Food pattern modeling to inform global guidance on complementary feeding of infants.

Nutrient needs are difficult to meet during infancy due to high nutrient requirements and the small quantities of food consumed. Guidelines to support food choice decisions are critical to promoting optimal infant health, growth and development and food pattern modeling can be used to inform guideline development. We employed the Optifood modeling system to determine if unfortified complementary foods could meet 13 nutrient targets for breastfed infants (6-11 months), and to describe food patterns that met, or came as close as possible to meeting targets. We also examined the impacts of eliminating food groups, increasing starchy staple foods or adding sentinel unhealthy foods. We collated a global food list from dietary studies in 37 countries and used this list to develop nutrient values for a set of 35 food subgroups. We analyzed infant dietary intakes from studies in eight countries to inform maximum quantities and frequencies of consumption for these subgroups in weekly food patterns. We found that unfortified foods could meet targets for most infants for 12 nutrients, but not for iron. For the smallest and youngest infants, with the lowest energy intakes, there were additional deficits for minerals. Best-case food patterns that met targets or came as close as possible to meeting targets included ample amounts of diverse vegetables, diverse plant- and animal-source protein foods, small amounts of whole grain foods and dairy and no refined grains or added fats or sugar. There were nutrient deficits if animal-source foods or vegetables were eliminated or if unhealthy foods were included.

C-reactive protein increases with gestational age during pregnancy among Chinese women.

OBJECTIVE: To examine the concentration of C-reactive protein (CRP) in relation to gestational weeks during pregnancy among Chinese women. METHODS: From a randomized control trial of prenatal supplementation with folic acid, iron-folic acid, and multiple micronutrients in China, we examined 834 pregnant women with CRP measured initially between 5 and 20 weeks and at follow-up between 28 and 32 weeks gestation. We calculated and plotted CRP geometric means by gestational weeks. The same analysis was repeated for women who had normal pregnancies (624 women) by excluding women with stillbirth, preterm, small for gestational age, body mass index <18.5 kg/m(2) or >30 kg/m(2) at enrollment, and hypertension or anemia during pregnancy. RESULTS: We observed a significant positive trend between log-transformed CRP and gestational age from 5 to 20 weeks and from 28 to 32 weeks both in the full sample and in the subset of women who had normal pregnancies. CRP geometric mean was 0.81 mg/l at 5-7 weeks of gestation, 2.85 mg/l at 19-20 weeks of gestation, and 3.89 mg/l at 32 weeks of gestation. A similar increasing trend in the CRP median or percentage of elevated CRP were also observed. CONCLUSION: We concluded that CRP increased with gestational age among healthy Chinese women who delivered healthy infants. Am. J. Hum. Biol. 28:574-579, 2016. © 2016 Wiley Periodicals, Inc.

Iron-containing micronutrient supplementation of Chinese women with no or mild anemia during pregnancy improved iron status but did not affect perinatal anemia.

Universal prenatal daily iron-folic acid (IFA) and multiple micronutrient (MM) supplements are recommended to reduce the risk of low birth weight, maternal anemia, and iron deficiency (ID) during pregnancy, but the evidence of their effect on iron status among women with mild or no anemia is limited. The aim of this study was to describe the iron status [serum ferritin (SF), serum soluble transferrin receptor (sTfR), and body iron (BI)] before and after micronutrient supplementation during pregnancy. We examined 834 pregnant women with hemoglobin > 100 g/L at enrollment before 20 wk of gestation and with iron measurement data from a subset of a randomized, double-blind trial in China. Women were randomly assigned to take daily 400 µg of folic acid (FA) (control), FA plus 30 mg of iron, or FA, iron, plus 13 additional MMs provided before 20 wk of gestation to delivery. Venous blood was collected in this subset during study enrollment (before 20 wk of gestation) and 28-32 wk of gestation. We found that, at 28-32 wk of gestation, compared with the FA group, both the IFA and MM groups had significantly lower prevalence of ID regardless of which indicator (SF, sTfR, or BI) was used for defining ID. The prevalence of ID at 28-32 wk of gestation for IFA, MM, and FA were 35.3%, 42.7%, and 59.6% by using low SF, 53.6%, 59.9%, and 69.9% by using high sTfR, and 34.5%, 41.2%, and 59.6% by using low BI, respectively. However, there was no difference in anemia prevalence (hemoglobin < 110 g/L) between FA and IFA or MM groups. We concluded that, compared with FA alone, prenatal IFA and MM supplements provided to women with no or mild anemia improved iron status later during pregnancy but did not affect perinatal anemia. This trial was registered at clinicaltrials.gov as NCT00137744.

Intakes of dairy products and dietary supplements are positively associated with iodine status among U.S. children.

Although pregnant women and some groups of reproductive-age women in the US may be at risk of iodine deficiency, data also suggest that iodine intake among many U.S. children may be above requirements. Our objective was to describe the association of iodine sources with iodine status among children. We analyzed 2007-2010 NHANES data of urine iodine concentration (UIC) spot tests for children aged 6-12 y (n = 1553) and used WHO criteria for iodine status (median UIC: 100-199 µg/L = adequate; 200-299 µg/L = above requirements; ≥300 µg/L = excess). The overall median UIC was above requirements for children aged 6-12 y [211 µg/L (95% CI: 194, 228 µg/L)]. Median UIC increased by quartile of previous day dairy intake, ranging from adequate in the lowest quartile [157 µg/L (95% CI: 141, 170 µg/L)] to above requirements in the highest quartile [278 µg/L (95% CI: 252, 336 µg/L)]. Median UIC was 303 µg/L (95% CI: 238, 345 µg/L) among the 17% of children who had taken a dietary supplement containing iodine the previous day, compared with 198 µg/L (95% CI: 182, 214 µg/L) among those who had not. In adjusted regression analyses, recent dairy intake and recent supplement use were significantly positively associated with UIC levels, whereas recent grain intake was negatively associated. Adding salt to food at the table was not associated with UIC. Iodine-containing supplements are likely not needed by most schoolchildren in the US because dietary iodine intake is adequate in this age group.

Infant Feeding Practices Study II: study methods.

OBJECTIVE: Our goal is to describe the methods used in the Infant Feeding Practices Study II (IFPS II), a study of infant feeding and care practices throughout the first year of life. Survey topics included breastfeeding, formula and complementary feeding, infant health, breast-pump use, food allergies, sleeping arrangements, mother's employment, and child care arrangements. In addition, mothers' dietary intake was measured prenatally and postnatally. PARTICIPANTS AND METHODS: The IFPS II sample was drawn from a nationally distributed consumer opinion panel of 500,000 households. All questionnaires were administered by mail, 1 prenatally and 10 postpartum. Qualifying criteria were used to achieve the sample goals of mothers of healthy term and late preterm singleton infants. In addition to the questionnaires about the infants, women were sent a diet-assessment questionnaire prenatally and at approximately 4 months after delivery; this questionnaire was also sent to members of a comparison group who were neither pregnant nor postpartum. RESULTS: A sample of 4902 pregnant women began the study, and approximately 2000 continued through their infant's first year. Response rates ranged from 63% to 87% for the different questionnaires. Compared with adult mothers of singletons from the nationally representative sample of the National Survey of Family Growth, IFPS II participants had a higher mean education level; were older; were more likely to be middle income, white, and employed; were less likely to smoke; and had fewer other children. Compared with women who participated in the National Immunization Survey who gave birth in 2004, IFPS II mothers were more likely to breastfeed and to breastfeed longer. CONCLUSIONS: The IFPS II provides a valuable database because of its large sample size, the frequency of its questionnaires, and its wide coverage of issues salient to infant feeding.

Sources of supplemental iron among breastfed infants during the first year of life.

OBJECTIVES: Primary prevention of iron deficiency requires adequate iron intake. Although recommendations exist to promote adequate intake of iron among infants through iron-rich foods and iron supplements, few studies have examined adherence to these recommendations. Our objectives were to describe the consumption of iron-rich foods, oral iron supplements, and iron-fortified formula among US infants and to assess adherence to iron-intake recommendations. METHODS: We analyzed data from the Infant Feeding Practices Study II, a longitudinal study of mothers and infants followed from late pregnancy through the first year of their infant's life. Mothers completed near-monthly questionnaires that assessed how frequently they fed their infants breast milk, formula, infant cereals, and meats in the previous 7 days and whether their infants were given an oral iron supplement > or = 3 times per week during the previous 2 weeks. We examined use of iron-fortified formula among infants who consumed formula; intake of cereal, meat, oral iron supplements, and formula among infants consuming any breast milk; and whether 6-month-old breastfed and mixed-fed (breast milk and formula) infants consumed sources of supplemental iron with recommended frequency. RESULTS: At 6 months of age, 18% of the term breastfed and mixed-fed infants had not received infant cereal or meat in the previous 7 days, and 15% had not received infant cereal, meat, regular iron supplements, or formula; among solely breastfed infants, 23% had not received infant cereal, meat, or regular iron supplements. Fifty-eight percent of the mixed-fed infants and 70% of the solely breastfed infants received < 2 daily servings of infant cereal, meat, or formula combined and did not receive oral iron supplements > or = 3 times per week. Among preterm breastfed and mixed-fed infants, none received oral iron supplements > or = 3 times per week before 3 months of age, 2% received them at 3 months, and 13% received them at 10.5 months. CONCLUSIONS: Our findings indicate that recommendations regarding iron intake among breastfed infants are not being followed by a substantial proportion of mothers.

Hemoglobin and ferritin are currently the most efficient indicators of population response to iron interventions: an analysis of nine randomized controlled trials.

Governments and donor agencies have implemented pilot and large-scale iron fortification programs, but there has been no consensus on the best choice of indicators to monitor population response to these interventions. We analyzed data from 9 randomized iron intervention trials to determine which of the following indicator(s) of iron status show the largest response in a population: hemoglobin (Hb), ferritin, transferrin receptor (TfR), zinc protoporphyrin (ZPP), mean cell volume (MCV), transferrin saturation (TS), and total body-iron store. We expressed the change in each indicator in response to the iron intervention in SD units (SDU) for the intervention group compared with the control group. Ferritin increased by > or =0.2 SDU in all trials and was significant in 7. Hb changed by > or =0.2 SDU in 6 and was significant in 5. TfR increased by > or =0.2 SDU in 5 of 8 interventions in which it was measured and was significant in 4. ZPP increased by > or =0.2 SDU and was significant in 3 of 6 interventions. Excluding Hb, the indicator with the largest change in SDU was ferritin in 4 trials, TS in 2 trials, body-iron store in 2 trials, and TfR in 1. In the 2 cases in which body-iron stores showed the largest change, the change in ferritin was nearly as large. Our results suggest that with currently available technologies, ferritin shows larger and more consistent response to iron interventions than ZPP or TfR. We cannot make confident inference about MCV or TS, which were included in only 4 and 2 trials, respectively. It is possible that the optimal indicator(s) may differ with age, sex, and pregnancy. There were too few trials in each age and sex group to allow us to explore this question.