blind, randomized controlled trial of mothers and their 6-month-old infants (up to n=300) who have not yet started solids. Infants are randomized into one of 3 groups: control arm (C), standard kumara intervention (K), and a kumara intervention with added banana powder product (K+) to be consumed daily for 4 months until the infant is approximately 10 months old. Infants are matched for sex using stratified randomization. Data are collected at baseline (prior to commencing solid food) and at 2 and 4 months after commencing solid food (at around 8 and 10 months of age). Data and samples collected at each timepoint include weight and length, intervention adherence (months 2 and 4), illness and medication history, dietary intake (months 2 and 4), sleep (diary and actigraphy), maternal dietary intake, breast milk, feces (baseline and 4 months), and blood samples (baseline and 4 months). RESULTS: The trial was approved by the Health and Disability Ethics Committee of the Ministry of Health, New Zealand (reference 20/NTA/9). Recruitment and data collection did not commence until January 2022 due to the COVID-19 pandemic. Data collection and analyses are expected to conclude in January 2024 and early 2025, respectively. Results are to be published in 2024 and 2025. CONCLUSIONS: The results of this study will help us understand how the introduction of a specific prebiotic complementary food affects the microbiota and relative abundances of the microbial species, the modulation of immune development, and infant health. It will contribute to the expanding body of research that aims to deepen our understanding of the connections between nutrition, gut microbiota, and early-life postnatal health. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12620000026921; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378654. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/56772.

A web-based and mobile randomised controlled trial providing complementary feeding guidelines to first-time parents in France to promote responsive parental feeding practices, healthy children's eating behaviour and optimal body mass index: the NutrienT trial study protocol.

BACKGROUND: Childhood obesity is a crucial public health issue. Early childhood is a critical time to foster the establishment of healthy eating behaviours and growth, which are partly shaped by parental feeding practices. To inform French parents of the recently updated national complementary feeding guidelines for 0-3 years (in terms of nutrition and responsive feeding as a mean to encourage infant appetite control skills and promote healthy growth), an official printed brochure was developed and nationally disseminated in 2021 by the French public health agency, Santé publique France. This randomised controlled trial aims to investigate whether the provision of guidelines through digital (smartphone application) and printed (brochure) tools (vs. the printed brochure alone, usual service) results in healthier parental feeding practices, infant eating behaviours and weight status. METHODS: This double-blinded monocentric 2-arm trial is currently conducted among first-time parents living in the area of Dijon (France) and recruited in a maternity ward. From child age 3 to 36 months (mo), an app provides a range of 106 age-adapted messages, including dietary recommendations, educational advice, recipes, and tips (intervention group only). Additionally, parents of both groups are provided with 48 messages related to child general development and the printed brochure at child age 2.7 mo. The primary outcome is the body mass index (BMI) z-score at child age 36 mo. Secondary outcome measures include a combination of online parents' reports and behavioural assessments (experimental meals) of parental feeding practices and infant eating behaviours from inclusion to 36 months of age. Analyses of covariance on these outcomes will assess the effect of the intervention, adjusted for relevant confounders. Complementary mediation and moderation analyses will be conducted. Sample size was determined to be n = 118 in each arm of the trial, plus 20% to compensate for potential attrition. DISCUSSION: This is the first public eHealth randomised control trial in France to assess the effect of a web-based and mobile intervention targeted to first-time parents to improve child feeding practices and child growth. TRIAL REGISTRATION: This trial was registered at clinicaltrials.gov as NCT05285761 (March 18, 2022).

Inappropriate complementary feeding practice and associated factors among children aged 6-23 months in Shashemene, Southern Ethiopia: a community-based cross-sectional study.

BACKGROUND: Inappropriate complementary feeding is widely practiced in low and middle income countries. These contribute to undernutrition, morbidity and mortality among young children. The incidence of malnutrition in the first two years of life has been directly linked with inappropriate complementary feeding practices along with high infectious disease levels. OBJECTIVE: To assess the level of inappropriate complementary feeding practice and associated factors among children aged 6 to 23 months in Shashemene, Southern Ethiopia. METHOD: A community-based cross-sectional study was conducted from July to August 2021 among 609 children aged 6 to 23 months paired with their caregivers. Systematic random sampling was used to identify study participants. Data were analyzed by using SPSS version 25 software. Binary logistic regression analysis was used to identify predictors of inappropriate complementary feeding practice. Statistical significance was determined using Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI). RESULTS: The prevalence of inappropriate complementary feeding practice among children aged 6-23 months was 55.3%. Being a mother under the age of 25 years [AOR = 2.07, 95% CI: 1.30, 3.31], aged 25-34 years [AOR = 1.82, 95% CI: 1.14, 2.91], having an occupation [AOR = 2.73, 95% CI: 1.84, 4.05], and households where husbands' are the sole decision makers on their income [AOR = 2.41, 95% CI: 1.54, 3.77] increased the chance of inappropriate complementary feeding practice. On the other hand, mother's whose infants were aged 9-11 months [AOR = 0.30, 95% CI: 0.19-0.45] were less likely to practice inappropriate complementary feeding. CONCLUSIONS: The prevalence of inappropriate complementary feeding practice in the study area was high compared to the WHO recommendation. Child's age, maternal age, maternal occupation, and decision-making role on income were found to be associated with inappropriate complementary feeding practice. Appropriate behavioral change communication to family and community decision-makers, and involvement of husbands in infant and young child feeding practice are recommendable.

Complementary Feeding in the Clinical Practice: An Exploratory Survey among Italian Primary Care Pediatricians.

Introduction: Complementary feeding (CF) is the process of introducing solid or liquid foods (complementary foods, CFs) other than human breast milk (HBM) or infant formula into infants' diet when HBM or infant formula is no longer sufficient to meet infants' nutritional needs. Primary care pediatricians (PCPs) are paramount in guiding and educating infants' families during CF. Materials and Methods: Our exploratory survey aimed to investigate PCPs' current clinical approach to managing CF. From 1 March 2024 to 30 April 2024, a digital questionnaire composed of 32 multiple-choice questions investigating PCPs' attitudes toward CF in healthy, full-term infants was proposed to 1620 PCPs contacted through scientific societies. Results: The questionnaire was completed voluntarily; 707 PCPs (79.5% female, 66.1% aged over 50 years) fully responded to the survey in the proposed timeframe (participation rate 43.6%). Among the responders, 47.5% recommended traditional CF; 42.1% declared to know the baby-led weaning (BLW) approach and on-demand CF (ODCF), but only 32.8% and 12.5% of them recommended these types of CF, respectively. The vast majority (95%) of participants recommended that CF start between 4 to 6 completed months of age. CF routinely based on vegetarian or plant-based diets was supported by 45/707 (6.1%), only if planned by a specialist by 253/707 (35.8%), and only upon request by caregivers by 257/707 (36.3%). Egg and fish introduction was mostly advised in the first year of life, although in case of a positive family history of food allergy, 13.3% of participants recommended the introduction of egg and fish after 12 months. Conclusions: In conclusion, PCPs did not display a homogenous approach to CF; further studies and educational programs are needed to achieve more flexibility and knowledge on this important nutritional issue.

Understanding perceptions and practices of mothers toward infant and young child feeding in Toke Kutaye districts: Community-based qualitative study.

BACKGROUND: Complementary feeding is a process starting at 6 months of age when breastfeeding alone cannot provide the nutrients infants require. Foods and liquids are started along with breastfeeding up to 24 months, while complementary foods are available either from a garden or local market appropriate to complement breast milk at 6 months to satisfy the nutritional needs of the infant. Infancy is from birth to 12 months of age, and the term young child is used when referring to infants and children from 12 months to 2 years of age. Infants and young children require a sufficient diet that includes all nutrients that support overall growth and development. Appropriate feeding practices are crucial during infancy and early childhood. In addition to breastfeeding, complementary feeding should be started on time, administered safely and appropriately, and in sufficient amounts with regularity, consistency, and a variety of foods to meet nutritional needs. OBJECTIVES: This work was designed to understand the perceptions and practices of infant and young child feeding among mothers with children under 2 years in the West Shewa Zone Toke Kutaye districts. METHODS: The study was conducted from December 05 to December 30, 2023. Twenty-seven mothers with children under 2 years old participated. The study was a cross-sectional descriptive qualitative study that employed focus group discussions and in-depth interviews to gather perceptions, opinions, practices, beliefs, and experiences about infant and young child feeding. Before coding, texts were double-checked against audio files to ensure accuracy and consistency. Afan Oromo conducted verbatim transcriptions of the focus group discussions and in-depth interviews, transcribed into Microsoft Word 2010. RESULTS: The study revealed that most infants were not initiated early into breastfeeding and were not exclusively breastfed because most mothers gave cow milk, especially after 2 months, when mothers returned to working on other activities. Most mothers begin complementary feeding at the age of 4 months. CONCLUSIONS: The responses of mothers from all age strata regarding factors that hinder appropriate infant and young child feeding show a lack of awareness about initiating early breastfeeding. Extreme work overload prevented the feeding of breast milk and preparation of a complementary diet as per protocol, low utilization of family planning, and a perceived shortage of food items to prepare a balanced diet for complementary feeding were factors that hindered appropriate infant and young child feeding. Concerned stakeholders should work to alleviate the extreme workload among mothers with children under 2 years old and reduce their lack of awareness by designing appropriate infant and young child feeding education; cooking demonstrations are strongly recommended.

Exploring Maternal Socio-Demographic Factors Shaping Children's Dietary Patterns in Brazil: Results from the 2019 National Health Survey.

This study aimed to identify the dietary patterns of Brazilian children aged 6-23 months and to investigate their association with maternal socio-demographic factors. Data from the 2019 Brazilian National Health Survey were used in this cross-sectional study. Mothers of 1616 children aged 6-23 months reported on their children's dietary intake. Dietary patterns were identified using principal component analysis, and their associations with maternal socio-demographic characteristics were assessed using linear regression models. The first consisted of healthy patterns and the second, unhealthy ones. Linear regression showed that adherence to a healthy dietary pattern was higher among children of mothers who were older (ß = 0.02, p = 0.01), had more years of education (ß = 0.49, p = 0.04), reported living with a partner (ß = 0.29, p = 0.01), and resided in an urban area (ß = 0.35, p = 0.01). Conversely, adherence to the unhealthy pattern was positively associated with mothers who declared themselves as black or brown (ß = 0.25, p = 0.03). Our results show that older mothers with higher levels of education and paid work and who live with a partner are more likely to contribute to their children's healthy eating patterns. We conclude that socio-demographic factors may influence the quality of the food offered to children. Nevertheless, advocating for public policies promoting nutritious complementary diets emphasising fresh and minimally processed foods remains crucial for children whose mothers do not possess these favourable socio-demographic characteristics.

Complementary feeding challenges: Insights from Swiss parents' perspectives.

Parents play a crucial role in deciding what foods to introduce to their infants during the transition from milk to solids. This study examined the challenges they face, including adherence to official complementary feeding recommendations and the struggles and concerns across different stages of feeding. Specifically, this study focused on the initial stage (transition from breastmilk/formula to mashed foods), middle stage (consumption of mashed foods and some fingerfoods, transitioning towards family foods) and late stage (complete transition to family diet). Findings from 22 semi-structured interviews with Swiss parents reveal that, despite being well-informed, practical obstacles such as returning to work, limited time for preparing homemade foods, managing multiple children, and food preferences often hinder adherence. Safety concerns like allergies and choking were prominent early on but decreased as infants grew older and parents gained confidence. In the middle phase, concerns shifted towards pesticides, indicating a growing awareness of food quality. Maintaining a healthy diet was a constant concern, with early reassurance from breastfeeding or formula feeding giving way to worries about balanced nutrition as solids became more prominent. Time constraints were particularly significant in the first two stages, due to the effort of preparing small amounts of mash and later cooking separate meals. Tailored support and clear communication can help parents navigate these challenges and promote healthier feeding practices.

A Comparison of Infant Feeding Practices in South Asian-Born Mothers and Australian-Born Mothers Living in Australia.

South Asian infants and children have a higher predisposition to central adiposity, increasing their risk of metabolic diseases in childhood. Infant feeding practices are a key factor in reducing the risk of obesity in children. The current study aimed to compare infant feeding practices of South Asian-born mothers to Australin-born mothers. The 2010 Australian National Infant Feeding Survey data were used to compare infant feeding practices between South Asian-born mothers and Australian-born mothers with children aged up to 2 years. Chi-square and t-tests were conducted, as well as regression models, with adjustment for covariates, to assess individual infant feeding practices between the two groups. A total of 298 South Asian-born mothers and 294 Australian-born mothers were included. The age at which a child stopped receiving breast milk was lower among Australian-born mothers (3 months) compared with South Asian-born mothers (5 months, p < 0.001). A greater proportion of South Asian-born mothers reported that solids were introduced at or after 6 months of age compared to Australian-born mothers (86% vs. 69%, p < 0.001, respectively). South Asian-born mothers were engaging in some health-promoting infant feeding practices compared to Australian-born mothers; however, they were not meeting the infant feeding guidelines for exclusive breastfeeding and the introduction of solids. Further research is needed to better understand factors influencing infant feeding practices in South Asian-born immigrant mothers in Australia to determine whether culturally tailored interventions are needed to help these women achieve optimal feeding practices for their infants.

Caregiver perceptions of complementary feeding in rural and urban Indonesia: A qualitative comparative study.

OBJECTIVE: To explore caregivers' perspectives on complementary feeding in rural and urban areas of Central Java, Indonesia. DESIGN: A qualitative comparative study using in-depth interviews. We applied thematic analysis to identify themes and subthemes and presented representative quotes. SETTING: Rural and urban villages in Central Java Province, Indonesia. PARTICIPANTS: 46 mothers and grandmothers of 6- to 23-month-old children. FINDINGS: We identified five themes: 1) timing of food introduction, 2) types of complementary foods, 3) meal preparations, 4) complementary food benefits, and 5) expectations toward complementary foods. While caregivers in urban areas had more favourable perceptions of complementary feeding, some misperceptions existed regarding complementary feeding in both areas. These misconceptions included the age of complementary food introduction, the delay in introducing animal-source foods, and the emphasis on any food the child preferred as long as they ate rather than on healthy food choices. KEY CONCLUSIONS: There were similarities and differences in complementary feeding perspectives between caregivers in rural and urban areas. Therefore, policymakers and public health workers should design interventions to enhance complementary feeding practices by addressing the contextual issues in specific settings.

Desigualdad en las prácticas de lactancia y alimentación complementaria en la Argentina, según nivel de ingresos del hogar en 2018-19 / Inequality in breastfeeding and complementary feeding practices in Argentina by household income level in 2018­2019

Introducción. La calidad de la alimentación es un derecho vinculado con la supervivencia, el crecimiento saludable, la prevención de enfermedades crónicas y malnutrición en todas sus formas. El objetivo de este trabajo fue analizar las prácticas de lactancia y de alimentación de menores de 2 años de áreas urbanas de la Argentina en 2018-19, según el nivel de ingreso de los hogares. Población y métodos. Estudio secundario con datos de la 2da. Encuesta Nacional de Nutrición y Salud 2018-19. Se analizaron indicadores de lactancia y alimentación complementaria, según metodología de la Organización Mundial de la Salud (OMS) y Unicef. Se estratificó según nivel de ingresos del hogar. Resultados. El análisis incluyó 5763 menores de 24 meses. Aunque el 97 % fue alguna vez amamantado, solo el 47 % de los menores de 6 meses tuvo lactancia exclusiva el día previo y el 48 % mantenía la lactancia luego del año, con mayor prevalencia en los niños/as de menores ingresos. En el día previo, el 23 % de los niños/as de 6 a 23 meses no consumió ninguna verdura o fruta; el 60 % consumió alimentos no saludables y el 50 %, bebidas dulces. Las bebidas dulces y la ausencia de frutas y verduras fueron mayores en aquellos de hogares de menores ingresos. Conclusión. La calidad de la alimentación de los niños/as dista de las recomendaciones y está condicionada por los ingresos. En los sectores empobrecidos, es menor el inicio temprano de la lactancia, la diversidad alimentaria mínima y el consumo de frutas y verduras, y es mayor el consumo de bebidas dulces.

Introduction. Diet quality is a right related to survival, healthy growth, prevention of chronic diseases, and malnutrition in all its forms. The objective of this study was to analyze breastfeeding and feeding practices in children younger than 2 years from urban areas of Argentina in 2018­2019 according to their household income level. Population and methods. Secondary analysis of data of the Second National Survey on Nutrition and Health (ENNyS2) of 2018­2019. Breastfeeding and complementary feeding indicators proposed by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) were analized. Data were stratified by household income level. Results. The analysis included 5763 children younger than 24 months old. Although 97% was ever breastfed, only 47% of infants younger than 6 months were exclusively breastfed the previous day and 48% continued with breastfeeding after 1 year old, with a higher prevalence in low-income children. The previous day, 23% of children aged 6 to 23 months did not eat any fruit or vegetable, 60% consumed unhealthy foods, and 50% consumed sweet beverages. The consumption of sweet beverages and the absence of fruit and vegetables were higher in low-income households. Conclusion. The quality of children's diet is far from the recommendations and is conditioned by income. Early initiation of breastfeeding, minimum dietary diversity, fruit and vegetable consumption are lower and sweet beverage consumption is greater in impoverished sectors.

Feeding Practices of Infants and Young Children in Pokhara Metropolitan City.

BACKGROUND: For children to grow and develop normally, appropriate feeding practices are essential, especially in the first two years of their lives. These practices can vary depending on the different sociodemographic factors. This study aims to study the feeding practices of infants and young children in different wards of Pokhara Metropolitan City. METHODS: A community-based cross-sectional study was conducted and 280 mothers of infants and young children 0-23 months of age were interviewed using a semi-structured questionnaire. Data were entered and cleaned in Ms-Excel and then exported to SPSS version 21.0 for statistical analysis. Binary logistic regression analysis was used to find the association of feeding practices with different independent variables. RESULTS: Only 32.3% of children 0-5 months of age were found to be appropriately breastfed, and 41.8% of children 6-23 months of age were found to have appropriate complementary feeding practices. Children delivered by normal vaginal delivery (AOR 18.118, p < 0.01, 95% CI 3.831 - 85.689) were more likely to have appropriate breastfeeding practices than those delivered by caesarean section. Children of birth order two or more (AOR 2.226, p = 0.016, 95% CI 1.171 - 4.620) and living in nuclear families (AOR 2.488, p = 0.013, 95% CI 1.120 - 5.116) were found to have appropriate complementary feeding practices. CONCLUSIONS: This study concludes that the feeding practices of the majority of the infants and young children in Pokhara are not adequate as per the WHO and UNICEF standards.

Effects of New Complementary Feeding Guidelines on Eating Behaviour, Food Consumption and Growth in Colombian Children: 6-Year Follow-Up of a Randomised Controlled Trial.

Complementary feeding (CF) may influence later eating behaviour and growth. Our previous Randomised Control Trial (RCT) reported that new CF guidelines (NCFGs) implemented in 6-12-month-old infants in Bogota, Colombia, had positive short-term effects on red meat, vegetable and fruit consumption. Here, we assessed the effects of the NCFGs on food consumption, eating behaviour and growth at 6 years of age. Weight and height were measured using 50 children (58.8%) from the cohort. Feeding behaviour was measured using the Child Eating Behaviour Questionnaire (CEBQ) and maternal and child food consumption was measured using a semi-quantitative food frequency questionnaire. The control group (CG) had a significantly higher weekly consumption of chocolate milk drinks (p = 0.05). The mean food responsiveness (FR) score was significantly higher in the CG (p < 0.001). Although HAZ (height for age Z-score) at 6 years of age was significantly higher in the CG (p < 0.02), there was no significant difference between groups in the change in HAZ from 6 months and 12 months to 6 years of age. BMIZ (body mass index Z-score) and % overweight (CG 18.5% versus NCFG 13%) or obese (3.7% versus 0%) were not significantly different between groups. BMIZ was positively predicted by FR (ß 0.293; p = 0.014) and negatively predicted by weekly red meat consumption episodes per week at 12 months (ß -0.169; p = 0.020). Although there was no direct effect of an intervention on BMIZ at 6 years of age, the results were consistent with an indirect effect via intervention effects on meat consumption at an age of 12 months and FR at 6 years of age. However, further longitudinal studies with a larger sample size are needed.

Positive changes in breastfeeding and complementary feeding indicators in Brazil are associated with favorable nurturing care environments.

OBJECTIVES: To analyze trends in breastfeeding and complementary feeding indicators for infants and young children receiving primary health care (PHC) services in Brazil, considering the contextual aspects of local nurturing care (NC) environments. STUDY DESIGN: Ecological time-series study. METHODS: Ten feeding indicators were extracted from 1,055,907 food intake records of children aged <2 years reported by PHC facilities from 2015 to 2019. Local NC environments were assessed with the Brazilian Early Childhood Friendly Municipal Index, calculating overall and stratified scores for the NC domains of adequate nutrition, good health, opportunities for early learning, and security and safety. Prais-Winsten regression was used to calculate annual percent changes (APC) by sex and the contrast in APC between the lower and upper quintiles of NC scores. Positive or negative APC with P-values <0.05 represented increasing or decreasing trends. RESULTS: No significant trends of exclusive and continued breastfeeding, food introduction, or minimum dietary diversity were observed, with 2019 prevalences of 54.5%, 45.2%, 92.5%, and 78.2%, respectively. Increasing trends were observed for mixed milk feeding (2019: 19.2%; APC, +2.42%) and minimum meal frequency (2019: 61.1%; APC, +2.56%), while decreasing trends were observed for sweet beverage consumption (2019: 31.9%; APC, -5.92%) and unhealthy foods (2019: 16.1%; APC, -4.69%). Indicator improvements were significantly stronger in environments more favorable for NC. CONCLUSIONS: Although the indicators did not meet global targets for infant feeding practices, the results suggest that the local NC environment encompasses facilitators that may be strategic in the design of early childhood programs and policies to improve nutrition.