Recomendaciones de alimentación complementaria según los Comités de Nutrición de la AAP, ESPGHAN y AEP / Complementary Feeding according ESPGHAN, AAP and AEP Nutrition Committees recommendations

Las recomendaciones en la introducción de la alimentación complementaria (AC) han ido variando a lo largo de las últimas décadas, y aun hoy en día existen algunas diferencias entre regiones y sociedades científicas, unas veces motivadas por la ausencia de suficiente evidencia científica y otras muchas por diferencias culturales en relación con la alimentación. El objetivo principal de esta revisión es recopilar las últimas recomendaciones sobre AC de los Comités de Nutrición de las principales sociedades científicas pediátricas de influencia en nuestro entorno (Asociación Española de Pediatría [AEP], Sociedad Europea de Gastroenterología, Hepatología y Nutrición Pediátrica [ESPGHAN] y Academia Americana de Pediatría [AAP]), haciendo especial énfasis en las diferencias que entre ellas pudieran existir. La definición de AC es compartida por las tres sociedades, y las recomendaciones en relación con su introducción son muy similares entre sí. Establecen que debería iniciarse no antes de los 4 meses pero tampoco más allá de los 6, principalmente por motivos nutricionales y de desarrollo neurológico. De acuerdo con las últimas evidencias científicas publicadas, todas ellas propugnan que tanto los alimentos potencialmente alergénicos como el gluten pueden introducirse con el resto de la AC, en cualquier momento a partir de los 4 meses. Asimismo, ninguna de las tres sociedades realiza recomendaciones acerca de cuál es el mejor método de alimentación para introducir la AC, si bien la ESPGHAN y la AEP comentan la necesidad de que se realicen más estudios comparativos a largo plazo

Recommendations regarding the introduction of complementary feeding (CF) have been changing over the last decades and even today there are some differences between regions and scientific societies. Sometimes discrepancy is motivated by insufficient scientific evidence or differences between food culture. The main aim of this review is to summarize the latest recommendations of the Nutrition Committees of the main pediatric scientific societies with influence in our environment (Spanish Pediatric Association [AEP], European Society of Pediatric Gastroenterology, Hepatology and Nutrition [ESPGHAN] and American Academy of Pediatrics [AAP]) in order to emphasize the differences between them. The definition of CF is the same for the three societies and the introduction recommendations are very similar. They establish the beginning not before 4 months and not beyond 6, mainly due to nutritional and neurological developmental reasons. According to the latest published scientific evidence all of them advocate that both potentially allergenic foods and gluten can be introduced whenever desired, after 4 months of age. None of them recommend any particular method for food introduction, although ESPGHAN and AEP highlight the need for more long-term comparative studies

Feeding practices of low birth weight Brazilian infants and associated factors.

OBJECTIVE: To characterize complementary feeding and to analyze the influence of individual and contextual factors on dietary practices of low birth weight infants. METHODS: This cross-sectional study included 2,370 low birth weight infants aged 6 to 12 months included in the Breastfeeding Prevalence Survey in Brazilian Municipalities (2008), which covered the 26 state capitals, the Federal District and 37 municipalities. Dietary practices were assessed using two indicators: I) dietary diversity, characterized by the consumption of five food groups: meat, beans, vegetables, fruit and milk; II) consumption of ultra-processed foods, characterized by the ingestion of at least one of the following foods on the day prior to the survey: soda, or processed juice, or cookie, cracker and crisps. The covariates of interest were the socioeconomic characteristics of infants, mothers and health services. The contextual factor was the "municipal prevalence of child undernutrition." The individualized effect of the study factors on outcomes was assessed by multilevel Poisson regression. RESULTS: Approximately 59% of infants consumed ultra-processed foods, while 29% had diverse feeding. Mothers living in municipalities with child undernutrition prevalence below 10%, with higher education and working outside the home were more likely to offer dietary diversity. Consumption of ultra-processed foods was higher among infants living in municipalities with child undernutrition prevalence below 10%, whose mothers were younger and multiparous. CONCLUSIONS: The low prevalence of diverse feeding combined with the high prevalence of ultra-processed food consumption characterizes the low quality of feeding of low birth weight Brazilian infants. Individual and contextual factors impact the feeding quality of this population, suggesting the need for effective strategies to increase the consumption of fresh and minimally processed foods and decrease the consumption of ultra-processed foods by this vulnerable population.

Feeding practices of low birth weight Brazilian infants and associated factors / Práticas alimentares de lactentes brasileiros nascidos com baixo peso e fatores associados

ABSTRACT OBJECTIVE To characterize complementary feeding and to analyze the influence of individual and contextual factors on dietary practices of low birth weight infants. METHODS This cross-sectional study included 2,370 low birth weight infants aged 6 to 12 months included in the Breastfeeding Prevalence Survey in Brazilian Municipalities (2008), which covered the 26 state capitals, the Federal District and 37 municipalities. Dietary practices were assessed using two indicators: I) dietary diversity, characterized by the consumption of five food groups: meat, beans, vegetables, fruit and milk; II) consumption of ultra-processed foods, characterized by the ingestion of at least one of the following foods on the day prior to the survey: soda, or processed juice, or cookie, cracker and crisps. The covariates of interest were the socioeconomic characteristics of infants, mothers and health services. The contextual factor was the "municipal prevalence of child undernutrition." The individualized effect of the study factors on outcomes was assessed by multilevel Poisson regression. RESULTS Approximately 59% of infants consumed ultra-processed foods, while 29% had diverse feeding. Mothers living in municipalities with child undernutrition prevalence below 10%, with higher education and working outside the home were more likely to offer dietary diversity. Consumption of ultra-processed foods was higher among infants living in municipalities with child undernutrition prevalence below 10%, whose mothers were younger and multiparous. CONCLUSIONS The low prevalence of diverse feeding combined with the high prevalence of ultra-processed food consumption characterizes the low quality of feeding of low birth weight Brazilian infants. Individual and contextual factors impact the feeding quality of this population, suggesting the need for effective strategies to increase the consumption of fresh and minimally processed foods and decrease the consumption of ultra-processed foods by this vulnerable population.

RESUMO OBJETIVO Caracterizar a alimentação complementar e analisar a influência de fatores individuais e contextuais sobre práticas alimentares de lactentes que nasceram com baixo peso. MÉTODOS Este estudo transversal incluiu 2.370 lactentes nascidos com baixo peso e com idade entre 6 e 12 meses incluídos na Pesquisa de Prevalência de Aleitamento Materno em Municípios Brasileiros (2008), que abrangeu as 26 capitais, o Distrito Federal e mais 37 municípios. As práticas alimentares foram avaliadas usando dois indicadores: i) diversidade alimentar, caracterizada pelo consumo dos cinco grupos alimentares: carnes, feijão, legumes e verduras, frutas e leite; ii) consumo de alimentos ultraprocessados, caracterizado pela ingestão de pelo menos um dos seguintes alimentos no dia anterior à pesquisa: refrigerante, ou suco industrializado, ou bolacha, biscoito e salgadinho. As covariáveis de interesse corresponderam às características socioeconômicas, dos lactentes, das mães e dos serviços de saúde. O fator contextual foi a "prevalência municipal de desnutrição infantil". O efeito individualizado dos fatores de estudo sobre os desfechos foi avaliado mediante regressão de Poisson com estrutura multinível. RESULTADOS Aproximadamente 59% dos lactentes consumiram alimentos ultraprocessados, enquanto 29% apresentaram diversidade alimentar. Mães que residiam em municípios com prevalência de desnutrição infantil inferior a 10%, com maior nível de escolaridade e que trabalhavam fora de casa foram mais propensas a oferecer diversidade alimentar. O consumo de alimentos ultraprocessados foi maior entre lactentes residentes em municípios com prevalência de desnutrição infantil inferior a 10%, cujas mães eram mais jovens e multíparas. CONCLUSÕES A baixa prevalência de alimentação diversa aliada à alta prevalência do consumo de alimentos ultraprocessados caracteriza a baixa qualidade da alimentação dos lactentes brasileiros com baixo peso ao nascer. Fatores individuais e contextuais impactam a qualidade da alimentação dessa população, sugerindo a necessidade de adoção de estratégias eficazes para aumentar o consumo de alimentos in natura e minimamente processados e diminuir o consumo de alimentos ultraprocessados por esta população vulnerável.

Patrón de consumo alimentario y su relación con el estado de nutrición en lactantes de la región del Istmo de Tehuantepec / Pattern of food consumption and its relation to the nutritional status of infants in the Isthmus of Tehuantepec region

FUNDAMENTOS: En la etapa lactante los patrones de consumo alimentario (PCA) adecuados pueden mantener el correcto estado nutricional. La presente investigación buscó asociar el PCA durante la alimentación complementaria con el estado nutricional en lactantes. MÉTODOS:Se realizó un estudio transversal analítico (mayo-julio de 2017) con población lactante (n=35, femeninos 60% y masculinos 40%) de 4 a 12 meses de edad del municipio de Santo Domingo, Oaxaca. Se evaluó el estado nutricional con indicadores (Peso/Edad, Peso/Longitud y Longitud/Edad), así como se realizó valoración dietética aplicada a las madres o cuidadoras. RESULTADOS: El 68,57% de los lactantes presentaron un estado de nutrición normal. Se encontró una asociación significativa entre el adecuado estado de nutrición y el consumo de verduras, cereales sin grasa, alimentos de origen animal, leche, aceites sin proteína y con proteína. La asociación del estado de nutrición con el PCA no fue significativa (p=0,501). CONCLUSIONES: Se encontró una asociación significativa entre el adecuado estado de nutrición y el consumo de ciertos alimentos. El balance energético positivo de los lactantes es un factor que conduce a un sesgo de información, ya que el PCA inadecuado en esta etapa y la ingesta elevada de calorías incrementa el peso corporal

BACKGROUND: In the lactating stage, adequate dietary consumption patterns (PCA) can maintain the correct nutritional status. The present investigation seeks to associate the PCA during complementary feeding with the nutritional status in infants. METHODS: An analytical cross-sectional study was included (May-July 2017) with a lactating population (n=35, 60% female and 40% male) from 4 to 12 months of age born from the Santo Domingo, Oaxaca. The nutritional status was evaluated with indicators (Weight/Age, Weight/Length and Length/Age), as well as dietary assessment applied to mothers or caregivers. RESULTS: 68.57% of infants had a normal nutritional status. A significant association was found between the proper state of nutrition and the consumptionof vegetables, non-fat cereals, foods of animal origin, milk, oils without protein and with protein. The association of the nutritional status with the PCA was not significant (p = 0.501). CONCLUSIONS: A significant association was found between the proper state of nutrition and the consumption of certain foods. The positive energy balance of infants is a factor that leads to information bias, since inadequate PCA at this stage and high calorie intake increases body weight

Un título que llama a error: ¿cuál es la edad adecuada para la introducción del gluten en la dieta de los lactantes? / No disponible

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Maternal eating disorder and infant diet. A latent class analysis based on the Norwegian Mother and Child Cohort Study (MoBa).

Knowledge of infant diet and feeding practices among children of mothers with eating disorders is essential to promote healthy eating in these children. This study compared the dietary patterns of 6-month-old children of mothers with anorexia nervosa, bulimia nervosa, binge eating disorder, and eating disorder not otherwise specified-purging subtype, to the diet of children of mothers with no eating disorders (reference group). The study was based on 53,879 mothers in the Norwegian Mother and Child Cohort Study (MoBa). Latent class analysis (LCA) was used to identify discrete latent classes of infant diet based on the mothers' responses to questions about 16 food items. LCA identified five classes, characterized by primarily homemade vegetarian food (4% of infants), homemade traditional food (8%), commercial cereals (35%), commercial jarred baby food (39%), and a mix of all food groups (11%). The association between latent dietary classes and maternal eating disorders were estimated by multinomial logistic regression. Infants of mothers with bulimia nervosa had a lower probability of being in the homemade traditional food class compared to the commercial jarred baby food class, than the referent (O.R. 0.59; 95% CI 0.36-0.99). Infants of mothers with binge eating disorder had a lower probability of being in the homemade vegetarian class compared to the commercial jarred baby food class (O.R. 0.77; 95% CI 0.60-0.99), but only before adjusting for relevant confounders. Anorexia nervosa and eating disorder not otherwise specified-purging subtype were not statistically significantly associated with any of the dietary classes. These results suggest that maternal eating disorders may to some extent influence the child's diet at 6 months; however, the extent to which these differences influence child health and development remains an area for further inquiry.

La alimentación infantil, el marketing y los medios de comunicación / No disponible

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Comparison of primary dentition caries experience in pre-term low birth-weight and full-term normal birth-weight children aged one to six years.

AIM: The aims of the study were to determine and compare the primary dentition caries experience and the variables that may influence the occurrence of caries, in preterm low birth weight and full term normal birth weight children aged one to six years. SETTINGS AND DESIGN: A cross-sectional comparative study was conducted among 250 full term normal birth weight (FTNBW) and 250 preterm low birth weight (PTLBW) children one to six years, born in the two hospitals in Davangere: Bapuji Hospital and Chigatere Hospital. A purposive sampling was used to select the study group. MATERIALS AND METHODS: Required and relevant information regarding demographic characteristics, feeding practices and oral hygiene practices were obtained. Dentition status and treatment need index (World Health Organization 1997) was used to record dental caries. STATISTICAL ANALYSIS USED: Chi-square test, Student's t-test and ANalysis Of VAriance (ANOVA) test were used for statistical analysis. RESULTS: Statistically significant difference was observed in caries prevalence between PTLBW and FTNBW groups (P<0.05), however, the difference in mean Decayed, missing and filled teeth index (dmft) was not statistically significant (P=0.30). Statistically significant differences were observed in caries experience between the two groups in relation to exclusive breast feeding for longer duration, i.e 7-12 months (P<0.05), bottle feeding habits (P<0.05) and sticky food consumption (P<0.01). CONCLUSIONS: A significant relationship was found between caries and PTLBW status though the difference in caries experience between the groups was not statistically significant, thus illustrating the higher caries risk in PTLBW children compared to FTNBW children.

Impact of infant feeding practices on caries experience of preschool children.

AIM: This study investigated the association between breastfeeding, bottle feeding, night feeding, age, and sex of the child on the caries experience. METHOD: Information was collected from the mothers of preschool children. Information included the age of the child, sex of the child, form of breastfeeding (whether exclusive, almost exclusive or mixed), duration of breastfeeding, night feeding habits of the child, and duration and content of bottle feeding. Intraoral examination was done to assess the dmft. The impact of the variables on the caries experience (rampant caries, no caries and the dmft) was then assessed. RESULTS: The duration of breast feeding (p = 0.002), and form of breast feeding (p = 0.03) were significant predictors of the dmft. The dmft was highest in children who were breastfed for longer than 18 months and highest for children who were exclusively breastfed. There is a strong association between rampant caries and duration of breast feeding only (p < 0.001). The risk of having rampant caries increases by 10% (p = 0.012) with every month increase in the duration of breastfeeding. CONCLUSION: The duration of breastfeeding increased the risk for rampant caries in preschool children in Nigeria. The longer the duration, the higher the risk for caries.

Sources of energy and nutrients in the diets of infants and toddlers.

OBJECTIVE: To identify major sources of energy and 24 nutrients and dietary constituents in the diets of US infants and toddlers and to describe shifts in major nutrient sources as children age. DESIGN: Data from 24-hour recalls collected in the 2002 Feeding Infants and Toddlers Study were analyzed to determine the percentage contribution of foods and supplements to total intakes of energy, nutrients, and other dietary constituents. A total of 3,586 unique foods and dietary supplements were reported. Reported foods and supplements were classified into 71 groups based on similarities in nutrient content and use. Nine-hundred seventy-nine food mixtures were disaggregated into their ingredients and ingredients were classified into one of the 71 groups using the same decision rules that guided classification of foods analyzed at the whole food level. SUBJECTS/SETTING: A national random sample of 3,022 US infants and toddlers 4 to 24 months of age. STATISTICAL ANALYSES PERFORMED: The population proportion formula was used to determine the percentage contribution of each of the 71 groups to total intakes. This was done by summing the weighted amount of a given nutrient provided by a given group for all individuals in the sample and dividing by the total weighted amount of that nutrient consumed by all individuals from all foods and supplements. Groups that provided at least 1% of the nutrient in question were rank-ordered. Separate tabulations were prepared for three age groups (4-5 months, 6-11 months, and 12-24 months). RESULTS: Infant formula, breast milk, and milk are major contributors of energy and most nutrients in the diets of infants and toddlers. Among toddlers, juices and fruit-flavored drinks are the second and third most important sources of energy. Fortified foods make substantial contributions to intakes of many essential nutrients, and these contributions increase as children age. For example, among toddlers, fortified grain-based foods make substantial contributions to intakes of vitamin A, iron, and folate, relative to foods that are naturally rich in these nutrients. Supplements also make substantial contributions to intakes of vitamins and selected minerals, particularly among toddlers. CONCLUSIONS: In assessing dietary intakes of infants and toddlers, dietetics professionals need to carefully consider contributions of fortified foods and supplements. Dietetics professionals should educate caregivers of infants and toddlers about the importance of foods (rather than just nutrients) in promoting health and about the importance of early feeding practices in the development of lifelong eating habits. Caregivers should be encouraged to avoid relying on fortified foods and supplements to meet nutrient needs and educated about the potential risk of excessive intakes. Caregivers of toddlers and infants over 4 to 6 months of age who are consuming solid foods should be encouraged to feed a wide variety of fruits, vegetables, and whole grains, as well as foods naturally rich in iron.

Parental beliefs and practices regarding early introduction of solid foods to their children.

This study was a cross-sectional survey of primary female caregivers during their child's 4-month well-child visit. Our objectives were to document current caregiver awareness of infant feeding guidelines, and calculate the frequency of and reasons for early introduction of solid foods. Questionnaires were completed for 102 children. Forty-five respondents (44%) introduced solids at less than 4 months of age. Hispanic caregivers, OR 0.2 (0.07-0.9), and those who breastfed (partial or exclusive), OR 0.4 (0.2-0.9), were less likely to introduce cereal at less than 4 months of age. Among caregivers who introduced solids at less than 4 months, 36 (80%) stated that the child was not satisfied with formula or breast milk alone and 24 (53%) stated that solids helped the child sleep better at night. Thirty-four caregivers (76%) who started solids at less than 4 months were aware of guidelines regarding proper infant feeding practices. Despite knowledge of infant feeding guidelines, female caregivers frequently introduce solids at less than 4 months of age. Early targeted anticipatory guidance is needed to address the most common reasons caregivers begin solid foods before the recommended age.

Infant nutritional recommendations from pediatricians. Epidemiologic survey of feeding recommendations for the first year of life in Piedmont.

AIM: Timing the introduction of solids and milk formulas in infants' diet varies throughout the world. The aim of the present study was to assess the modalities of weaning, suggested by pediatricians in Piedmont, Italy, and to compare them to current scientific guidelines. METHODS: The survey was conducted using data recording forms sent to the pediatricians of our area (both practitioners and hospital physicians) from September 2000 to January 2001. Pediatricians were asked to fill in a questionnaire about the time of solid food introduction in the 1st year of life. The study was supported by 168 pediatricians, of these 105 practitioners, 53 hospital doctors and 9 university physicians. RESULTS: The mean age of weaning was 4.5 months. The 1st beikost was vegetable soup with rice flour, meat and parmesan in 65.4%; in 73.8% it was given with a spoon. In 94.6% no salt was added, in 84.5% no sweetener was added. Homogenized fruit was introduced at a mean age of 4.4 months: apple was the 1st fruit to be introduced (4.5 months), followed by pear (4.8 months) and banana (5.6). Lyophilised meat was introduced at 5 months, homogenized meat was introduced at 6.2 months, and minced meat was introduced at 8.2 months. Vegetables (potatoes, carrots, courgettes) were introduced between 5.2 to 5.4 months of age. Parmesan was introduced at 5.3 months; gluten at 6.2 months. Egg yolk was the 1st to be introduced (mean age = 8.9 months), while albumen was introduced at a mean age of 11.6 months. Fish was given at a mean age of 8.2 months. Cow's milk was introduced at 9 months. CONCLUSION: Paediatricians give indications about the introduction of solid foods according to scientific guidelines, with the exception of cow's milk which is introduced too early.

Extensive and partial protein hydrolysate preterm formulas: the effect on growth rate, protein metabolism indices, and plasma amino acid concentrations.

BACKGROUND: The use of protein hydrolysate preterm formulas is restricted because data on their nutritional adequacy are scarce. The authors evaluated the rate of growth and indices of protein metabolism in low-birth weight infants fed extensive and partial protein hydrolysate preterm formula followed for 12 weeks. METHODS: A total of 61 low-birth weight infants were assigned randomly to receive extensive protein hydrolysate preterm formula (EH: n = 16), partial protein hydrolysate preterm formula (PH: n = 15), and standard preterm formula (SF; n = 15), or were fed their own mother's fortified breast milk (FBM; n = 15). The infants were investigated at study entry, and at 4, 8, and 12 weeks after study entry. RESULTS: There were no differences with respect to growth rate (weight gain, increments in length and head circumference), urea, albumin, prealbumin, transferrin, and plasma amino acid concentrations (except for tyrosine on a single occasion) according to the degree of hydrolysis. There were also no differences between groups fed hydrolyzed formulas and SF. However, several differences were found when EH and PH were compared with FBM. Weight gain from the entry to 12 weeks, serum urea at 12 weeks, and total plasma essential amino acids at 8 weeks were significantly higher in groups fed EH and PH than in those fed FBM. In addition, valine was significantly higher in groups fed PH (P < 0.05) than in the group fed FBM at 8 and 12 weeks, tyrosine was higher in EH and PH in comparison with FBM at 4 weeks, and in PH versus FBM at 12 weeks after study entry. CONCLUSIONS: This study suggests that experimental EH and PH are at least nutritionally equivalent to SFs.

Euro-Growth references for breast-fed boys and girls: influence of breast-feeding and solids on growth until 36 months of age. Euro-Growth Study Group.

BACKGROUND: The World Health Organization (WHO) recommends exclusive breast-feeding during the first 4 to 6 months of life, but limited information is available regarding the growth performance of infants fed according to the recommendation. The present study used data from the Euro-Growth study to determine the growth of breast-fed European infants who did or did not receive solids from an early age, in comparison with growth of infants who were fed by other modes. METHODS: There were 319 infants who were exclusively breast-fed according to the WHO recommendations for at least 4 to 5 months, and 185 infants who were breast fed but received solids (but no formula) from an early age. There were 1,509 infants who were fed in a variety of ways, which included breast-feeding during the early months of life in the majority (65%) of infants. Anthropometric data were available from birth to 36 months of age. Growth of the two groups of breast-fed infants was assessed by comparing z-scores of length, weight, and body mass index with those of the group fed by other means. Furthermore, multiple regression analysis was used to assess the influence on increment in length and weight of the duration of breast-feeding and the age at which solids were introduced. Euro-Growth references for breast-fed boys and girls were developed and compared with the National Center for Health Statistics (NCHS)-WHO and Euro-Growth references. RESULTS: The pattern of growth of children who were fed according to the WHO recommendations showed higher weight during the first 2 to 3 months of life and lower weight and length from 6 to 12 months. Between 12 and 36 months of age, differences between groups were small and clinically nonrelevant. Duration of breast-feeding was negatively correlated with increment in length and weight until 12 and 24 months but not until 36 months of age. The influence of duration of breast-feeding was much weaker than that of mid-parental height. The mean and standard deviation z-scores of the Euro-Growth references for weight of breast-fed infants deviate substantially from the NCHS-WHO references during the first 6 months of life in particular. The mean and standard deviation z-scores for length and weight of breast-fed children were close to the Euro-Growth references. CONCLUSION: The Euro-Growth references may be used to monitor length, weight, body mass index, and body circumferences of children who are fed according to WHO recommendations. The additional references, which were developed for breast-fed boys and girls, will be useful in view of the commitment of WHO to the collection of data for the development of a new international growth reference.

Detection of counterfeit and relabeled infant formulas by high-pH anion-exchange chromatography-pulsed amperometric detection for the determination of sugar profiles.

High pH anion-exchange separation with pulsed amperometric detection (HPAE-PAD) is used to characterize various milk-based, soy-based, and protein hydrolysate infant formulas based on carbohydrate profiles. Counterfeit and relabeled formulas are compared to authentics. Figures of merit are shown for glucose, fructose, lactose, sucrose, and maltose.