Home-made and commercial complementary meals in German infants: results of the DONALD study.

BACKGROUND: Infant complementary food can be home-made or bought as ready-to-eat commercial products. The nutrient composition of commercial products is regularised in a European Commission guideline, whereas the preparation of home-made complementary meals is the responsibility of caregivers. In the present study, the composition of commercial and home-made complementary meals as eaten by healthy German infants was compared. METHODS: Of 8226 complementary meals (74% commercial and 26% home-made) recorded in 1083, 3-day weighed dietary records from 396 participants (6-12 months old) of the German DONALD (DOrtmund Nutritional and Anthropometric Longitudinally Designed) study were analysed. RESULTS: Median energy density (kcal 100 g(-1)) was highest in commercial and home-made cereal-milk meals (89 kcal 100 g(-1)). In home-made savoury and cereal-fruit meals, the energy density was significantly higher compared to their commercial counterparts. Median protein contents were highest in savoury and cereal-milk meals (>2.5 g 100 g(-1)) and dairy-fruit meals (2-4 g 100 g(-1)). Added sugars were found in less than a quarter of meals. Highest median sodium contents were found not only in commercial savoury meals (median 38 mg 100 g(-1)) and vegetable meals (32 mg 100 g(-1)), but also in home-made cereal-milk meals (36 mg 100 g(-1)). Both median fat and iron contents were higher in home-made meals compared to commercial savoury and cereal-fruit meals. CONCLUSIONS: With the exception of the higher sodium content in commercial savoury meals for older infants, the lower fat content in commercial savoury and cereal-fruit meals, and the added sugar content in some commercial dairy-fruit meals, a comparison of commercial and home-made complementary meals did not reveal any serious inadequacy.

Development of an estimated food record for 9-36-month-old toddlers.

OBJECTIVES: Adequacy of dietary intake in the sensitive period of toddler development is a key determinant of health in a short- and long-term perspective. Therefore, studies focussing the nutrition of toddlers are of importance. For this purpose, tailored dietary record methods are an important prerequisite. The objective of this work is to develop a toddler-specific estimated food record (EFR) in a booklet providing photographs of age-specific foods and portion sizes that should be accurate and simple. SUBJECTS/METHODS: For a toddler study in Germany, a 7-day consecutive EFR was developed. Data were obtained from a sample of toddlers in Germany. The basis is an evaluation of 3-day weighing food records on food choice and portion size of the DONALD (Dortmund Nutritional and Anthropometric Longitudinally Designed) study for 227 toddlers (118 boys) aged 9-36 months from January 2004 to March 2008. RESULTS: In the analysed food records, a total of 15.147 eating occasions with 24.820 dishes were reported and grouped in 17 food groups. To estimate the portion size, the median consumption amounts of the 194 most frequently consumed dishes were calculated and photographed. Formula and commercial complementary food are collected separately. EFR was structured into seven eating occasions of the day: before breakfast, breakfast, mid-morning, lunch, mid-afternoon, dinner, and before bed. CONCLUSIONS: The EFR booklet provides a simple, feasible and validated instrument that can be used to update information on dietary habits during the transition from infant to childhood diet for families in different social classes.

German national consensus recommendations on nutrition and lifestyle in pregnancy by the 'Healthy Start - Young Family Network'.

Diet and physical activity before and during pregnancy affect short- and long-term health of mother and child. The energy needs at the end of pregnancy increase only by about 10% compared to nonpregnant women. An excessive energy intake is undesirable since maternal overweight and excessive weight gain can increase the risks for a high birth weight and later child overweight and diabetes. Maternal weight at the beginning of pregnancy is especially important for pregnancy outcome and child health. Women should strive to achieve normal weight already before pregnancy. Regular physical activity can contribute to a healthy weight and to the health of pregnant women. The need for certain nutrients increases more than energy requirements. Before and during pregnancy, foods with a high content of essential nutrients should be preferentially selected. Supplements should include folic acid and iodine, iron (in case of suboptimal iron stores), the ω-3 fatty acid docosahexaenoic acid (in case of infrequent consumption of ocean fish) and vitamin D (in case of decreased sun exposure and decreased endogenous vitamin D synthesis). Pregnant women should not smoke and not stay in rooms where others smoke or have smoked before (passive smoking). Alcohol consumption should be avoided, since alcohol can harm unborn children.

[Nutrition in pregnancy - Practice recommendations of the Network "Healthy Start - Young Family Network"]. / Ernährung in der Schwangerschaft - Teil 1.

Nutrition, physical activity and lifestyle in pregnancy influence maternal and child health. The "Healthy start - Young Family Network" supported by the German Government with the national action plan IN FORM developed recommendations on nutrition in pregnancy. Energy needs increase by only ≈10 % by the end of pregnancy whereas micronutrient needs increase much more. Normal weight should preferably be achieved before pregnancy. Dietary recommendations follow those for the general population. Folic acid supplements (400 µg/day) should be started before pregnancy and continue for at least the first trimester. Iodine rich foods and salt and an iodine supplement (100-150 µg/day) are recommended. Long-chain omega-3 fatty acids should be provided with ≥ 1 weekly portion of oily sea fish, or a DHA-supplement if regular fish consumption is avoided. Vitamin D supplementation is advisable unless there is regular exposure to sunlight. Health care professions should lead parents to health-promoting lifestyles. Subjects of part 2 of the article are practice recommendations on nutrition in pregnancy, especially vegetarian diets, recommendations on micronutrient supplementation, risk reduction of listeriosis and toxoplasmosis, alcohol, tobacco, caffeine and physical activity in pregnancy.

[Nutrition in pregnancy - Practice recommendations of the Network "Healthy Start - Young Family Network"]. / Ernährung in der Schwangerschaft - Teil 2. Handlungsempfehlungen des Netzwerks "Gesund ins Leben - Netzwerk Junge Familie".

Nutrition, physical activity and lifestyle in pregnancy influence maternal and child health. The "Healthy start - Young Family Network" supported by the German Government with the national action plan IN FORM developed recommendations on nutrition in pregnancy. Folic acid supplements (400 µg/day) should be started before pregnancy and continue for at least the first trimester. Iodine rich foods and salt and an iodine supplement (100-150 µg/day) are recommended. Long-chain omega-3 fatty acids should be provided with ≥ 1 weekly portion of oily sea fish, or a DHA-supplement if regular fish consumption is avoided. Vitamin D supplementation is advisable unless there is regular exposure to sunlight. Iron supplements should be used based on medical history and blood testing. Vegetarian diets with nutritional supplements can provide adequate nutrition, but counselling is recommended. In contrast, a vegan diet is inadequate and requires additional micronutrient supplementation. For risk reduction of listeriosis and toxoplasmosis, raw animal foods, soft cheeses and packed fresh salads should be avoided; fresh fruit, vegetables and salad should be washed well and consumed promptly. Pregnant women should remain physically active and perform sports with moderate intensity. They should avoid alcohol, active and passive smoking. Up to 3 daily cups of coffee are considered harmless, but energy drinks should be avoided. Childhood allergy is not reduced by avoiding certain foods in pregnancy whereas oily sea fish is recommended. Health care professions should lead parents to health-promoting lifestyles. Subjects of part 1 of the article are practice recommendations on nutrition, on energy needs, micronutrient needs and body weight/weight gain in pregnancy.

Analysis and risk assessment of furan in coffee products targeted to adolescents.

The aim of this work was to analyse the furan concentrations in coffee products targeted to adolescents and to estimate the health risk for those consumers by using the consumption data of the Dortmund Nutritional and Anthropometric Longitudinally Designed Study (DONALD). Three different kinds of coffee beverages were analysed: 'coffee ready to drink' (i.e. industrially manufactured and packaged products available in cans or plastic cups), 'coffee instant' (i.e. soluble coffee in powder form) and 'coffee from coffee chains' (i.e. freshly prepared coffee sampled on-site). Furan was analysed according to the US Food and Drug Administration (USFDA) method using headspace-GC-MS and quantification with standard addition. The lowest furan concentrations were found within the category 'coffee instant', with an average of 4.6 µg kg(-1), followed by the category 'coffee ready to drink', with an average of 41.3 µg kg(-1), while the products from the coffee chains showed the highest concentrations, on average 100.5 µg kg(-1). According to the obtained furan contents, it seems that the highest furan exposure for adolescents is generally given in the consumption of products within the category 'coffee from coffee chains', while the lowest is given in the category 'coffee instant'. Risk assessment based on the margin of exposure (MOE) approach showed that in different consumption scenarios except for consumers of instant coffee, the MOE lay below 10,000, a range that is judged to be of public health relevance. The lowest MOE was found for consumers in the age group 10-12 years (especially females) and for both sexes in the age group 16-18 years.

Harmonisation of food categorisation systems for dietary exposure assessments among European children.

Within the European project called EXPOCHI (Individual Food Consumption Data and Exposure Assessment Studies for Children), 14 different European individual food consumption databases of children were used to conduct harmonised dietary exposure assessments for lead, chromium, selenium and food colours. For this, two food categorisation systems were developed to classify the food consumption data in such a way that these could be linked to occurrence data of the considered compounds. One system served for the exposure calculations of lead, chromium and selenium. The second system was developed for the exposure assessment of food colours. The food categories defined for the lead, chromium and selenium exposure calculations were used as a basis for the food colour categorisation, with adaptations to optimise the linkage with the food colour occurrence data. With this work, an initial impetus was given to make user-friendly food categorisation systems for contaminants and food colours applicable on a pan-European level. However, a set of difficulties were encountered in creating a common food categorisation system for 14 individual food consumption databases that differ in the type and number of foods coded and in level of detail provided about the consumed foods. The work done and the problems encountered in this project can be of interest for future projects in which food consumption data will be collected on a pan-European level and used for common exposure assessments.

Iodine intake in the youngest: impact of commercial complementary food.

Iodine is a nutrient contributing to the development of the central nervous system. To assure a sufficient iodine intake, iodine fortification of complementary food (CF) is recommended. We describe the current fortification practice of commercial CF and formula in Germany as an example for other European countries, based on a market survey conducted in autumn 2008. In addition, we estimated the iodine intake of an 8-month-old infant, fed one portion of milk and three complementary meals per day. All formulae were fortified with iodine, and half of CF products. Iodine concentration varied depending on product groups. A partially breast-fed infant getting homemade CF reached less than 50% of the recommended iodine intake. Using infant formula and commercial CF, the recommended intake was exceeded by 39 or 100%, depending on which products were chosen. A well-balanced fortification of commercial CF, including pure infant cereals, would be required to ensure an adequate iodine supply.

Modification of dietary polyunsaturated fatty acids via complementary food enhances n-3 long-chain polyunsaturated fatty acid synthesis in healthy infants: a double blinded randomised controlled trial.

OBJECTIVE: To study the effect of modified polyunsaturated fatty acid (PUFA) profiles of complementary food on long-chain (LC) PUFA composition in healthy infants. DESIGN: Double blinded, randomised, controlled intervention trial. SETTING: Dortmund, Germany. PATIENTS: Free-living sample of healthy term infants. METHODS: Participants were randomly assigned within the first 2 months of life. During the intervention period from 4 to 10 months, the control group (n = 53) received commercial complementary meals with corn oil (3.4 g/meal) rich in n-6 linoleic acid (LA), the intervention group (n = 49) received the same meals with rapeseed oil (1.6 g/meal) rich in n-3 alpha-linolenic acid (ALA). Fatty acid intake was assessed from dietary records throughout the intervention period. Fatty acid proportions (% of total fatty acid) in total plasma were analysed before and after the intervention. RESULTS: Plasma fatty acid profiles did not differ between the intervention and control groups before the intervention. During the intervention, the only difference in fatty acid intake between the intervention and control groups was a higher intake of ALA in the intervention group, 21% deriving from study food and a lower ratio of LA/ALA (10.7 vs 14.8). At the end of the intervention, the plasma proportions of total n-3 fatty acids and of n-3 LC-PUFA, but not of ALA, were higher and the ratios of n-6/n-3 fatty acids were lower in the intervention group. CONCLUSIONS: Feasible dietary modifications of the precursor fatty acid profile via n-3 PUFA-rich vegetable oil favoured n-3 LC-PUFA synthesis in the complementary feeding period when LC-PUFA intake from breast milk and formula is decreasing.

Changes in time-trends of nutrient intake from fortified and non-fortified food in German children and adolescents--15 year results of the DONALD study. Dortmund Nutritional and Anthropometric Longitudinally Designed Study.

BACKGROUND: Although fortified products have played an increasing role in food marketing since the 1980s in Germany, data as to the consumption of fortified food is sparse. AIM OF THE STUDY: To assess long-term data on changes in fortified food supply or consumption patterns, nutrient intake, and time trends in the DONALD Study (Dortmund Nutritional and Anthropometric Longitudinally Designed Study). METHODS: Between 1985 and 2000 consumption of nutrient intake (total and from fortified foods) was evaluated and time trends in energy and nutrient intake were assessed on the basis of 3-day weighed dietary records (n = 4193) of 2-14 year-old males (n = 383) and females (n = 404) enrolled in the DONALD Study. Nutrient intake was expressed as percentage of the current German recommendations. Food products were defined as fortified if enriched with at least one of the following nutrients: Vitamin A or provitamin A carotenoids (summarised as Vitamin A), Vitamins E, B1, B2, B6, C, niacin, folate, calcium or iron. Nutrient supplements and medicine were excluded from this evaluation. Time trends were analysed using linear and non-linear regression models (PROC MIXED, SAS 6.12). RESULTS: In percent of German references [3], non-fortified food contributed to folate intake by 20-30%, to Vitamin E by about 40%, to Vitamin B1 by 50-65%, to Vitamin A, C, B2, calcium, iron by about 65-95%, and to Vitamin B6 and niacin intake by 100% and more. Fortified food alone provided no more than 5% of calcium intake, about 10-20% of iron, Vitamin A and folate intake, up to 40-50% of Vitamin C, B1, B2, E, niacin and up to 80% of Vitamin B6 intake. During the 15 year period of the DONALD Study with total food, we only found a significant linear time trend for Vitamin C, whereas significant non-linear time trends were found for calcium, Vitamin E, B1, B2, B6, niacin and folate. In the latter there was a uniform increase until 1994 and a decrease thereafter. For iron and Vitamin A no significant time trend could be identified. Only iron and Vitamin A intake from fortified food showed a significant linear time trend. All other nutrients studied here gave significant non-linear time trends. Nutrient intake with fortified food reached maximum values between 1994 and 1996 followed by a decrease thereafter. CONCLUSIONS: Signs of changing food consumption patterns were found, pointing to an almost uniform decrease of nutrient intake since 1994/96 in our population of German children and adolescents. This could be an alarming indicator of a slight but unpreferable tendency to eat energydense, nutrient-poor foods.

Significance of fortified beverages in the long-term diet of German children and adolescents: 15-year results of the DONALD Study.

Fortified beverages and instant drinks are the most frequently consumed fortified products in children and adolescents in Germany. However, little is known about the contribution of these products to micronutrient intake. Between 1986 and 2000, consumption of fortified food (total and the subgroup of fortified beverages) and time trends in energy and micronutrient intake were assessed on the basis of 3 day-weighed dietary records (n = 4358) of males and females between the ages of 2 and 14 years (n = 398/408) enrolled in the DONALD Study (Dortmund Nutritional and Anthropometric Longitudinally Designed Study). As percentage of recent references for micronutrient intake, a significant increase in intake from fortified beverages was observed for calcium (from 1 to 3%), iron (3 to 4%), vitamin A (5 to 15%), and vitamin C (5 to 60%). Significant increases in intakes were only observed from 1995-1997 for vitamin E, folate, and niacin (all 5 to 15-25%), vitamin B1 and B2 (both 10-15 to 25-30%) and vitamin B6 (20 to 55%). Thereafter significant decreases were found. Among the fortified beverages, juice was the most important for micronutrient intake, followed by soft drinks (calcium, vitamin A, E, C, folate, niacin) or by instant beverages (energy, iron, vitamin B1, B2, B6). Significant linear and nonlinear time trends in micronutrient intakes from fortified food and fortified beverages were observed in German children and adolescents.

Vitamin and mineral supplements for the use of children on the German market: products, nutrients, dosages.

A market survey of vitamin and mineral supplements was carried out considering various points of purchase. 37 of 146 producers offered a total of 110 supplements marketed 'directly' (42%) or 'indirectly' (58%) for the use of children. These products contained 31 different nutrients, vitamins more frequently than minerals. The number of nutrients per product ranged from 1 (23%) to over 10 (13%), maximum 26. In most cases, the daily dosage recommended by producers reached from 100 to 200% of the reference doses for nutrition labelling for vitamins and from 50 to 100% for minerals. In total, the findings point to an abundance of products, nutrients and dosages in the German market supply of vitamin and mineral supplements for the use of children.

Ten-year trends in vitamin and mineral intake from fortified food in German children and adolescents.

OBJECTIVE: We investigated time trends in consumption patterns, and energy and nutrient intakes (protein, fat, carbohydrates, added sugars, vitamins A, E, C, B1, B2 and B6, niacin, folate, calcium and iron) from fortified food in children and adolescents between 1987 and 1996 in Germany. DESIGN: Mixed longitudinal survey (DONALD study) with 3 d weighed dietary records (n=2062 from 594 subjects), one subject per family per year chosen by random. SETTING: Dortmund (Western Germany) district cohort. SUBJECTS: 285 males, 309 females; mean age 6 y (2-13 y). RESULTS: Almost all children and adolescents consumed fortified food irrespective of the year studied. With the exception of vitamin E, significant time trends in the proportions of nutrient intakes from fortification were observed. The fortification of food with vitamins A, C, B1, B2 and B6 and niacin raised the already adequate intakes from non-fortified food (100% to 150% of reference intake values) by 20-50%. The fortification of food with vitamin E and folate raised the low intakes from non-fortified food (about 50% of reference intake values) to about 80% (folate) and 100% (vitamin E) of the references. Fortification of food with calcium and iron was not significant (<10%), but while total intake of calcium was adequate, total intake of iron remained critical. CONCLUSIONS: Since the nutrient intake of the population of children and adolescents studied is adequate with respect to vitamins A, C, B1, B2 and B6, niacin and calcium, fortification seems inefficient, while fortification of food with vitamin E and folate, but not iron, improves an inadequate intake. SPONSORSHIP: The DONALD study is supported by the German Federal Ministry of Health and the North-Rhine-Westphalian Ministry of Science and Research. European Journal of Clinical Nutrition (2000) 54, 81-86

Vitamin intake of 3- to 36-month-old German infants and children--results of the DONALD-Study.

Infants and young children are a vulnerable group with regard to nutrition. However, there is a lack of information about the dietary composition of healthy German infants and children. Therefore, the intake of vitamins (A, C, E, B1, B2, B6, folate, niacin) was assessed in 354 healthy German infants and children aged 3 to 36 months from 3-day-weighed diet records and compared with German, European and US reference values. Intake of all B-vitamins (B1, B2, B6, folate, niacin) increased during the first 3 years of life, whereas intake of vitamin E decreased. Intake of vitamin A and C varied between age groups. The highest levels of the nutrient densities of most vitamins were found at the end of the first year of life. Depending on the reference values chosen, the vitamin supply of the study population ranged between sufficient and very good. The reported satisfactory intake of vitamins in infants and young children in this study gives rise to the question of whether the current extent of fortification of commercial infant food in Germany is necessary.

Consumption of fortified food between 1985 and 1996 in 2- to 14-year-old German children and adolescents.

Since the 1980s, fortified food plays an increasing role in food marketing in Germany. However, there is a lack of data concerning fortified food consumption. We therefore evaluated dietary information of the DONALD Study. A total of 2251 3-days weighed records between 1986 and 1996 from 637 different subjects aged between 2 and 14 years (mean: 6.6 years) were evaluated. Food products were defined as fortified if enriched at least with one of the following nutrients: vitamin A (including provitamin A carotenoids), E, B1, B2, B6, C, niacin, folate, calcium, magnesium, potassium, iron or phosphate. Products were grouped in 'Diary products', 'Cereals', 'Beverages', 'Instant Beverages', 'Sweets/biscuits', 'Fats/oils', and 'Beikost' (i.e. dietetic food intended for infants and young children under 4 years). Over the last 11 years almost all children and adolescents consumed fortified food products. Excluding the food group 'Fats/oils' the proportion of consumers of fortified food increased by about 20% between 1986 and 1996. During the same period the consumption rate increased up to five-fold for the food group 'Beverages' and fourfold for 'Cereals'. Since 1988, a relatively constant consumption ratio of 62-68 different fortified products per 100 consumers has been found. 'Beverages' showed the highest food-group-specific diversity. In Germany, vitamins are more often used than minerals to fortify food, whereas vitamin C is the most frequent added nutrient. We found some interesting time trends in the use of vitamins and minerals for fortification with a continuous increase in the use of vitamin C and E. Only vitamin A showed a decrease in use during the study period. Finally, we found a decreasing number of consumers of all fortified products at the end of the study period.

[Survey of the present-day supply of fortified food products in Germany]. / Ubersicht der derzeitigen Nährstoff-anreicherung von Lebensmitteln in Deutschland.

A survey and critical evaluation of the present-day supply of fortified common food products on the German market is presented concerning products, nutrients and amounts for fortification. The data were collected from the original food labels by personal informations from the manufacturers (40 asked, 68% answered) and by a local market survey in Dortmund (spring 1994). A total of 288 fortified food products (78 manufacturers) were found out of 6 different food products (78 manufacturers) were found out of 6 different food categories (manufacturers/products): beverages (26/95), sweets (24/57), cereals (5/53), milk products (7/35), powdered instant beverages (10/31), ready-to-eat meals (6/17). Sugar was added to 56% of the fortified products. A total of 10 vitamins (E, B1, B2, B6, B12, C, niacin, folate, biotin, pantothenic acid) and 7 minerals (Na, K, Cl, Ca, P, Mg, Fe) were used for fortification. The number of nutrients used for fortification in single products ranged from 1 (94 products) to 16 (3 products). The amounts used for fortification per average portion varied considerably among the different products and the different nutrients in the food categories. In a considerable number of cases, amounts for fortification of more than 100% (maximum 660%) of the recommended daily dose of a nutrient (EC-directive for nutrition labelling) have been observed. Relatively to the contribution of a portion to meet the energy requirement, the fortification of cereals and milk-products (about 30%) as well as of sweets (about 10%) could be rated as acceptable whereas the fortification of beverages (about 50-100%) was overdone. The present-day supply of fortified food is extremely heterogenous from the qualitative and quantitative point of view. Therefore, it is rather difficult for the consumer to reach an overall nutrient intake that is in accordance with the recommendations. The specific requirements of children, who are a preferred group for food advertising, are not at all considered adequately.

[Nutrient and energy administration with formula diets, exemplified by Crohn disease. 2. Calculation of energy and nutrient administration with various formula diets]. / Nährstoff- und Energiezufuhr mit Formula-Diäten, dargestellt am Beispiel des Morbus Crohn. 2. Mitteilung: Berechnungen der Energie- und Nährstoffzufuhr mit verschiedenen Formula-Diäten.

In a recent inquiry in Children's Hospitals (1st communication), the 14 formula diets generally used in cases of Crohn's Disease were determined. Based on an energy intake of 2,500 kcal/day (recommendations of the german nutrition council [DGE] and the U.S. standard [RDA]) and assuming correct dosage, intake values for the following nutrients were calculated: liquid, Na, Cl, K, Ca, P, Mg, Fe, Zn, Cu, J, Mn, vitamins A, D, E, B1, B2, B6, B12, C, and folic acid. Protein, fat and carbohydrates were calculated as energy equivalents. Osmolarities are based on manufacturers' specifications. The applicability of recommendations for healthy individuals to the nutritional needs of the sick is discussed. Comparing recommendations (DGE, RDA, B undesgesundheitsamt) with calculated intake values there are pronounced differences in the amounts of basic components (i.e. protein, fat, carbohydrates), whereas the formulas, with only a few exceptions, generally show a balanced picture for the other nutrients. It is pointed out that the manufacturers should use standardized nomenclature, specification of ingredients and instructions for dosage. The availability of balanced basic formulas, to be supplemented with individual components as necessary, would be highly desirable.

[Remarks concerning the treatment of hyperkinetic children with the so-called "diet poor in phosphate (author's transl)]. / Bemerkungen zu einer sogenannten phosphatarmen Diät für Kinder mit Hyperkinetischem Syndrom.

Compared with normal diets, the so-called "diet poor in phosphate" is really not poor in phosphate. Phosphate intake amounts only to 3% when ingested as food stuffs with phosphate additions permitted by law. The so-called "diet poor in phosphate" is poor in carbohydrates, dietary fiber and ascorbic acid. Animal proteins and fats, however, are high in this diet there by increasing the cholesterol intake. We cannot recommend this so-called "diet poor in phosphate" for children.

[On additional food for young infants on commercially prepared milk formulae before the age of four months (author's transl)]. / "Beikost" für Säuglinge im 1. Lebenshalbjahr bei Ernährung mit industriell hergestellten Milchnahrungen.

Infants often get extra food ("Beikost") in addition to their milk formula at an earlier time than recommended in text-books of pediatrics. The dangers connected with such feeding practices, i.e. insufficient protein and calcium supply and an overnutrition with carbohydrates, are pointed out. Gluten sensibilisation as a result of early feeding with milk-pap, the high content of sugar in fruit preparations, the addition of salt and the nitrate content of vegetables are discussed. A better label of the composition for industrially prepared "Beikost" is recommended. There exists no nutritional or psychological reason to start with "Beikost" before the 4th month of life for infants fed on industrially prepared milk formulae with added vitamines and minerals.