Infant and young child feeding practices among mothers in the pilot Micronutrient Powder Initiative in four geographically and ethnically diverse districts in Ghana.

In Ghana, breastfeeding and complementary feeding counselling have been used as a nutritional intervention to promote optimal Infant and Young Child Feeding (IYCF) and nutrition. This study examined IYCF practices in four geographically and ethnically diverse districts (Ho West, Tain, Talensi and Tolon). A qualitative study involving key informant interviews (KIIs) and focus group discussions (FGDs) was conducted between November and December 2019 among women who participated in a pilot micronutrient powder intervention for children 6-23 months of age. The KIIs and FGDs were audio-taped, transcribed verbatim, and analyzed thematically using NVivo 10. Three themes emerging from the KIIs and FGDs were: level of adherence to IYCF recommendations among mothers and caregivers; IYCF recommendations perceived as the hardest to follow; and perceived motivators, facilitators, and barriers to IYCF practices. Mothers in the four districts generally followed the eight IYCF recommendations. Mothers in the Tolon district demonstrated adherence to IYCF practices, often citing the need for early initiation of breastfeeding, timely introduction of complementary feeding, and feeding children aged 9-23 months 3 times daily in addition to breastfeeding. In contrast, mothers in other districts faced challenges that hindered adherence. Giving children 4 or more food groups and timely introduction of complementary feeding were perceived as the hardest practices to follow. The main facilitators of IYCF practices include midwives and frontline nurses teaching mothers how to breastfeed, and midwives ensuring mothers initiate breastfeeding immediately after delivery. The main barriers to IYCF practices identified were insufficient breastmilk; mothers-in-law giving water to children before six months; resumption of work; and lack of financial means. Mothers in the Ho West district reported more barriers to IYCF practices, followed by mothers in the Tain, Talensi, and Tolon districts. Health practitioners, stakeholders, and policymakers should design targeted interventions that address the contextual barriers to improve IYCF practices in the various districts.

Breastfeeding in PKU and Other Amino Acid Metabolism Disorders-A Single Centre Experience.

In addition to the numerous immunological and nutritional benefits that breast milk offers to infants, its proportion in the diet must be limited or even excluded in the case of inborn errors of amino acid metabolism (IEM). The objective of the study was to expand knowledge about breastfeeding and the degree of contribution of breast milk to the feeding of infants with IEM before and after the introduction of expanded newborn screening. A retrospective single-centre study was conducted on 127 infants born between 1997 and 2020: 66 with phenylketonuria (PKU), 45 with other IEM (non-PKU), all diagnosed through newborn screening (NBS), and 16 non-PKU diagnosed through selective screening (SS). The time of initiation of dietary treatment and the proportion of breast milk in the diet, both expressed and breastfed, with or without intake control, were analysed at 1, 3, and 6 months after birth. For 47% of the newborns in Groups 1 and 2, the dietary treatment was started before the 10th day of life; in Group 3, the dietary treatment was started after the 10th day of life for all children. During the first month of life, the proportion of infants receiving breast milk was higher in the NBS-PKU (74%) and the NBS non-PKU (80%) groups, compared with 38% in the SS non-PKU infants. In the subsequent months of life, the proportion of infants receiving human milk (either from the breast or a bottle) declined in all groups. This decline occurred more in bottle-fed rather than directly breast-fed infants. Our observations indicate that the model of feeding from a bottle with expressed milk may have had an adverse effect on maintaining lactation and may have contributed to a faster transition to formula milk. Maintaining lactation and extending the period of feeding the infant with human milk in the first 6 months of life is possible by breastfeeding on demand, under regular biochemical monitoring: preferably weekly in PKU infants, and at least every 2-4 weeks in infants with other IEM.

Desigualdad en las prácticas de lactancia y alimentación complementaria en la Argentina, según nivel de ingresos del hogar en 2018-19 / Inequality in breastfeeding and complementary feeding practices in Argentina by household income level in 2018­2019

Introducción. La calidad de la alimentación es un derecho vinculado con la supervivencia, el crecimiento saludable, la prevención de enfermedades crónicas y malnutrición en todas sus formas. El objetivo de este trabajo fue analizar las prácticas de lactancia y de alimentación de menores de 2 años de áreas urbanas de la Argentina en 2018-19, según el nivel de ingreso de los hogares. Población y métodos. Estudio secundario con datos de la 2da. Encuesta Nacional de Nutrición y Salud 2018-19. Se analizaron indicadores de lactancia y alimentación complementaria, según metodología de la Organización Mundial de la Salud (OMS) y Unicef. Se estratificó según nivel de ingresos del hogar. Resultados. El análisis incluyó 5763 menores de 24 meses. Aunque el 97 % fue alguna vez amamantado, solo el 47 % de los menores de 6 meses tuvo lactancia exclusiva el día previo y el 48 % mantenía la lactancia luego del año, con mayor prevalencia en los niños/as de menores ingresos. En el día previo, el 23 % de los niños/as de 6 a 23 meses no consumió ninguna verdura o fruta; el 60 % consumió alimentos no saludables y el 50 %, bebidas dulces. Las bebidas dulces y la ausencia de frutas y verduras fueron mayores en aquellos de hogares de menores ingresos. Conclusión. La calidad de la alimentación de los niños/as dista de las recomendaciones y está condicionada por los ingresos. En los sectores empobrecidos, es menor el inicio temprano de la lactancia, la diversidad alimentaria mínima y el consumo de frutas y verduras, y es mayor el consumo de bebidas dulces.

Introduction. Diet quality is a right related to survival, healthy growth, prevention of chronic diseases, and malnutrition in all its forms. The objective of this study was to analyze breastfeeding and feeding practices in children younger than 2 years from urban areas of Argentina in 2018­2019 according to their household income level. Population and methods. Secondary analysis of data of the Second National Survey on Nutrition and Health (ENNyS2) of 2018­2019. Breastfeeding and complementary feeding indicators proposed by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) were analized. Data were stratified by household income level. Results. The analysis included 5763 children younger than 24 months old. Although 97% was ever breastfed, only 47% of infants younger than 6 months were exclusively breastfed the previous day and 48% continued with breastfeeding after 1 year old, with a higher prevalence in low-income children. The previous day, 23% of children aged 6 to 23 months did not eat any fruit or vegetable, 60% consumed unhealthy foods, and 50% consumed sweet beverages. The consumption of sweet beverages and the absence of fruit and vegetables were higher in low-income households. Conclusion. The quality of children's diet is far from the recommendations and is conditioned by income. Early initiation of breastfeeding, minimum dietary diversity, fruit and vegetable consumption are lower and sweet beverage consumption is greater in impoverished sectors.

Minimum acceptable diet and associated factors among 6-23 months old children enrolled in outpatient therapeutic program in the Tulla district, Sidama region, Ethiopia: a community-based cross-sectional study.

BACKGROUND: Improving the minimum acceptable diet (MAD) is essential for ensuring optimal growth and development of children, as well as preventing malnutrition and its consequences. Previous studies in Ethiopia have focused on the magnitude and determinants of a minimum acceptable diet. However, much emphasis was not given to minimum acceptable diet and its associated factors among 6-23 months old children enrolled in Outpatient therapeutic programs (OTP), particularly, in the study area. This study determines the minimum acceptable diet and associated factors among 6-23-month-old children enrolled in OTP. METHODS: A community-based cross-sectional study was conducted among 346 randomly selected mothers with children aged 6-23 months who were admitted to the OTP. The data were collected using interviewer-administered structured questionnaires. The data were entered, cleaned, coded into Epidata version 4.6, and exported to SPSS version 26 for further analysis. Multivariate logistic regression was used to assess the determinants of MAD. RESULTS: The overall prevalence of minimum Acceptable diet among children aged 6-23 months enrolled to OTP was 14.5% (95% CI: 12.02-19%). The odds of MAD were 1.9 times higher among children aged 18-23 months compared to children aged 6-11 months (AOR = 1.9, 95% CI ((1.2 3.9). The odds of MAD were 2.9times higher in children whose mothers had a good knowledge on recommended feeding (AOR = 2.9, 95% CI (1.2, 6.35). Mothers who had no formal education were 81% less likely to provide minimum acceptable diets for their children compared to their counterpart.(AOR = 1.94, 95% CI = 1.24, 4.19). CONCLUSION: The practice of a minimum acceptable diet is inadequate. Nutrition education should be emphasized to improve the mothers' nutrition knowledge regarding infant and young child feeding recommendations, to support mothers in overcoming barriers to feeding their children with adequate diets, and to foster complementary feeding practices for malnourished children.

Defining Optimal Cobalamin Status for Neonates and Infants.

BACKGROUND: An optimal cobalamin status is necessary for normal neurodevelopment. OBJECTIVE: To give a description of the epidemiology, pathophysiology and diagnostic challenges related to cobalamin insufficiency in neonates and infants in order to prevent its occurence. RESULTS: Inadequate cobalamin status is prevalent among neonates and young infants, due to a high prevalence of maternal cobalamin deficiency, exclusive breastfeeding for extended periods and late introduction of animal food. Cobalamin insufficiency is associated with delayed neurodevelopment and subtle clinical symptoms like feeding difficulties, regurgitations and constipation in young infants. Early diagnosis and treatment of impaired cobalamin status is important to prevent neurologic damage. CONCLUSION: Clinical suspicion of cobalamin insufficiency in infants should infer immediate biochemical testing and a plasma total homocysteine > 5.0 µmol/L indicate cobalamin insufficiency in need of intramuscular treatment with hydroxycobalamin, followed by introduction of animal food after 4 months of age.

Plain language titleVitamin B12 Is Important for Normal Development in Young ChildrenPlain language summaryVitamin B12, also called cobalamin, is found only in animal-sourced food. As low-meat, vegetarian, and vegan diets are increasingly popular in Western countries, vitamin B12 deficiency has become common, also in pregnant women and babies. Vitamin B12 status is essential for normal development and adequate levels of this vitamin is particularly important during pregnancy and the first years of life. In pregnancy, vitamin B12 is transferred from the mother to the fetus, so the baby has a store of this vitamin at birth. However, if the mother has vitamin B12 deficiency or the baby is born premature or with a low birth weight, the vitamin store may be insufficient and the baby may develop vitamin B12 deficiency. Maternal vitamin B12 status is important as long as the baby is exclusively breastfed. Breast milk contains vitamin B12, but the concentration decreases after 4 to 6 weeks and may be too low to support the baby until animal-sourced foods are introduced. The vitamin B12 content in formula milk is higher than in breast milk, and vitamin B12 deficiency is more common in exclusively breastfed babies. Vitamin B12 deficiency is associated with diffuse symptoms in small babies and may be difficult to detect, and the diagnosis have a mean delay of 4 months in this age-group. Typical symptoms are regurgitations or spitting up, constipation, problems with feeding and swallowing, and delayed psychomotor development. Suspicion of vitamin B12 insufficiency in babies should prompt immediate biochemical testing. Plasma total homocysteine is a metabolic marker of vitamin B12 status and can be measured in a blood sample from the baby. A level >5.0 µmol/L indicates probable vitamin B12 insufficiency and the baby should receive vitamin B12 supplementation, followed by introduction of animal-sourced foods at 3 to 4 months of age.

Introduction of Solid Foods in Preterm Infants and Its Impact on Growth in the First Year of Life-A Prospective Observational Study.

The aim of this study was to investigate whether age at introduction of solid foods in preterm infants influences growth in the first year of life. This was a prospective observational study in very low birth weight infants stratified to an early (<17 weeks corrected age) or a late (≥17 weeks corrected age) feeding group according to the individual timing of weaning. In total, 115 infants were assigned to the early group, and 82 were assigned to the late group. Mean birth weight and gestational age were comparable between groups (early: 926 g, 26 + 6 weeks; late: 881 g, 26 + 5 weeks). Mean age at weaning was 13.2 weeks corrected age in the early group and 20.4 weeks corrected age in the late group. At 12 months corrected age, anthropometric parameters showed no significant differences between groups (early vs. late, mean length 75.0 vs. 74.1 cm, weight 9.2 vs. 8.9 kg, head circumference 45.5 vs. 45.0 cm). A machine learning model showed no effect of age at weaning on length and length z-scores at 12 months corrected age. Infants with comorbidities had significantly lower anthropometric z-scores compared to infants without comorbidities. Therefore, regardless of growth considerations, we recommend weaning preterm infants according to their neurological abilities.

Clinically Relevant Topics and New Tendencies in Childhood Nutrition during the First 2 Years of Life: A Survey among Primary Care Spanish Paediatricians.

A multicenter cross-sectional study was conducted among 245 experienced Spanish paediatricians, who completed an online survey based on clinically relevant topics in nutrition during the first two years of life and their recommendations to parents in daily clinical practice. Most participants advise about the choking risk associated with baby-led weaning (BLW) and more than 60% consider that infants can receive an insufficient variety and quantity of nutrients with this practice. The general opinion is that there is a lack of evidence for delaying the introduction of gluten and other allergenic foods in the complementary feeding of healthy infants. Most participants agree/strongly agree that two servings of dairy products are the adequate daily amount in a diversified diet and 93.4% disagree/strongly disagree with the use of vegetal beverages under 1 year of life. There is a general agreement to avoid added salt and sugar before 12 months of life, the consideration that organic foods do not have a better nutritional profile than non-organic ones, and the limitations of vegetarian diets especially for adequate provision of micronutrients. Overall, there is an adequate knowledge of the new trends by paediatricians and younger ones seemed more in favor of them and interested in receiving more information on most topics.

The Effectiveness of Nutritional Interventions Implemented through Lady Health Workers on the Reduction of Stunting in Children under 5 in Pakistan: The Difference-in-Difference Analysis.

In Pakistan, the 2018 National Nutrition Survey reported that 40% of children under five years old were stunted. This study assessed the effectiveness of nutritional supplementation in reducing stunting among children under five years old in two rural districts in Sindh, Pakistan. This was a mixed-method quasi-experimental study comprising intervention and control populations, with 3397 and 3277 children under five years old participating in the baseline and end-line surveys, respectively. The study areas were similar in terms of demographic and economic circumstances. In the intervention group, pregnant and lactating women (first six months post-partum) received wheat soy blend, children 6-23 months old received Wawamum (lipid-based supplement), and children 24-59 months old received micronutrient powders, all through lady health workers. This was underpinned by nutrition behaviour change communication for appropriate complementary feeding practices and hygiene promotion targeted at primary caregivers. The control group received no intervention. The impact was assessed using the difference-in-difference analysis with kernel propensity score matching to adjust the differences among the control and intervention populations. The overall DID analysis indicated that the intervention did not significantly reduce the prevalence of stunting (under 5 years) [DID = -5.1, p = 0.079]. The adjusted DID indicated a significant decrease of 13% [DID = -13.0, p = 0.001] in the number of stunted children 24-59 months of age at the endline survey. A significant reduction in underweight among children 24-59 months old was also observed (DID = -9.4%, p = 0.014). In conclusion, this evidence further establishes that nutrient uptake through an intervention for a short duration cannot effectively reduce stunting. It requires continuous nutritional supplementation for mothers during the pregnancy and an initial six months of lactation and then nutritional supplementation for children 6-59 months of age underpinned by effective behaviour change communication targeting mothers and other caregivers for improving complementary feeding practices and hygiene promotion.

Timely initiation of complementary feeding and associated factors among mothers having children aged 6 to 24 months in North-West Ethiopia: a comparative cross-sectional study.

BACKGROUND: The timely introduction of complementary foods during infancy is necessary for nutritional reasons, and to enable the transition from milk feeding to family foods. In the past years, despite efforts that have been put to increase the utilization of timely initiation of complementary feeding practice in Ethiopia, improvements are not satisfactory. OBJECTIVE: To compare the prevalence of timely initiation of complementary feeding and its associated factors among mothers who have Children 6-24 months in Debre Tabor town and rural Farta district, North-west Ethiopia, 2021. METHODS: A community-based comparative cross-sectional study was employed from December 1/2020 to 30/ 2020 among 1100 mothers. Data were collected using a structured questioner and analyzed using Statistical Product and Service Solutions. Logistic regression analysis with a 95% confidence interval carried out to determine the association between explanatory and the outcome variables. A P-value of < 0.05 was considered statistically significant. RESULTS: The prevalence of timely initiation of complementary feeding among urban and rural mothers was 69.8% with (95% CI: 66%, 74%) and 51.9% with (95% CI: 48- 56%) respectively. Urban residence [AOR = 1.39, 95% CI: (1.02-1.94)], had antenatal care visits [AOR = 0.24 (95%CI: (0.13, 0.44)], had post natal care checkups [AOR = 0.44, 95%CI: (0. 27- 0.72)] and being a governmental employee [AOR = 2.82; 95% CI: (1.91-6.1)] were factors associated with timely initiation of complementary feeding among urban mothers. Whereas in rural settings: institutional delivery [(AOR = 2.21, CI: 1.35-3.65)], post natal care checkups [(AOR = 0.53, CI: (0.36-0.77)] being daily laborer [AOR = 3.47; 95% CI: (1.78-6.75)] were associated with timely initiation of complementary feeding. CONCLUSION: The prevalence of timely introduction of complementary feeding in children aged 6-24 months is still low in the study areas. There was also disparity between urban and rural mothers in which urban mothers practiced better.

Statistical analysis plan for cluster randomised trial to evaluate a community-level complementary food safety and hygiene and nutrition intervention in Mali: the MaaCiwara study.

BACKGROUND: Diarrheal disease is a significant cause of morbidity and mortality in under-fives in many low- and middle-income countries. Changes in food safety, hygiene practices, and nutrition around the weaning period may reduce the risk of disease and improve infant development. The MaaCiwara study aims to evaluate the effectiveness of a community-based educational intervention designed to improve food safety and hygiene behaviours, as well as child nutrition. This update article describes the statistical analysis plan for the MaaCiwara study in detail. METHODS AND DESIGN: The MaaCiwara study is a parallel group, two-arm, superiority cluster randomised controlled trial with baseline measures, involving 120 clusters of rural and urban communities. These clusters are randomised to either receive the community-based behaviour change intervention or to the control group. The study participants will be mother-child pairs, with children aged between 6 and 36 months. Data collection involves a day of observation and interviews with each participating mother-child pair, conducted at baseline, 4 months, and 15 months post-intervention. The primary analysis aims to estimate the effectiveness of the intervention on changes to complementary food safety and preparation behaviours, food and water contamination, and diarrhoea. The primary outcomes will be analysed generalised linear mixed models, at individual level, accounting for clusters and rural/urban status to estimate the difference in outcomes between the intervention and control groups. Secondary outcomes include maternal autonomy, enteric infection, nutrition, child anthropometry, and development scores. In addition, structural equation analysis will be conducted to examine the causal relationships between the different outcomes. TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number (ISRCTN) register: ISRCTN14390796 . Registered on 13 December 2021.

Dietary Diversity and Associated Factors among Children 6-23 Months Old in Ethiopia: Systematic Review and Meta-Analysis.

BACKGROUND: Feeding diversified food for children is the major indicator of nutritional quality and adequacy that is crucial during the complementary feeding period for infants and young children aged 6-23 months. Ensuring diversified food is highly essential for the normal growth and development of the infant and young children. In Ethiopia, malnutrition and food insecurity remain prevalent, underscoring the need to understand and improve dietary diversity among children. The primary objective of this review was to determine the pooled prevalence of dietary diversity and its associated factors among children aged 6-23 months in Ethiopia. METHODS: We thoroughly searched some electronic databases, including Pub Med, Africa Index Medicus, Science Direct, Hinari, and Google Scholar, to perform a meta-analysis. Excel was used to extract and combine the data, while Stata 17 was used for statistical analysis. To estimate pooled prevalence rates and related associated factors, we used a random-effect model and the Der Simonian-Laird technique. The I2-test was utilized to examine heterogeneity, and funnel plots, in conjunction with Egger's and Begg's tests, were employed to investigate publication bias. RESULT: This review analyzed 42 full-text studies, finding a pooled prevalence of 26.78% (95% confidence interval (CI): 23.35-30.21) with significant heterogeneity (I2 = 98.95%). Maternal education levels-college & above Adjusted Odds Ratio (AOR: 5.377, 95% CI: 3.116-9.279), secondary and above (AOR: 3.324, 95% CI: 1.939-5.700), primary (AOR: 3.065, 95% CI: 2.275-3.129), and formal education (AOR: 2.484, 95% CI: 1.722-3.583)-showed higher odds than counterparts. Similarly, fathers' education-secondary and above (AOR: 2.837, 95% CI: 1.981-4.065) and primary (AOR: 2.082, 95% CI: 1.016-4.266)-and father's occupation as merchant (AOR: 2.739, 95% CI: 1.355-5.539), and mother's occupation as housewife (AOR: 3.636, 95% CI: 2.457-5.381) showed higher odds. Additionally, male child sex (AOR: 1.877, 95% CI: 1.185-2.972), child age 18-23 months (AOR: 2.470, 95% CI: 1.568-3.987), and 12-17 months (AOR: 2.460, 95% CI: 1.914-3.163) indicated higher odds than counterparts. Having Postnatal Care (PNC) follow-up, counseling on infant and young child feeding (IYCF) practices, and no history of child illness were associated with higher odds (AOR: 3.155, 95% CI: 2.104-4.732), (AOR: 2.960, 95% CI: 2.288-3.829), and (AOR: 2.420, 95% CI: 1.765-3.318), respectively. Maternal knowledge of dietary diversity, urban residency, Antenatal Care (ANC) follow-up, child growth monitoring, and media exposure also showed higher odds. Similarly, maternal age groups 25-34 years and 35-44 years had higher odds compared to those aged 15-24 years. Other factors associated with higher odds included home grading, food security, institutional delivery, availability of cow milk, and household wealth index. CONCLUSION: Among Ethiopian children aged 6-23 months, the prevalence of recommended dietary diversity feeding practices was remarkably low, with only about 25% meeting the minimum recommended diversified food. The scientific predictors factor affecting dietary diversity included maternal media exposure, place of delivery, food security, urban residency, availability of cow milk, child growth monitoring, age, and knowledge of IYCF practices; paternal factors like education and occupation; child-related variables like age, sex, and history of illness; and history of ANC and PNC.

Trends in Complementary Feeding Indicators in Children Aged 6-23 Months According to Participation in a Conditional Cash Transfer Program: Data from the Brazilian Food and Nutrition Surveillance System, 2015-2019.

Inadequate practices during complementary feeding are associated with malnutrition, especially in children experiencing vulnerable conditions and social inequality. The aim of this study was to evaluate the trends in complementary feeding indicators (CFIs) according to participation in a Brazilian cash transferu program-the Bolsa Família Program (BFP). This was a time-series study with secondary data from 600,138 children assisted from 2015 to 2019 and registered within the Brazilian Food and Nutrition Surveillance System. The CFIs assessed were food introduction, minimum meal frequency and appropriate consistency, minimum dietary diversity, iron-rich food, vitamin A-rich food, ultra-processed food consumption, and zero vegetable or fruit consumption. Prevalence and 95% confidence intervals were calculated for the CFIs according to BFP, the region of residence, and the child's age. The Prais-Winsten regression method was used to analyze the temporal trend. There was a steady trend for all CFIs of a healthy diet. A decrease in ultra-processed food consumption for both BFP (-10.02%) and non-BFP children (-9.34%) was observed over the years. Children residing in the North and Northeast regions and those enrolled in the BFP were more distant from the recommended feeding practices when compared to the other regions and non-BFP children. The results highlight the relevance of nutritional surveillance and the need to improve food and nutrition public policies for children aged 6-23 months, particularly for those experiencing greater social vulnerability.

Effects of New Complementary Feeding Guidelines on Eating Behaviour, Food Consumption and Growth in Colombian Children: 6-Year Follow-Up of a Randomised Controlled Trial.

Complementary feeding (CF) may influence later eating behaviour and growth. Our previous Randomised Control Trial (RCT) reported that new CF guidelines (NCFGs) implemented in 6-12-month-old infants in Bogota, Colombia, had positive short-term effects on red meat, vegetable and fruit consumption. Here, we assessed the effects of the NCFGs on food consumption, eating behaviour and growth at 6 years of age. Weight and height were measured using 50 children (58.8%) from the cohort. Feeding behaviour was measured using the Child Eating Behaviour Questionnaire (CEBQ) and maternal and child food consumption was measured using a semi-quantitative food frequency questionnaire. The control group (CG) had a significantly higher weekly consumption of chocolate milk drinks (p = 0.05). The mean food responsiveness (FR) score was significantly higher in the CG (p < 0.001). Although HAZ (height for age Z-score) at 6 years of age was significantly higher in the CG (p < 0.02), there was no significant difference between groups in the change in HAZ from 6 months and 12 months to 6 years of age. BMIZ (body mass index Z-score) and % overweight (CG 18.5% versus NCFG 13%) or obese (3.7% versus 0%) were not significantly different between groups. BMIZ was positively predicted by FR (ß 0.293; p = 0.014) and negatively predicted by weekly red meat consumption episodes per week at 12 months (ß -0.169; p = 0.020). Although there was no direct effect of an intervention on BMIZ at 6 years of age, the results were consistent with an indirect effect via intervention effects on meat consumption at an age of 12 months and FR at 6 years of age. However, further longitudinal studies with a larger sample size are needed.

Bovine Milk Fat Globule Membrane Supplementation and Neurocognitive Development: A Systematic Review and Meta-Analysis.

Given the limited evidence, there is no conclusive proof of the neurocognitive benefits of bovine milk fat globule membrane supplementation in infant formula. This study evaluates the neurocognitive benefits of bovine milk fat globule membrane supplementation in formula, comparing it to standard formula and assessing its noninferiority to breast milk. Data were sourced from studies published between January 2000 and March 2024 from PubMed, Cochrane Library, Web of Science, and Embase. Eight randomized controlled trials involving 1352 healthy term neonates, infants, and children up to 2 years old were included. Bovine milk fat globule membrane supplementation was significantly associated with improved cognitive development (mean difference: 3.29, 95% CI: 1.65 to 4.93, p < 0.001) and demonstrated minimal heterogeneity (I2 = 0%, p = 0.564). It showed significant improvement in executive function but not in language, motor, or social-emotional development. In non-inferiority analysis, there was no significant difference compared to breast milk regarding cognitive development. These findings support bovine milk fat globule membrane as a valuable addition to infant formula for cognitive benefits.

Personalized Nutrition with Banked Human Milk for Early Gut Microbiota Development: In Pursuit of the Perfect Match.

The correct initial colonization and establishment of the gut microbiota during the early stages of life is a key step, with long-lasting consequences throughout the entire lifespan of the individual. This process is affected by several perinatal factors; among them, feeding mode is known to have a critical role. Breastfeeding is the optimal nutrition for neonates; however, it is not always possible, especially in cases of prematurity or early pathology. In such cases, most commonly babies are fed with infant formulas in spite of the official nutritional and health international organizations' recommendation on the use of donated human milk through milk banks for these cases. However, donated human milk still does not totally match maternal milk in terms of infant growth and gut microbiota development. The present review summarizes the practices of milk banks and hospitals regarding donated human milk, its safety and quality, and the health outcomes in infants fed with donated human milk. Additionally, we explore different alternatives to customize pasteurized donated human milk with the aim of finding the perfect match between each baby and banked milk for promoting the establishment of a beneficial gut microbiota from the early stages of life.

A Descriptive Study of Spanish and Ecuadorian Commercial Infant Cereals: Are They in Line with Current Recommendations?

Cereals are an important source of nutrients, especially used in complementary feeding. The objective of this study is to review the nutritional composition of cereal-based foods for infants from 4 months and toddlers that are offered in Spain and Ecuador, countries selected because of the opportunity to work in them, and due to their socio-economic differences (industrialized and developing countries, respectively). The number of these products was 105 cereals in Spain and 22 in Ecuador. The products were classified as gluten-free cereals, five cereals, eight cereals, multigrain cereals, and cookies. A 25 g serving was used to determine the percentage in which the samples analyzed can cover the Reference Nutrient Intake (RNI) for micronutrients in infants from 7 months and toddlers according to the European Food Safety Authority (EFSA). Nutritional information per 100 g of dry product was collected according to medium, minimum, and maximum units, and nutrient density was calculated. The age range in which these products are recommended is different in both countries. The nutritional composition presents some differences; Spanish cereals show a lower content of sodium, added sugars, hydrolyzed cereals, and maltodextrin than Ecuadorian cereals. Commercialized cereals could contribute to satisfying the nutritional needs of infants and toddlers; however, they can also be a source of non-recommended components.

Association of early-term birth and breastfeeding practices with nutritional outcomes in singleton term infants: a multicenter cross-sectional study.

BACKGROUND: Limited research has explored the associations of gestational age (GA) and breastfeeding practices with growth and nutrition in term infants. METHODS: This multicenter cross-sectional study recruited 7299 singleton term infants from well-child visits in Shandong, China, between March 2021 and November 2022. Data on GA, gender, ethnicity, birth weight, parental heights, gestational diabetes and hypertension, age at visit, breastfeeding practices (point-in-time data at visit for infants < 6 months and retrospective data at 6 months for infants ≥ 6 months), complementary foods introduction, infant length and weight, were collected. 7270 infants were included in the analysis after excluding outliers with Z-scores of length (LAZ), weight or weight for length (WLZ) <-4 or > 4. Linear regression models adjused for covariates explored the impact of GA and breastfeeding practices on LAZ and WLZ, while logistic regression models evaluated their effect on the likelihood of moderate and severe stunting (MSS, LAZ<-2), moderate and severe acute malnutrition (MSAM, WLZ<-2) and overweight/obesity (WLZ > 2). Sensitivity analysis was conducted on normal birth weight infants (2.5-4.0 kg). RESULTS: Infants born early-term and exclusively breastfed accounted for 31.1% and 66.4% of the sample, respectively. Early-term birth related to higher WLZ (< 6 months: ß = 0.23, 95% confidence interval (CI): 0.16, 0.29; ≥6 months: ß = 0.12, 95% CI: 0.04, 0.20) and an increased risk of overweight/obesity throughout infancy (< 6 months: OR: 1.41, 95% CI 1.08, 1.84; ≥6 months: OR: 1.35, 95% CI 1.03, 1.79). Before 6 months, early-term birth correlated with lower LAZ (ß=-0.16, 95% CI: -0.21, -0.11) and an increased risk of MSS (OR: 1.01, 95%CI 1.00, 1.02); Compared to exclusive breastfeeding, exclusive formula-feeding and mixed feeding linked to lower WLZ (ß=-0.15, 95%CI -0.30, 0.00 and ß=-0.12, 95%CI -0.19, -0.05, respectively) and increased risks of MSAM (OR: 5.57, 95%CI 1.95, 15.88 and OR: 3.19, 95%CI 1.64, 6.19, respectively). Sensitivity analyses confirmed these findings. CONCLUSIONS: The findings emphasize the health risks of early-term birth and the protective effect of exclusive breastfeeding in singleton term infants, underscoring the avoidance of nonmedically indicated delivery before 39 weeks and promoting exclusive breastfeeding before 6 months.

PremieFeed: Investigating Preterm Infant Feeding Behaviors, Growth, and Caregiver Experiences in the First Weeks After NICU Discharge.

PURPOSE: This study aimed to longitudinally investigate the preterm infant feeding regimens, feeding behaviors, effect on infant growth, and caregiver perceptions and experiences with feeding in the first 4 weeks following hospital discharge. BACKGROUND: Preterm infants face high nutritional risk due to their underdeveloped gastrointestinal systems and feeding coordination. METHODS: Caregivers of preterm infants were recruited to participate in a weekly telephone survey for the first 4 weeks following the infant's hospital discharge. Responses for infant feeding behaviors and caregiver experiences were scored on a 3-point Likert scale. Growth and feeding data were collected from the infant's first neonatal intensive care unit (NICU) developmental follow-up visit. RESULTS: Twenty-four caregivers completed the study. Changes in feeding regimens were common (8/24 infants; 33%), with the percentage of infants receiving any human milk feedings decreasing from 70% at hospital discharge to 54% at 4 weeks post-discharge. Poor infant feeding skills were weakly associated with poor caregiver feeding experiences, and 46% of caregivers reported contacting their healthcare provider with feeding-related questions. Thirty-eight percent of infants required nutritional intervention at NICU developmental follow-up visit. Infants who received fortified feedings during the first 4 weeks after hospital discharge grew an average of 2.5 g/day faster than infants who did not receive fortified feedings. CONCLUSION: The postdischarge period for preterm infants is characterized by feeding regimen changes, a decrease in human milk use, and caregiver questions about feeding. IMPLICATIONS FOR PRACTICE AND RESEARCH: Future studies should further investigate the period after hospital discharge to enable better feeding support for preterm infants and their caregivers.