Observation of Traditional Caregiver-Infant Feeding Behaviours and Porridge and Energy Intakes during One Meal to Define Key Messages for Promoting Responsive Feeding in the Amparafaravola District, Rural Madagascar.

Undernutrition is highly prevalent in young children in Madagascar and insufficient intake per meal could be one of the main causes. A cross-sectional survey of infant feeding practices including video-recorded meal observations was carried out with 101 caregiver-infant pairs in the Amparafaravola district, Northeast Madagascar. The objective was to quantify the porridge/energy intake of 9-11-month-old children and assess its association with the caregiver-infant feeding behaviours. Then, key messages for promoting responsive feeding (RF) were developed and tested through focus group discussions. The mean porridge intake was 12.8 ± 7.5 g/kg body weight (BW)/meal, corresponding to hardly one-third of the 300 kcal recommended from complementary foods for 9-11-month-old children. Analysis of meal videos suggested that mothers practiced the five positive feeding behaviours (self-feeding, responsive, active, social, and distraction), and rarely the negative ones. Only 6.9% of mothers used positive RF "very frequently", although it was associated with higher intakes (p < 0.05), with mean intake reaching 21 g/kg BW. In focus groups, caregivers approved the six RF messages and related counselling cards. They suggested some modifications to improve their understanding, and counselling cards were revised accordingly. The long-term impact of RF-promoting card use on the meal intakes and the nutritional status of young children must now be assessed.

The Level of Processing, Nutritional Composition and Prices of Canadian Packaged Foods and Beverages with and without Gluten-Free Claims.

Little is known about the healthfulness and cost of gluten-free (GF) foods, relative to non-GF alternatives, in Canada. This study compared the extent of processing, nutritional composition and prices of Canadian products with and without GF claims. Data were sourced from the University of Toronto Food Label Information Program (FLIP) 2013 (n = 15,285) and 2017 (n = 17,337) databases. Logistic regression models examined the association of NOVA processing category with GF claims. Calorie/nutrient contents per 100 g (or mL) were compared between GF and non-GF products. Generalized linear models compared adjusted mean prices per 100 g (or mL) of products with and without GF claims. The prevalence of GF claims increased from 7.1% in 2013 to 15.0% in 2017. GF claims appeared on 17.0% of ultra-processed foods, which were more likely to bear GF claims products than less-processed categories. Median calories and sodium were significantly higher in GF products; no significant differences were observed for saturated fat or sugars. Compared to non-GF products, adjusted mean prices of GF products were higher for 10 food categories, lower for six categories and not significantly different for six categories. Overall, GF claims are becoming increasingly prevalent in Canada; however, they are often less healthful and more expensive than non-GF alternatives, disadvantaging consumers following GF diets.

Current practice in the introduction of solid foods for preterm infants.

OBJECTIVE: The present study compared the age of first solid foods in a cohort of preterm infants with term infants and identified factors influencing timing of solid food introduction. DESIGN: Structured interviews on infant feeding practices, growth and medical status at term equivalence and at 3, 6, 9 and 12 months corrected postnatal age. The age of solid food introduction was compared between term and preterm infants, and the influence of maternal, infant and milk feeding factors was assessed. SETTING: This prospective longitudinal study recruited primary carers of preterm and term infants from a regional metropolitan referral hospital in eastern Australia. PARTICIPANTS: One hundred and fifty infants (preterm, n 85; term, n 65). RESULTS: When corrected for prematurity, preterm infants received solid foods before the recommended age for the introduction of solid foods for term infants. Median introduction of solid foods for preterm infants was 14 weeks corrected age (range 12-17 weeks). This was significantly less than 19 weeks (range 17-21 weeks) for term infants (P < 0·001). Lower maternal education and male gender were associated with earlier introduction of solid foods among preterm infants. CONCLUSIONS: Preterm infants are introduced to solid foods earlier than recommended for term infants, taking account of their corrected age. Further research is needed to assess any risk or benefit associated with this pattern and thus to develop clear evidence-based feeding guidelines for preterm infants.

The use of finger foods in care settings: an integrative review.

BACKGROUND: Reduced food intake is prevalent in people in residential and hospital care settings. Little is known about the use of finger foods (i.e. foods eaten without cutlery) with respect to increasing feeding independence and food intake. The Social Care Institute for Excellence (Malnutrition Task Force: State of the Nation, 2017) recommends the use of finger foods to enable mealtime independence and to prevent loss of dignity and embarrassment when eating in front of others. The aim of this review is to identify and evaluate the existing literature regarding the use and effectiveness of finger foods among adults in health and social care settings. METHODS: An integrative review methodology was used. A systematic search of electronic databases for published empirical research was undertaken in October 2018. Following screening of titles and abstracts, the full texts of publications, which investigated outcomes associated with the provision of finger foods in adult care settings, were retrieved and assessed for inclusion. Two independent investigators conducted data extraction and quality assessment using Critical Appraisal Skills Programme checklists. Thematic analysis was used to summarise the findings. RESULTS: Six studies met the inclusion criteria. Four themes were identified: Finger food menu implementation; Importance of a team approach; Effect on nutrition; and Influence on wellbeing. Study designs were poorly reported, with small sample sizes. CONCLUSIONS: There is some evidence that the provision of finger foods may positively affect patient outcomes in long-term care settings. There is a paucity of research evaluating the use of a finger food menu in acute care settings, including economic evaluation. Future high quality trials are required.

Visual plate waste in hospitalized patients: length of stay and diet order.

The purpose of this pilot research was to investigate the effect of diet order, sex, diagnosis, and length of stay on visual lunch plate waste in hospitalized patients. Information on 346 patients was collected using the computer program CBORD Diet Office. Visual plate waste during lunch was measured and analyzed for 4 consecutive days. Neither sex nor diagnosis at admittance was associated with visual plate waste. However, the odds of visual plate waste increased by 14.1% for every day a patient was admitted. In patients receiving a diabetic diet order, odds of visual plate waste decreased by 61.2%, indicating there was reduction in plate waste. Conversely, in patients receiving altered consistency diet orders, odds of visual plate waste increased by 344%, signifying a rise in plate waste. Due to an increase of visual plate waste associated with long length of stay and altered consistency diet orders, registered dietitians working in acute-care facilities need to develop strategies to create cost-effective, nutritionally balanced, altered consistency diets that would enhance patient acceptance and consumption of food.