Development and validation of the baby eating behaviour coding system (BEBECS) to assess eating behaviour during complementary feeding.

Eating behaviour in children is a matter of study for which diverse tools have been designed. Coding systems for videotaped meals allow the extraction of detailed in vivo information; however, there is no tool available for infants following a Baby-Led Weaning (BLW) method. This study aimed to create and validate a new tool to assess eating behaviour in infants during weaning, applicable regardless of the complementary feeding method. The Baby Eating Behaviour Coding System (BEBECS) was developed comprising time variables, behaviours, feeder-led actions, and other meal-related variables. Sixty videos of infants aged 6-18 months following spoon-feeding (SF) or BLW methods were coded by two trained coders. These scores were analysed together with intake and maternal ratings of liking and calmness. Additionally, combined analysis and internal comparison assessed the possible differences in BEBECS variables between SF and BLW. Inter-rater and test-retest reliability had good to excellent agreement: Cohen's Kappa >0.75, Lin's CCC >0.70, and Intraclass Correlation Coefficient >0.75, for almost all variables. Infants' liking and intake of the offered food correlated positively with meal duration and total count of mouth approaches but negatively with having leftovers and time between mouth approaches. Infants' calmness and tiredness were negatively correlated. More food than initially offered was available during the meal in BLW but not in SF. There was a tendency towards more autonomous behaviour in BLW infants regarding changes observed in the time the food was in the mouth at each stage (6, 12, and 18 months). In conclusion, BEBECS has the potential to be a valid tool for application in the research of infant eating behaviour during weaning by trained coders.

Chemical characterization of baby food consumed in Italy.

In this study, a total of 30 elements (essential and non-essential or toxic) were determined in 25 foods consumed in Italy by children aged 0-6 months and produced in Europe. Inductively Coupled Plasma-Atomic Emission Spectrometry and Inductively Coupled Plasma-Mass Spectrometry were used as measurement techniques for the elements of interest. The estimated intakes for one-year-old infants were compared with risk estimators and nutritional requirements. Data indicate that commercially available baby food in Italy provides an excellent contribution for Mn, Cu, Fe, Zn, Ca, K, and P, covering up to approximately 70% of the adequate intake (AI) for an infant aged 6-12 months. The intake of detectable toxic elements was always below the safety limit: even the most concentrated toxic elements never exceeded about 86% of the Provisional Tolerable Weekly Intake (PTWI). This result indicates that the analyzed baby food is of good quality and does not pose risks to children's health.

A repeated cross-sectional analysis of the Icelandic baby food market surveyed in 2016, 2019 and 2021.

World Health Organisation (WHO) has stated that countries need to know their local commercial baby food (CBF) market. Data from other countries suggest rapid changes in CBF options, highlighting the need for repeated analysis. In that context, this repeated cross-sectional study analysed the options and nutrient quality of different CBF types available in Iceland in years 2016, 2019 and 2021. Data was gathered on formulas, porridge flours, foods in jars and pouches, finger-foods, other CBF. They were classified into 26 subgroups based on ingredients and taste (sweet/savoury). Minimum consumer age as suggested by the manufacturers and nutritional content were registered. In each data-collection, 250-275 products were available. Over a third of products (37%-44%) were in pouches. Availability of products intended for 4-11-month-old infants decreased, driven largely by a 65% decrease in availability of food in jars (sweet/savoury) between 2016 and 2021. Availability of products intended from 12+ months or without age-labels increased, driven largely by quadrupling of finger-foods (predominantly sweet) between 2016 and 2021. The overall percentage of products classified as sweet increased from 65% (2016) to 73% (2019) and 77% (2021). Some finger-foods had high sugar content (up to 72 g/100 g), partly from fruit concentrate or sugar/syrup. Like other countries, the Icelandic CBF market has moved towards less availability of food intended in the first year and more availability of sweet finger-foods for an expanded consumer age. As sugar is added to some CBF, stronger regulations on promotion of foods for young consumers and updated recommendations for parents/caregivers may be needed.

Assessment of quality and safety aspects of homemade and commercial baby foods.

Dietary Guidelines in some countries recommend avoiding commercially processed baby food, while others encourage the consultation of ingredients and nutritional information. Therefore, the objective of this study was to systematically analyze different baby foods obtained from commercial market and "homemade" produced, in order to verify whether comercial products have low nutritional and unsafety attributes. The samples were analyzed for chemical composition, physicochemical aspects, texture, microbiological and mycotoxin contamination, and pesticide residues. Results showed that, in general, commercial samples have a higher energy density and better ratio of macronutrients. The sodium, pH, and texture of both products were in accordance with the recommendations. None of the baby foods evaluated were contaminated with yeast and molds, total coliforms, or Escherichia coli; however, Salmonella sp. was confirmed in one homemade sample. Pesticide residues were detected in all analyzed baby food samples; however, at lower levels than the limit of quantification. Ochratoxin A was detected in one homemade baby food sample (5.76 µg /kg). Considering the samples evaluated, commercial baby food samples appeared to be safer in relation to microbiological, pesticide residue standards, and mycotoxin contamination. Therefore, it could be concluded that the quality of commercial and homemade baby foods still needs to be improved, as well as more studies related to a critical analyses of both types of processes used.

Level of minimum acceptable diet and its associated factors among children aged 12-23 months in Ugandan districts.

Uganda has made notable progress in improving child nutrition indicators, albeit not fast enough to meet global targets. Navigating the landscape of child nutrition in Uganda demands attention, particularly in light of the necessity for a minimum acceptable diet (MAD) for children aged 12-23 months. While the focus on local nutritional planning is crucial, the absence of routine-specific nutritional status data creates a significant information gap. To bridge this void, this study used datasets from the 2021 Lot Quality Assurance Sampling (LQAS) survey. Data were analysed using multilevel mixed-effects logistic regression (clustering districts based on regional boundaries) at a 5% statistical significance level using STATA version 17. Of the 7,111 children surveyed, 3,256 (49.20%) received the minimum meal frequency, 695 (9.80%) received the minimum dietary diversity, and only 380 (5.34%) received the MAD. There was a notable variation in the proportion of children that received the MAD across regions and districts. Children living in urban areas, children whose mothers had a higher education, and children whose mothers had a diverse diet were more likely to receive the MAD. Children were less likely to receive the MAD if they lived in a household that did not receive a health worker visit within the year. These findings suggest a need to prioritize initiatives aimed at increasing dietary diversity among children in Uganda. This could be done through a variety of approaches, such as leveraging the use of home gardens to boost nutrition through diverse crop cultivation, demonstration gardens, and offering nutrition counselling through village health teams.

Evaluation and identification of chemical migrants leached from baby food pouch packaging.

Multilayer plastic pouch (MLPP) has an estimated 9% annual increase of market growth. However, the migrants it can introduce to food has not yet been systematically studied. A total of 79 MLPPs for baby food were purchased from major retail outlets in Australia. The methodology for testing chemical migration followed the design of previous studies using four types of selected simulants according to the European Committee Regulation No. 10/2011 method. Four bisphenols and five phthalic acid diesters (PAEs) were detected, including the ones known for endocrine disrupting effect in human. Three intentionally added and 23 non-intentionally added substances (NIAS) were tentatively identified through a suspect screening procedure. Out of the 23 NIAS, neopentyl glycol - phthalic acid - 1,6-hexanediol - phthalic acid oligomer was identified for the first time with MLPP. A further two NIAS were detected for the first time in baby food related products. For 40% of the pouches where adipic acid - diethylene glycol was detected, the estimated exposure from consuming one pouch of food per day may exceed the threshold of toxicological concern established based on the Cramer classification.

Concentration of Essential, Toxic, and Rare Earth Elements in Ready-to-Eat Baby Purees from the Spanish Market.

BACKGROUND: The infant population is particularly sensitive, so the risk posed by their diet must be analyzed. The aims of the present study were (i) to determine the contents of 38 elements in 159 samples of ready-to-eat baby food sold in Spain and (ii) to estimate the dietary intakes and risk assessments of these elements in name brands and store brands in infants ranging between 6 and 12 months of age. METHODS: A list of essential, non-essential/toxic elements, rare earth elements (REEs), and other hi-tech-related elements that are currently considered as emerging environmental pollutants were measured in ready-to-eat baby foods by ICP-MS. RESULTS: Fish purees showed the highest concentrations of mercury (28.1 ng/g) and arsenic (346.2 ng/g). The levels of manganese, molybdenum, and chromium exceed the adequate intake, being higher in the case of store brands. The acute hazard index was above 1 for molybdenum and manganese. A risky consumption of thallium and mercury was observed, being higher among name brands. The risk associated with the consumption of REEs was low, although its presence should be highlighted. CONCLUSIONS: This is the first time that these chemical elements have been measured in ready-to-eat purees for babies. The presence of some of them, such as mercury, should be sufficient to monitor the levels of these contaminants in food intended for such a sensitive population as children.

Development and Validation of a Modified QuEChERS protocol Coupled to Liquid Chromatography-Tandem Mass Spectrometry for the Rapid and Accurate Determination of Acrylamide in Cereal-Based Baby Foods.

BACKGROUND: With the widespread consumption by children of cereal-based baby food, acrylamide contamination is a prevalent risk that may have carcinogenic consequences. OBJECTIVE: This study aims to develop and validate a modified QuEChERS protocol (quick, easy, cheap, effective, rugged, and safe) without solvent exchange, followed by rapid separation and accurate determination of acrylamide in cereal-based baby foods using reversed-phase (RP)-LC-MS/MS. METHODS: Samples were extracted using a modified QuEChERS protocol of the AOAC version and cleaned up with basic alumina. Separation was performed on a Phenomenex® Kinetex C18 column (100 Å × 3.5 µm × 4.6 mm × 150 mm) using a gradient elution program with a mobile phase of 10 mM ammonium formate-methanol. Determinations were conducted using electrospray ionization (ESI)-MS/MS in positive-ion mode. RESULTS: Basic alumina yielded clean extracts, resulting in acceptable recovery percentages and a tolerable matrix effect (ME) <5%. This allowed extraction without a solvent exchange step. Efficient separation was achieved at a retention time (tR) of 3.39 ± 0.05 min employing an RP-C18 column with core-shell properties in a relatively short analysis run time of only 5 min. Trueness, precision, LOD, LOQ, linearity range, and R2 results were 92.5-104.6%, RSD ≤12.2%, 5 µg/kg, 20 µg/kg, 4.0-1000.0 µg/kg, and > 0.9999, respectively. The test method applicability was demonstrated by proficiency testing (PT) and 50 real samples of cereal-based baby foods. Most of the tested samples were in violation of acrylamide's established European Union benchmark (40 µg/kg). CONCLUSION: Acetate-buffered QuEChERS protocol in conjunction with optimized amounts of basic alumina was confirmed as an efficient extraction protocol for acrylamide from cereal-based baby foods resulting in optimal method performance. Successful selection of the RP-C18 column is key for selective separation for acrylamide in a relatively short analysis run time. HIGHLIGHTS: The modified AOAC QuEChERS protocol with a dispersive solid phase extraction (d-SPE) of basic alumina assisted in reducing the ME to tolerable levels while maintaining acceptable method performance. The use of an RP-C18 column with core-shell properties enabled a rapid and accurate acrylamide determination.

Infant formulae - Key components, nutritional value, and new perspectives.

Breastfeeding is the most effective strategy for meeting the nutritional demands of infants, whilst infant formulae are manufactured foods that mimic human milk and can be safely used to replace breastfeeding. In this paper, the compositional differences between human milk and other mammalian milk are reviewed, and thus nutritional profiles and compositions of standard bovine milk-based formulae as well as special formulae are discussed. Differences between breast milk and other mammalian milk in composition and content affect their digestion and absorption in infants. Characteristics and mimicking of breast milk have been intensively studied with the objective of narrowing the gap between human milk and infant formulae. The functions of the key nutritional components in infant formulae are examined. This review detailed recent developments in the formulation of different types of special infant formulae and efforts for their humanization, and summarized safety and quality control of infant formulae.

Commercially available foods for young children (<36 months) in Australia: An assessment of how they compare to a proposed nutrient profile model.

ISSUE ADDRESSED: To assess the nutritional composition of commercially available foods (CAFs) for infants and toddlers sold in Australia to determine whether they meet World Health Organization (WHO) Europe's proposed standards for nutritionally appropriate foods for children <36 months. METHODS: A cross-sectional retail audit of infant (n = 177) and toddler (n = 73) foods found in-store and online at three major Victorian supermarkets was conducted in August/September 2019. Products were grouped according to WHO Europe's food categories and their nutrient content assessed against specific composition standards applicable to their category. The presence of added sugar in each product was also recorded. RESULTS: Most infant products (71%) were soft-wet spoon-able, ready-to-eat foods whereas the most prevalent category for toddler products was dry finger foods and snacks (71%). Overall, just one-third of CAFs met all the nutrient recommendations for their category, with infant foods more likely to be compliant than toddler foods (43% vs. 10%; P < .001). Around 9 in 10 infant (93%) and toddler (89%) CAFs contained added sugar according to the Public Health England definition of 'free' sugars. CONCLUSIONS: There is considerable scope to improve the nutritional composition of Australian CAFs for both infants and toddlers, to reduce harmful sugars in these foods and to improve the energy density of them. For CAFs marketed as suitable for toddlers there is also considerable scope to reduce the sodium content. SO WHAT?: These findings support the need for stronger regulation of CAFs for infants and toddlers to better promote healthy eating patterns and taste preferences in young children.

Missing data and other challenges in assessing inappropriate marketing of baby foods in the Russian Federation: a cross-sectional study.

OBJECTIVES: We used the WHO draft nutrient profile model (NPM) to evaluate baby foods targeted at infants and young children (IYC) aged 6-36 months in the Russian Federation to assess their suitability for marketing. DESIGN: A cross-sectional study in Moscow (Russian Federation). SETTING: Nutrition information of baby food was primarily collected from retailer websites, with some complementary data from physical stores. Both specialist stores for IYC and general supermarkets were included. PARTICIPANTS: Two hundred and thirty baby food products targeted to IYC were selected. Breastmilk substitutes and products targeted at children over 3 years old were excluded. MAIN OUTCOME MEASURES: Per cent of missing nutrition data, per cent of products with added sugar or sweetener and exceeded sodium or salts, per cent of products marketed as suitable for IYC under 6 months. RESULTS: Most products were 'ready-to-eat', including fruit (n=42, 18.5%) and vegetable (n=29, 12.8%) purees, meat, fish or cheese purees (n =26, 11.5%); 'dry or instant cereal/starchy foods' (n=27, 11.9%), including predominantly dry cereals, 'juices and other drinks' (n=26, 11.5%). 95% (n=219/230) of products were missing total sugar information, 78% (n=180/230) were missing either sodium or salt, and 25% (n=57/230) were missing total fat. Among products with sugar and sodium information, 41% (n=94/230) included added sugar or sweeteners, and 48% (n=24/50) exceeded the NPM sodium threshold. 40% of products (n=92/230) were marketed as suitable for IYC aged under 6 months. CONCLUSION: Baby foods marketed for IYC showed a high per cent of missing nutrition information and disparity with WHO's guidelines for complementary feeding, age of introduction, sugar and salt content. Stronger regulation is needed in this area to minimise higher risk of non-communicable diseases (NCDs) in later life.

Infant egg consumption during introduction to solid food remains low in the United Kingdom but increases with infant age and a baby-led weaning approach.

BACKGROUND: As a nutritious food-providing protein, essential fatty acids, vitamin D, iodine and choline eggs have historically been central to an infant weaning diet. However, food poisoning scares and allergy concerns have contributed to low consumption among infants aged 6-12 months. METHODS: This paper presents a secondary data analysis of infant egg exposure and intake using three weaning data sets: a 7-day food frequency questionnaire (n = 297), a 24-h recall (n = 180) and a 3-day weighed food diary (n = 71). Egg introduction, frequency of consumption and intake in grams were analysed for infants aged 6-8, 9-10 and 11-12 months). Comparisons were made by whether infants were following a baby-led approach to weaning (where infants self-feed family foods) or a traditional approach where pureed foods are given alongside finger foods. Data were collected in the United Kingdom between 2015 and 2018. RESULTS: Our data showed that despite introduction being recommended from the start of weaning at 6 months of age by the Department of Health, just 54% of infants aged 6-8 months had ever been offered eggs. Average egg intake was one to two times per week, increasing with age. However, in terms of frequency and grams consumed, our data suggest a small increase in consumption compared with previous research, although limitations of our smaller sample size should be noted. Finally, a baby-led approach was associated with increased exposure and consumption; baby-led infants consumed eggs twice as frequently as spoon-fed infants. CONCLUSIONS: The findings have important implications for public health messaging and for supporting families in introducing solid foods.

A survey of toxic elements in ready to eat baby foods in the US market 2021.

A non-targeted convenience survey was conducted in 2021 to estimate the range of total arsenic (As), cadmium (Cd), total mercury (Hg) and lead (Pb) concentrations in ready-to-eat baby foods. Four hundred samples were purchased both online and in brick-and-mortar retail. Samples included both organic and non-organic products, packaged in glass or plastic jars and foil or plastic pouches. Samples were analysed by acid assisted microwave digestion and ICP-MS with an emphasis on ultra-low detection limits. Limits of quantification were 2.26, 1.31, 0.72, and 3.14 µg/kg (ppb) for As, Cd, Hg and Pb, respectively. The median concentrations of As, Cd, Hg, and Pb in tested products were 2.60, 1.81, 0.09, and 1.38 µg/kg, respectively. Foods containing rice were more likely to contain arsenic. Foods with leafy greens, such as spinach and kale, were more likely to contain cadmium and foods with root vegetables had the highest concentrations of lead.

Dietary exposure assessment of infant formula and baby foods' oxidized lipids in the US population.

Baby Foods (BFs) and Infant formulas (IFs) are the main sources of nutrition for an infant throughout the 1st year of life. Various enriched products are commercially available for parents seeking to fulfill their baby's nutritional needs. Consequently, different bioactive lipids are present in BFs and IFs, including dietary oxysterols (DOxS), whose known toxicity has been associated with mutagenicity, cancer, and other chronic diseases. In this work, we performed an exposure assessment of 25 bioactive lipids on IFs (n = 30) and BFs (n = 13) commercially available in the US. To determine dietary exposure, we used EPA's SHEDS-HT probabilistic model. Even though ß-Sitosterol was the most exposed bioactive lipid with 75,410 µg/day, cholesterol was the most absorbed compound during the entire first year (19.3 mg/day). Additionally, we found 7α-hydroxycholesterol (7α-OH) as a potential DOxS biomarker of the BFs manufacturing process. This is the first time an infant's exposure assessment (including DOxS) after BFs and IFs consumption is performed, enabling much-needed information regarding these hazardous compounds and their potential effects on infants' health.

Infant formula and baby food as a source of perfluoroalkyl substances for infants.

The present study reports infants' exposure to fourteen perfluoroalkyl substances (PFASs) in infant formula and baby food. First infant milk, follow-on milk and three types of baby food were analyzed: a variety made of fruits and vegetables, a variety with added fish and one containing meat. The mean lower-bound (LB) concentration of ∑14 PFASs was 0.22 µg/kg wet weight (w.w.) in first infant milk and 0.24 µg/kg w. w. In follow-on milk. Lower levels were noticed in baby food, where the mean LB concentration of ∑14 PFASs was in a 0.019-0.025 µg/kg w. w. Range. Perfluorotetradecanoic acid was found to be in the highest concentration both in baby formula and baby food. Dietary intake of ∑14 PFASs (LB concentration) via infant formula was in 0.3-83.1 ng/kg body weight (b.w.) and 0.3-31.1 ng/kg b. w ranges for first infant milk and follow-on milk respectively. The mean dietary intakes of ∑14 PFASs via one serving of baby food were similar for three varieties and were in a 0.46-0.57 ng/kg b. w. Range. Dietary intake of ∑4 PFASs was negligible in regard to the tolerable weekly intake of 4.4 ng/kg b. w. Recently established by the European Food Safety Authority. This preliminary study brings new information on infant exposure to PFASs in Poland. It is suggested that more sensitive methods be used in the future, and since there are many types of infant foods with different compositions of ingredients, more studies should be conducted.

To feed or let eat! A scale of independence, exploration, and family to measure baby-led weaning as a complementary feeding approach.

BACKGROUND: This article reports the development and validation of a measure of parents' use of baby-led weaning (BLW). BLW is a child-centred approach to complementary feeding where the infant is allowed to eat whole foods (rather than purees) and explore a variety of foods and textures. To date, parents' use of BLW has been assessed using either single items or a wide variety of measures. METHOD: In this study, exploratory and confirmatory factor analyses on independent samples supported three BLW subscales: independence, exploration, and family. RESULTS: The final 13-item scale showed adequate fit statistics and good reliability (χ2 (62) = 115.02, p < 0.001; CFI = 0.98; TLI = 0.98; RMSEA = 0.05; SRMR = 0.06; exploration a = 0.738; family a = 0.715; independence a = 0.809). In addition, the scale demonstrated good external validity and related in theoretically expected ways to an infant feeding-style measure and parent report of complementary feeding approach. This study was limited as it was mostly white parents, and the scale should be validated on a more diverse sample. CONCLUSIONS: Future research can use this scale to examine if BLW relates to infant taste preferences, parenting styles, and child eating behaviours to improve child nutrition and health outcomes.

Factors associated with suboptimal complementary feeding practices among mothers of infants and young children in India.

Objectives: To examine the current complementary feeding practices among infants and young children aged 6 to 23 months in India, and factors influencing these practices at child, parental, household and community levels. Material and methods: Data on 74,095 last-born children aged 6 to 23 months used in this study were obtained from the 2015 India Demographic and Health Survey (IDHS). Complementary feeding indicators (timely introduction of complementary foods to infants aged 6 to 8 months old, minimum meal frequency, minimum dietary diversity, and minimum acceptable diets) were estimated, and their associated factors were identified using descriptive and multivariate (logistic regression) analyses. Results: The prevalence of the timely introduction of complementary foods to infants aged 6 to 8 months was 45.1%. The proportion of children between ages 6 to 23 months who received the minimum meal frequency, minimum dietary diversity and minimum acceptable diets were 36%, 21% and 9.1%, respectively. Findings from the multivariate analyses revealed that mothers of infants delivered at home, mothers who had no antenatal check-up, mothers who are Hindus, mothers living in rural areas or those from the Western/Northern geographical regions of India were at higher risk of suboptimal complementary feeding practices.Conclusions. Our findings indicate that, among other factors, achieving the recommended four or more antenatal visits was consistently associated with improved complementary feeding practices. Thus, policies that ensure increased coverage and quality of antenatal check-up could improve complementary feeding practices of mothers in India, and help towards achieving sustainable development goal 2, targeted at eradicating hunger and malnutrition.

Sweetpotato-based infant foods produce porridge with lower viscosity and aflatoxin level than cereal-based complementary blends.

The viscosity, protein, and total aflatoxins contents in orange-fleshed sweetpotato (OFSP) and cereal-based commercial complementary formulations and the effect of dilution on the protein content of the formulations were investigated. Standard procedures were used for the determination of these parameters. Over 80% of the formulations had a viscosity above the recommended consistency of 1000-3000 cP for feeding young children. The consistency of OFSP-legume porridge was significantly (2392.5 cP; p < 0.001) lower, about 1.7 and 3.4 times than cereal-only and cereal-legume blends, respectively. All the complementary flours, except the cereal-only, met the proposed protein requirement of 6 to 11 g per 100 g for feeding children aged 6 to 23 months on an as-is basis. However, the protein content in the porridges on an as-would-be-eaten basis was about 6% lower than the as-is basis value. About 38% of the complementary foods had total aflatoxin level above the acceptable limit of 10 ppb, mainly in blends containing peanuts, maize, or both. Adding more water to meet the required thickness of cereal-only and cereal-legume porridges diluted the protein content. More efforts are needed from regulatory bodies and all stakeholders to ensure complementary foods are safe in terms of mycotoxin levels, particularly those containing maize, peanut, or both as ingredients.