Baby's first bites: Association between observed maternal feeding behavior and infant vegetable intake and liking.

Positive experiences with the introduction of solid food in infancy may lead to positive associations with feeding in both parent and infant. During this transitional period, parental feeding behavior and infant eating behavior might mutually reinforce each other. A feeding style that is found to be associated with positive child eating behavior, is sensitive feeding. In the present study we tested bidirectional prospective relations between mother and infant behavior in a cross-lagged model using observations of two feeds on two consecutive days on which the first bites of solid food were offered. The sample consisted of 246 first-time mothers and their infants, whose feeding interactions were videotaped during two home visits. Maternal sensitive feeding behavior (consisting of responsiveness to child feeding cues, general sensitivity and non-intrusiveness) and maternal positive and negative affect were coded. In addition, infant vegetable intake was weighed and vegetable liking was reported by mother. Results showed at least some stability of maternal feeding behavior and infant vegetable intake and liking from the first to the second feed. In addition, during the second feed maternal sensitive feeding and positive affect were associated with infant vegetable intake (r=.34 and r=.14) and liking (r=.33 and r=.39). These associations were mostly absent during the first feed. Finally, infant vegetable liking during the first feed positively predicted maternal sensitive feeding behavior during the second feed (ß=.25), suggesting that the infant's first response might influence maternal behavior. Taken together, mother and infant seem more attuned during the second feed than during the first feed. Future studies might include multiple observations over a longer time period, or micro-coding. Such insights can inform prevention programs focusing on optimizing feeding experiences during the weaning period.

Detection of gluten in duplicate portions to determine gluten intake of coeliac disease patients on a gluten-free diet.

This study determined the gluten content of foods and meals consumed by coeliac disease (CD) patients who adhere to a gluten-free diet, and to estimate the total daily intake of gluten of these patients. CD patients fulfilling defined inclusion criteria were preselected and approached for participation in the study. Duplicate portions (DP) of foods and mixed dishes were collected from the CD patients for evaluating complete daily food intake during two individual days. Also, for these days, written food records were completed by the participants. From each DP, a laboratory sample was prepared and analysed for its gluten concentration and total daily gluten intake was calculated. Each individual's total daily intakes of energy and macronutrients were calculated using the Dutch food composition database. In total, twenty-seven CD patients participated, seven males and twenty females, aged between 21 and 64 years. In thirty-two (6 %) of 499 food samples collected in total, more than 3 mg/kg gluten was present. In four of these thirty-two samples, the gluten concentration was above the European legal limit of 20 mg/kg and three of the four samples had a gluten-free label. The maximal gluten intake was 3·3 mg gluten/d. The gluten tolerance for sensitive CD patients (>0·75 mg/d) was exceeded on at least six out of fifty-four study days. To also protect these sensitive CD patients, legal thresholds should be re-evaluated and the detection limit of analytical methods for gluten analysis lowered.

Baby's first bites: a randomized controlled trial to assess the effects of vegetable-exposure and sensitive feeding on vegetable acceptance, eating behavior and weight gain in infants and toddlers.

BACKGROUND: The start of complementary feeding in infancy plays an essential role in promoting healthy eating habits. Evidence shows that it is important what infants are offered during this first introduction of solid foods: e.g. starting exclusively with vegetables is more successful for vegetable acceptance than starting with fruits. How infants are introduced to solid foods also matters: if parents are sensitive and responsive to infant cues during feeding, this may promote self-regulation of energy intake and a healthy weight. However, the effectiveness of the what and the how of complementary feeding has never been experimentally tested in the same study. In the current project the what and how (and their combination) are tested in one study to determine their relative importance for fostering vegetable acceptance and self-regulation of energy intake in infants. METHODS: A four-arm randomized controlled trial (Baby's First Bites (BFB)) was designed for 240 first-time Dutch mothers and their infants, 60 per arm. In this trial, we compare the effectiveness of (a) a vegetable-exposure intervention focusing on the what in complementary feeding; (b) a sensitive feeding intervention focusing on the how in complementary feeding, (c) a combined intervention focusing on the what and how in complementary feeding; (d) an attention-control group. All mothers participate in five sessions spread over the first year of eating solid foods (child age 4-16 months). Primary outcomes are vegetable consumption, vegetable liking and self-regulation of energy intake. Secondary outcomes are child eating behaviors, child anthropometrics and maternal feeding behavior. Outcomes are assessed before, during and directly after the interventions (child age 18 months), and when children are 24 and 36 months old. DISCUSSION: The outcomes are expected to assess the impact of the interventions and provide new insights into the mechanisms underlying the development of vegetable acceptance, self-regulation and healthy eating patterns in infants and toddlers, as well as the prevention of overweight. The results may be used to improve current dietary advice given to parents of their young children on complementary feeding. TRIAL REGISTRATION: The trial was retrospectively registered during inclusion of participants at the Netherlands National Trial Register (identifier NTR6572 ) and at ClinicalTrials.gov ( NCT03348176 ). Protocol issue date: 1 April 2018; version number 1.

Social aspects of patients with pulmonary tuberculosis in Indonesia.

Tuberculosis (TB) patients have not only medical but also social problems related to their illness, which may influence their motivation for the completion of treatment. This study investigated the social aspects of patients with TB in an urban area of Jakarta, Indonesia. Most TB patients had poor nutritional status and lived in crowded environments. They faced joblessness and negative attitudes from their neighbors and relatives. A few of the patients were afraid that they would not find a partner; others said that their diseases impaired their marriages. We found that patients with a subnormal body mass index restricted their social contact with their family more than patients with a normal body mass index. In general, patients were supported by their families, both financially and socially. Our findings suggest that priority should be given to developing programs aimed at strengthening the family support of TB patients.

Measurements of body fat in Indonesian adults: Comparison between a three-compartment model and widely used methods.

Body composition was assessed in Indonesian male (n = 18) and female (n = 23) students using densitometry (underwater weighing), deuterium oxide dilution, skinfold thickness measurements, bioelectrical impedance analysis (BIA) and a prediction equation based on the body mass index. From body density and total body water percentage body fat (BF%) was calculated using a three-compartment body composition model. Percentage body fat obtained by this three-compartment model was regarded as the reference value and BF% obtained by the single methods were compared with this value. Mean differences (± SD) in BF% from the threecompartment model minus the single methods were -1.1 ± 2.1 for densitometry, +1.1 ± 1.6 for deuterium oxide dilution, +1.3 ± 2.8 for skinfold thickness measurement, +2.8 ± 4.3 for BIA and +3.4 ± 4.8 for body mass index in males. In females these values were +0.1 ± 1.7, +0.2 ± 1.4, +3.6 ± 3.3, +3.6 ± 2.4 and +8.7 ± 2.0 BF%, respectively. Correlation coefficients between different methods were high and significant (P < 0.05 in males, P < 0.001 in females). This study shows that the single predictive methods have considerable mean and individual biases compared with the three-compartment model and all predictive methods underestimated body fat in the studied subjects. It is concluded that the development of population-specific prediction formulas may be necessary.

Seasonal weight loss and metabolic adaptation in rural Beninese women: the relationship with body mass index.

A large variation in seasonal weight loss between individuals exists in rural communities in developing countries. Therefore, it was investigated whether some individuals show a metabolic adaptation and, through that, prevent large body-weight losses during the preharvest season. Basal metabolic rate (BMR), energy intake and physical activity level (PAL) of rural Beninese women were measured in three seasons. Groups of subjects were: women with a body mass index (BMI) < 18 (n 18), and a BMI > 23 (n 16), and women who had shown small (n 18) and large (n 15) preharvest weight loss. All groups of subjects decreased energy intake during the preharvest season by 0.66-1.09 MJ/d. PAL did not show significant seasonal changes in any of the four groups. Only subjects with a BMI < 18 decreased BMR during the preharvest season with 2.9 (SD 6.7) J/kg per min (P < 0.05), with a decrease of 0.8 (SD 1.4) kg (P < 0.05) in body weight. In very thin women with a BMI < 17 (n 5) BMR expressed per unit body weight decreased even more during the preharvest season (by 12%).

Body composition of Indonesian adults assessed by skinfold thickness and bioelectrical impedance measurements and by a body mass index equation.

Body composition was assessed in Indonesian male (n=29) and female (n=17) students and rural women (n=35) using skinfold thickness measurements, bioelectrical impedance measurements (BIA) with two different equations, and a body mass index equation. Correlation between different methods was significant (P<0.01). In rural women and female students fat mass by skinfold measurements was respectively 2.5± 2.9 kg (P<0.01) and 2.2± 2.3 kg (P<0.01) lower than by BIA. In male students the difference between skinfold and BIA measurements was 0.8± 2.6 kg. Disagreement between methods increased with larger fat mass. In some individuals differences between assessed values were substantial. It is concluded that, especially under field conditions, results obtained by different methods are not interchangeable.