Complementary Foods and Milk-Based Formulas Provide Excess Protein but Suboptimal Key Micronutrients and Essential Fatty Acids in the Intakes of Infants and Toddlers from Urban Settings in Malaysia.

This study determined the intakes of complementary foods (CFs) and milk-based formulas (MFs) by a total of 119 subjects aged 6-23.9 months from urban day care centers. Dietary intakes were assessed using two-day weighed food records. Intake adequacy of energy and nutrients was compared to the Recommended Nutrient Intakes (RNI) for Malaysia. The most commonly consumed CFs were cereals (rice, noodles, bread). The subjects derived approximately half of their energy requirements (kcals) from CFs (57 ± 35%) and MFs (56 ± 31%). Protein intake was in excess of their RNI requirements, from both CFs (145 ± 72%) and MFs (133 ± 88%). Main sources of protein included meat, dairy products, and western fast food. Intake of CFs provided less than the RNI requirements for vitamin A, thiamine, riboflavin, folate, vitamin C, calcium, iron, and zinc. Neither CF nor MF intake met the Adequate Intake (AI) requirements for essential fatty acids. These findings indicate imbalances in the dietary intake of the subjects that may have adverse health implications, including increased risk of rapid weight gain from excess protein intake, and linear growth faltering and intellectual impairment from multiple micronutrient deficiencies. Interventions are needed to improve child feeding knowledge and practices among parents and child care providers.

[Common practices and beliefs in the preparation of complementary infant feeding in a Spanish sample: a cross-sectional study]. / Prácticas y creencias habituales en la preparación de la alimentación complementaria infantil en una muestra española: estudio transversal.

INTRODUCTION: Introduction: complementary feeding together with breast milk should cover the nutritional needs of children from 6 months onwards. Thus, inadequate dietary practices can lead to poor nutritional intake. The objective of this study was to examine infant food handling and cooking in Spanish households. Methodology: a cross-sectional study was carried out using an online survey in non-institutionalized adults living in Spain who usually prepare infant food for children under 2 years of age. Results: a total of 1,944 people (37.4 ± 6 years; 65.5 % women) answered the survey. Of these, 72 % prepared mainly mashed foods and 21 % used store-bought baby cereals frequently. Zucchini (39 %), chicken (62 %), hake (64 %) and banana (44 %) were the most commonly used foods. Boiling (63 %) and freezing (59 %) were the most widely used culinary and preservation practices. An inappropriate use of salt and some unsafe foods (large fish and chard) was identified, whereas olive oil and eggs were offered below the current nutritional recommendations. Conclusion: the population surveyed preferred to use mashed foods to feed children under 2 years of age. Even though they were aware that homemade food is nutritionally better, on certain occasions they offer store-bought baby cereal. Furthermore, some inappropriate feeding practices were detected, highlighting the need to implement nutritional education policies regarding infant food preparation.

INTRODUCCIÓN: Introducción: la alimentación complementaria junto con la leche materna debe permitir cubrir las necesidades nutricionales de los niños a partir de los 6 meses de edad. Las prácticas alimentarias inadecuadas determinan una ingesta nutricional deficiente. El objetivo de este estudio fue conocer las prácticas alimentarias en los hogares españoles en relación con la preparación y elaboración de la alimentación infantil. Metodología: se realizó un estudio transversal mediante una encuesta online en adultos residentes en España y no institucionalizados, encargados de la preparación de la alimentación infantil de menores de 2 años. Resultados: la encuesta fue respondida por 1944 personas (37,4 ± 6 años; 65,5 % mujeres). El 72 % de los encuestados prepara principalmente triturados y el 21 % utiliza papillas comerciales frecuentemente. El calabacín (39 %), el pollo (62 %), la merluza (64 %) y el plátano (44 %) son los alimentos más utilizados. El hervido (63 %) y la congelación (59 %) son las técnicas culinarias y de conservación más practicadas. Se identificó el uso inadecuado de la sal y algunos alimentos no seguros (pescados de gran tamaño y acelgas), así como un uso por debajo de las recomendaciones para el aceite de oliva y el huevo. Conclusión: los españoles encargados de la alimentación de los niños menores de 2 años prefieren los alimentos triturados. Aunque son conscientes de que la alimentación preparada en casa es nutricionalmente mejor, en ciertas ocasiones ofrecen papillas comerciales. Además, se han detectado algunas prácticas inadecuadas, por lo que parecen necesarias políticas de educación nutricional destinadas a los responsables de la elaboración de la alimentación infantil.

Establishing a Foundation for Optimal Feeding Outcomes in the NICU.

Many infants in the NICU experience difficulties with oral feeding, which contribute to prolonged length of stay. Oral feeding is a complex task involving sensorimotor functioning of the face, mouth, and larynx, as well as coordination of sucking, swallowing, and breathing. The care provided in the NICU starting at birth sets the stage for future oral feeding. The purpose of this article is to describe strategies that will establish a positive foundation to support optimal oral feeding. Nurses can use these strategies to protect newborns from noxious stimuli and promote positive auditory, tactile, gustatory, and olfactory experiences to optimize neurodevelopment for the complex task of feeding.

High confidence, yet poor knowledge of infant feeding recommendations among adults in Nova Scotia, Canada.

In Canada, adherence to the national 'Nutrition for Healthy Term Infants' recommendations of infant and young child feeding (IYCF; 0-24 months) is suboptimal. While maternal knowledge of IYCF is commonly assessed, that of the general public has rarely been explored. Our objective was to assess the knowledge of, and confidence in answers to, Canadian IYCF recommendations among a diverse sample of adults in Nova Scotia, Canada. Between March and May 2018, a self-administered questionnaire examining IYCF knowledge, self-rated confidence, and sociodemographic information was conducted among Nova Scotians (≥19 years) in public locations. We surveyed 229 adults; 60% (n=134) were women. Mean (95% CI) age was 44 (41,46) years, 73% self-identified as white, 77% were born in Canada, and 69% were parents. Knowledge deficits were: age to terminate breastfeeding (18.3 (16.7,19.9) months; recommendation: ≥24 months), age to introduce solids (9.2 (8.2,10.2) months; recommendation: 6 months), vitamin D supplementation (10% correct), and optimal complementary foods (only 37% indicated iron-rich foods). Correct IYCF knowledge was lower among men, non-parents, young adults (19-29 years) and low-income adults (<$50,000/year). Mean self-rated confidence (out of 10) was high (7.2 (6.9,7.5)), and not different (p>0.05) between correct and incorrect responses for: best food for a newborn, age to terminate any breastfeeding, and age to start family meal foods. We found low knowledge of IYCF guidelines, yet high confidence in responses regardless of accuracy, among adults in Nova Scotia. General public knowledge deficits may contribute to an unsupportive culture around IYCF practices and low adherence to current recommendations.

Contribution of commercial infant products and fortified staple foods to nutrient intake at ages 6, 12, and 18 months in a cohort of children from a low socio-economic community in South Africa.

Fortification of two staple foods, maize meal and wheat flour (bread), is mandatory, and commercial infant products are widely available in South Africa. Using a 24-hr recall, we determined the contribution of these foods towards nutrient intakes at ages 6 (n = 715), 12 (n = 446), and 18 (n = 213) months in a cohort of children in a peri-urban community, North West province. On the day of recall, commercial infant products were consumed by 83% of children at 6 months, 46% at 12 months, and 15% at 18 months; fortified staples were consumed by 23%, 81%, and 96%, respectively. For consumers thereof, commercial infant products contributed 33% energy and 94% iron intakes at 6 months and 27% energy and 56% iron intakes at 12 months; nutrient densities of the complementary diet was higher than for nonconsumers for most micronutrients. For consumers of fortified staples, energy contribution thereof was 11% at 6 months versus 29% at 18 months; at 18 months, fortified staples contributed >30% of iron, zinc, vitamin A, thiamine, niacin, vitamin B6, and folate; at 12 months, nutrient densities of the complementary diet were higher for zinc, folate, and vitamin B6 but lower for calcium, iron, vitamin A, niacin, and vitamin C than nonconsumers. At ages 12 and 18 months, ~75% of children had low calcium intakes. At 12 months, 51.4% of consumers versus 25.0% (P = 0.005) of nonconsumers of fortified staples had adequate intakes (>EAR) for all eight fortificant nutrients. However, despite fortification, nutrient gaps remain.

Use of monitoring data to improve implementation of a home fortification program in Bihar, India.

This paper describes the use of program-monitoring data to track program performance and inform activities. Monitoring data were collected as part of an effectiveness trial of multiple micronutrient powders (MNPs) for children 6-18 months in Bihar, India. Communities (n = 70; reaching over 10,000 children) were randomized to receive either counselling on infant and young child feeding or both counselling and MNPs. Government frontline health workers (FLWs) implemented and monitored program activities with support from CARE India and university partners. Monitoring data were collected over the duration of the entire program to assess program impact pathways using various checklists, which captured information about (a) attendance and training of FLWs at health subcentre meetings, (b) distribution of MNPs, (c) receipt and use of MNPs at the household level, and (d) midline mixed methods survey. At the beginning of the program, 72% of households reported receiving and 53% reported currently consuming MNPs. These numbers fell to 40% and 43% at midline, respectively. The main barrier to use by household was a lack of MNPs, due in part to infrequent FLW distribution. However, FLWs rarely reported MNP shortages at Anganwadi centres. Side effects also emerged as a barrier and were addressed through revised recommendations for MNP use. Qualitative data indicated high community acceptance of MNPs and a good understanding of the program by FLWs. The use of real-time program data allowed for recognition of key program issues and decision-making to enhance program implementation.

Baby-led complementary feeding: Randomized controlled study.

BACKGROUND: Baby-led weaning (BLW) is an approach to introducing solid foods to infants that gives control of the feeding process to the infant. Anecdotal evidence suggests that BLW is becoming popular with parents, but scientific research is limited to a few publications. This study assessed growth, hematological parameters and iron intake in 6-12-month-old infants fed by traditional or baby-led complementary feeding. METHODS: We recruited 280 healthy 5-6-month-old infants allocated to a control (traditional spoon feeding; TSF) group or an intervention (BLW) group in a randomized controlled trial. Infant growth, hematologic parameters and iron intake were evaluated at age 12 months. RESULTS: Infants in the TSF were significantly heavier than those in the BLW group. Mean weight in the BLW group was 10.4 ± 0.9 kg compared with 11.1 ± 0.5 kg in the TSF group. There was no statistically significant difference in the iron intake from complementary foods between the BLW (7.97 ± 1.37 mg/day) and TSF (7.90 ± 1.68 mg/day) participants who completed the diet records. Hematologic parameters were similar at 12 months. The incidence of choking reported in the weekly interviews was not different between the groups. CONCLUSIONS: To the best of our knowledge, this is the first randomized -controlled study to have examined the impact of weaning method on iron intake, hematological parameters and growth in breast-fed infants. BLW can be an alternative complementary feeding type without increasing the risk of iron deficiency, choking or growth impairment.

Postdischarge Feeding of Very-low-birth-weight Infants: Adherence to Nutrition Guidelines.

OBJECTIVES: Infant feeding guidelines are important public health strategies to promote optimal growth, development, and chronic disease prevention, but their effectiveness is contingent upon families' ability to adhere to them. Little is known of adherence to guidelines among nutritionally vulnerable infants, specifically those born very-low-birth-weight (VLBW) (<1500 g). This study investigated whether postdischarge feeding practices for VLBW infants align with current recommendations and explored parental and infant baseline sociodemographics related to these practices. METHODS: Prospectively collected data from families of 300 VLBW infants participating in a randomized clinical trial (ISRCTN35317141) were used. Baseline demographics were obtained at enrollment and postdischarge feeding practices via monthly telephone questionnaires to 6 months corrected age (CA). RESULTS: At discharge, 4 and 6 months CA, 72%, 39%, and 29% of infants received any amount of mother's milk, respectively; exclusive breast-feeding rates were 49%, 20%, and 6%, respectively. Among infants receiving mother's milk, rates of vitamin D supplementation were ≥83%. Recommendations for introducing solids between 4 and 6 months CA were followed by 71% of the cohort and for iron supplementation by 58%. Overall, 12% of infants adhered to all aforementioned recommendations. Mothers with university degrees were more likely to provide mother's milk, whereas mothers of Middle Eastern/South Asian ethnicity were less likely to provide mother's milk. CONCLUSIONS: Low rates of partial and exclusive breast-feeding of VLBW infants to 6 months CA were reported. Overall adherence to iron supplementation was low. Strategies to provide increased support for mothers identified as at-risk should be developed.

Complementary feeding practices for infants and young children in South Asia. A review of evidence for action post-2015.

Some 37% (~64 million) South Asian children under 5 years are stunted. Most stunting occurs during the complementary feeding period (6-23 months). Our objective was to (a) characterize complementary feeding practices in South Asia and (b) review the effectiveness of information, education, and counselling (IEC) interventions aiming to improve complementary feeding in South Asia. We conducted a comprehensive review of (a) the latest nationally representative survey data and (b) peer-reviewed interventions (January 1990 to December 2015) that used IEC as the main strategy to improve complementary feeding. The analytical sample included 30,966 children aged 6-23 months. Foods made from grains are the main complementary food (76.8% of children). Only 33.2% of children are fed fruits and vegetables rich in vitamin A and a mere 17.1% are fed complementary foods containing meat, fish, poultry and/or eggs. Timely introduction, minimum meal frequency, minimum dietary diversity, and minimum acceptable diet were estimated at 57.4%, 47.7%, 33.0%, and 20.5%, respectively. The evidence on the effectiveness of IEC interventions is limited in quantity, quality, and scale. The 12 intervention studies that met the inclusion criteria indicate that IEC interventions delivered by many types of primary care workers/community resource persons using multiple contact opportunities improved the timeliness, frequency, diversity, and/or adequacy of complementary feeding. However, acceptability, availability, and affordability seem to constrain improvements in diet diversity, particularly foods of animal origin. The small size of most intervention studies and the training and/or supervision intensity of counsellors raise concerns about the potential for scale and/or sustainability of some of the interventions reviewed.

Are Commercial Complementary Food Distributions to Refugees and Migrants in Europe Conforming to International Policies and Guidelines on Infant and Young Child Feeding in Emergencies?

In 2015, more than one million migrants and refugees arrived in Europe. Commercial complementary foods, processed foods marketed for infants and young children 6-23 months of age, were distributed by various humanitarian actors along migrant routes and in European refugee camps. Unsolicited donations and distributions of commercial complementary food products were problematic and divergent from international policies on infant and young child feeding during humanitarian emergencies. Interim guidance regarding commercial complementary foods was published during the peak of the emergency but implemented differently by various humanitarian actors. Clearer and more technical specifications on commercial complementary foods are needed in order to objectively determine their suitability for operational contexts in Europe and emergency nutrition assistance in the future.

Complementary Feeding Diets Made of Local Foods Can Be Optimized, but Additional Interventions Will Be Needed to Meet Iron and Zinc Requirements in 6- to 23-Month-Old Children in Low- and Middle-Income Countries.

BACKGROUND: The question whether diets composed of local foods can meet recommended nutrient intakes in children aged 6 to 23 months living in low- and middle-income countries is contested. OBJECTIVE: To review evidence of studies evaluating whether (1) macro- and micronutrient requirements of children aged 6 to 23 months from low- and middle-income countries are met by the consumption of locally available foods ("observed intake") and (2) nutrient requirements can be met when the use of local foods is optimized, using modeling techniques ("modeled intake"). METHODS: Twenty-three articles were included after conducting a systematic literature search. To allow for comparisons between studies, findings of 15 observed intake studies were compared against their contribution to a standardized recommended nutrient intake from complementary foods. For studies with data on intake distribution, %< estimated average requirements were calculated. RESULTS: Data from the observed intake studies indicate that children aged 6 to 23 months meet requirements of protein, while diets are inadequate in calcium, iron, and zinc. Also for energy, vitamin A, thiamin, riboflavin, niacin, folate, and vitamin C, children did not always fulfill their requirements. Very few studies reported on vitamin B6, B12, and magnesium, and no conclusions can be drawn for these nutrients. When diets are optimized using modeling techniques, most of these nutrient requirements can be met, with the exception of iron and zinc and in some settings calcium, folate, and B vitamins. CONCLUSION: Our findings suggest that optimizing the use of local foods in diets of children aged 6 to 23 months can improve nutrient intakes; however, additional cost-effective strategies are needed to ensure adequate intakes of iron and zinc.

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.

A focused ethnographic assessment of Middle Eastern mothers' infant feeding practices in Canada.

The aim of this study was to examine the barriers to following complementary feeding guidelines among Middle Eastern mothers and the cultural considerations of practitioners from an emic perspective. This is a two-phase focused ethnographic assessment of infant feeding among 22 Middle Eastern mothers in Western Canada who had healthy infants aged <1 year. Data were collected through four focus groups conducted in Arabic/Farsi, and were further complemented by comprehensive survey data collected in the second phase of study. Mothers' main criterion for choosing infant foods was whether or not foods were Halal, while food allergens were not causes for concern. Vitamin D supplements were not fed to 18/22 of infants, and mashed dates (Halawi), rice pudding (Muhallabia/Ferni) and sugared water/tea were the first complementary foods commonly consumed. Through constant comparison of qualitative data, three layers of influence emerged, which described mothers' process of infant feeding: socio-cultural, health care system and personal factors. Culture was an umbrella theme influencing all aspects of infant feeding decisions. Mothers cited health care professionals' lack of cultural considerations and lack of relevance and practicality of infant feeding guidelines as the main reasons for ignoring infant feeding recommendations. Early introduction of pre-lacteal feeds and inappropriate types of foods fed to infants among immigrant/refugee Middle Eastern mothers in Canada is cause of concern. Involving trained language interpreters in health teams and educating health care staff on cultural competency may potentially increase maternal trust in the health care system and eventually lead to increased awareness of and adherence to best practices with infant feeding recommendations.

[Evaluation of the feeding status of infants and young children under 2 years old in rural areas of Hubei province].

OBJECTIVE: To evaluate the current feeding status of infants and young children under 2 years old in rural areas of Hubei province. METHODS: The study was conducted by cluster random sampling from September 2009 to march 2010. The data on breastfeeding and complementary food supplement of the 1 197 infants and young children aged 0-23 months in 8 counties of Hubei province were collected through questionnaires. The feeding status was analyzed according to the WHO 2008 edition of Indicators for assessing infant and young child feeding practices. RESULTS: A total of 1 197 children aged 0-23 months were investigated. The rate of ever breastfeeding of children aged 0-23 months reached up to 93.9% (1 124/1 197), while the percentage of early initiation of breastfeeding was only 22.0% (263/1 197). The rates of exclusive breastfeeding under 6 months, continued breastfeeding for 1 year, and continued breastfeeding for 2 years were 72.1% (277/384), 17.0% (26/153) and 4.9% (7/144), respectively. The median time of giving complementary food was the 6th month and the weaning time was the 9th month. The rate of complementary food supplemented from 6th-8th month in time was 61.8% (444/718) . The rates of minimum dietary diversity, minimum meal frequency, minimum acceptable diet, and consumption of iron-rich or iron-fortified foods among children aged 6-23 months were 61.7% (502/813), 81.5% (663/813), 54.4% (442/813) and 50.1% (407/813), respectively. CONCLUSION: Late initiation of breastfeeding, non-continued breastfeeding, giving complementary food too early or too late, inadequate category and frequency of complementary food, and the low rate of consumption of iron-rich or iron-fortified foods were the main issues to be concerned on infant feeding in rural areas of Hubei province.

Complementary feeding patterns in the first year of life in the city of Rio de Janeiro, Brazil: time trends from 1998 to 2008.

This study aimed to analyze time trends in complementary feeding practices among children under one year of age in the city of Rio de Janeiro, Brazil, from 1998 to 2008. Based on comparable questions on food consumption in five surveys conducted in representative randomized samples of children in 1998 (n=3,762), 2000 (n=3,670), 2003 (n=4,305), 2006 (n=3,686), and 2008 (n=2,621), 16 complementary feeding indicators were constructed. The percentage frequency of all indicators was estimated for each year of the study. Linear trend analyses were also conducted by means of multivariate regression models. All indicators of early complementary feeding decreased from 1998 to 2008. In the 6-11.9 month age group, there was a significant downward trend in the proportion of children receiving food with adequate consistency for their age, consumption of iron-rich foods, and overall adequacy of the diet. A significant upward trend in fruit consumption was observed. There was a decrease in the early complementary feeding, and generally a worsening of complementary feeding practices in children aged 6-11.9 months in Rio de Janeiro during the period studied.

Complementary feeding patterns in the first year of life in the city of Rio de Janeiro, Brazil: time trends from 1998 to 2008 / Padrões de alimentação complementar no primeiro ano de vida no Município do Rio de Janeiro, Brasil: tendência temporal (1998-2008) / Patrones de alimentación complementaria durante el primer año de vida en la ciudad de Río de Janeiro, Brasil: tendencias temporales (1998-2008)

This study aimed to analyze time trends in complementary feeding practices among children under one year of age in the city of Rio de Janeiro, Brazil, from 1998 to 2008. Based on comparable questions on food consumption in five surveys conducted in representative randomized samples of children in 1998 (n = 3,762), 2000 (n = 3,670), 2003 (n = 4,305), 2006 (n = 3,686), and 2008 (n = 2,621), 16 complementary feeding indicators were constructed. The percentage frequency of all indicators was estimated for each year of the study. Linear trend analyses were also conducted by means of multivariate regression models. All indicators of early complementary feeding decreased from 1998 to 2008. In the 6-11.9 month age group, there was a significant downward trend in the proportion of children receiving food with adequate consistency for their age, consumption of iron-rich foods, and overall adequacy of the diet. A significant upward trend in fruit consumption was observed. There was a decrease in the early complementary feeding, and generally a worsening of complementary feeding practices in children aged 6-11.9 months in Rio de Janeiro during the period studied.

Este estudo objetivou analisar as tendências temporais das práticas de alimentação complementar entre crianças < 1 ano de idade na cidade do Rio de Janeiro, Brasil, de 1998 a 2008. Com base em questões comparáveis sobre o consumo de alimentos de cinco inquéritos realizados em amostras probabilísticas de crianças em 1998 (n = 3.762), 2000 (n = 3.670), 2003 (n = 4.305), 2006 (n = 3.686) e 2008 (n = 2.621), foram construídos 16 indicadores de alimentação complementar. A frequência percentual dos indicadores foi estimada para cada ano. Análises de tendências lineares foram realizadas por meio de modelos de regressão multivariada. Os indicadores de alimentação complementar precoce diminuíram de 1998 a 2008. No grupo de 6 a 11,9 meses de idade, houve tendência significativa do aumento no consumo de frutas e de queda na proporção de crianças que recebiam preparações com consistência adequada para sua idade, que consumiam alimentos ricos em ferro e que recebiam alimentação adequada. Durante o período estudado, houve queda da alimentação complementar precoce e, em geral, pioraram as práticas de alimentação complementar em crianças de 6 a 11,9 meses no Rio de Janeiro.

Se analizaron las tendencias temporales de las prácticas de alimentación complementaria en niños < 1 año de edad en la ciudad de Río de Janeiro, Brasil, de 1998 a 2008. En base a preguntas comparables acerca del consumo de alimentos en cinco encuestas, basadas en muestras aleatorias de niños en 1998 (n = 3.762), 2000 (n = 3.670), 2003 (n = 4.305), 2006 (n = 3.686) y 2008 (n = 2.621), se construyeron 16 indicadores de alimentación complementaria. Se calculó para cada año la frecuencia porcentual de los indicadores. Los análisis de tendencia lineal se realizaron por medio de modelos de regresión multivariable. Los indicadores de alimentación complementaria precoz disminuyeron. En niños con 6 a 11,9 meses de edad, hubo una tendencia significativa de aumento del consumo de frutas y una caída en la proporción de los que recibieron papillas con una consistencia adecuada para su edad, que consumieron alimentos ricos en hierro y que recibieron una alimentación adecuada. Durante el período de estudio, hubo una disminución de la alimentación complementaria precoz y, en general, un deterioro de las prácticas de alimentación complementaria en niños de 6 a 11,9 meses de edad en Río de Janeiro.

Complementary feeding of infants in their first year of life: focus on the main pureed baby foods.

OBJECTIVE: To evaluate the complementary feeding practices for infants, focusing on the main pureed baby foods, and verify adherence to the guidelines adopted in Brazil. METHODS: Through cross-sectional study, aspects of complementary feeding of 404 healthy infants between 4 and 9 months of age (São Paulo, Curitiba and Recife) were evaluated. Socio-demographic data, history and food habits were collected. Mothers described three recipes (preparations) usually used in key baby foods. The findings were compared with those recommended by the Brazilian Society of Pediatrics. RESULTS: The average age was 6.9 ± 1.6 months. Among infants, 241/404 (59.6%) were still breastfeeding. Among those who received another type of milk, 193/368 (52.4%) received whole cow's milk, while 151/368 (41.0%) drank infant or follow-on formulas. Regarding baby food recipes salted reported by mothers, it was seen that 30% and 60% contained meat and vegetables, respectively. The percentages less suitable for feeding in general were observed for use of cow's milk and added sugar, chocolate and cereal in feeding bottles; 79% and 80.5% of the families interviewed would adopted such practices. CONCLUSION: The early termination of exclusive/predominant breastfeeding and the practice of an inadequate transition diet have shown a picture of quantitatively and qualitatively inadequate feeding, with the risk of causing serious nutritional problems in later ages, such as anemia and vitamin A deficiency, or excess of nutrients, leading to obesity, diabetes and dyslipidemias.

Nutritional status of breast-fed and non-exclusively breast-fed infants from birth to age 5 months in 8 Chinese cities.

This study aimed to assess the nutritional status of infants aged 0 to 5 months by different feeding approaches. A cross-sectional study on infant nutrition was performed in eight cities in China. A total of 622 infants from birth to 2 months of age and 456 infants from 3 months to 5 months of age were included in this study. Mix-fed infants received breast milk and complementary foods from birth to 2 months of age. Approximately 38.2% of mix-fed infants received excessive vitamin A, and 15.6% of infants exceeded the tolerable upper intake levels (ULs) of zinc. For artificially fed infants who received only complementary foods, approximately 20% and 12.5% infants received inadequate dietary vitamin A and zinc intakes, respectively. The vitamin A and zinc intakes of half of the infants exceeded the ULs. Results showed that the usual intake distribution of the infants from 3 months to 5 months of age were similar to that of the infants from birth to 2 months of age. The common vitamin A and zinc intakes were also severely imbalanced. In addition, higher disease prevalence and lower Z scores of length-forage, weight-for-age, and weight-for-length were found in artificially fed infants and mix-fed infants compared with those in breast-fed infants. In conclusion, the usual nutrient intakes were adequate for the majority of Chinese infants, except for an important number of infants at risk for imbalance of vitamin A and zinc intakes.

Patterns of nutrients' intake at six months in the northeast of Italy: a cohort study.

BACKGROUND: Adequate complementary feeding is recognized as an important predictor of health later in life. The objective of this study was to describe the feeding practices and nutrients' intake, and their association with breastfeeding at six months of age, in a cohort of infants enrolled at birth in the maternity hospital of Trieste, Italy. METHODS: Out of 400 infants enrolled at birth, 268 (67%) had complete data gathered through a 24-hour feeding diary on three separate days at six months, and two questionnaires administered at birth and at six months. Data from feeding diaries were used to estimate nutrients' intakes using the Italian food composition database included in the software. To estimate the quantity of breastmilk, information was gathered on the frequency and length of breastfeeds. RESULTS: At six months, 70% of infants were breastfed and 94% were given complementary foods. The average daily caloric intake was higher in non-breastfed (723 Kcal) than in breastfed infants (547 Kcal, p < 0.001) due to energy provided by complementary foods (321 vs. 190 Kcal, p < 0.001) and milk (363 vs. 301 Kcal, p = 0.007). Non-breastfed infants had also higher intakes of carbohydrates, proteins, and fats. The mean intake of macronutrients was within recommended ranges in both groups, except for the higher protein intake in non-breastfed infants. These consumed significantly higher quantities of commercial baby foods than breastfed infants. CONCLUSIONS: Contrary to what is recommended, 94% of infants were not exclusively breastfed and were given complementary foods at six months. The proportion of daily energy intake from complementary foods was around 50% higher than recommended and with significant differences between breastfed and non-breastfed infants, with possible consequences for future nutrition and health.

Complementary feeding of infants in their first year of life: focus on the main pureed baby foods / Alimentação complementar de lactentes no primeiro ano de vida: ênfase nas papas principais

Objective: to evaluate the complementary feeding practices for infants, focusing on the main pureed baby foods, and verify adherence to the guidelines adopted in Brazil. Methods: through cross-sectional study, aspects of complementary feeding of 404 healthy infants between 4 and 9 months of age (São Paulo, Curitiba and Recife) were evaluated. Socio-demographic data, history and food habits were collected. Mothers described three recipes (preparations) usually used in key baby foods. The findings were compared with those recommended by the Brazilian Society of Pediatrics. Results: the average age was 6.9±1.6 months. Among infants, 241/404 (59.6%) were still breastfeeding. Among those who received another type of milk, 193/368 (52.4%) received whole cow's milk, while 151/368 (41.0%) drank infant or follow-on formulas. Regarding baby food recipes salted reported by mothers, it was seen that 30% and 60% contained meat and vegetables, respectively. The percentages less suitable for feeding in general were observed for use of cow's milk and added sugar, chocolate and cereal in feeding bottles; 79% and 80.5% of the families interviewed would adopted such practices. Conclusion: the early termination of exclusive/predominant breastfeeding and the practice of an inadequate transition diet have shown a picture of quantitatively and qualitatively inadequate feeding, with the risk of causing serious nutritional problems in later ages, such as anemia and vitamin A deficiency, or excess of nutrients, leading to obesity, diabetes and dyslipidemias. .

Objetivo: avaliar as práticas relacionadas à alimentação complementar de lactentes, com ênfase nas papas principais, e verificar a concordância com as recomendações atualmente adotadas no Brasil. Métodos: por meio de estudo transversal, foram avaliados os aspectos da alimentação complementar de 404 lactentes saudáveis entre 4 e 9 meses de vida (São Paulo, Recife e Curitiba). Coletaram-se dados sociodemográficos de antecedentes e hábitos alimentares. As mães descreveram três receitas (preparações) que costumam utilizar nas papas principais. Os achados foram comparados ao preconizado pela Sociedade Brasileira de Pediatria. Resultados: a média de idade foi de 6,9±1,6 meses. Cerca de 241 lactentes (59,6%) permaneciam em aleitamento materno. Entre os que recebiam outro tipo de leite, 193 dos 368 (52,4%) recebiam leite de vaca integral, e 151 dos 368 (41%), fórmulas infantis ou de seguimento para lactentes. Em relação às receitas de papas salgadas relatadas pelas mães, foi possível observar que 30 e 60% delas continham leguminosas e carnes, respectivamente. Os piores percentuais de adequação na alimentação, em geral, foram observados para uso de leite de vaca e adição de açúcar, achocolatado e cereais em mamadeiras; 79 e 80,5% das famílias entrevistadas adotavam essas práticas. Conclusão: o abandono precoce do aleitamento materno exclusivo/predominante e a prática de uma dieta de transição inadequada têm mostrado um quadro de consumo quantitativa e qualitativamente inapropriado, com riscos de acarretar graves problemas nutricionais nas faixas etárias posteriores, como anemia e hipovitaminose A, ou excessos de nutrientes, como obesidade, diabete e dislipidemias. .