Breastfed and Formula-Fed Infants: Need of a Different Complementary Feeding Model?

Suboptimal nutrient quality/quantity during complementary feeding (CF) can impact negatively on infants' healthy growth, even with adequate energy intake. CF must supplement at best human milk (HM) or formulas, which show nutritional differences. Considering this, a differentiated CF is probably advisable to correctly satisfy the different nutritional needs. To assess whether current needs at 6-24 months of age can still be met by one single CF scheme or different schemes are needed for breastfed vs. formula/cow's milk (CM) fed infants, protein, iron and calcium intakes were assessed from daily menus using the same type and amount of solid food, leaving same amounts of HM and follow-up formula at 9 and again 18 months of age, when unmodified CM was added. Depending on the child's age, calcium- and iron-fortified cereals or common retail foods were used. The single feeding scheme keeps protein intake low but higher than recommended, in HM-fed children while in formula/CM-fed ones, it achieves much higher protein intakes. Iron Population Recommended Intake (PRI) and calcium Adequate Intakes (AI) are met at the two ages only when a formula is used; otherwise, calcium-fortified cereals are needed. ESPGHAN statements on the futility of proposing different CF schemes according to the milk type fed do not allow to fully meet the nutritional recommendations issued by major Agencies/Organizations/Societies for all children of these age groups.

[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.

[Influential factors of iron deficient anemia among infants aged 8 months based on a case-control study].

OBJECTIVE: To study the status and influential factors of iron deficient anemia (IDA) among infants aged 8 months in Changsha City.
 Methods: A case-control study was performed in this research. The case group including 105 8-month-old infants definitely diagnosed as IDA based on standardized blood test. Four-times numbers of age- and genger-matched infants without IDA were selected as a control group. Chi-square test and conditional logistic regression was used to analyze the influential factors for IDA.
 Results: The incidence rate of IDA among infants aged 8 months in Changsha City was 14.7%. The risk factors were as follows: mother with anemia in late pregnancy (OR=3.540, 95% CI 1.898 to 6.601), mixed feeding within 6 months old (OR=1.682, 95% CI 1.099 to 2.574), artificial feeding within 6 months old (OR=4.162, 95% CI 1.343 to 12.896), complementary feeding before 6 months old (OR=1.423, 95% CI 1.022 to 1.982), complementary feeding at or after 7 months old (OR=4.415, 95% CI 2.150 to 9.064), recurrent respiratory tract infections within 8 months old (OR=2.878, 95% CI 1.224 to 6.764), and repeated diarrhea within 8 months old (OR=3.710, 95% CI 1.533 to 8.980).
 Conclusion: There is certain incidence rate of IDA among infants aged 8 months in Changsha City. To prevent the IDA among infants, we should treat mothers' anemia during pregnancy, advocate scientific feeding, encourage complete breastfeeding until 6 months old, add complementary food timely and reasonably, treat infants suffering from respiratory or digestive diseases actively.

Optimal nutrition in lactating women and its effect on later health of offspring: A systematic review of current evidence and recommendations (EarlyNutrition project).

BACKGROUND: EarlyNutrition ( www.project-earlynutrition.eu ) is an international research consortium investigating the effects of early nutrition on metabolic programming. OBJECTIVE: To summarize current evidence and standards, recommendations, guidelines, and regulations on nutrition or supplements in lactating women with emphasis placed on long-term health effects in offspring, including cardiovascular disease, hypertension, overweight/obesity, metabolic syndrome, diabetes, or glucose intolerance. METHODS: Medline, Embase, selected databases and websites were searched for documents published between 2010 and 2015. RESULTS: Thirteen documents met the inclusion criteria. Effects of maternal long-chain polyunsaturated fatty acid (LC-PUFA) supplementation on overweight/obesity or hypertension in offspring were assessed in 10 studies. One study described the effect of maternal vitamin D supplementation on overweight/obesity, and the remaining 2 studies assessed the effects of maternal probiotic/synbiotic supplementation during lactation on overweight/obesity or metabolic syndrome in their infants. Forty-one documents contained dietary recommendations on various macro- and micronutrients for lactating women, but without consideration of our long-term health outcomes in infants. CONCLUSION: Literature on nutrition of lactating women and its effect on their infants' later health with respect to metabolic programming outcomes appeared to be scarce, and focused mostly on supplementation of LC-PUFA's. No recent guidelines or recommendations were available, highlighting the significant research gaps regarding this topic.

Breastfeeding and Complementary Feeding.

BACKGROUND: Proper infant nutrition promotes healthy growth and development and lowers the risk of disease in later life. METHODS: This review is based on pertinent articles retrieved by a selective search, including guidelines, meta-analyses, and systematic reviews. RESULTS: Infants should be exclusively breast-fed until at least the age of 4 months. Infants who are no longer being breast-fed, or no longer exclusively so, should be given commercially available low-protein infant formula containing long-chain polyunsaturated fatty acids. Infants with a family history of allergy should be fed with infant formula based on hydrolyzed protein until complementary feeding begins. Complementary feeding should be initiated no earlier than the beginning of the 5th month and no later than the beginning of the 7th; it should include iron derived from meat, as well as fish once or twice a week. Later initiation of complementary feeding is associated with an increased risk of allergies and is not recommended. Ordinary cow's milk should not be drunk in the first year of life. All infants should be given 2 mg of vitamin K at birth, at 7-10 days, and at 4-6 weeks of age, as well as daily oral supplementation of vitamin D (400-500 IE) and fluoride (0.25 mg). CONCLUSION: Physicians should advise families about healthful infant nutrition in order to lay the foundation for lifelong good health through a proper diet.

Proposal of indicators to evaluate complementary feeding based on World Health Organization indicators.

This study compares complementary feeding World Health Organization (WHO) indicators with those built in accordance with Brazilian recommendations (Ten Steps to Healthy Feeding). A cross-sectional study was carried out during the National Immunization Campaign against Poliomyelitis in Guarapuava-Paraná, Brazil, in 2012. Feeding data from 1,355 children aged 6-23 months were obtained through the 24 h diet recall. Based on five indicators, the proportion of adequacy was evaluated: introduction of solid, semi-solid, or soft foods; minimum dietary diversity; meal frequency; acceptable diet; and consumption of iron-rich foods. Complementary feeding showed adequacy higher than 85% in most WHO indicators, while review by the Ten Steps assessment method showed a less favorable circumstance and a high intake of unhealthy foods. WHO indicators may not reflect the complementary feeding conditions of children in countries with low malnutrition rates and an increased prevalence of overweight/obesity. The use of indicators according to the Ten Steps can be useful to identify problems and redirect actions aimed at promoting complementary feeding.

The SHINE Trial Infant Feeding Intervention: Pilot Study of Effects on Maternal Learning and Infant Diet Quality in Rural Zimbabwe.

The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial is designed to measure the independent and combined effects of improved water, sanitation, and hygiene and improved infant feeding on child stunting and anemia in Zimbabwe. We developed and pilot-tested the infant feeding intervention delivered by 9 village health workers to 19 mothers of infants aged 7-12 months. Between September 2010 and January 2011, maternal knowledge was assessed using mixed methods, and infant nutrient intakes were assessed by 24-hour recall. We observed positive shifts in mothers' knowledge. At baseline, 63% of infants met their energy requirement and most did not receive enough folate, zinc, or calcium; none met their iron requirement. Postintervention, all infants received sufficient fat and vitamin A, and most consumed enough daily energy (79%), protein (95%), calcium (89%), zinc (89%), folate (68%), and iron (68%). The SHINE trial infant feeding intervention led to significant short-term improvements in maternal learning and infant nutrient intakes.

Composition of Follow-Up Formula for Young Children Aged 12-36 Months: Recommendations of an International Expert Group Coordinated by the Nutrition Association of Thailand and the Early Nutrition Academy.

BACKGROUND: There are no internationally agreed recommendations on compositional requirements of follow-up formula for young children (FUF-YC) aged 1-3 years. AIM: The aim of the study is to propose international compositional recommendations for FUF-YC. METHODS: Compositional recommendations for FUF-YC were devised by expert consensus based on a detailed literature review of nutrient intakes and unmet needs in children aged 12-36 months. RESULTS AND CONCLUSIONS: Problematic nutrients with often inadequate intakes are the vitamins A, D, B12, C and folate, calcium, iron, iodine and zinc. If used, FUF-YC should be fed along with an age-appropriate mixed diet, usually contributing 1-2 cups (200-400 ml) of FUF-YC daily (approximately 15% of total energy intake). Protein from cow's milk-based formula should provide 1.6-2.7 g/100 kcal. Fat content should be 4.4-6.0 g/100 kcal. Carbohydrate should contribute 9-14 g/100 kcal with >50% from lactose. If other sugars are added, they should not exceed 10% of total carbohydrates. Calcium should provide 200 mg/100 kcal. Other micronutrient contents/100 kcal should reach 15% of the World Health Organization/Food and Agriculture Organization recommended nutrient intake values. A guidance upper level that was 3-5 times of the minimum level was established. Countries may adapt compositional requirements, considering recommended nutrient intakes, habitual diets, nutritional status and existence of micronutrient programs to ensure adequacy while preventing excessive intakes.

Glutamina: su papel en el paciente crítico / Glutamine: the role in critically ill patients

La glutamina es un aminoácido condicionalmente esencial considerado actualmente como un importante fármaco-nutriente. Niveles plasmáticos bajos de glutamina han demostrado comportarse como un factor independiente de mortalidad en el paciente crítico, y su adición al soporte nutricional ha probado disminuir las complicaciones infecciosas, la mortalidad y la estancia hospitalaria. En los últimos años han aparecido nuevos estudios que indicanla necesidad de individualizar la vía de acceso y la dosis y el período de suplementación para determinados grupos de pacientes candidatos a la suplementación con glutamina, y por otra parte, a tenor de los resultados, es aconsejable evitarla en situaciones deshock hipovolémico inestable, fallo multiorgánico o insu¬ciência renal no sometida a técnicas de depuración.

Glutamine is a conditionally essential aminoacid which is nowadays considered an important pharmaco nutrient. Low serum levels of glutamine have proven to be an independent predictor of mortality in the critically ill patient. Supplementation with glutamine as a part of a nutritional therapy has demonstrated to reduce infectious complications, length of stay in hospital and mortality. Recent new published data show the need to individualize the route, dose, length of supplementation for determined groups of candidate patients to glutamine administration. On the other hand, according to results, glutamine is not recommended in case of unstable hypovolemic shock, multiorgan faillure, or renal failure not subjected to depuration techniques.

Threonine Requirement of the Enterally Fed Term Infant in the First Month of Life.

OBJECTIVE: Threonine is one of the essential amino acids. Its major fate is incorporation into intestinal mucosal proteins and synthesis of secretory glycoproteins. Therefore, it has an important function in the neonatal gut barrier integrity. The objective was to quantify the threonine requirement in fully enterally fed term neonates by means of the indicator amino acid oxidation (IAAO) method, using L-[1-C]phenylalanine as indicator. METHODS: After a 24-hour test diet adaptation, containing randomly assigned amounts of threonine (range 5-182 mg · kg · day), the participating neonates received a primed continuous infusion of [C]bicarbonate and L-[1-C]phenylalanine. At baseline and during the plateau phase of both infusions, breath samples were obtained for CO2. The fractional L-[1-C]phenylalanine oxidation (FCO2) was estimated and plotted against the threonine intakes. Biphasic linear regression crossover analysis was used to calculate the breakpoint of the FCO2, representing the mean threonine requirement. Data are presented as mean ±â€ŠSD. RESULTS: Thirty-two term neonates (gestational age 39 ±â€Š1 weeks, birth weight 3.3 ±â€Š0.3 kg, mean postnatal age 10 ±â€Š4 days) were studied. The mean threonine requirement was estimated to be 68 mg · kg · day with an upper and lower 95% confidence interval of 104 and 32 mg · kg · day, respectively (r = 0.37). CONCLUSIONS: The determined threonine requirement is extremely close to the existing requirement recommendations (∼90% of the present World Health Organization requirement guidelines). Infant formula preparations presently on the market, however, contain up to twice as much threonine as recommended. The threonine intake in formula-fed infants may therefore be reduced considerably.

Effects of dietary supplementation with lemon verbena extracts on serum inflammatory markers of multiple sclerosis patients / Efecto de la suplementación dietética con extractos de hierbaluisa en los marcadores de inflamación en suero de personas con esclerosis múltiple

Introduction: Inflammation is one of the main contributory factors to the etiopathogenesis of multiple sclerosis (MS). Dietary interventions with Lipia citriadora (lemon verbena) extracts have been proved to be effective in the prevention of inflammatory diseases. Objectives: The aim of this study is to evaluate the effect of lemon verbena supplementation in pro- and anti- inflammatory serum biomarkers of patients with different clinical subtypes of multiple sclerosis. Methods: The effect of lemon verbena supplementation (10% w/w verbascoside) was evaluated in a randomized, double-blinded placebo-controlled study with 30 participants classified in relapsing-remitting (n=10), primary progressive (n=5) and secondary progressive (n=15) MS presentations. Serum cytokine and C reactive protein levels were assessed in intervention and control groups for each MS clinical subtype after 28 days of dietary supplementation. Results: Serum levels of C reactive protein and 8 cytokines/ inflammatory (IFN-γ, IL-12, IL-23, IL-6, TNF-α, TGF-β, IL-4 and IL-10) markers were studied. Secondary progressive MS- supplemented patients showed C reactive protein concentrations significantly lower compared to the placebo group (p<0.005). IFN-γ levels decreased for all MS-treated groups whereas IL-12 diminished levels were observed for relapsing-remitting type (p<0.05). Anti-inflammatory cytokine concentrations of IL-4 (difference 2.98 ± 2.99 pg/mL) and IL-10 (difference 1.78 ± 5.54 pg/mL) increased in secondary progressive MS patients (p<0.05). Conclusion: The variation of several pro- and anti-inflammatory markers after supplementation suggests that lemon verbena extracts may affect cytokine profiles in multiple sclerosis. Further investigation on dietary components with antioxidant and anti-inflammatory properties may contribute to understand MS pathogenesis and ameliorate MS symptoms (AU)

Introducción: La inflamación es uno de los principales factores que contribuyen en la etiopatogénesis de la esclerosis múltiple (EM). Se ha demostrado que las intervenciones en la dieta con extractos de Lipia citriadora (hierbaluisa) son efectivas en la prevención de las enfermedades inflamatorias. Objectivos: El objetivo de este estudio es evaluar el efecto de la suplementación con extractos de hierbaluisa en los biomarcadores de inflamación en suero de pacientes con diferentes subtipos clínicos de esclerosis múltiple. Métodos: El efecto de la suplementación con hierbaluisa (10 % p/p verbascósido) se evaluó mediante un estudio aleatorizado de doble ciego controlado con grupo placebo, constituido por 30 participantes clasificados según la forma de presentación de EM en: remitentes-recaídas (n=10), primaria progresiva (n=5) y secundaria progresiva (n=15). Los niveles de citoquinas y proteína C reactiva en suero se valoraron en los grupos intervención y control de cada uno de los subtipos clínicos de EM después de 28 días de suplementación en la dieta. Resultados: Se estudiaron los niveles en suero de proteína C reactiva y de 8 citoquinas como biomarcadores deinflamación (IFN-γ, IL-12, IL-23, IL-6, TNF-α, TGF-β, IL-4 e IL-10). Los pacientes del grupo de intervención con EM secundaria progresiva presentaron concentraciones de proteína C reactiva significativamente más bajos comparados con el grupo placebo (p<0.005). Los niveles de IFN-γ disminuyeron en todos los grupos tratados a la vez que se detectaron niveles inferiores de IL-12 en las formas secundaria progresiva y remitente-recaídas (p<0.05). Las concentraciones de las citoquinas anti-inflamatorias: IL-4 (diferencia 2,98 ± 2,99 pg/mL) y IL-10 (diferencia 1,78 ± 5,54 pg/mL) aumentaron en los pacientes con EM secundaria progresiva (p<0.05). Conclusión: La variación en la concentración de varias citoquinas pro- y anti-inflamatorias después de la suplementación con los extractos de hierbaluisa puede afectar al perfil de las citoquinas en la esclerosis múltiple. La investigación futura de los componentes de la dieta con propiedades anti-inflamatorias y antioxidantes puede contribuir a entender la patógenesis de la esclerosis múltiple así como a disminuir sus síntomas (AU)

Efeito do ácido graxo ômega 3 sobre a composição corporal, controle glicêmico e risco cardiovascular de indivíduos adultos e idosos / Effect of omega 3 fat acid on body composition, glycemic control and cardiovascular risk score in adults and elderly

Os benefícios dos ácidos graxos poli-insaturados ômega 3 (w-3) no metabolismo lipídico e na saúde cardiovascular são amplamente aceitos. Entretanto, o impacto do w-3 na composição corpórea, na homeostase da glicose e consequente modificação do risco cardiovascular não tem sido foco dos desfechos primários da maioria dos estudos clínicos. Objetivo: Avaliar o impacto da suplementação de w-3 sobre a composição corporal, o controle glicêmico e o nível de risco cardiovascular em indivíduos adultos. Métodos: A partir de uma sub-amostra do estudo CARDIONUTRI (estudo clínico, randomizado, controlado e duplo cego com seguimento de 2 meses) foram selecionados 86 indivíduos (grupo w-6, 3g de óleo de girassol/d) e 88 indivíduos (grupo w-3, 3g de óleo de peixe/d 60 por cento EPA/DHA). O efeito das intervenções foi monitorado nos tempos basal e T=8 (oito semanas). Nestes períodos foram coletadas informações demográficas, clínicas, atividade física, dieta, antropométricas e de composição corporal. Amostras de sangue foram coletadas após jejum de 12h e a partir do plasma/soro foram avaliados glicemia, insulina, colesterol total e associado a LDL e HDL, triacilgliceróis e as apolipoproteína AI e B utilizando métodos comerciais. O nível de risco cardiovascular dos indivíduos foi estimado pelo Escore de Risco de Framingham (ERF)...

The benefits of polyunsaturated omega 3 (n-3) on lipid metabolism and cardiovascular health fatty acids are widely accepted. However, the impact of n-3 in body composition, glucose homeostasis and consequent modification of cardiovascular risk has not been the focus of the primary outcomes of most clinical trials. Aim: To evaluate the impact of n-3 supplementation on body composition, glycemic control and the level of cardiovascular risk in adults. Methods: From a subsample of CARDIONUTRI study were selected (clinical, randomized, controlled, double blind study with follow-up of 2 months) 86 patients (group n-6, 3g of sunflower oil/d) and 88 individuals (n-3 group, 3g fish oil/d - 60 per cent EPA/DHA ). The effect of the interventions was monitored at baseline and T = 8 (eight weeks). In these periods were collected demographic information, clinical, physical activity, diet, anthropometric and body composition. After 12h fasting, blood samples were collected and, from plasma/serum, were evaluated glucose, insulin, total cholesterol, cholesterol associated with LDL and HDL, triacylglycerol, apolipoprotein AI and B using standard methods. The level of cardiovascular risk of individuals was estimated by the Framingham Risk Score (FRS)...

Poor complementary feeding practices and high anaemia prevalence among infants and young children in rural central and western China.

BACKGROUND/OBJECTIVES: Infant and young child feeding (IYCF) has not been documented in central and western China, where anaemia is prevalent. To support policy advocacy, we assessed IYCF and anaemia there using standardized methods. SUBJECTS/METHODS: A community-based, cross-sectional survey of 2244 children aged 6-23 months in 26 counties of 12 provinces. Analysis of associations between haemoglobin concentration (HC), IYCF indicators and other variables using crude and multivariate techniques. RESULTS: Only 41.6% of those surveyed consumed a minimum acceptable diet. Fewer still-breastfeeding than non-breastfeeding children consumed the recommended minimum dietary diversity (51.7 versus 71.9%; P<0.001), meal frequency (57.7% v. 81.5%; P<0.001) or iron-rich food (63.3% v. 78.9%; P<0.001). Anaemia (51.3% overall) fell with age but was significantly associated with male sex, extreme poverty, minority ethnicity, breastfeeding and higher altitude. Dietary diversity, iron intake, growth monitoring and being left behind by out-migrating parents were protective against anaemia. A structural equation model demonstrated associations between IYCF, HC and other variables. Meal frequency, iron intake and altitude were directly and positively associated with HC; dietary diversity was indirectly associated. Health service uptake was not associated. Continued breastfeeding was directly associated with poor IYCF and indirectly with reduced HC, as were having a sibling and poor maternal education. CONCLUSION: Infant and young child anaemia is highly prevalent and IYCF is poor in rural central and western China. Continued breastfeeding and certain other variables indicate risk of poor IYCF and anaemia. Major policy commitment to reducing iron deficiency and improving IYCF is needed for China's rural poor.

Orange-fleshed sweet potato-based infant food is a better source of dietary vitamin A than a maize-legume blend as complementary food.

BACKGROUND: White maize, which is widely used for complementary feeding and is seldom fortified at the household level, may be associated with the high prevalence of vitamin A deficiency among infants in low-income countries. OBJECTIVE: The nutrient composition of complementary foods based on orange-fleshed sweet potato (OFSP) and cream-fleshed sweet potato (CFSP), maize-soybean-groundnut (Weanimix), and a proprietary wheat-based infant cereal (Nestlé Cerelac) were assessed using the Codex Standard (CODEX STAN 074-1981, Rev. 1-2006) specification as a reference. Additionally, the costs of OFSP complementary food, CFSP complementary food, and Weanimix production at the household level were estimated. Phytate and polyphenols, which limit the bioavailability of micronutrients, were assessed. METHODS: Energy, macronutrients, and micronutrients listed as essential composition in the Codex Standard were determined and expressed as energy or nutrient density. RESULTS: All the formulations met the stipulated energy and nutrient densities as specified in the Codex Standard. The beta-carotene content of OFSP complementary food exceeded the vitamin A specification (60 to 180 microg retinol activity equivalents/100 kcal). All the formulations except Weanimix contained measurable amounts of ascorbic acid (> or = 32.0 mg/100 g). The level of phytate in Weanimix was highest, about twice that of OFSP complementary food. The sweet potato-based foods contained about twice as much total polyphenols as the cereal-based products. The estimated production cost of OFSP complementary food was slightly higher (1.5 times) than that of Weanimix. CONCLUSIONS: OFSP complementary food is a good source of beta-carotene and would therefore contribute to the vitamin A requirements of infants. Both OFSP complementary food and Weanimix may inhibit iron absorption because of their high levels of polyphenols and phytate, respectively, compared with those of Nestlé Cerelac.

Papel de los cereales en la alimentación infantil / Role of the cereals in infant feeding

En el primer año de vida, la lactancia materna es el referente durante al menos los 6 primeros meses, pero hay una cierta dispersión de tendencias cuando se llega a la edad de introducir la alimentación complementaria. Tradicionalmente, los cereales han sido y son los primeros alimentos que se aconsejan como inicio de la alimentación complementaria. En los últimos tiempos se ha observado un descenso que posiblemente esté relacionado con algunos tópicos negativos, por lo que nos ha parecido oportuno actualizar su papel. Las características fisiológicas de los primeros años de vida son circunstancias que tienen gran importancia para conseguir una buena adaptación en la progresión de la alimentación atendiendo a las capacidades que el nuevo ser va adquiriendo en estos primeros años, preferentemente en sus funciones digestivas, renales y neuromusculares. Los cereales son una excelente fuente nutricional, pero no todos tienen las mismas propiedades, por lo que se repasa su composición para valorar los beneficios que representan en la salud del niño, tanto como aporte de la energía que va necesitando para cubrir sus necesidades, como para evitar deficiencias proteicas y de vitaminas y oligoelementos. No sólo es importante la cantidad, sino también la calidad y el contexto de una alimentación variada y equilibrada que ayude a compensar el resto de los aportes. Ya que los cereales son fundamentales en la alimentación de nuestros hijos, es bueno recordar algunas recomendaciones actualizadas sobre su uso en los diferentes periodos de la vida, ya sea en forma de papillas en los primeros meses o de cereales más complejos en etapas más avanzadas, así como resaltar la vigencia que conservan en la alimentación de los primeros años si se utilizan correctamente(AU)

In the first year, the breastfeeding is the gold standard for at least the first 6 months, but there is some dispersion of trends when it reaches the age of introducing complementary feeding. Traditionally, cereals are and have been the first foods that have been recommended as the start of complementary feeding. In recent times there has been a decline that is possibly related to some negative stereotypes so we thought it timely to update its role. The physiological characteristics of the first years of life are circumstances that are very important to get a good fit in the progression of food in response to the new capabilities will be acquired, in these early years, preferably in their digestive, renal and neuromuscular functions. Cereals are an excellent source of nutrition, but not everyone has the same properties, so it reviews the composition thereof, to assess the benefits that they have to the health of children, as well as the energy input is needed to cover their needs, and to avoid protected of deficits in vitamins and trace elements. Not only the quantity is important, it is undoubtedly the quality of them and place them in a context of varied and balanced diet that helps compensate the rest of the contributions. Being important cereals in the diet of our children, we should remember some updated recommendations in different periods of life will have on their use, either in the form of porridge in the early days, as more complex grain more advanced age and highlight the effect that conserve importance in the early years if used correctly(AU)

Alimentación complementaria dirigida por el bebé («baby-led weaning»). ¿Es una aproximación válida a la introducción de nuevos alimentos en el lactante? / Baby-led weaning, a valid approach to complementary feeding?

Tradicionalmente, la introducción de la alimentación complementaria pasa por un periodo de alimentación triturada, hasta que el lactante adquiere las habilidades para tomar comida en trocitos. En la práctica, el momento de la introducción de alimentos no triturados se ha ido retrasando, lo que ha llevado a una mayor frecuencia de problemas en la alimentación en esa edad. La alimentación complementaria guiada por el bebé (baby-led weaning) se basa en que sea el propio lactante quien se alimenta llevándose la comida a la boca, en vez de ser alimentado con una cuchara por un adulto. En esta práctica, el lactante se incorpora pronto a la comida familiar y comparte su menú, manteniendo la lactancia materna. Algunos estudios observacionales de pequeño tamaño sugieren que esta técnica favorece los patrones de alimentación, aunque no se ha podido demostrar si se plasma en efectos beneficiosos para la salud. Su difusión surge a raíz de la recomendación de la Organización Mundial de la Salud de retrasar la introducción de la alimentación complementaria hasta los 6 meses, en un momento en que el lactante ha alcanzado hitos importantes en su desarrollo, lo que haría posible que se alimentara por sí mismo. Algunos de los aspectos contenidos en esta filosofía serían válidos para la mayoría de los lactantes, aunque es difícil aceptarlo en su radicalidad (oposición a las comidas con cuchara). Las principales dudas que se plantean respecto a esta técnica son saber si el lactante recibe suficiente variedad de nutrientes y en una cuantía suficiente (p. ej., el hierro), si existe riesgo de atragantamiento y si la técnica es aplicable en todos los niños. A fecha de hoy, parece importante que los pediatras conozcamos en qué consiste esta técnica de alimentación y podamos responder a las preguntas de los padres sobre su eficacia y seguridad(AU)

Usually complementary feedings include, at least temporar­ily, pureed foods or spoon foods until infant is able to grasp food and feed herself. In daily practice time for chewable foods has delayed is this is a cause of eating problems in late infancy. Baby-led weaning (BLW) is an alternative approach for introducing complementary foods that emphasises infant self-feeding rather than adult spoon-feeding. In this way infants early joins family meals and share familial menu. Some small observacional studies suggest that this approach enhances eating patterns, although benefits for health are still to be probed. Its diffusion is according to the recommendations from the WHO to delay complementary feedings till 6 months of age. Many of the considerations of these phylosophy could be applied to most infants, although it is difficult to agree in some radical aspects (opposition to pureed foods). Main unanswered questions are: do infants following BLW obtain sufficient nutrients, including energy and iron? Are iron deficiency, choking and growth faltering real concerns for those following BLW approach? Is the technique suitable for all infants? Up to date, it seems important that pediatricians know about BLW approach, its benefits and risks(AU)

Nutrient density in complementary feeding of infants and toddlers.

The paradigm of the first 1000 days of life, the period from conception to the second birthday, has been advanced as a critical window of opportunity to save a life and a child's future. Infancy and toddler life, through the first 24 months after birth, is a unique period during which human milk is recommended as either the exclusive source of nutrition (6 months) or a variable component thereof. After the maternal delivery of milk is accounted for, the remainder of the energy and nutrients needs come from complementary foods. There is an intrinsic gap left by the maternal milk supply in volume and micronutrient content in relation to expanding infant and toddler needs. The nutrient density approach provides us with a mathematical framework to manage the closing of the nutrient gap. The intrinsic nutrient content of the unprocessed foods appropriate for young children is limited. The most problematic nutrients are calcium, iron and zinc. Some manner to enhance the nutrient density of the complementary foods is an incontestable necessity. The nutrient density consideration, which identifies for us the nature of the problem, offers a tool for the titrating of the fortification to an adequate--but safe--addition.

Funcionalidad y recomendaciones nutricionales de ácidos grasos esenciales y sus derivados en la alimentación del lactante a partir de los 6 meses de edad / Functonality and nutritional recommendations of essential fatty acids and their derivatives in breastfeeders of six months onwards

Los requerimientos de ácidos grasos esenciales (AGEs) y ácidos grasos poliinsaturados de cadena larga (AGPI-CL) durante los últimos meses de gestación y los primeros años de vida son importantes de acuerdo al crecimiento y desarrollo neuronal que está teniendo lugar durante este periodo de vida. El objetivo de este trabajo ha sido destacar la importancia de garantizar un correcta ingesta de AGEs para cubrir los requerimientos nutricionales de estos, a través de la ingesta de alimentos que contienen en su composición nutricional a estos ácidos de forma natural o han sido enriquecidos con ellos. La metodología empleada para este fin ha sido la utilización de bases de datos electrónicas como MedLine, ScienceDirect, Scirus, Trip database y de la hemeroteca científica de la Universidad de Murcia; También han sido consultadas las páginas web de organismos nacionales e internacionales tales como la Asociación Española de Pediatría (AEP), Agencia Europea de Seguridad Alimentaria (EFSA) y European Society of Pediatric, Gastroenterology, Health and Nutrition (ESPGHAN). Los resultados obtenidos muestran como los AGEs e incluso los AGPI-CL (DHA y ARA) son esenciales para el correcto desarrollo del lactante y niño de corta edad; pues aún estando el lactante desde el primer día de vida dotado de todo el sistema enzimático necesario para la conversión de AGEs en sus correspondientes AGPI-CL y sus derivados, esta conversión podría ser insuficiente, siendo necesario y/o esencial el aporte de estos AGPI-CL a través de la dieta. Las conclusiones derivadas de este trabajo fueron que durante los seis primeros meses de vida el aporte de AGEs y AGPI-CL está asegurado a través de la leche materna o en su defecto a través de las fórmulas de inicio; a partir de los 6 meses con la introducción de la alimentación complementaria y la introducción de la leche de vaca a partir de los 12 meses de vida (introducción en contra de las recomendaciones de ESPGHAN), podría verse comprometida la aportación de estos ácidos. Existe un vacío legal en cuanto a la aportación de AGEs a través de la alimentación complementaria distinta a los cereales; sin embargo, comités como el de la AEP recomienda que en los tarritos infantiles de carnes y pescados con verdura, el aporte de AL sea entre 3-4.5% de la energía de la dieta y al menos 0.5% desde ALN para satisfacer los requerimientos de AGEs en lactantes y niños de corta edad (AU)

Essential fatty acids and long-chain unsaturated fatty acids are important for growth and neuronal development during the final months of gestation and the early years of life. The aim of this study is to highlight the importance of ensuring a correct intake of EFAs for nutritional requirements through the intake of foods which naturally contain these acids or which have been enriched with them. The methodology used was basee on the review of electronic databases MedLine, ScienceDirect, Scirus, Trip database and that of the scientific journal library of the University of Murcia. National and international websites such as the Asociación Española de Pediatría (AEP), European Agency for Food Safety (EAFS) and the European Society of Pediatric, Gastroenterology, Health and Nutrition (ESPGHAN) were also consulted. The results show how EFAs and also AGPI-CL (DHA and ARA) are essential for the correct development of breastfeeders and infants. Even though the breastfeeder is enzymatically fully equipped from the first day of life to convert EFAs into AGPI-CL and derivatives, the conversion may be insufficient and it may be necessary to include AGPI-CL in the diet. The conclusions are that during the first 6 months of life the provision of EFAs and AGPI-CL is assured thanks to the mother’s milk or through starter formulas; at six months the introduction of complementary foods and the adaptation to cow’s milk at twelve months (against the recommendations of the ESPGHAN) may affect the provision of these acids. There is a legal vacuum in the issue of the provision of EFAs through complementary foods other than cereals although committees like the AEP recommend that AL in meat and fish baby foods with vegetables should suppose 3-4.5% of the energy provision, and ALN at least 0.5% in order to satisfy EFA requirements in breastfee ans infants (AU)

A treatment trial of vitamin D supplementation in breast-fed infants: universal supplementation is not necessary for rickets prevention in Southern Louisiana.

This study was conducted to determine if vitamin D supplementation is required to prevent rickets in breast-fed infants. Breast-feeding rates are increasing, and there are concerns about whether the vitamin D content of breast milk is sufficient. There are a few treatment trials of vitamin D supplementation in breast-fed infants; these were conducted in northern climates. The authors therefore performed a prospective clinical trial comparing vitamin D supplementation with placebo as control in southern Louisiana. Blood samples and questionnaires were collected at birth, 2, 4, and 6 months of age. There were no cases of rickets observed, and no differences in alkaline phosphatase levels between groups. Thus, there was no evidence that vitamin D supplementation reduced rickets risk in the authors' study population. This suggests that the current recommendations for universal vitamin D supplementation of breast-fed infants throughout the United States may need to be revised.