Dietary and Lifestyle Changes During COVID-19 and the Subsequent Lockdowns among Polish Adults: A Cross-Sectional Online Survey PLifeCOVID-19 Study.

The present study aimed to identify patterns of dietary changes during the COVID-19 pandemic and their associations with sociodemographics, body mass index (BMI) before pandemic, and lifestyle changes in Polish adults and to examine the effects of lockdowns on dietary-lifestyle changes. This study used a cross-sectional online survey to collect data. The k-means algorithm was used to determine of patterns of dietary changes, and logistic regression analyses were performed. During the study period, 43% of respondents decreased physical activity (PA), 49%-increased screen time, and 34%-increased food consumption. Among the three dietary changes patterns, two opposite patterns were found: Prohealthy (28% participants) and Unhealthy (19% participants).The adherence to the Prohealthy pattern was negatively associated with age, but positively with being overweight (aOR 1.31) or obese before pandemic (aOR 1.64). Residing in a macroeconomic region with GDP > 100% decreased adherence to the Prohealthy (aOR 0.73) but increased adherence to the Unhealthy pattern (aOR 1.47). Adults over 40 years old, those living with children, unemployed, those living in a region with a higher GDP, and those not consuming homemade meals could be more exposed to unhealthy behaviors. From a public health perspective, enhancing the message "to be active" during the compulsory isolation period should be prioritized.

The Use of Added Salt and Sugar in the Diet of Polish and Austrian Toddlers. Associated Factors and Dietary Patterns, Feeding and Maternal Practices.

Children aged <2 years should not be given meals with the addition of salt and sugar due to health risks and to promote healthier dietary habits. The aims of this study were: to assess the prevalence of the use of added salt (AS), sugar (ASu) and both salt and sugar (AS&Su) in the diets of Polish and Austrian toddlers aged 12-24 and 25-36 months; to explore the sociodemographic and early nutritional factors associated with the use of AS and ASu; to investigate the difference in dietary habits and maternal concerns about toddlers' eating regarding the use of AS and ASu in toddlers' diet. This cross-sectional anonymous study was conducted in 5893 mothers of children aged 12-36 months, recruited through social media in 2017-2019. The questionnaire consisted of questions about sociodemographics, early feeding practices and current children's nutrition (e.g., use of AS and ASu, food frequency questionnaire). Multivariate logistic regression and cluster analyses were applied. Austrian mothers more often used AS than mothers from Poland (at 2 years old: 74.8% vs. 52.8%; at 3 years old 87.4% vs. 74.4%, p ≤ 0.001), however Polish mothers were more prone to use ASu (at 2 years old: 34.7% vs. 27.7%; at 3 years old: 59.0% vs. 45.8%, p ≤ 0.001). In younger toddlers (12-24 months), the odds of using of AS, ASu, and AS&Su increased with toddlers' age, when the mother was a multipara, was not currently breastfeeding, or had exclusively breastfed for 4-5 months. This risk decreased when older toddlers (25-36 months) were introduced to solids by baby-led weaning (BLW). Toddlers from both countries who consumed meals with AS or ASu more often a followed Western-like dietary pattern. Our study emphasizes the need for parental nutritional education when beginning to introduce solid foods.

Analysis of Association between Breastfeeding and Vegetable or Fruit Intake in Later Childhood in a Population-Based Observational Study.

Vegetable and fruit consumption in childhood remains below recommendations in many countries. As the intake of fruit and/or vegetables during childhood in a few studies was associated with breastfeeding, it may be suggested as a serious interfering factor while analyzing the association between breastfeeding and its long-term health effects. Thus, it may be important for creation and implementation of effective public health programs. The aim of this study was to evaluate the association between breastfeeding and consumption of fruit or vegetables in later childhood. The study was conducted within the Project "ABC of Healthy Eating-ABC of Kids and Parents" among a representative sample of 703 pairs of mothers and children aged 7-12 years in Poland. A systematic purposive-quota selection according to gender, age, place of residence, and region of Poland was applied. The study was conducted by interviewers in the respondents' homes in 2017. Logistic regression analysis was conducted, and models adjusted for children's age, BMI centile and gender, maternal education, employment status, and economic situation, as well as for EU-28 average Gross Domestic Product (GDP) region. Almost 86% of children were ever breastfed. Vegetables for breakfast, second breakfast, dinner, supper, and between meals were consumed by 23.9%, 18.6%, 47.4%, 26.7%, and 4.0% of children, whereas fruit was consumed by 13.9%, 46.1%, 7.7%, 12.9%, and 59.7% of children, respectively. Breastfeeding for a period of 4-6 months increased the chance of vegetable consumption for breakfast in the whole group (aOR 3.80, 95%CI 1.90-7.59, p ≤ 0.001) and particularly in girls (aOR 4.60, 95%CI 1.43-14.75, p ≤ 0.01) when compared to boys (aOR 3.17, 95%CI 1.32-7.63, p ≤ 0.01). Longer duration of breastfeeding (over 12 months) increased the chance of vegetable consumption for dinner in the total group (aOR 2.36, 95%CI 1.30-4.26, p ≤ 0.01) and particularly in girls (aOR 3.04, 95%CI 1.24-7.46, p ≤ 0.01) when compared to boys (aOR 2.20, 95%CI 1.01-4.95, p ≤ 0.05). We showed a positive association between breastfeeding and vegetable consumption for breakfast and dinner among children aged 7-12 years. These associations were gender-specific (stronger among girls) and were not diminished by socio-demographic factors.

Protective Effect of Breastfeeding on the Adverse Health Effects Induced by Air Pollution: Current Evidence and Possible Mechanisms.

Air pollution is a major social, economic, and health problem around the world. Children are particularly susceptible to the negative effects of air pollution due to their immaturity and excessive growth and development. The aims of this narrative review were to: (1) summarize evidence about the protective effects of breastfeeding on the adverse health effects of air pollution exposure, (2) define and describe the potential mechanisms underlying the protective effects of breastfeeding, and (3) examine the potential effects of air pollution on breastmilk composition and lactation. A literature search was conducted using electronic databases. Existing evidence suggests that breastfeeding has a protective effect on adverse outcomes of indoor and outdoor air pollution exposure in respiratory (infections, lung function, asthma symptoms) and immune (allergic, nervous and cardiovascular) systems, as well as under-five mortality in both developing and developed countries. However, some studies reported no protective effect of breastfeeding or even negative effects of breastfeeding for under-five mortality. Several possible mechanisms of the breastfeeding protective effect were proposed, including the beneficial influence of breastfeeding on immune, respiratory, and nervous systems, which are related to the immunomodulatory, anti-inflammatory, anti-oxidant, and neuroprotective properties of breastmilk. Breastmilk components responsible for its protective effect against air pollutants exposure may be long chain polyunsaturated fatty acids (LC PUFA), antioxidant vitamins, carotenoids, flavonoids, immunoglobins, and cytokines, some of which have concentrations that are diet-dependent. However, maternal exposure to air pollution is related to increased breastmilk concentrations of pollutants (e.g., Polycyclic aromatic hydrocarbons (PAHs) or heavy metals in particulate matter (PM)). Nonetheless, environmental studies have confirmed that breastmilk's protective effects outweigh its potential health risk to the infant. Mothers should be encouraged and supported to breastfeed their infants due to its unique health benefits, as well as its limited ecological footprint, which is associated with decreased waste production and the emission of pollutants.

Factors Influencing the Age of Complementary Feeding-A Cross-Sectional Study from Two European Countries.

The timing of introducing complementary feeding affects nutritional status and children's health. The aim of this study was to determine sociodemographic and birth-related factors associated with the age of introducing complementary foods. This cross-sectional study investigated parents (n = 5815) of children aged 12-36 months from Poland (n = 4065) and Austria (n = 1750) using a single online questionnaire. During the study, detailed data about sociodemographic characteristics, variables related to pregnancy, and early feeding practices were collected. Univariate and multivariate logistic regression models were used to investigate factors associated with the introduction of complementary feeding before 4 completed months, between 4 and 6 months, and after 6 completed months separately for both countries. Complementary foods were introduced before 4 months in 3.0% of infants (2.4% in Poland and 4.3% in Austria), between 4 and 6 months in 65.0% (60.5% in Poland and 75.3% in Austria), and after 6 completed months in 32.1% of infants (37.1% in Poland and 20.4% in Austria). The factors related to earlier introduction of complementary feeding were lower maternal age (in Austria 25-29 years: aOR 2.21 (95% CI 1.06-4.65)) and education level (in Poland and Austria primary and vocational: aOR 14.49 (95% CI 3.73-56.35), aOR 2.13 (95% CI 1.10-4.11), respectively), preterm birth (in Poland and Austria: aOR 10.21 (95% CI 5.73-18.20); aOR 4.45 (95% CI 2.42-8.18), respectively), never breastfeeding (Poland: aOR 2.73 (95% CI 1.29 - 5.76)) and receiving an infant formula after hospital discharge (in both countries: aOR 3.73 (95% CI 2.06-6.75); aOR 3.65 (95% CI 1.87-7.12), respectively). These factors should be taken into account by health professionals in identifying mothers who are least likely to follow nutritional recommendations.

Lipid Profile, Lipase Bioactivity, and Lipophilic Antioxidant Content in High Pressure Processed Donor Human Milk.

Human milk fat plays an essential role as the source of energy and cell function regulator; therefore, the preservation of unique human milk donors' lipid composition is of fundamental importance. To compare the effects of high pressure processing (HPP) and holder pasteurization on lipidome, human milk was processed at 62.5 °C for 30 min and at five variants of HPP from 450 MPa to 600 MPa, respectively. Lipase activity was estimated with QuantiChrom™ assay. Fatty acid composition was determined with the gas chromatographic technique, and free fatty acids content by titration with 0.1 M KOH. The positional distribution of fatty acid in triacylglycerols was performed. The oxidative induction time was obtained from the pressure differential scanning calorimetry. Carotenoids in human milk were measured by liquid chromatography. Bile salt stimulated lipase was completely eliminated by holder pasteurization, decreased at 600 MPa, and remained intact at 200 + 400 MPa; 450 MPa. The fatty acid composition and structure of human milk fat triacylglycerols were unchanged. The lipids of human milk after holder pasteurization had the lowest content of free fatty acids and the shortest induction time compared with samples after HPP. HPP slightly changed the ß-carotene and lycopene levels, whereas the lutein level was decreased by 40.0% up to 60.2%, compared with 15.8% after the holder pasteurization.

Association between Breastmilk LC PUFA, Carotenoids and Psychomotor Development of Exclusively Breastfed Infants.

The first months of infant life are crucial for proper neurodevelopment, which may be influenced by several factors, including nutrition and nutrients (e.g., long-chain polyunsaturated fatty acids (LC PUFA) and carotenoids) of which the concentration in breastmilk is diet-dependent. This study analysed the relationship between the average concentrations of selected LC PUFA and carotenoids in breastmilk samples from the first and third months of lactation and the psychomotor development of exclusively breastfed infants at the sixth month of life. Infant psychomotor development was assessed using the Children Development Scale (DSR). The average age of infants during the assessment was 6.6 ± 0.2 months and 30.9 ± 3.8 years for mothers (n = 39 mother⁻infant pairs). The average concentration of docosahexaenoic acid (DHA) was 0.50% of fatty acids. The average concentration of carotenoids was 33.3 nmol/L for ß-carotene, 121 nmol/L for lycopene and 33.3 nmol/L for lutein + zeaxanthin. The total results of the Performance scale and Motor subscale were 39 centiles and 4.1 points, respectively. Adjusted multivariate regression models revealed associations between breastmilk DHA and motor development (ß = 0.275; p ≤ 0.05), α-linolenic acid (ALA; ß = 0.432; p ≤ 0.05), n-3 LC PUFA (ß = 0.423; p ≤ 0.05) and ß-carotene (ß = 0.359; p ≤ 0.05). In addition, an association between the Perception subscale and DHA was observed (ß = 0.316; p ≤ 0.05; model 2). There were no significant associations between the overall Performance scale scores. Due to the positive association between concentrations of n-3 LC PUFA (ALA and DHA) and ß-carotene in breastmilk and infant motor development, it is important to provide these nutrients with breastmilk. According to the diet-dependent concentration of these compounds in breastmilk, breastfeeding mothers should have a diet abundant in dietary sources of these nutrients, e.g., fish, nuts, seeds, vegetable oils, vegetables and fruits.

Carotenoid Content in Breastmilk in the 3rd and 6th Month of Lactation and Its Associations with Maternal Dietary Intake and Anthropometric Characteristics.

Carotenoids are diet-dependent milk components that are important for the visual and cognitive development of an infant. This study determined ß-carotene, lycopene and lutein + zeaxanthin in breastmilk and its associations with dietary intake from healthy Polish mothers in the first six months of lactation. Concentrations of carotenoids in breastmilk were measured by HPLC (high-performance liquid chromatography) (first, third, sixth month of lactation) and dietary intake was assessed based on a three-day dietary record (third and sixth month of lactation). The average age of participants (n = 53) was 31.4 ± 3.8 years. The breastmilk concentrations of carotenoids were not changed over the progress of lactation. Lycopene was a carotenoid with the highest content in breastmilk (first month 112.2 (95% CI 106.1⁻118.3)-sixth month 110.1 (103.9⁻116.3) nmol/L) and maternal diet (third month 7897.3 (5465.2⁻10329.5) and sixth month 7255.8 (5037.5⁻9474.1) µg/day). There was a positive correlation between carotenoids in breastmilk and dietary intake (lycopene r = 0.374, r = 0.338; lutein + zeaxanthin r = 0.711, r = 0.726, 3rd and 6th month, respectively) and an inverse correlation with maternal BMI in the third month of lactation (ß-carotene: r = -0.248, lycopene: r = -0.286, lutein + zeaxanthin: r = -0.355). Adjusted multivariate regression models confirmed an association between lutein + zeaxanthin intake and its concentration in breastmilk (third month: ß = 0.730 (0.516⁻0.943); 6th: ß = 0.644 (0.448⁻0.840)). Due to the positive associations between dietary intake and breastmilk concentrations, breastfeeding mothers should have a diet that is abundant in carotenoids.

The combined effects of alcohol and tobacco use during pregnancy on birth outcomes

Background: Exposure to alcohol and tobacco during pregnancy may lead to developmental disorders in the foetus and can also adversely impact pregnancy outcomes and the newborn's health status. Objective: Assessment of alcohol consumption and tobacco use during pregnancy as well as their impact on pregnancy outcomes and birth parameters of the newborn in a selected group of mothers with children aged ≤ 2 years. Material and methods: The study was conducted in 104 mothers with children aged ≤ 2 years living in the Mazowiecki Voivodeship. A questionnaire was used for assessing selected lifestyle parameters tobacco and alcohol use, dietary supplements use, physical activity during pregnancy, socio-demographic characteristics as well as children's birth parameters (birth weight, length, head circumference, chest circumference). Data were analyzed statistically using logistic regression analysis, Spearman's rang correlation, the Mann-Whitney U, Kruskal-Wallis, Student-t, Tukey and Chi2 tests (p≤0.05; STATISTICA 13.1 PL). Results: 22% of the participants solely smoked cigarettes, 13% solely drank alcohol while 7% smoked cigarettes and drank alcohol. Both cigarette smoking and alcohol use increased the risk of preterm birth (OR 9.6, 95% CI 2.9 ­ 31.4, p=0.00015; OR 5.3 95% CI 1.3 ­ 22.3, p=0.0199, respectively) as along with a low birth weight (OR 6.9, 95% CI 1.9 ­ 25.2, p=0.0028; OR 7.6, 95% CI 1.7 ­ 34.3, p=0.007). Cigarette smoking and alcohol use by the pregnant women also adversely impacted on children's health status (8.7 ± 1.4 vs. 9.7 ± 0.8, p=0.001 and 8.5 ± 1.9 vs. 9.6 ± 0.8, p=0.027, respectively). Simultaneous use of alcohol and cigarettes exacerbated the adverse impact of such substances on birth parameters and health status (birth weight, body length, Apgar score) as well as on pregnancy duration. Conclusions: The introduction of educational programs for high risk groups as well as prenatal obligatory consultations for mothers about the negative effects of substance use on fetus and the development of the child are warranted. Conclusions: Introducing educational programs are thus warranted for high risk groups as well as prenatal obligatory consultations for mothers about the adverse effects of such substance use on foetal and child development.

Reasons for non-exclusive breast-feeding in the first 6 months.

BACKGROUND: Maternal sociodemographic, delivery- and infant-related factors as well as hospital practice are relevant for breast-feeding practice. The aim of this study was to identify the sociodemographic and delivery-related factors that may affect exclusive breast-feeding (EBF) of infants aged 0-6 months in Poland. METHODS: A total of 446 mothers (18-42 years old) of infants aged 0-6 months were interviewed using the computer-assisted Web interview method. The questionnaire collected information about maternal sociodemographic situation and anthropometrics, delivery-related factors, and infant feeding-related factors. Data were analyzed using the chi-squared test and Mann-Whitney U-test. Predictors of non-exclusive breast-feeding (N-EBF) in the first 6 months of life were assessed on multivariate logistic regression. RESULTS: A total of 43% of mothers did not breast-feed exclusively (n = 191; N-EBF group) and 57% did breast-feed exclusively during the study period (n = 255; EBF group). After adjustment for other potential risk factors, the highest risk factors for N-EBF were maternal age <20 years (OR, 6.12; P ≤ 0.01), and inadequate breast-feeding knowledge (OR, 3.43; P ≤ 0.01), whereas the lowest risk was associated with pre-pregnancy intention to breast-feed (OR, 0.35; P ≤ 0.01), very good knowledge about breast-feeding (OR, 0.45; P ≤ 0.001) and maternal age 26-30 years (OR, 0.48; P ≤ 0.001). In a multivariate model, maternal education, employment status and preterm delivery were no longer statistically significant. CONCLUSIONS: Breast-feeding practice is influenced by a variety of factors, including sociodemographic and psychosocial conditions, maternal obesity and mode of delivery. Further work is needed to establish the role of education and prophylactic programs in modifying the aforementioned risk factors.

Health Effects of Carotenoids during Pregnancy and Lactation.

Adequate nutrition is particularly important during pregnancy since it is needed not only for maintaining the health of the mother, but also determines the course of pregnancy and its outcome, fetus development as well as the child's health after birth and during the later period of life. Data coming from epidemiological and interventions studies support the observation that carotenoids intake provide positive health effects in adults and the elderly population. These health effects are the result of their antioxidant and anti-inflammatory properties. Recent studies have also demonstrated the significant role of carotenoids during pregnancy and infancy. Some studies indicate a correlation between carotenoid status and lower risk of pregnancy pathologies induced by intensified oxidative stress, but results of these investigations are equivocal. Carotenoids have been well studied in relation to their beneficial role in the prevention of preeclampsia. It is currently hypothesized that carotenoids can play an important role in the prevention of preterm birth and intrauterine growth restriction. Carotenoid status in the newborn depends on the nutritional status of the mother, but little is known about the transfer of carotenoids from the mother to the fetus. Carotenoids are among the few nutrients found in breast milk, in which the levels are determined by the mother's diet. Nutritional status of the newborn directly depends on its diet. Both mix feeding and artificial feeding may cause depletion of carotenoids since infant formulas contain only trace amounts of these compounds. Carotenoids, particularly lutein and zeaxanthin play a significant role in the development of vision and nervous system (among others, they are important for the development of retina as well as energy metabolism and brain electrical activity). Furthermore, more scientific evidence is emerging on the role of carotenoids in the prevention of disorders affecting preterm infants, who are susceptible to oxidative stress, particularly retinopathy of prematurity.

Vegetables and fruit, as a source of bioactive substances, and impact on memory and cognitive function of elderly.

The phenomenon of population aging is not only associated with an increase in the number and proportion of older people in society, but also with an increase in the incidence of cognitive impairment. This can impair the functioning of the elderly in everyday life, work and social life participation and impair their quality of life. Hence, it is important to identify the protective factors. Neurodegenerative changes are closely linked to inflammatory processes and oxidative stress. Diet is of great importance, with particular attention being paid to the adequate intake of fruits and vegetables, due to their proven health benefits. This may be correlated to the protective effect of the bioactive substances that are present in fruits and vegetables, in particular flavonoids and carotenoids. The elderly who consume 5 servings a day of fruits and vegetables have a higher antioxidant capacity of blood serum, while the risk of chronic diseases, including neurodegenerative and mortality rates are lower. The analysis included the results of 16 published epidemiological studies, including people aged 65+. Their results are discussed in 4 fields of the effects on cognitive function (1) fruit and vegetable intake; (2) flavonoids intake; (3) carotenoid nutritional status; (4) mechanism of action of plant bioactive substances. It has been found that the positive effects of consumption of fruits and vegetables may be associated with cognitive functions in the three possible areas, ie.: (1) improvement in cognitive testing; (2) delaying or preventing age-related deterioration of cognitive decline; (3) reducing the risk of neurodegenerative diseases.

Breastfeeding knowledge and exclusive breastfeeding of infants in first six months of life

Background: Exclusive breastfeeding is the gold standard in infant nutrition. The maternal decision to breastfeed is affected by various factors, including breastfeeding knowledge. Objective: The purpose of this study was the assessment of the breastfeeding knowledge in selected group of mothers of infants under 7 months and its relationship to the exclusivity of breastfeeding. Material and methods: The study was carried out using the CAWI method from Dec 2014 till Feb 2015 among 446 mothers (aged 18-42) of infants under 7 months. The most of women lived in towns >100.000 inhabitants, had an university education and normal pre-pregnancy BMI. Breastfeeding knowledge was estimated using 15 questions (both 6 in general and child-related category and 3 in mother-related category). Results were analysed using multivariate logistic analysis and Chi2 and U-Mann Whitney tests. Results: 57% (group A) of women exclusively breastfeed their infants and 43% (group B) did not. Average mean breastfeeding knowledge test score was 11.9±3.4 points. Higher mean was observed in group A compared with group B (12.9±2.8 vs. 10.6±3.7 points; p≤0.001). Predictors of lower score (<11 points) were professional education, overweight and living in the rural area. Each correct answer to questions in general (OR1.93; 95%CI 1.57-2.37) or in child-related (OR1.33; 95%CI 1.10-1.63) category improved the chance of exclusive breastfeeding. Women from group A had a better score in every question. Conclusions: Breastfeeding education for mothers may improve breastfeeding rates.