Secular trends in infant feeding practices during the first year of life in Norway: findings from 1998 to 2019 - the Spedkost surveys.

The aims of the present study were to assess secular trends in breast-feeding and to explore associations between age at introduction of solid foods and breast-feeding duration. Data from three national dietary surveys in Norway were used, including infants born in 1998 (Spedkost 1, n 1537), 2006 (Spedkost 2, n 1490) and 2018 (Spedkost 3, n 1831). In all surveys, around 80 % of the infants were breastfed at 6 months of age. At 12 months of age, breast-feeding rate was 41 % in Spedkost 1, increasing to 48 % in Spedkost 2 and 51 % in Spedkost 3. Compared with earlier introduction, introduction of solid foods at ≥ 5 months of age was associated with a lower risk of breast-feeding cessation during the first year of life in the two most recent Spedkost surveys. In Spedkost 2, the adjusted hazard ratio for breast-feeding cessation during the first year of life for those introduced to solid foods at ≥ 5 months of age was 0·43 (95 % CI (0·31, 0·60)), P < 0·001, while the corresponding number in Spedkost 3 was 0·44 (95 % CI (0·29, 0·67)), P < 0·001. In conclusion, breast-feeding at infant age 12 months increased over time. Introduction of solid foods at ≥ 5 months of age was positively associated with breast-feeding duration in the two most recent Spedkost surveys. As breast-feeding contributes to numerous health benefits for infant and mother, and possibly improved dietary sustainability in infancy, findings point to the importance of continued protection, support and promotion of breast-feeding.

The contribution of breastfeeding to a healthy, secure and sustainable food system for infants and young children: monitoring mothers' milk production in the food surveillance system of Norway.

OBJECTIVE: The mother-child breastfeeding dyad is a powerful force for achieving healthy, secure and sustainable food systems. However, food system reports exclude breastfeeding and mother's milk. To help correct this omission and give breastfeeding women greater visibility in food systems dialogue and action, we illustrate how to estimate mother's milk production and incorporate this into food surveillance systems, drawing on the pioneering experience of Norway to show the potential value of such analysis. DESIGN: The estimates use data on the proportion of children who are breastfed at each month of age (0-24 months), annual number of live births and assumptions on daily human milk intake at each month. New indicators for temporal and cross-country comparisons are considered. SETTING: It is assumed that a breastfeeding mother on average produces 306 l of milk during 24 months of lactation. PARTICIPANTS: The annual number of live births is from Statistics Norway. Data for any breastfeeding at each month of age, between 0 and 24 months, are from official surveys in 1993, 1998-1999, 2006-2007, 2013 and 2018-2019. RESULTS: Estimated total milk production by Norwegian mothers increased from 8·2 to 10·1 million l per year between 1993 and 2018-2019. Annual per capita production increased from 69 to 91 l per child aged 0-24 months. CONCLUSIONS: This study shows it is feasible and useful to include human milk production in food surveillance systems as an indicator of infant and young child food security and dietary quality. It also demonstrates significant potential for greater milk production.

High sugar content of European commercial baby foods and proposed updates to existing recommendations.

The aim was to determine whether commercial baby foods marketed within Europe (up to 36 months of age) have inappropriate formulation and high sugar content and to provide suggestions to update European regulations and recommendations as part of a nutrient profile model developed for this age group. The latter was produced following recommended World Health Organization (WHO) steps, including undertaking a rapid literature review. Packaging information from countries across the WHO European region was used to determine mean energy from total sugar by food category. The percentage of products containing added sugar and the percentage of savoury meal-type products containing pureed fruit were also calculated. A total of 2,634 baby foods from 10 countries were summarised: 768 sold in the United Kingdom, over 200 each from Denmark (319), Spain (241), Italy (430) and Malta (243) and between 99-200 from Hungary, Norway, Portugal, Estonia and Slovenia. On average, approximately a third of energy in baby foods in these European countries came from total sugar, and for most food categories, energy from sugar was higher than 10%. Use of added sugars was widespread across product categories, with concentrated fruit juice most commonly used. Savoury meal-type purees did not contain added sugars except in United Kingdom and Malta; however, fruit as an ingredient was found in 7% of savoury meals, most frequently seen in UK products. Clear proposals for reducing the high sugar content seen in commercial baby foods were produced. These suggestions, relating to both content and labelling, should be used to update regulations and promote product reformulation.

Dietary patterns among Norwegian 2-year-olds in 1999 and in 2007 and associations with child and parent characteristics.

Infant and childhood nutrition influences short- and long-term health. The objective of the present paper has been to explore dietary patterns and their associations with child and parent characteristics at two time points. Parents of Norwegian 2-year-olds were, in 1999 (n 3000) and in 2007 (n 2984), invited to participate in a national dietary survey. At both time points, diet was assessed by a semi-quantitative FFQ that also provided information on several child and parent characteristics. A total of 1373 participants in the 1999 sample and 1472 participants in the 2007 sample were included in the analyses. Dietary patterns were identified by principal components analysis and related to child and parent characteristics using the general linear model. Four dietary patterns were identified at each time point. The 'unhealthy' and 'healthy' patterns in 1999 and 2007 showed similarities with regard to loadings of food groups. Both the 'bread and spread-based' pattern in 1999 and the 'traditional' pattern in 2007 had high positive loadings for bread and spreads; however, the 'traditional' pattern did also include positive associations with a warm meal. The last patterns identified in 1999 and in 2007 were not comparable with regard to loadings of food groups. All dietary patterns were significantly associated with one or several child and parent characteristics. In conclusion, the 'unhealthy' patterns in 1999 and in 2007 showed similarities with regard to loadings of food groups and were, at both time points, associated with sex, breastfeeding at 12 months of age, parity, maternal age and maternal work situation.

Factors associated with exclusive breast-feeding and breast-feeding in Norway.

OBJECTIVE: To identify factors associated with exclusive breast-feeding and breast-feeding during the first year of life among Norwegian infants. DESIGN: Data on breast-feeding practices were collected by a semi-quantitative FFQ. SETTING: In 2006-2007 about 3000 infants were invited to participate in a population-based prospective cohort study in Norway. SUBJECTS: A total of 1490 mothers/infants participated at both 6 and 12 months of age. RESULTS: Exclusive breast-feeding at 4 months was associated with parental education, parity and geographical region, while exclusive breast-feeding at 5·5 months was associated only with maternal age. At both ages, a negative association with exclusive breast-feeding was observed for maternal smoking. Breast-feeding at 6 months was associated with parental education, maternal age and marital status. Breast-feeding at 12 months was associated with maternal education, maternal age and number of children. At both ages, negative associations with breast-feeding were observed for maternal smoking and descending birth weight. At 12 months, a negative association was also observed for having day care by other than the parents. CONCLUSIONS: Even though Norway has an extensive and positive breast-feeding tradition and a maternal leave system that supports the possibility to breast-feed, factors like maternal education, maternal age and maternal smoking are strongly associated with duration of exclusive breast-feeding and breast-feeding. Research to better understand the reasons for inequalities in breast-feeding is needed to facilitate the development of more effective breast-feeding promotion strategies. This again may improve compliance with recommendations and reduce inequalities in infant feeding practices.

Protein intake from 0 to 18 years of age and its relation to health: a systematic literature review for the 5th Nordic Nutrition Recommendations.

The present systematic literature review is a part of the 5th revision of the Nordic Nutrition Recommendations. The aim was to assess the health effects of different levels of protein intake in infancy and childhood in a Nordic setting. The initial literature search resulted in 435 abstracts, and 219 papers were identified as potentially relevant. Full paper selection resulted in 37 quality-assessed papers (4A, 30B, and 3C). A complementary search found four additional papers (all graded B). The evidence was classified as convincing, probable, limited-suggestive, and limited-inconclusive. Higher protein intake in infancy and early childhood is convincingly associated with increased growth and higher body mass index in childhood. The first 2 years of life is likely most sensitive to high protein intake. Protein intake between 15 E% and 20 E% in early childhood has been associated with an increased risk of being overweight later in life, but the exact level of protein intake above which there is an increased risk for being overweight later in life is yet to be established. Increased intake of animal protein in childhood is probably related to earlier puberty. There was limited-suggestive evidence that intake of animal protein, especially from dairy, has a stronger association with growth than vegetable protein. The evidence was limited-suggestive for a positive association between total protein intake and bone mineral content and/or other bone variables in childhood and adolescence. Regarding other outcomes, there were too few published studies to enable any conclusions. In conclusion, the intake of protein among children in the Nordic countries is high and may contribute to increased risk of later obesity. The upper level of a healthy intake is yet to be firmly established. In the meantime, we suggest a mean intake of 15 E% as an upper limit of recommended intake at 12 months, as a higher intake may contribute to increased risk for later obesity.

Breastfeeding, introduction of other foods and effects on health: a systematic literature review for the 5th Nordic Nutrition Recommendations.

The present systematic literature review is part of the 5th revision of the Nordic Nutrition Recommendations. The overall aim was to review recent scientific data valid in a Nordic setting on the short- and long-term health effects of breastfeeding (duration of both any and exclusive breastfeeding) and introduction of foods other than breast milk. The initial literature search resulted in 2,011 abstracts; 416 identified as potentially relevant. Full paper review resulted in 60 quality assessed papers (6A, 48B, and 6C). A complementary search found some additional papers. The grade of evidence was classified as convincing, probable, limited-suggestive, and limited-no conclusion. The evidence was convincing of a protective dose/duration effect of breastfeeding against overweight and obesity in childhood and adolescence, overall infections, acute otitis media, and gastrointestinal and respiratory tract infections. The evidence was probable that exclusive breastfeeding for longer than 4 months is associated with slower weight gain during the second half of the first year which could be part of the reason behind the reduced risk of later overweight or obesity. There was also probable evidence that breastfeeding is a protective factor against inflammatory bowel disease, celiac disease, and diabetes (type 1 and 2), provides beneficial effects on IQ and developmental scores of children as well as a small reductive effect on blood pressure and blood cholesterol levels in adulthood. Other associations explored were limited-suggestive or inconclusive. In conclusion, convincing and probable evidence was found for benefits of breastfeeding on several outcomes. The recommendation in NNR2004 about exclusive breastfeeding for 6 months and continued partial breastfeeding thereafter can stand unchanged. The relatively low proportion of infants in the Nordic countries following this recommendation indicates that strategies that protect, support and promote breastfeeding should be enhanced, and should also recognize the benefits for long-term health.

Changes in knowledge and attitudes of folate, and use of dietary supplements among women of reproductive age in Norway 1998-2000.

AIMS: From March 1998, Norwegian nutrition authorities have recommended that women consume a folic acid supplement before and early in pregnancy to prevent neural tube defects. The authors wished to establish Norwegian data on knowledge of, use of, and attitudes to folic acid supplement and dietary supplements before and after implementing national information campaigns on folate and pregnancy. METHODS: Telephone surveys were carried out in late 1998 and in late 2000 among, respectively, 1,146 and 1,218 Norwegian women of reproductive age. RESULTS: Overall, 50% of the women in 1998 and 60% of the women in 2000 had heard about folate, 33% and 46% knew about its role in pregnancy, and 9.5% and 21% knew that it may prevent a congenital malformation. Only 4.0% and 8.5% of the women, respectively, knew that the critical period for folic acid supplement to reduce the risk of neural tube defect is before and early in pregnancy. Knowledge and increase in knowledge between the two surveys were highest among women close to pregnancy (woman planning pregnancy, pregnant women, or women who had given birth within the last 12 months), and among women with high education. Among the 54 women in 1998 and the 55 women in 2000 whose last birth was within the previous year, use of a folic acid supplement before or early in the last pregnancy was reported by 10% (95% confidence interval (CI) 5-21%) and by 47% (95% CI 35-60%), respectively. Among women close to pregnancy, 76% in 1998 and 87% in 2000 stated that they would use a folic acid supplement in a future pregnancy. CONCLUSIONS: Knowledge and use of folate among Norwegian women increased from 1998 to 2000. Future information strategies on folate and pregnancy should in particular aim at increasing women's knowledge on the critical period for folic acid supplementation, as well as reducing socio-demographic differences in use and knowledge of folate.

Breast-feeding at 12 months of age and dietary habits among breast-fed and non-breast-fed infants.

OBJECTIVE: To analyse factors associated with breast-feeding and use of sweetened drinks at 12 months, and to compare dietary habits among breast-fed and non-breast-fed infants. DESIGN: Data were collected by a semi-quantitative food-frequency questionnaire filled in by the parents. SETTING: National dietary survey in Norway. SUBJECTS: In total, 1932 12-month-old infants were included. RESULTS: At 12 months, 36% of the infants were breast-fed. The odds of breast-feeding at this age were more than doubled both for mothers > or =35 years compared with mothers <25 years and for mothers in the highest educational group compared with mothers in the lowest. A negative association was found for maternal smoking, and the odds of breast-feeding were 40% lower for mothers who smoked than for non-smokers. Some dietary differences were observed between breast-fed and non-breast-fed infants apart from intake of milk. In particular, breast-fed infants had a significantly lower daily intake of sweetened drinks than non-breast-fed infants and a 16% lower mean daily intake of added sugars (P<0.001). Furthermore, breast-fed infants had 30% higher odds of not receiving sweetened drinks daily, compared with non-breast-fed infants. CONCLUSIONS: Maternal age, education and smoking status were important factors for breast-feeding at 12 months. Breast-fed infants had lower intakes of sweetened drinks and added sugars than non-breast-fed infants. From a public health perspective, continued promotion of breast-feeding is needed to reduce inequalities in breast-feeding. Moreover, prevention of high intakes of sweetened drinks and added sugars should start in infancy.